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.


  1. Dear Attorney:

    Our benefactor Dr. Scalpel brings valuable experience and information to the decision of making a change, of starting medical school (relatively) late in life, of the financial and personal pressures therein, and about the difficulties with the many options available. I must agree with him on every point, especially the recommendation to "give it a lot of thought".

    As he mentioned, it has been done by others, and by others starting out with less than you have now. Your assets, as the good doctor implied, are surprisingly meager given their worth to the general public. However, plenty of physicians have taken and will continue to take on significant debt to pursue their education. There will continue, of course, to be the question whether it's worth it. To many (but not most) physicians and surgeons, it is.

    Your "nontraditional" background brings with it challenges and opportunities. While I'd not been fully invested in a career prior to medical school, I was on a quite different track, in graduate school as a mathematician, when I realized I must switch to medicine. I similarly had to do additional coursework to meet medical school prerequisites; I was already in significant debt. However, my experience, "unusual" background, education, and "maturity" were identified as positives in my medical school interviews and applications. I was admitted to a very competitive program, and have been successful since. I've still got debt, of course.

    Having a family is not simply an additional responsibility, but a fantastic support system as well. Having a postgraduate degree---in any field---is recognized as ability to do more advanced work than those students just leaving college. Having "real world" experience is a remarkable advantage for becoming a leader in your class and among your colleagues. Changing to a career you're made for, a career of your choosing, is worth it---for me. It's not for everybody, and it can be, of course, incredibly difficult.

    Skeptical Scalpel is significantly more experienced than I am, but I believe significantly more pessimistic as well (or, perhaps, significantly more realistic). Like him, I'll make no recommendations regarding your specific course here other than to "give it a lot of thought"; in any case, best wishes and best of luck.

    Christian Jones, MD
    Acute Care Surgeon
    The Ohio State University Medical Center

  2. Christian, thanks for the thoughtful comments. Not many are more pessimistic than I.

    Here's a tweet from Mark L. Stram, MD ‏@nstzyadoc: I did it @ 32. 1 year of prereq, Entered at 33. IM res @ 37 Hospitalist @ 40, Anesth. res @ 46. Insane, yes! Do over, no way

    And from Jensen Tan ‏@jtan78 if I couldn't do surgery now that's what I'd do! I'm that age and can't imagine starting from square 1 on path to surg now

    1. I Loved medicine my whole life, didn't go to med school till 30. What was hardest was the sleep deprivation. The necessary commitment of your soul to caring for patients leaves little time for anything else. My kids have NO interest in medicine, because they lived the life. Follow your Passion.

  3. Hello,

    I'm the lawyer and government guru in question. Unfortunately, it appears that my initial instincts are true and this would be far too much time and effort and money at my age. It's unfortunate, but I've not received much positive feedback.

    The passion is the MD, but sometimes you just gotta accept when "that ship has sailed."

    1. Yes and no-had two careers before medicine. Language major in undergrad before military (non-med) and corporate America. Then did post bac followed by 7 years of gen Surg and now four in Surg specialty. Yes I get paid less than I did in 1999 as a pgy billion in 2015. Yes my wife and kids have made sacrifices. Yes we paid off a lot of debt hers and mine, but we lived frugally and it's all paid off and it wasn't a small amount.

      But this still one of the few professions where you see a direct impact on people's lives. I will look for my first Attdg job at 45 almost 46. Yes it's long nights of call at times but people respect your work ethic and life experience that your bring to your patients. For me this is definitely a calling because otherwise as everyone has mentioned it is a lot of sacrifice. I do not go back into the military for med school because a skeptical notes they own you. I came from a long line of military so it was tempting. But in the end I knew I wanted to do surgery and a fellowship.

    2. If you want to discuss this further since I am likely an outlier in terms of doing this, I am sure somehow we can exchange information. Apologies for the typos above-the ipad iOs 8 makes typing annoying for me.

    3. Best of luck, then, Mr. Guru, and best wishes for the future!

  4. I admire your passion, but I would say no at this point. From the outside, the life of a surgeon (and perhaps a physician in general) may look exciting and glamorous, but at this point it is about as mundane as any other job, with a lot more risks and headaches. The prestige is gone just about everywhere except in rural areas (in which I happen to practice, and I admit that rural people do give you an extra measure of respect), and the regulatory burden is only going to increase. If someone offered me a job outside of medicine, at the same salary and without having to incur more training debt, I'd take it tomorrow.

    I'm sorry, but it's not worth it at this point. If healthcare presents itself to you as a burning desire, consider the PA or NP route. It's likely that you'll get to do almost the same things, but with a lot less expense and time lost, not to mention that a lot of those jobs are 9-5, without call. Don't discount call. It is the single most onerous thing in medicine.

