The Big Fat Lie of Someday
O LORD, you have deceived me, and I was deceived; you are stronger than I, and you have prevailed. I have become a laughingstock all the day; everyone mocks me. Jeremiah 20:7
My Sunday school teacher reprimanded me when I said that Jeremiah was not afraid of hard work or failures – he just expected more from life. His perspective on this is different than mine, so I write wondering if anyone else of any faith feels deceived in the same way.
From a young age, I wanted to be a doctor. I believed it would be very hard work to get there and when I became a doctor I believed it would be long hours, hard work, sadnesses. But I also believed a few other things, which I will list along with my reality. If yours are a different reality, that’s wonderful. These are mine:
I would be able to work well into old age. I unconsciously latched on to the Norman Rockwell illustration of the old doctor easily in his 80s listening to the doll of a child to ease her young fears. Reality? I have bilateral familial neuropathy and cannot feel my feet. My estranged father died with bilateral above-the-knee amputations. I had a left DVT from ankle to groin from a Covid infection and am now on lifetime aspirin. This spring I blew out my left ACL with minimal force. LASIK both eyes, deaf left ear from idiopathic sudden hearing loss or variant Meniere’s. Hypertension, severe prolonged bipolar depression. I am 53. I have given my youth to this career and I am giving my health and vitality to it as well – I won’t survive long at this rate.
My patients would love me. Reality? They do, until I am unable to see them that day, or call in their med like the vending machine they think I am. If I have a lifetime of positives with them and one disappointment they will leave as they destroy me on Google and Yelp. They will all laugh when I die (that topic is a separate blog, but patients laugh when docs die, they all do) and I envision a tiny funeral.
My family would appreciate me. Reality? They don’t because they cannot. They don’t know the unwantedness, privation, and poverty I grew up with. I thought that I could throw in to my kids with vacations, weekends, everything and then the empty nest would reignite home and travel. It hasn’t. I have not gone a week in my private practice without seeing patients doing what I wanted – sexually, traveling , financially – without hope of fulfilling those desires for me. They do the continents and vacations and beach homes and mountain cabins and early retirements. I haven’t turned my phone off in decades, I am always on call, and literally turned down TWO all expenses paid trips to Kenya this spring because I could not go.
I would work hard but be rewarded financially. Reality? At this exact moment, I am late on payments for my wife’s student loans that are 30 years old and still not paid off, the house payment, and the gas bill. I have one Roth IRA good for 2-3 months of retirement that is from 26 years ago that is the entirety of my retirement aside from social security. I will never have the rewards I expected. When I calculate the hours and income (80-100 hours a week) I make 95 dollars an hour. I should have been an electrician – I would be making closer to 150 by now.
Solution?
To those in premed pathways, I strongly suggest – get out. Go away. Forfeit the hours, do not pass this way. Become something else. Medicine scars the soul. It is not good to cut abscesses while people scream in pain and you not care, to see the darkness in us all, to suffer the moral damages we do, to see nakedness and train yourself to not care. The entire thing is inherently unnatural if not outright evil.
To those in med school? DO NOT go into practice by yourself. Work for salary, never ever work more than 50 hours a week. They do not pay you enough to destroy yourself, so don’t. When they say to you that you must work more more more or someone will die – trust that another patient will be along shorty also about to die. When work tells you that your health is less important than your patient’s then quit: that day. I have had to do
telemedicine days, but I have missed one day for illness (a surgery) in 24 years of practice (never missed a day in med school or residency either.). No one cares about you if you don’t care for yourself. No one. Let me revise – no one cares about you.
Those in private practice? Quit. I hope to sell, but if I can’t I still have to see vastly fewer people. I am quitting and doing concierge care. Do DPC, small care, or a salary job somewhere.
Will we survive if all the docs quit, retire, or scale down? Don’t care. If the need gets high enough, some semblance of equity will happen. I mean with fairness – I make too little, ophtho makes way too much, CV surgeons make too little, many Wellmed and other Medicare advantage programs last year paid millions each to primary care docs. We cannot afford that as a country. Change is needed badly.
I was promised more but got less. I doubt this will ever become a medical school graduation speech. But from one 53-year-old extremely old doctor’s opinion, it should.
I have explained for YEARS that I love being in the room with the patient, but I hate everything else, when hospital employed! In private practice now and learning to decorate my own office.
