Med school
It seems a good time to revisit the subject of what I'm doing with myself in the hopes that some of my regulars will share their thoughts with me.
(If you don't care to read about my life, stop reading now.)
In case the other entry is too long, here's the short version: I'm not a pharmacist. I was a pharmacy student and got kicked out due to poor grades. It's been almost 2 years since I've been in school. I was just sort of skating along back then, but my entire life and attitude is different now. I wish I had done things differently, but I'm ready to pick up the pieces and re-take certain classes if need be, to get where I want to go.
For as long as I can remember, I have actively resisted the idea of going to med school for a whole host of reasons, which I will expound upon here. And then there are the things that I can't ignore that seem to be propelling me in the direction of med school — and always have — that I always went out of my way to ignore. I have always actively resisted the idea of being a doctor.
(These lists aren't in any particular order.)
CONSTRAINING FACTORS
1. Malpractice
From sky-high insurance premiums to a litigation happy public to entitlement issues ("He died so I deserve some money") — everything about med mal terrifies me. I don't know what it would do to me on a personal level if I were to be sued. I'm pretty resilient as people go when it comes to emotional trauma, so I'd probably handle it pretty well, but it's still something I'd prefer not to experience.
It also seems very wrong morally and ethically to me that as a physician, I'd probably pay more in malpractice than I'd take home in a year. Especially if I did primary care — which is one of my two main interests. That's not right.
2. The system
The entire US healthcare system has its priorities wrong. They bother me now and I'm not directly affected by them. P4P, emphasis on treating conditions rather than preventing them, etc. It's all wrong.
3. Money
I've got $140,000 in debt right now thanks to pharmacy school. That's a mountain of debt, and I'll likely accrue more debt by going to medical school. More than I would if I finished my PharmD. I've messed up so badly in the past that my family is reluctant to take a chance on me. I will have to retake some core classes to go to med school, and I fully intend to get A's, as I'm more than capable and my motivation is right. I am hoping that this will persuade them that I'm finally serious.
This might be slightly offset by the fact that the amount of money I earn passively is constantly growing. By the end of this year, it should cover my car insurance and cell phone bill, for instance. This is a small comfort to me.
I think I'd like to either be a primary care doctor or a neurologist. I'm leaning more towards primary care, but economic constraints might force me to specialize. This irritates me, and though I suspect that Paul Levy is probably right in the long run, that time is not now. Everything is cyclical.
4. Residency
I don't mind scut work, and I'm more than happy to work my tail off, even outside my comfort zone, but I'm one of those unlucky souls who requires 7-8 hours of sleep per night to be a functioning person. I pledged a fraternity back when I was a second year pharmacy student. I know what sleep deprivation is like. I'm a complete and utter mess. The thought of an 80 hour week doesn't scare me, but the thought of all-nighters where lives are quite literally in my hands terrifies me. Under normal (non-sleep-deprived) circumstances, I would feel privileged and confident, but not if I'm exhausted. Then it's just scary.
And the whole issue of getting paid pennies with a world of responsibility on your shoulders rankles me, too. (Not to mention that my loans will be accruing interest. *cringe*)
5. Bad grades
Imagine you're bowling: you've made bad throw, and the ball is teetering on the edge of the gutter and it could go either way. Then! At the last moment, it falls into the gutter and you end up with nothing. That's pretty much my college career right there.
This is the reason I'm not about to start my pharmacy rotations in another 4 weeks. I had lots of things happening in my life during the early part of my college career — parents getting divorced when I was a freshman; dad getting re-married; a sudden attack of Crohn's disease that put me in the hospital for a week the week before 4 major exams my third year that I was never able to recover from; ADHD; panic disorder; myriad other factors. Ultimately, my failure is my own, however. No one else's.
I've gotten all of these extraneous factors under control. I've made huge lifestyle changes. I cringe at how cavalier my attitude was towards school. I feel like I'm looking back at someone else's life. And I want to fix these mistakes. I was always very proud — I'm a smart guy, and I took pleasure in doing well without making any effort. That didn't work so well during my second year. Or my third. But I'd never learned to study. I've gotten over my pride. I've learned quite a few life lessons along the way. I honestly don't care where I go to med school, because it doesn't really matter. School is what YOU make of it, not the name of the institution on your diploma.
And in the real world, I've always been a stand-out. I've never known how to be anything but. I'm ready to be an academic stand-out now, too.
MOTIVATING FACTORS
1. Redundancy
To complete my PharmD, I'd have to make up a few pharmacy classes — actually, about a year's worth — and I really don't want to do this. The reason being is that once I've actually learned something, I don't forget it. Even though it's been two years since I've taken any classes, I could still take those exams and pass them again. However professional schools do not allow advanced-standing transfers, except in very rare cases. This is a double-edged sword. I'll have an advantage when it comes to basic physiology and pathophysiology, whereas I won't have to take industrial pharmacy courses (Zzzz) in med school.
2. I love medicine
I don't know what to add to this, except that the feeling I get when I help someone can't be quantified in dollars and cents. (That doesn't mean that I don't think I should be well-compensated for my work, however.)
