Friday, March 21, 2008

The Great Balance: Work vs. Life

A lot of people have been asking me what I plan on doing after graduation (May 17), especially if I don't get into any medical schools. I tell them that even if I did get into a medical school I probably want to go to Physician Assistant school instead. I get many blank stares with this one, mostly from family. I tell them about how the physicians I meet are not all that happy with their lives, and that it seems that the profession almost dictates how you lead your personal life. People don't seem to understand what I mean when I say this. Unfortunately, I don't have any family members in medicine to better explain what I'm trying to say.

From what I can see through medical blogs and talking to people it is basically impossible to have any kind of social life during medical school and residency. That means that for the next 7 years (minimum) I will basically just be going through the system, almost isolated from the outside world. In medical school you are basically limited to hanging out with your classmates because they have the same crazy/limited schedule as you. Now don't get me wrong, I'm not afraid of the hard work. If I were afraid of work I would have dropped out of my major a looong time ago. It's the fact that for 4 years of my life, I won't have one.

Okay, fine. Let's say I do go to medical school. I'm 26 years old and finally out of school and working. I start residency and am committed to this residency for another 3 years, minimum. Some say that it is possible to have a social life, and I believe them. I'm sure it is. But lets look at the economics of the situation. Now I know some people will yell at me for bringing up money when talking about the noble profession of medicine, but I'm not talking about getting rich here. I'm talking about being able to pay bills. As a resident I'm looking to be making about 45k a year, while working 80 hours a week. (BTW, while working 80 hours a week, and sleeping 8 hours a night - ha, like that would really be happening - I would 4.5 hours a day to myself.) That comes out to $11.25 an hour before taxes. Okay, so paying off that debt from medical school won't be happening any time soon. Oh, and by this time I'm 29 (minimum) and finally starting my life, aka have a pay check to do things with. I had a breast cancer surgeon confirm that you cannot start "creating your life" until you get an attending's salary. By that I mean getting a house, car, vacation, let alone be able to finance a family. She was 39 and said she had just reached the point in her life that she had been aiming for. (Even though she was still working 12+ hour days) She also didn't want kids, but she was legitimately happy. She's the definition of "marrying your job." God bless her.

I see myself going into Internal Medicine. 1. Because that's the most interesting to me. 2. Because for the love of God I cannot, will not, spend anymore time in school. I've been told time and time again that with the debt from medical school, and the bills of regular life primary care just doesn't cut it. And by cut it I mean that between the amount of time I spent in medical school and residency the cash I would be making just isn't reasonable. If I'm going to spend that much time in school I think I deserve an above average salary. If that makes me a jerk, then so be it.

So let's look at what I could expect should I go the PA route

I take the next year "off." I apply to PA school and in the meantime get an medical office bitch job. (read as: medical assistant) We'll get back to the perks of this "year off" later.

So I start PA school at 23. Have two years where I don't have a social life. Fine, I can handle that, especially since I just had a year off. Come out of it at 25, still ahead of the game compared to medical school.

Now if I go PA I think I will definitely want to be a surgical PA. The reason for this is because I know that PAs see the routine in whatever field they go into, and honestly the routine in primary care is just not going to cut it. I need to be a little more stimulated than seeing cold, after cold, after cold. After working in the ER I don't think I could handle the routine there even if I was a physician. I hope that as a surgical PA I would be able to do a lot of pre and post-op care, but even if I was mainly first assisting I think it would still be a cool deal. What specialty to go into as a PA is a totally different post. So depending on whether I did a PA residency or not I start actually working at 25/26, as opposed to the 29 (min) of being a physician.

Now lets look at the PA economic deal. 2 years of PA school < 4 years of medical school. The salary of a surgical PA I estimate to be anywhere in the range of 80-120K. This is plennnnty of money for me to live happily. (taking into the consideration the investment I put in to get to this point) Whereas the average IM-physician averages something like 150K. And he has more debt to take care of, spent more time to get there, and I presume dedicates more of his life as an attending to work than a PA does. I've also had physicians specifically tell me that from an economic point of view PAs win out.

Then there is my whole personal life situation to take into account. I've recently "come out" (I fucking hate that expression) and am a bit socially retarded when compared to my peers. And I don't mean "retarded" in terms of intelligence, but as in I'm "behind" in the game. If you think about it I have the dating experience of a 13 year old. I have some life experiencing to make up for, something that that "year off" could definitely come in handy for. Also, should I ever decide to start a family the flexibility of being a PA comes into play. I could either work as the "bread winner" or I could be the stay-at-home-dad and easily get some per diem work.

I think too much.

So this is the end (for now) of the longest post in the history of my blog. I don't know why you bothered reading the entire thing. My life is not that interesting.

PS - I'm not editing this beast. I'm not as dedicated to my blog as some others.

1 comment:

Anonymous said...

Dr. House - you are completely on point regarding the math of PA vs MD/DO.
I have been an MD >30yrs. The money is laughable, given my hours and responsibility. The horror of seeing people at the worst moments of their lives, all CLAWING at you for stuff [get me welfare, get me disability, get me pain relief, get me a home attendant, get me pregnant, get me unpregnant] penetrates your soul.

As an MD, you can never close the damn door. You are on call, no overtitime pay, the responsibility never ends. PA's put in their hours, leave and do whatever.

Better off dead than med.