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Who Wants To Be a Doctor? And Why.

New MED students reflect shifting medical landscape

Who wants to be a doctor?

The BU School of Medicine Class of 2015 is being groomed for a respected profession now in financial upheaval and plagued by what many believe is a worrying trend away from the traditional, often nearly lifelong doctor-patient relationships nurtured by primary care. But despite concerns about health care access and future loan debt, interviews with incoming MED students reveal optimism about a career that will enable them to serve not just their patients, but their communities.

Plucked from 11,400 applicants, the 173 members of the new class hail from 32 states and 19 nations. On August 8, at the storied White Coat welcoming ceremony, they recited the Hippocratic Oath, and then, lest the proceedings get too solemn, were reminded by Kitt Shaffer, a MED professor of radiology, that “being a doctor is the best job on the planet,” and that “if you’re not having fun, you don’t have the right attitude.”

And then the grind began. Already confounded by the demands of gross anatomy, many first-year medical students are eyeing specialty medicine right off the bat—it’s not uncommon for even premed students to be planning careers not just in, say, orthopedic surgery, but in hand surgery.

Heather Dehaan, Boston University School of Medicine

Heather Dehaan (MED’15): “Today’s doctors are seen as being more humanitarian, and more involved with public health.” Photo by Vernon Doucette

“I always worry about people having a fixed idea so early, making decisions based on a very incomplete understanding of themselves,” says Robert Witzburg (MED’77), a MED professor of medicine and associate dean for admissions. But in recent years, says Witzburg, MED and other medical schools that had routinely selected applicants most adept in the sciences are now choosing students based on a more holistic review.

“That changes everything about the admissions process,” Witzburg says. “It creates a structure in which every element of the application is considered in the context of every other element. The academic record is no longer looked at as a stand-alone item, but rather in the context of the applicant’s life experience, the adversities he or she has faced, the advantages he or she may have had.”

He says adopting the holistic approach is part of an effort to “educate more students interested in community health and primary care specialties.” But, he says, “in essence we just don’t know yet.”

While he acknowledges the need for specialists, Witzburg echoes a growing sentiment in his profession that primary care is slighted by the payment system, and accumulating medical school debt is pushing young doctors toward the more lucrative specialties. Because doctors are compensated more for procedures like diagnostic scopes, scans, and biopsies than for services such as counseling or dispensing prescriptions, core primary care services are difficult to quantify and reimburse. The income gap between primary care doctors and those in subspecialties has grown steadily in the last decade, with a difference in median income of as high as $250,000 between primary care physicians and those practicing diagnostic radiology and orthopedic surgery, according to a report by the Robert Graham Center, which surveyed doctors’ incomes between 1979 and 2004. The disparity is seen as the main cause for a drop, by nearly one half, in the odds medical students will choose primary care. And the report estimated a drop of 30 percent in the odds a student will end up working in a rural health center.

Javier Rios, Boston University School of Medicine

Javier Rios (MED’15): “I feel like, even during residency, you can have time for your family.” Photo by Vernon Doucette

The dramatic decline in primary care is compounded by an aging U.S. population and the expansion of health care access under the 2010 Patient Protection and Affordable Care Act, often referred to as Obamacare. A report by the American Academy of Family Physicians predicts a shortfall of almost 40,000 primary care providers by 2020. At the same time, the American Association of Medical Colleges estimates that among 2010 medical school graduates, average debt was almost $160,000, almost double the $87,000 in debt for graduates in 2002.

“There’s no doubt that students and residents tend to gravitate toward highly lucrative careers that are respected by their colleagues,” says Witzburg, an internist who as a young man turned down a prestigious cardiology fellowship. “And it’s common for people to turn their noses up at primary care after looking at primary care doctors struggling with paperwork and being paid poorly, and seeing other people doing high-class procedures, making disease go away in 60 minutes and being very well compensated for it. It’s not lost on medical students that these specialists are sought after by hospitals, have big fancy offices and big fancy cars, and live a different life than primary care doctors.”

