Is Being a Doctor Worth It?

This article is a slight deviation from my regular financially-centered post.  However, as a ‘motivated’ M.D. I feel it is important to address the medical aspect of my profession as much as the financial.  I am often asked by colleagues, peers, and friends, ‘Is being a doctor worth it?’ 

How do we begin to provide an honest and transparent answer to this question?  It depends on so many aspects including one’s personality, compensation, chosen specialty, grit, the list goes on.  As I have grown in my career, so too has my answer.  With this post, I wanted to break the answer down into certain relevant categories.  There are often certain themes that arise when I am asked to reflect on my career choice.  These include time, compensation, work-life balance, impact on relationships/family, and fulfillment.

How much time does ‘being a doctor’ occupy?

Being a physician is very time consuming.  For starters, the educational process takes the better part of a decade.  In the United States, one must first graduate college (4 years), then attend medical school (4 more years).  Following completion of medical school, it is then necessary to complete residency training.  There is variation in the years required to complete residency based on specialty.  For example, internal medicine, emergency medicine, pediatrics, and family medicine are generally 3-year residency programs.  Anesthesiology, neurology, psychiatry, and obstetrics and gynecology are generally 4-year programs.  Lastly, surgical specialties like general surgery, neurological surgery, cardiothoracic surgery, and orthopedic surgery can range from 5 to 7 years! 

I have not even begun to address fellowship (subspecialty training) which can add another 1 to 3 years of training after residency.  I mention this to highlight the fact that there is a large upfront time commitment to become a certified and residency/fellowship trained physician in the US. 

Following completion of all required training, you have earned the privilege to practice medicine.  As I have previously alluded to, there is sweeping variation in time commitments as it pertains to being a physician.   This is heavily influenced by your ratio of inpatient (in the hospital), outpatient (ambulatory medicine/clinics), and procedures.  Further this can be influenced by how you are employed (i.e. self, academic, hybrid, or community/private). 

The ‘average’ physician work schedule

With all of this said, the ‘average’ full-time physician works between 40-50 hours a week (Monday through Friday).  She will often have to cover night calls (depending on specialty) every few nights or weeks.  She will also likely be required to cover emergency calls on a weekend every few months.  The ‘average’ physician works similar hours to the average American job during the weekdays, but commonly has shared nighttime and weekend commitments, periodically.  This can be a factor as you parent or have other obligations at home.  Keep this in mind.

It takes a long time to become a physician.  For some, this process can take the better half of a decade after completion of college/university.  From the time one finishes all required training for their specialty, their time commitment largely is influenced by their specialty, their ratio of inpatient versus outpatient, and their procedural volume.  For the majority of specialties, you will rotate call and weekends.  Depending on how many physicians share weekend and night time responsibilities will dictate how frequently you are required to work at night/weekends.

How much do doctors make?

As with physician schedules, understanding compensation is equally variable.  Compensation is based on the particular reimbursement model, physician specialty, geographic location, and institution (to name a few). 

A physician’s specialty largely impacts how much they are compensated.  There are a multitude of factors that dictate why a pathologist makes substantially less than a cardiothoracic surgeon, but suffice to say, different specialties make different amounts.  Medscape releases an annual comprehensive physician compensation report each year that takes a detailed look at national doctor reimbursement.  You can find that report here.

From quantity to quality…sort of…

Nationally, the physician reimbursement system is going through some changes.  Previously, physicians were largely reimbursed based on procedures performed and time spent caring for a patient.  Currently there have been some institutions adopting an outcomes-based approach for reimbursement.  Either way, as it stands, Relative Value Units (RVUs) still primarily dictate how much a physician is reimbursed.  Because of this, procedurally heavy specialties tend to generate more RVUs, and thus more compensation. 

This culture has created large variations in income between physicians.  Where a family medicine physician spends the majority of their time in the clinic, answering patient questions and treating routine outpatient complaints, orthopedists are spending their time in the operating rooms performing invasive procedures.  As such, the RVUs generated from orthopedic procedures are reimbursed significantly higher (by insurance) than routine outpatient care.  That is why the average family medicine physician (based on the Medscape report) averages an income of $236,000, while the average orthopedic surgeon makes approximately $511,000!

