"We make those decisions emotionally at
the start and then, much later in private
medical practice, we can view our fragile
decisions with far more discernment and
reasoning. Each physician has to deal with
their own regrets, exaggerated expectations
about their medical career, and recognizing
that we change our minds to keep meeting
the situations and circumstances we
face at the time."
There's not enough due diligence paid by new medical students and young doctors to try to understand and make use of the advantages for choosing the right specialty to master and the profound reality it holds for the career life of any physician.
It has always made me wonder how many physicians make a major change in their original specialty or just change to another area of the specialty during their medical careers. I've never seen such a survey about that issue.
The praiseworthy choice to become a general practitioner results often in a career life of lower income, personal family frugality, and persistent tolerance for living and practicing with those circumstances. As I see that choice, it's a medical career that offers few monetary rewards and a truckload of fulfillment. There's nothing wrong with the choice except that it involves a sacrifice of lifestyle, family necessities, ultimately of a physician's full medical career potential, and sometimes the marriage and family. It seems to me to be a very disruptive decision--primary care practice.
Knowing what I know, feel, and think about my medical career today, starting over I would choose a high earning specialty like plastic surgery, orthopedics, dermatology, anesthesiology, or invasive cardiology. Yes, I included dermatology. If you take a look at the 2020-21 survey by Medical Economics about physician salaries, You will see the top ranked income specialty salaries
listed there.
Avoiding the high medical malpractice risk specialties would be an absolute certainty--like OBG. Hell, let the CNM's (Certified Nurse Midwives) do that work as much as possible because they are rarely sued, and most are well trained. Medical malpractice insurance carriers often increase costs to physicians in high-risk specialties to a point of unaffordability. That makes those high-risk specialties almost masochistic in nature. The efforts of physicians in those specialties carry with them a career long daily concern for increased numbers of lawsuits which requires a constant worry. It requires a strong risk tolerance level as well.
I would likely choose a midwest city to practice in (net income best in country) that contains a college or university, around 500,000 to a million people, year round tolerable weather, and near good recreational areas. In present day medicine I would join a single specialty group where call coverage and time off can be easily managed. A single specialty association of several private practice physicians would be acceptable. Most of the single specialty group practices seem to have significant issues with incompatible members off an on, but it often is short lived.
I would obtain at least 4 to 6 state medical licenses and maintain them in active status long term and at least one license after retirement. That's because of the increasing numbers of medical doctors moving elsewhere for a bundle of valid reasons during their medical careers. I expect there will be a significant increase in numbers of medical doctors changing their practice situations in the future--mainly to larger cities.
As much as I loved medical practice during my career, it is certain that I would not ever enter the medical profession again for many reasons. I would not select OBG and face high risk of medical malpractice daily for years and years. Female OBGs have less malpractice problems. It is likely that I would have ended up in plastic surgery or ophthalmology based on my natural skills in as a surgeon and the fulfillment that I had doing surgery.
Knowing what I now know about business and marketing, I wouldn't advise students to choose a career in medical practice for one legitimate reason--business education not being offered by medical schools. And that is because I have seen and recognize how complicated, financially disrupting, and income unstable medical practice has become without an academic business education.
That one single factor that is responsible for nearly all of the problems in private medical practice today in one way or another is lack of a business education. And physicians have no idea how fantastic and enjoyable their medical careers would be with a business education--especially the amount of income they would know how to make using the business tools provided. It is a true tragedy in the medical profession that has persisted for a century.
I will be very blunt with you. Practicing medicine without a thorough business knowledge leaves any physician in private medical practice in a constant financial battle throughout your whole medical career.
What you will lack and suffer from during your medical practice career are...
- Your income from medical practice will never reach the height you deserve.
- You will not know or understand how to do your private medical practice business management that is required for every successful business in the world today.
- You will have a persistent battle with attracting new patients because you know nothing
about physician marketing, medical practice business planning, and practice marketing. - Your gross income from private medical practice will be continuously lower than you expected because you lack the knowledge how to use business tools and marketing strategies that are critical to the need for your medical practice to be constantly growing and income producing.
- Your net income you take home will be much less than desired because you will be trying to manage a medical practice business you created using the advice of other physicians that are also business ignorant and that lacks efficiency, business systems, and significant growth and it is run by a physician that is incompetent at medical practice business management for lack of the knowledge necessary for top income production, and the management of employees.
- You will under these conditions violate all the business standards for medical practice business success that you were never told about while in medical school or premed. And that is what will prevent you ever being able to ever reach your maximum income as well as your optimal potential as a physician in skills and knowledge that you were capable of all along.
- The most egregious factor that you will have to live with is the final result of your efforts, time, education priorities, and medical training--that of finally recognizing that without your medical school providing you with a business education, that they have sent you out into the world of medical practice business knowing that you are financially predetermined to fail in your career to some degree.
Other issues that I would avoid as much as possible...
I would avoid marriage until I finished medical school, even if I had to wear a chastity belt. If you need a bed partner, fine. Just don't make long-term commitments before you finish specialty training. Having a wife working full time to put you through medical school is not for the serious physician candidates. These factors require far more self-control than most candidates have,
like me.
Transportation of all kinds today are available for use and saves the costs of owning a car. It is a great convenience if you can afford it. However, you may end up spending more money on public transportation than buying a car outright. Used cars can be a better choice.
Try to attend a medical school near where you intend to start your practice. If circumstances permit that to happen, you have saved yourself a significant amount of time and effort deciding your practice location later.
If you don't mind living in snow country, it opens up a much larger area in the country to choose from to practice in.
Avoid new recently opened medical schools because of the many functions in the teaching programs that haven't had the wrinkles ironed out yet. Staff in those schools are not usually of high-grade in the beginning.
Attend a college with a premed program that "feeds premeds" to the medical schools you prefer. Colleges and medical schools in the same state commonly do such things. No one will tell you, so you have to ask and do your research about that.
These ideas may be of some value for physicians who have kids heading for medical schools. There are reasonable options to all I have said here.
----Professional Probe----
"When you feel like you are being pressured
by our government politicians, who are plastering
you with fee restrictions and mandates to force
you out of private medical practice, you are right."
Articles©2013-2022/CGG INVESTMENTS LLC. All rights reserved. #130, 3-16-22
