Should Sammy go to medical school?

Apologies to all who sent comments and emails whilst I was away. They have all been read, and I am doing my best to reply to them but, realistically, I will not be able to reply to all.

One in particular stood out:

Dear Dr Crippen

Do you have anything positive to say on a career in medicine? I ask because I will be applying to university soon, possibly for medicine, and so far the cons seem to outweigh the pros.

Competition to get into medical school is crazy-fierce, and yet everyone in healthcare I have spoken to tells me to get out while I still can and become an accountant or a children’s TV presenter or something.

So I humbly call upon your mighty wisdom!

Are all those straight ‘A’ students so misguided?

Or am I just missing something?


Sammy

There is some thing special about being a doctor. It slightly changes your relationship with fellow human beings. It entitles you to put that mystical word “doctor” before your name. Yes, I know, lots of other people are doing it too now (the dentists, the vets and so on) but nonetheless in the medical context it means something special.

Practising medicine really is about helping people.

Of course, you cannot say that at a medical school interview. The interviewing Dean of Medicine will fall of his chair giggling and ask why you are not joining the fire-brigade. Actually, not such a stupid question. That is also about helping people too.

Job satisfaction is crucial. Anything you do for forty years will have ups and downs, and a genuine love of the job, a belief in the value of the service you provide, will sustain you through thick and thin.

However, if you work in the UK, you are trapped in an environment where “health care” is perceived as a “right” and as something that should be provided “for free”. Therefore, doctors’ salaries are mostly regarded as being too high. You are part of the largest nationalised industry in the world and your every move will be constrained by red tape and these days the red tape is carried by over-promoted nurses.

In most countries, doctors are reasonably well paid. As a UK doctor you will never be poor. But you will never be rich. And you are unlikely ever to earn as much money as friends of equal intelligence going into different careers. You will have excellent job security and, unless you start having sex with the patients, will never be sacked.

How much will you earn?

In today’s terms, if you become a GP you can expect £100,000 a year, give or take. If you become a consultant, your NHS pay will be between £70,000 and £90,000 a year before private practice and merits awards. Most consultants do not have a huge private practice, and few make a great deal from merit awards. A successful gynaecologist or ENT surgeon can make very serious additional money indeed. A psychiatrist, a geriatrician, a haematologist, or a paediatrician may make no more than the basis NHS pay.

How much money do you want? What a vulgar question.

When I was 18 I did not think of that at all. I had a vague assumption I would be reasonably comfortable, and I am. But I could not do the things we do if my wife was not a full-time high earner herself.

Kenilworth Castle

If you want to live in a salubrious suburban middle class area such as, for example, Kenilworth, and you want to have two cars, a wife who does not need to work, four children all educated privately and a couple of expensive foreign holidays a year, then you are not going to be able to do it on a single doctor’s salary. Unless, possibly, you are a gynaecologist with a large private practice. You could do all that easily if you were London City solicitor. There will be howls of anguish in the comments column about this paragraph. Ignore them. The fact of the matter is that you have the intelligence and ability to command this sort of income.

You are right about the current educational entry requirements for medical school. They are absurdly high. If you are clever enough to get into medical school nowadays, you are clever enough to do anything. Personally, I would regard working in the city as a lawyer/fund-manager/accountant/stockbroker/investment banker as a fate worse than death, but that is where the money is.

My wife and I are both doctors. We have four children all of whom are (if it does not sound too arrogant) clever enough to go to medical school. None of them will, and that is not because we have discouraged them. We have a lot of friends who are doctors. I cannot off hand think of a single medical couple who has a child who is going to follow in their foot steps. That in itself speaks volumes. A generation ago, medicine was almost an hereditary career.

Doing medicine will deprive you of most of your twenties. Both my wife and I spent the greater part of our late youth working every hour that god sends in hospitals. Our social lives closed in. Friends who were not doctors lost patience with the fact that we were usually not available and, when we were, we kept dozing off in the middle of conversations. It is not as bad as it was. But shift work is destructive. And now, there is the real possibility of unemployment for young doctors. The government has realised that it is cheaper to use none medically trained staff to do traditional medical jobs and, to an extent, they are getting away with it.

Sammy, all I can say to you is that, if the passion burns deep, then you must do it. But it if it is just one of several options, then I would look elsewhere.

I still enjoy my job, when I am allowed to do it.

But, knowing everything I know now, looking down the all powerful retrospectoscope, would I do it again?

No.

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Dr Crippen is a middle aged GP who has been beavering away in the NHS for over 20 years. He has complete insight into the fact that he may not be the best person to advise a young putative doctor and would therefore appreciate as many comments as possible from other doctors, and medical students, about the wisdom of entering medicine in 2006. It would be helpful if any doctors replying felt able to disclose their age.

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And Sammy may care to read the article below, RED TOP OUTRAGE (3), which is an all too common example of how the gutter press treats doctors. It is dispiriting, to say the least. How will she deal with it when she qualifies?