Compensation is complicated…

As you can see, answering the question of physician compensation is…complicated.  For comparison purposes, there are a plethora of non-physician professions that require extensively less education and training, that still pay 6-figure salaries.  For example, a physician’s assistant commonly makes $100,000 annually.  If their education takes approximately two years after college.  To be a family medicine physician, it requires 4 years of medical school and 3 years of residency…7 years total.  A physician’s assistant would have a 5-year head start on a family medicine physician!  This is a difference of close to half a million dollars in income already and significantly less educational debt burden. 

When you look at things from this perspective…the compensation conversation can become muddy.  It is hard to justify more than half a decade’s worth of extra training, responsibility and accountability all while accruing substantially more debt.  Many physicians do not catch up to their non-physician counterparts until they are well into their 30s and 40s.  That is not only delayed gratification.  That is lost time in the market, lost compounding interest, less time to accumulate opportunity funds, etc.  Let’s not forget the time it takes to pay off your educational debt, now averaging physicians $215,000!  My wife and I are currently trying to eliminate $670,000 worth of medical education debt! These factors need to be understood as it pertains to what the ‘doctor salary’ represents.  It represents a decade’s worth of work and delayed reimbursement. 

There is still plenty of money to be had

Now, I would be remiss if I did acknowledge that the numbers I am utilizing are ‘averages.’ Remember, there are many physicians who make well over the average.  There are family medicine doctors bringing home half a million a year!  The same can be said for internists, surgeons, radiologists, and more!  Sometimes the math does support the decision to become a physician.  Attending urologists who ‘live like a resident’ for a single year can tackle $250,000 worth of educational debt and still inflate their lifestyle substantially. 

Physician compensation is complicated.  In order to fully understand the larger 6-figure salaries you have to understand the opportunity costs of becoming a physician.  From delayed income potential, educational debt, and growing responsibilities, there is a reason our incomes are not only justified…they are necessary.

How is your ‘work-life balance’ as a doctor?

Over the past few decades, the advent of electronic health records, increasing documentation demands, medico-legal concerns, and incentives to generate RVUs can be overwhelming.  When I think about balancing work and life, I often ask myself ‘does my job allow me enough time away from work to recuperate?  This could apply to the interval between leaving work one day and returning the next.  This may also apply to sick leave, vacation, weekends off, or time between call responsibilities. 

The reason this is called a ‘balance’ and not specified as a certain duration of time is due to its subjectivity.  Those motivated by their careers may receive joy by having more regular intervals of time in the workplace.  On the other hand, an individual who works as a necessity may require more regular intervals of time away from the hospital.  It is subjective.

Your career will eventually ‘take a back seat’

For me, I am a father, a husband, and then a physician.  In that order.  I love my career, but it will always come second to my obligations as a parent and spouse.  I may not have known this when I was a spry young medical student, but such is life.  As you grow, your priorities change.  A career needs to be able to change with you. 

There is variability between specialties, but globally, physician careers tend to accommodate flexibility.  Much of one’s career is determined by the balance of inpatient, outpatient, and procedures.  As it pertains to work-life balance, you can alternate these ratios as you age.  If you need to be able to leave work earlier each day, make your mornings procedurally heavy.  If you need more weekends off, maybe you shift to more outpatient clinic work.  You can create a schedule that accents your needs.  This is a benefit to many physician careers.  Because of this, with minor variability in reimbursement, one has the opportunity to create a career that adapts to their needs to some extent.

How does ‘being a doctor’ impact your relationships?

I have said this multiple times as a jest but over the years it has become my motto… ‘Thank God my wife is also a physician!’  As I reflect on my time in medical school, the grueling hours, the late nights, the early mornings, the pre-test anxiety…it is a miracle she stayed with me!  Residency was filled with long interstate drives, visiting each other in separate programs.  We often only saw each other once a month while I was an intern and she was completing her emergency medicine training.  The cherry on top of this sundae was a global pandemic that occurred while completing my fellowship in pulmonary and critical care…all while she was an attending emergency medicine physician at the same institution!  Do you get it yet?