Lifestyle issues

But it’s not just concerns about income that is causing the shift in the medical landscape, he says. There are lifestyle issues—dermatology and ophthalmology, for example, have virtually no emergencies. Writing in the New York Times, surgeon Karen S. Silbert recently made waves by suggesting that women who want to work part-time—there’s an increasing trend for doctors to split jobs—should choose a profession other than medicine.

Heather Dehaan (MED’15), a University of Miami graduate from Nashua, N.H., thinks the attraction to lucrative specialized medicine has started to wane. “Today, doctors are seen as not being so selfish,” she says. “Doctors are seen as being more humanitarian and more involved with public health.” Dehaan hopes to be a pediatrician and is attending medical school on a U.S. Navy scholarship. Her lifelong resolve to be a doctor was strengthened as a college freshman, when her much younger sister became ill with cancer. “Caring for my sister reconfirmed what I already wanted to do,” she says. A biology major, she’s always wanted to work with children and believes that a career in pediatrics will afford her “the most influence and the most input” toward bettering kids’ lives. Under the terms of her scholarship, she’ll serve one year as a doctor in the Navy, beginning as a lieutenant, for each year of medical school. “I’m not going into this with the expectation of making a lot of money,” she says. The income question hasn’t come up in discussions with residents and fellow students, she says. Dehaan is engaged and would like to have children some day, but that will have to be put on hold until some point in the future. “And I’m okay with that,” she says.

Matthew McAdams, Boston University School of Medicine

Matthew McAdams (CAS’10, GRS’11, MED’15): “Access to health care is the biggest problem we’ll always face.” Photo by Vernon Doucette

Matthew McAdams (CAS’10, GRS’11, MED’15), of Vero Beach, Fla., believes that BU “actively selected our class for more humanism.” He and Luke Stevens (GRS’11, MED’15), of Winchester, Mass., completed BU’s master’s program in medical sciences, which they believe improved their medical school applications. They were thrilled to be accepted (it was McAdams’ second try), and they are allowing themselves to dream a bit, while coping with the much-dreaded anatomy lab. McAdams is interested in neurology; Stevens hopes to specialize in emergency medicine. Both expect to be well-compensated for their work, but as McAdams puts it, “if we wanted money, we’d go into business.” As for the prestige of being a doctor, “it’s not a bad thing,” says Stevens.

McAdams was drawn to medicine by his late grandfather, a general practitioner in rural Arkansas. He did house calls and sometimes took his grandson along. “I saw the magic in what he did,” says McAdams, who hopes to practice academic medicine, enabling him to have clinical hours, teach, and do research. He believes he probably “doesn’t have the wherewithal to perform surgery for 10 hours” and wants to work with people suffering from conditions like multiple sclerosis, neuropathy, and dementia—all of which have affected friends or family members.

Luke Stevens, Boston University School of Medicine

Luke Stevens (GRS’11, MED’15): “Even Superman couldn’t know all disease symptoms and processes.” Photo by Vernon Doucette

“I’m committed to doing emergency medicine,” says Stevens, who completed EMT training as an undergraduate. “I have a short attention span.” And with an ER doctor acquaintance estimating he’d see 40,000 patients by the end of his four-year residency, Stevens decided the specialty would be a good fit for him. “They see about three patients an hour; they see everything,” he says, and they usher patients through initial diagnosis and treatment. With median salaries of nearly $247,000, ER doctors have an added lifestyle benefit. “It’s shift work,” he says. “You’re not committed to be on call for 100 hours a week or anything crazy like that. You work as hard as you can for the hours you work, and then you go home.” Most important to him is the notion that “in the ER you have a really big chance to make an impact on each and every patient—it’s an intersection between public health and medicine.”

Javier Rios (MED’15) and Deirdre Rodericks (MED’15) have their eyes on orthopedic surgery, which, along with radiology and invasive cardiology, is among the top-earning medical specialties, followed closely by cardiology. For Rios, from El Paso, Tex., and Rodericks, who grew up in Coles Neck, N.J., the specialty’s pull is less about income and more about results: both see orthopedists as doctors with great physical competence and as clinicians who fix people. Rodericks, the daughter of a Mexican-American mother and Egyptian-Indian father, was recently in India shadowing orthopedic surgeons. “I wanted to be a mechanic when I was really little, and it’s like being the mechanic of physicians—you use drills and saws, and can see an immediate effect,” she says. She wants a family and hopes that while she’ll restore flexibility in her patients, her profession will afford her some, too. “I’ll have to plan really meticulously,” says Rodericks. “Upperclassmen have been a really big help. Though the surgeons I spoke with are all men, BU’s residency program is now about half and half.”