Everything about this is true. I joined the military at age 58 as I saw the writing on the wall in civilian care. As I eased out of civilian care, my military responsibilities increased. I have never been happier. I am currently 71 and will be requesting another extension to my mandatory retirement date. The kids are appreciative of the care I provide, leadership rewards my efforts, and I am part of something bigger than myself. Unfortunately, I doubt that I will deploy again (i’ve done so 3 times) due to my age, but every time I put on the uniform, I know that I dodged the bullet of civilian medicine.
Until civilian medicine leadership understands that the price controls established in the 1960’s prevents the hand of Adam Smith from working, civilian medicine will continue to decline-in both the rewards as well as value.
Just an old guy patient here. The tone of these posts is so disheartening and lamentable. Not right comes to mind; The destruction of another American mythology. Guess I have lucked out belonging to a large family practice, a partnership I presume. Now approaching 80 I have had only three or four docs since the 70’s, and have been happy and had good relationships with all. I don’t mind waiting in the rooms, as I understand the game. I, we, have appreciated every one of our docs, thank you all.
The theme of “woulda’-shoulda’-coulda'” can play large in all lives, mine included. I went into the Army at 18, and actually liked my job. What I did not like was boot polishing, the regimentation, and all that, so I bailed out when I could have gotten a promotion to E-6 and a $10K re-up bonus. This was as a non combatant in the late 60’s. There has been many a time I’ve looked back and wished I’d stayed in the Army. I could have been “retired” with full bennies before I was 50, including medical, but……. The results of choices, whether well considered or not, will be with one for the rest of the ride. Amazing how quickly 20 years can go by, eh?
What is particularly irksome is that youngsters don’t seem to want to hear any useful advice on the realities of working life, relationships or career choices. “I need to make my own mistakes” was what one child said. She’s done OK I guess, but it could have been a much smoother road. No one ever offered me that advice when it would have done some good.
Hopefully today’s poster will come to a peaceful resolve with life, and enough of the right people will read the lament and make beneficial changes to their lives and that of others. Hopefully the country and world holds together for a good while. BTW, non profit health insurance anyone?
I Guarantee you will live until you DIE.How well you live,how long or what rewards you get is ALL UP TO YOU,YOUR CHOICES. NOW QUIT BITCHING ABOUT YOUR GLASS HALF FULL
AND GO MAKE IT BETTER..FILL IT.. YOUR CHOICE,YOUR ATTITUDE..
I AM ONLY A PHYSICIAN ASSISTANT 47 YEARS.BURIED MY WIFE 2 YEARS AGO TOOK CARE OF HER AND HER DEMENTIA GRADUALLY GETTING WORSE FOR 16 YEARS ..FULL TIME BY MYSELF HER LAST 2 YEARS 28 HOUR DAYS,SLEPT WHEN I COULD.GOT CANNED FROM A 5 YEAR JOB,NO RENEWAL OF CONTRACT,FOR BEING POLITICALLY INCORRECT. WOULD NOT CHANGE IT,I AM RIGHT THE PERSON WAS WRONG.DON’T MATTER.IS WHAT IT IS. TRYING TO GO BACK TO WORK.FEW WILL HIRE ME,SOME WILL INTERVIEW.WITH MDS I AM SLOWLY DYING ANYHOW.. SOCIAL SECURITY,MILITARY RETIRED PAY I GET BY.BUT I THANK GOD EVERYDAY FOR BEING A PA,FOR MY WIFE AND CHILDREN,FOR THIS AMAZING LIFE AND WORK.ATTITUDE BABY,THE ONLT STRING YOU GOT TO PLAY. BE GREATFUL. WHATEVER LIFE YOU HAVE LEFT WILL BE A LOT BETTER… GOD BLESS YOU AND YOURS…..
Such amazing comments. My favorite is “seething with rage every day at work.” Truth is I love being in the rooms. I love that. I help. I connect. That is the reason I do this. I hate every single thing outside the room.
So bring the horses, I’ll have a job for you and a bit of land for them. And sir lance? Start blogging. Here.
“… I love being in the rooms. I love that. I help. I connect. That is the reason I do this. I hate every single thing outside the room.”
Same here. Probably should’ve been a bartender. I like hanging out and talking with people.
But the current situation is not what I bargained for.
Bravo, Ken.
To quote Neil Diamond, “… except for the names and a few other changes, when you talk about me, the story’s the same one.”