3. I'd be really good at it
There's no doubt in my mind that I would be a great doctor. None whatsoever. As a clinical pharmacist, I could do lots of things, but operate with autonomy is not one of them. A doctor has a lot more options in this regard. Clinical pharmacists also make less money than retail pharmacists — though one might think it should be the other way 'round — and I have to be mindful of financial considerations. I like retail pharmacy well enough, but ultimately I'd want to be a clinical pharmacist should I finish my PharmD. A BCPS of some kind.
4. I don't have any hobbies…
…except medicine. I spend all of my free time thinking about medicine, reading, or writing about it. On my days off, I honestly spend whatever free time I have reading journal articles, CEs, commentary, etc. This is my idea of a good time, sad as it might sound. Things that take time from my being a sponge irritate me. This is the main reason I know that I'll be a good student now.
I couldn't imagine doing something besides medicine. I've tried it, and it just feels empty.
[tags]Medicine, med school, pharmacy school[/tags]
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I couldn’t imagine doing something besides medicine. I’ve tried it, and it just feels empty.
That's it.
That alone outweighs your 1-5 "constraining" factors, and leaves the rest of your "motivating factors" in the dust.
Just to address some specifics, though:
Malpractice premiums may be outrageous, but do vary by specialty and by my calculations tend to run 20-25% of annual reimbursement. ie, an FP making 100K may pay about 20K in med-mal premiums, but although that neurosurgeon may be paying 100K premiums he's taking home 400-500K. It's only by comparing apples to oranges that you come up with the nonsensical idea of paying more than you're taking home.
Everything else — the money, the system, the training; all of it — is subordinate to the passion. The phenomenal rewards of medicine — especially Family Practice (pardon my bias) — are woefully underemphasized in conversation, including blogging. Keep your eyes on the prize: nothing less than your soul is at stake.
Think about it this way: on your deathbed, what are the chances you're going to say, "I should have settled for being a pharmacist."
Comment by #1 Dinosaur — April 9, 2007 @ 4:36 pm
The notion that most pharmacists really wanted to be physicians, but "settled" on pharmacy, is pretty laughable.
Truly a silly urban legend. Most might think of it for a few moments, then realize they can help patients, have one-tenth the liability exposure, not be on call 24 hours per day, not have every move watched by every member of the community, and make 80 - 90% of the salary of the normal PCP, with much less effort and headaches.
Comment by TyGallo — April 10, 2007 @ 10:55 am
You are quite right, Ty. I actually don't know of any pharmacists or pharmacy students whose second choice was pharmacy. Law school is, perhaps ironically, the second choice of many of the pharmacy students I know.
Actually, this bizarre notion is something I've been meaning to address in a blog entry for a month or two now.
For me, wanting to go to med school is a result of priorities shifting more than anything else.
Comment by RJS — April 10, 2007 @ 1:27 pm
Well Kiddo, and I get to call you that because I'm old enough to be your mother…
I used to be a hospital admin in another life. I wish I'd known you were coming out here for vacation and pondering this question, because we could have had this conversation in person. We live not too far from Ontario Airport and could have given you the grand tour and a meal while you were in CA. Just so you don't think we're some weirdo's on the Internet, we tend to collect student types here and the husband invites them to coffee or for a meal all the time…. If we were talking to you, I'd turn you over to the husband (a USC PharmD) and is a DOP/Clinical Pharmacist in a medium sized LA area hospital now some 25 years… Believe it or not we've had this conversation before…
Basically you're caught between a rock and a hard place. Okay so you screwed up! But at least you are smart enough to realize you will need to get your sh!t together and fix your mistakes. Some of the problems weren't yours. (Parents and illness) Others were and you're owning up to them. This is probably one of the best things that ever happened to you. It's easier to fix them now than never– ya know?
If I were advising you (or my husband was,) we'd advise you to get your Pharm.D. Reason? You need a fall back position. Also you've screwed up before, so finishing this degree would prove to your folks, you're serious and ready to take responsibility and get on with life. I'd also take my boards and do a little practice just to get your debt load down.
However– I would make it clear to your parents and everyone in your life, you are still seriously interested in going to med school. We know several people who have done this and honestly they've made great MD's.
All in all don't look at what kind of money you're going to make. It's the worst thing all of you students can do. Look at the good you can do for healthcare and before you ask for that big paycheck, be darn sure you can perform. Hospitals out here are looking for good people who are willing to learn and do. You know you can find those positions if you try. Go put in some time, deduce your debtload and start making plans for med school.
Good luck! Passion is something you should follow. But be sure you are acting responsible along the way!
Comment by Mary Lu Wehmeier — April 13, 2007 @ 6:15 pm
[...] on vacation at the moment, and I can't stop thinking about med school. It's pretty bad, actually. We all go out to do whatever, and my thoughts are a million miles [...]
Pingback by Peace :: OnThePharm — April 15, 2007 @ 10:39 am
My brother I would advice you to go back and finish your Pharma D and when you done you go on for med-school.
Comment by EJ — August 15, 2008 @ 1:27 am