A weight lifter and soccer and basketball player, Rios is drawn to orthopedics, specifically sports medicine. “It’s really fascinating to me,” he says. Rios envisions working with professional athletes, maybe being a team physician. But he also expects, as he puts it, to “have a life.” Marriage and family were not among the most urgent concerns of the male students interviewed, but they were discussed often by female medical students. “We have been talking a lot about what we’re going to do about having a husband and kids,” says Rodericks. “It’s a really big concern. We’ve joked about hiring surrogates. With so many women doing surgical residencies, you’re talking about nine more years of your life.”

Deirdre Rodericks, Boston University School of Medicine

Deirdre Rodericks (MED’15): “I’m really into preventive care and dealing with the obesity epidemic.” Photo by Vernon Doucette

Committed to doing medicine

When their conversation alights on issues beyond their new regimens and surroundings, the students share many concerns, and one that’s foremost in their minds is the lack of access to health care. “Access is a big deal for me,” says McAdams. “I have a brother who doesn’t have health insurance, and when he has an issue, he comes to his younger brother, who’s not a doctor yet, for advice. Access is the biggest problem we’ll always face.” Dehaan, too, worries about access, especially for children. “I didn’t have health insurance for a while when I was growing up,” she says. “My mom doesn’t have health insurance.”

Just moments after explaining their plans to enter specific fields, all the students interviewed conceded that everything could change. “I’m told every day that in four years I might be doing primary care,” says Rodericks. McAdams often hears that he “might come out on the other side wanting to do something completely different.”

But as Stevens puts it, what’s important is that “we’re all committed to doing medicine in some way.”

12 Comments
Susan Seligson

Susan Seligson can be reached at sueselig@bu.edu.

12 Comments on Who Wants To Be a Doctor? And Why.

  • Brad Zehr on 10.03.2011 at 8:38 am

    I don’t think “Obamacare” is the correct AP Style format for the 2010 Patient Protection and Affordable Care Act.

    • Liz on 10.03.2011 at 11:38 am

      Agreed.

    • Susan Seligson on 10.03.2011 at 1:04 pm

      An oversight, I agree. Correction made.

    • suafel on 10.04.2011 at 8:43 am

      i agree on every part of ur thougts. may GOD help u

  • Mike on 10.03.2011 at 9:46 am

    Being a recent graduate of the MA in Medical Science program I can first hand tell you they could care less of finding students who fit the holistic category. The first two days of orientation was spent pretty much telling us that if we did not get a 4.0 gpa it’s difficult to get into medical school.I have personally talked to the GMS and med students. All most of these students know how to do is walk around with an arrogant attitude and be simply good at the art of memorization. Too many med students today are going into medicine for the title and the money. The fact that primary care is declining is a perfect example. Prestige and money usually go to the surgeons.

    • Nathan on 10.03.2011 at 1:49 pm

      I think the American Medical Association(AMA) was founded on the principle that all doctors have the unalienable right to “walk around with an arrogant attitude.” – This is nothing new!

    • Tyler on 10.03.2011 at 10:14 pm

      Mike, there’s a lot in medical education to be disgruntled by. I’m a member of MED 2015, and I’ve actually felt incredibly humbled and honored to be working with so many incredible people. I certainly didn’t have a 4.0 getting into BU MED, and that’s really not the type of student that MED selects for. Many of my classmates have done previous healthcare work, several have worked with the Peace Corps, many have done health research. I’d say about half came straight from college, and half have had a few years of life experience away from school. No doubt, there are a few individuals who are hell-bent and determined to match to a very competitive specialty. But the majority of my classmates are here because they want to make a difference in the health of not only one individual, but whole communities. Primary care, preventative care, and public health is something that is very resonant with this idealistic class.

