Saturday, January 17, 2015

Going to med school and becoming a surgeon when you're older

A 34-year-old attorney writes I have a good salary, am married, and have two children. My whole life I've been drawn to medicine (I'm an EMT, have experience on the job with trauma related injuries, etc.) and have always enjoyed it. However, I have a Bachelor's in English literature, so I've always put it as unattainable to become a doctor. Now, once again, I'm considering doing one of the post bac premed programs out there and going for it.

Am I insane? At my age, I'll likely be 41-42 by the time I'd complete medical school, then residency. I'd love your opinion.

Let's do some math. You are 34. Most post bac premed programs take at least a year if you go to school full-time. Assuming you can get into a program this summer, you will be applying to medical school for a class starting in the fall of 2017. You will be 36 years old when you start.

Four years of medical school plus five years of general surgery residency and you will be 45 years old. If you want to take a fellowship in something for a year or two, add those years on.

What are you going to do for income while you are pursuing your medical degree? And let's not forget the tuition cost of the post bac program and medical school, living expenses, and your paltry salary for the 5 years of your residency.

I wrote a post about this four years ago. It was about a then 30-year-old man did not get into medical school until 2014 which means he is now in the middle of his first year at the age of 34.

My discussion of the "cons" of doing this is much more expansive in that post. Just remember that tuition costs have risen much faster than inflation and will continue to do so in the foreseeable future.

I can't tell you not to do it and it certainly has been done by others, but I strongly advise you to give it a lot of thought.

He replies Thanks for the response. Unfortunately, you paint the bleak reality I was afraid of. As I likely won't make cutoffs for the good post bac programs this year, you'd have to add another year to the equation.

What if I went for a less rigorous residency like emergency medicine? Or what if I consider having the military pay for medical school?

Does this change anything? Your post is so bleak, it definitely gives pause.

The family issue is a tough one. I'm fortunate to have about $200k in liquid assets, but it's still a big financial hardship.

$200K might just about cover your tuition for the post bac year and 4 years of med school.

Yes, emergency medicine will save you a couple of years, but it is very competitive.

Remember one thing about the military. Once you are in, they own you. They can send you to remote bases in the states, Afghanistan, or wherever they want. You cannot believe anything they tell about your ability to choose an assignment.

Readers, please comment if you agree or disagree.

Tuesday, January 13, 2015

Academic vs. community hospital for surgery residency

Here's question from a senior med student at a state school. She has excellent grades, USMLE Step 1 and 2 scores > 245, has co-authored 4 published papers, and was elected to AOA. She writes

I am looking to re-locate to a large city for residency as a number of my family members live there. I have interviewed at the large academic centers in the city as well as their community affiliates. I have also been involved in research and always assumed I would enjoy the biggest "named" institution possible. As I have interviewed, I truly feel that I would get better training (and be happier) and the academic-affiliated community programs in that city. However I have been told my several advisors at my home school that this would be "career suicide" and it would be "idiotic" not to take the best name that I have a chance at matching at. As far as fellowship, I have literally no idea what I want to do. Maybe surgical oncology, maybe transplant? Maybe vascular, maybe nothing?!

What is your insight into this? Should I seek what I perceive to be the best training/fit or should I rank the higher name academic programs for the sake of my career?

Here's my opinion. Be advised that it is strictly my opinion and may be neither popular or correct.

You should have no problem matching at any affiliated community hospital program and probably have a very good chance to match at every academic program in the city you want to be in.

I hope you have properly researched your top choices and are confident that the residents are happy and doing a lot of cases. Also you should be sure that the leadership of the program is stable. I suppose your mentors your school want you to take the academic track because that's what they did. It also enhances the reputation of the school when its students match in big name programs.

You remind me of me except I didn't have the publications you do. I took the "comfortable" choice for residency and never regretted it. I trained in the same city you are looking at. It's a great place to live.

I see it this way. Suppose after a couple of years in a community program, you decide you want to be an academic surgeon. After you residency, you can always take a fellowship in something at an academic medical center.

But if you go with a university program and are miserable, then what do you do? Five years (plus a year or two of research) is a long time to be miserable.

I went into more detail about this in a post three years ago.

Listen to your heart. Go for the place that you feel most comfortable with.

I strongly suggest ranking all of the programs you feel you can live with—just in case.

Good luck and let us know how it turns out.

Readers, feel free to disagree or agree as you see fit.