I’m a bit older (60), and lucky enough to be in a bit better health (the exertional chest pain really holds me back these days, but two cardiologists have told me nothing’s wrong, and it I keep my BP above 140, it’s not that bad), and got out of private practice earlier, but I’m now stuck as a wage slave.
I tried to start what was essentially a DPC practice, before there was DPC, in 2006, hammered away at it through 2007, finally admitted the truth in 2008, when the financial crisis killed everyone’s spending and the patients dried up, and went out and got a job in Urgent Care, which I’ve been doing ever since.
3 12s a week, OT if I want it, and I don’t leave work with any charts not finished.
That being said, I’ve got about 150k in student loans (I paid off my 100k in business loans a few years ago), my wife’s student loans from the ’70s (yeah, Baby!), no retirement savings of any consequence, no pension plan, no way out, and I seethe with hatred all day every day at work.
My patients love me. A day never passes without someone asking if I can be their primary doctor (No way, José!), and recently, on a particularly bad day, one of my RNs remarked that all of the patients were angry and complaining about being stuck in their rooms and waiting so long, but every one of them left with a smile after seeing me. I do this job well, but I have no realistic way of ever retiring, other than death, and I recognize the signs of a job that is actively killing me.
But what else can I do? My wife has horses, and she tells me they need to eat every single day.
I gave up two different government jobs, with good pensions, when I was younger. If I’d continued with the paperwork to get into the NYPD, I’d have been retired over a decade ago, with lifetime health care, and, at that time would have been making more than I was making as a doctor.
If I’d taken the LSAT instead of the MCAT when I did (I had the study materials for both), I’d have my own paneled office and staff catering to my every need.
But I thought that if I was smart, worked hard, got good grades, passed hard tests, didn’t sleep, and stayed in for the long haul, I’d be rewarded, and get to help people as well.
Stupid, stupid, stupid, stupid, stupid.
Like you, Ken, every day I see patients younger than me talking about their retirement, and all of the great things they’re doing. Regularly, when I’m out doing things, I talk to people, and they’ll ask me what I used to do before I retired. Ha.
I used to think of what I might do when I got out, when I started another business, when I got a better idea. I’m 60. I’m not getting out. It’s over. This is my life, and will be until I’m dead. I won’t retire, I won’t travel, I won’t have any sort of “independence” or “freedom.” This is it.
I’m trying to figure out how to warn myself not to do this again in my next incarnation.
I must have been a real prick in my last one.
I will be the first to say I can’t speak to the outpatient side of this. As a Hospitalist, at the same age that you are, I find joy in going to work every day. Yes, I work hard, yes there’s nights I go home exhausted And still have to work some more. You mentioned faith. For me, it’s the personal joy of doing a job I know I was made to do, doing it with the strength from the one who made me to do it, and being able to help other people. Yes there’s financial gain but I’ve always told my children don’t do something for money or because someone else is going to look up to you or respect you. Do it because it’s what gives you joy and it’s what you were made to do. I’ve had my share of health setbacks as well , including going through prostate cancer, having prostate surgery at a young age, having to work 48 straight hours in the hospital two weeks after surgery because of a hurricane. There are days where I certainly feel, burned out and exhausted, but even at my age, I’m still planning on working another 10 to 15 years because I enjoy what I do. The advice I would give to anybody thinking about medicine is the same I would give my children. Do it because you love it, want to help other people, are made for that job. Don’t do it for the money or the accolades. Those won’t happen. The other thing I would say is try to find a position where you don’t have to worry so much about rushing through the day. Too many of the doctors I see nowadays just want to rush through the rounds, don’t want to spend time talking to patients instead just want to look at the computer and diagnose everything from the computer. The joy of being a doctor is actually being able to connect with people (unless you’re a pathologist or radiologist). Just my two cents.
Couldn’t agree more. Thank you for pouring your heart out
Chicago teachers average over $100,000 a year for a 160 days of the year. They can retire in their 50s on a pension of at least 80% of their income
San Francisco police officers now average $200,000 a year and also can retire in their ’50s. Incidentally, the death rate from occupations is the same for surgeons as police officers. And those aren’t extremes. Lifeguards in LA make between $150, 000 and 400,000!
I calculated with pre-med, medical school residency and practice. I have put in over 150,000 hours of work. That is triple what most Americans work. I not only put in 100 weeks during residency but for 15 years I took call every night uncompensated all to be replaced by the hospital system politically.
Thank you for saying the truth, even if it is desolate.