    1. I agree that call can be a huge problem. You miss a lot of family time, meals and sleep.

  5. Dear Lawyer,

    I was in business for 12 years before entering med school at 36. Luckily, my post bac was pursued at a major university in Texas which, tuition wise, is a bargain. I am an Ob-Gyn ( 4 years), so I started private practice at 45. I encourage you to pursue medicine if you truly want to do it.. In some ways, school and residency at my "advanced" age were easier but in many ways more demanding. My biggest challenge has been paying-off the med school loans. On the one hand, I make better money than I ever did in business and love what I do. On the other hand, $920.00 per month would go a long way towards retirement.

    Additionally, when I started med school, I was not married and had no children.. DEFINITELY made things easier. However, in my med school class of 125, there were seven people who were older than me when we matriculated.

    Lastly, I did give up solo private practice last year... tired of decreasing reimbursents and fighting for every penny... So far, employment has been better.. Something to consider especially if your possible future employer(s) have tuition payment as part of benefits... Good luck with your decision

  6. It's difficult but doable. I'm currently in medical school graduating in May and there are at least three people in my class who were around 36 when we started. If it's something you want to do then go for it.

  7. dear lawyer,
    its like you have a 2012 BMW and it runs great and all paid off but you are enamored with the new 2015 Tesla or whatever. "i have to have it!!!!" "My life is incomplete with out it..."

    Your endeavor towards medicine will come at more than just the 200k you mention. First of all you are flushing that law degree down the toilet (not cheap). if you decide to use it as JD MD for hospital administration, you can go into administration now without an MD. many people know that you don't need medical knowledge to know how to run a hospital.

    The math that needs to be could probably study/post bac while working. You can't practice law while going to med school. Does your wife work? Is her salary enough to pay mortgage/rent/montly expenses? Is she willing to take the downgrade in quality of life so you can follow your dream? A marriage counselor can cost about 250 an hour btw when your marriage gets tested. Then when you are a resident you'll make about 60k/year when you could be making 200k+ (I'm assuming that's avg 40 yr old lawyer money....i know you have not made partner because you would not have enough time to daydream about this because you'd be swamped with work)

    idle hands are the devils workshop. I understand the need to learn, to challenge yourself, to grow. you're probably a high functioning person. take that energy and put it into your kids. that should be a ton of work right there. go and take that energy and stress about their academic performance. their schools. their college goals. their sports teams. their group of friends.

    if all else fails you could just buy a corvette or goto ashleymadison to help with this midlife crisis.

    1. He is a lawyer for the government so he's not likely to make partner. I left that out in the interest of space. Is 34 considered mid-life? I guess so.

  8. Do it….medicine is a gift to the physician, as well as the patient. There will always be a need for a good doc, and now the model will be moving more toward employment, so easier to start out. School debt is debt, but of all the things you worry about, don't let money make your decision for you. Good luck!

  9. I was also 34 as a first year in medical school and a practicing physician today even though doing 2 residencies and a fellowship. It was quite a journey, and the loss of freedom is quite high, but the rewards of saving the lives of others can never be replaced. Unless you have plenty of gold bars stashed away, school is expensive and the loss of income for 10 years forward is significant, but follow your dreams. Where would you be in 10 years anyway? DO IT!

  10. I did it 40 years ago before it was fashionable. I had 4 years of colege, 4 years of Seminary, 41/2 years as a Missionary in the Philippines, Came back and did pre-med in 2 years and 2 summers. Graduated from Med school in 3 years, and did General Surgery for 5. Missed a lot of events in family life. At that time tuition was not as expensive as now. Had a wonderful,supportive wife and children. We did without many things during that time, but it has been worth it. Make sure your wife is with you on this. You will always be wondering, what would it have been like to be a Physician? Do it!

    1. I apologize for overlooking your comment. I am supposed to receive email notification of new comments, but I didn't get one for yours. I just noticed it today on the site..

      Congratulations on successfully achieving your difficult goal. It was easier years ago. We were not wealthy, but my father made enough money to put me through college and med school without any loans. Tuition for my first year of (private) med school was $1200.

  11. What is it that you don't appreciate about having a life?

  12. I appreciate all the comments. I know our lawyer friend has been helped by them. Congrats to those of you who made it through after starting so late. I think it's called "grit."

  13. As the anonymous lawyer in question, I should add that I'm actually not in practice. I'm a federal agent for an undisclosed agency and spend significant time away from my family deployed around the world. I definitely know a thing or two about sacrifice and missing loved ones. That said, I also make a good six figure salary with benefits. It definitely makes the idea of pursuing this dream a tough one.

    I really do appreciate all comments made. I think at my age, with the responsibilities I have, I need to just accept that this isn't a very feasible option. I think it would be rather irresponsible of me to go this route with so many unknowns.

    Thanks again for all of the advice and if anyone has anything additional, please let me know!