What I have described may sound radical, but this is an all-too-common series of stresses in a physician’s life.  Asking a significant other to understand and accept the late hours, the night call, the unexplained emotions, or the sheer exhaustion is a tall order.  Even in my mid-thirties, I have already seen the turmoil that physician careers have on marriage.  Too many hospital acquaintances, peers, and friends have succumbed to divorce. 

It takes one to know one

Choosing a career in medicine is taxing, difficult, and lengthy.  It requires dedication, selfishness, time efficiency, patience, and support.  This can be an incredibly rough road for individuals who are not physicians.  Much like I cannot begin to understand what active combat is like for our service members, how can I expect a non-physician to understand my medical journey.  I believe that dual physician relationships thrive, comparatively, because there is a shared experience that cultivates understanding. 

I am able to have a hand in the lives of my children.  Like many professions, if you make it a priority, you will find the time.  The moment my first child was born I knew I needed to create a career that supported flexibility and time for me to parent.  Choosing careers in academic medicine offered me the lifestyle needed to prioritize these things.  As such, my marriage has never been stronger, I am a constant presence in my children’s lives and I have the opportunity to see friends and family on most weekends. 

Do you feel fulfilled as a doctor?

I absolutely feel fulfilled in my career as a physician.  Yes, there are bad days, but overwhelmingly I find great pride in what I do.  Physicians play a powerful societal role; that of the healer.  As cliché as it is, caring for the health of others is a pillar of civilization.  Though much has evolved as it pertains to ‘healing,’ there is still an immense joy that I experience when I have an impact on a patient’s care.  The form this impact takes can vary from saving a life, making a correct diagnosis, or honoring a patient’s wishes in their final hours.  I find fulfillment in my career every day. 

Staying in academic medicine allows me to educate the next generation of healthcare providers.  From medical students to nurses or mid-level providers, I find education wildly gratifying.  Reframing a complicated topic, that it is digestible and understood, is special.  I take pride in this. 

Physicians still feel integral to communities as a whole.  My wife and I have lived in our home for less than a year at the writing of this article and I could not describe how often our doorbell rings asking for second opinions, or the classic ‘can you take a look at this?’  Neighbors feel safer knowing a physician is within arm’s reach. 

Fulfillment can take many forms.  As a doctor, I feel fulfilled in my interactions with patients and colleagues alike.  I find fulfillment in the societal role I play.  I find fulfillment in the application of knowledge I have worked so hard to obtain.  It is a fulfilling profession. 

Take home points

So, is being a doctor worth it?  I think the answer to that question is significantly more nuanced today than it has ever been.  Between an educational debt crisis, wide inter-specialty income variation, dwindling self-employment, and the advent of mid-level providers, the decision to become a doctor is difficult.  This decision requires a significant amount of foresight, understanding, planning, and financial education. 

Oftentimes, questions on career worthiness are followed by ‘would you choose it again?’  In years past I would have answered: unequivocally yes!  However, that was before becoming a father, before becoming a husband, a writer.  That was before a global pandemic and the highest inflation in decades.  The world has changed significantly and I fear the profession of physician has failed to create appropriate incentives for future generations.  Yes, our compensation seems high by most standards, but factoring in debt, opportunity costs and lost income potential, it can often be inadequate to guarantee future financial success. 

One of the benefits of a modern medical career is that most specialties offer flexibility.  You can commonly create the schedule you want by modifying your ratios of inpatient to outpatient/procedural work.  This can allow more time to prioritize your life outside the workplace. 

Medicine remains a fulfilling career. 

Applying extensive medical knowledge clinically is incredibly rewarding.  Witnessing real time feedback, as it pertains to your decision making, is something most other careers lack.  I do find my job fulfilling and despite the stereotypical headaches of modern medicine, I do not expect this will change. 

Choosing a career in medicine is complicated.  One must understand the many factors that will influence your satisfaction.  It is difficult to know where your life will be in 10 years.  You will be a completely different person when you finish your medical education and training.  The world will have a whole new slew of influences to press upon you.  These variables will continue to evolve too.  When choosing to be a doctor, remember we are compensated highly for a reason.  Try and limit your educational debt as much as possible and understand your priorities will change as your life does.  If you choose a career in medicine with this mindset, it can still be worth it.  As always…

Stay Motivated!

The Motivated M.D.

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