  • Kay on 10.03.2011 at 10:47 am

    @Mike sure some people go into specialties for the title or better pay but also primary care and even many types of specialized care are being done by nurse practitioners and physicians assistants. If it is in the med student’s interest it is actually quite smart to go into a specialty.

    • Manuel Salnas MD on 10.18.2013 at 5:49 pm

      i have been very fortuante to have been involved in medcial education for all levels of providers. At all levels I have seen individials that excite me. Wishing at times I had another 40 years to give this profession. Anyone could change the oil in your car. A physcian with their additional training is expected to recognize other issues that must be addressed. The extra training does have an impact for all but the natually gifted
      Definitely the concept of ‘midlevels’ will impact all levels of physcian specialites. Terms used are cost effectiveness. This trend will eventually permeate all specialites. You already see it with pharmacy techs. auto techs ( my brother a mecahnic is faced with the same issue in his profession )
      Unfortuantely, this is a trend that will continue. The issue with any ‘health care provider’ is skill level. Both physicians and midlevels can provide a wide quality of care. Either could see a patient with a health issue and only deal with it superficailly.

      Historically a disease model profession. I was very fortunate to have mentors who taught me ‘not to just put air in the tire but to figure out why the air pressure is low’. When we incorporate the concepts on not only treating. But also controlling, preventing complications and most importantly achieving disese regression. Unfortutantely, this take time. Not always supported by the medical system

      Over my carreer I have found that physcians and mid levls who were motivateed by finances or were guided into this profession because ‘they could get in school’ are the most frustrated. Many have left their profession are now involved in other professions.

      For the rest of us it is probably the increased beraucracy and not the money that will drive us away. Historically, doctors were not necesearily highly oaid. This concept did not evovle until the creation fo insurance. My older colleges tell of increasing their fees at will and automaticaly geting paid in full. Since DRG’s in
      1982 this concept is gone.
      Hopefully, your motivation to be a member of the health care team with be with your always. My have been intereast in science, wanting to lern, tworking one on one with individuals and helping people to learn. My other profession was going to be a teacher. Fortieatnely I get to teach each and every patient at their viist. With the goal of having them learm n hwo to be theri own health car porovider. Most of the docs I know are happy when left alone to take care of their patients.

      I have enjoyed my tenure as a doctor. I counsel all interested to know what is calling you to this profeeison. If it is money you might be in trouble. But you will never be poor. Unless you live outside yoru means

  • Yasmin on 10.03.2011 at 12:57 pm

    @Mike: Considering the majority of BU Med graduates are going to be spending a hefty chunk of their professional lives paying off the massive debt of BU tuition I can’t say I blame them for avoiding primary care.

    • Lauren on 01.12.2012 at 10:04 am

      Although I sympathize with the debt situation, I would hope that anyone with a real passion for service will not let this determine the direction of their career. I graduated from the BU School of Public Health in 2005 with over $60,000 debt…an MPH gets you only half the debt of a physician with much less than half the earning potential of even a primary care physician. And I wouldn’t change a thing. Primary care physicians are still some of the best paid service professionals around and by most people’s standards make PLENTY for paying off their debt. I would hope that those with a passion for providing the care most of us need most of the time will not let all the hype about huge debt deter them from doing what they love.

  • Laurence A. LaGattuta (BUSM 1961) on 10.06.2011 at 10:04 am

    As I read your article about the dreams and aspirations of young people entering medical school today I was reminded of my own, some fifty odd years ago. Conditions for young people entering medical school haven’t changed. There is still the intense academic competition required foradmission, the financial burden, the long hours of study and the first livepatient contact which makes it all worthwhile. What has changed comesafter medical school. Today the technological advances in medicine are remarkable and because of great institutions like Boston University, tomorrow they will be even more remarkable. Sadly, however, we have lost one of the most important and satisfying elements of medical practice. We have lost continuity of care. As a result of that loss the bond of trust between patient and physician and the bond of commitment between physician and patient havebeen diminished.

    Laurence A. LaGattuta (BUSM 1961)
    Retired General Surgeon

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