    1. I think you are showing wisdom and maturity. I'm sorry if my post was a downer, but I have always felt that reality trumps passion. If it makes you feel any better, I'd love to give up surgery and try to get into something like what you do, but with a family to be responsible for, it's just not the right thing for me to do at this point (I'm 47).

      Try not to think of you occupation as your identity. It's one of the biggest mistakes I see in physicians. You are who you are when you get home, not when you go to work.

    2. Dear anon federal agent--I am the poster above who was a language major, prior military and am almost done with my surgical specialty training in my mid 40s (general surgery and two fellowships).

      I had skeptical send you one of my emails if you want to connect and discuss things.

      Like you I spent a lot of time away from family deployed before medicine. I look back sometimes in the middle of long calls and think "man, I could have retired from the military, had a good pension and be on my second career etc"

      But everyday, I am tremendously privileged to look a patient or their family in the eye (depends on the population I am working with at the time) and recommend a surgical plan, and then hopefully get them through a complex operation and home.

      Yes, going into medicine requires a lifestyle and budget change, and your spouse and kids need to be on board so you can come out the other end as a happy cohesive unit.

      Because I agree with artiger reality is a pain and surgery is a tough business--essentially all-consuming if you allow it to be. There will always be more patients than you can ever deal with and it will grind you down if you go into it for the wrong reasons. At the end of it all, your family is what you have left, not those patients etc.

      However, if you go into medicine for the right reasons with your family on board, from my experience (which is n of 1--so take that into account) it can be the best decision you ever made. Any federal agency has a ceiling, medicine is a profession where your interaction with a sick patient is an incredible privilege that you will never forget and is limitless when it is just you and patient at the bedside. Will it be tarnished by the pressure of administration, regulation etc? You bet! But in the end for me it was a question of calling, lots of people pointed out the reality piece to me, but I knew I wouldn't be happy unless I pursued my dream to help people in a very direct way. I also spend time overseas working in developing countries pro bono which helps keep me grounded too.

      If you decide to do medicine, on days were it gets rough, this may help--apparently Denton Cooley one of the pioneers in cardiac surgery had this posted on his OR wall from Teddy Roosevelt's "Man in the Arena" Speech:

      "It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat."

      Again this is only my two cents like everybody else and it may not help you at all. I wish you the best in whatever endeavor you pursue as you clearly have a lot of abilities!

      If you want to connect, you should have received an email from skeptical.

  14. I am a 66 year old MS 3 and did better than most of my "peers" academically. I am of the old school and believe that anything is possible. I do not listen to negative statements and as a United States Marine, I will focus on and achieve ANY goal I set my mind to. Drive on my friend and never, never quit; especially if this is something you were meant to do. My name is Michael Bishop in Nacogdoches, Texas.

    1. You just might be the oldest MS3 in captivity. Good for you. I hope you aren't planning to become a thoracic surgeon. It would take you a long time.

  15. Pursue your dream. Money comes and goes. Good luck.

  16. What is your current salary? Let us just look at a lifetime earning if you are an Assistant U.S. Attorney, the highest salary grade is around $145,244.00. Assuming you are sacrificing that to get into debt ($200,000). Let's just project out to your retirement at around age 65. The 10th percentile salary for a general surgeon is $248,886. Assuming you're making that much.

    Ok, so you don't finish school and residency until you're 45, straight up general surgery, and that's it. You will have a solid 20 years to work afterwards.

    Assuming you are starting now, your earning potential (minimum) is going to be

    $145k x 30 years = $4,350,000 solid salary only measure

    Now if you go to medical school, we are looking at you starting at AT LEAST -$200,000 at the age of 40.

    Then you start residency. Assuming you earn $50 per year (less than average for a lot of general surgery residency programs), you are looking at $250,000 at the end of your residency. You would be ahead $50,000 at the age of 45.

    Assuming you work at the 10th percentile of G.S. salary, you will be making the following:
    $250k x 20 = $5 million

    You're still AHEAD. I mean I understand if you invest as you earn money you could have a lot more money than the above mentioned amount, and you would lose out on nine years of investment if you go to med school. However, if you up your retirement contribution, the end result becomes a washout. Seriously...if you're pumping the majority of your new income as a G.S. into retirement for only seven years, you could potentially be in equal retirement amount at 65.

    My point is...don't let money be an issue. Follow your passion.

  17. I appreciate your comments, but I think you forgot some things.

    What is he supposed to do for income while he's in med school? How is he going to pay his tuition? He's going to have to borrow some money. He won't be able to pay off the loan(s) on his resident salary of $50-60K and still feed, health insure, and house his family.

    His debt will be way more than $200K and the interest will keep accruing while he's a resident.

  18. I think you should simply go for it is quite unfortunate we only live once