A Career in Medicine? — It Depends
- T Michael White MD FACP
- Dec 3, 2024
- 2 min read
Updated: Dec 5, 2024
By T Michael White MD FACP
“The young man knows the rules, but the old man knows the exceptions.”
Oliver Wendell Holmes, Sr.
“Obstacles are those frightful things you see when you take your eyes off your goal.”
Henry Ford
Tuesday, December 3, 2024
Dear Mr. President, Honorable Members of Congress, Distinguished Staff and Fine Citizens,
My progeny (children, grandchildren and former students and residents) now refer to me as a LIOM-C (certified legend in own mind) and have bestowed me the title (demoted me to) Patriarch Emeritus. I resemble those sentiments.
Nevertheless, from time to time, they earnestly approach me for my opinion. Of late, they wonder — should their own progeny consider a career in medicine? Having been asked to share my perspective, as a retired academic, administrative and clinical general (primary care) internist and patient, I would proffer:
I had a wonderful run as a physician. I cannot imagine a more fulfilling professional career;
I cannot abide consigning my progeny to a 15-year sentence (college, medical school, residency and fellowship) of abject poverty;
I cannot abide my progeny leaving training burdened by ponderous, insurmountable, educational debt;
Being a good listener, I observe two categories of current physicians:
High demand specialists who (sitting in the catbird seat) can dictate the terms of their professional practice; and
Primary care practitioners (family medicine, internal medicine and pediatrics) who are increasingly burdened {bullied actually) by administrators.
Therefore, I cannot abide my progeny entering primary care.
Looking at the present and imperfectly translating it to the future, I see administrators willfully blurring the significance of medical training. Physician assistants and nurse practitioners are now increasingly considered “the same as” a formally trained physician — until, of course, they are not.
I have observed advances in technology having consequences for the superbly trained physician. For example, invasive cardiologists placing stents have dramatically impacted the practice of open-heart surgeons. While crisis does equal opportunity, caution must be advised.
My summative advice? I can only speak for myself. Armed with my training, experience, personal gifts and inclinations:
If my training was supported by my family and community…
I would go to college and medical school and matriculate into psychiatry residency (I personally always had a soft spot for psychiatry) and fellowship and…
I would leave training as an organizational psychiatrist with a master’s degree providing expertise in business and leadership and then, in a New York minute…
I would dedicate my career to advancing a U. S. Health Care System that provides affordable basic compassionate safe, efficient, effective, equitable (just) patient-centered care (C-STEEEP) to all.
Thank you, esteemed Leadership, for giving consideration to my concern for physician training and practice. As always, I will be pleased to hear from you.
Respectfully submitted,
T Michael White MD FACP
Copy to: We The People at fixingushealthcare.com
Masterfully written. A few comments…
1. I don’t advise my kids against choosing a career in medicine, but I make them aware of the challenges ahead. Avoid surprises.
2. Unless circumstances changes, I’ll advise choosing a non-primary care career.
3. Be involved in advocacy work:
· Reduce the cost of medical school tuition
· Reduce the length of undergraduate years
· Focus training to reduce the number of years as residents and fellows.
· Bridge the pay gap between procedure-oriented vs intellectual oriented practices (primary care)
· View Healthcare as a service, not a business, hence remove the middlemen system that made the USA highest spender but with worst outcomes compared to peer countries.
· Free policymakers from the influence…
Another aspect of training which I find interesting is that, despite the number of potential physicians who are turned away from Medical Schools because of the fierce competition admission into such schools, residency training positions are often filled by foreign graduates, there being too few US graduates to fill the available positions. We have many thousands of excellent physicians who graduated from foreign medical schools and trained in the US, and we are blessed as a country that they were willing to come to the US to practice medicine. To Dr. White's point, though, we need more positions available in the US to produce home-grown physicians, who, as he points out, don't graduate drowning in debt. I agree this conc…