Becoming a doctor must have crossed your mind at least once and if this is the case - a warm welcome.  Perhaps you already completed your M.D. and you are just stopping by - thank you for reading and welcome.  We also welcome everyone who may not be deciding on whether or not to pursue a medical career.  We are delighted you stopped by. Although this discussion is focused towards helping one decide whether or not to choose a career in medicine, we hope it will provide some insight to other individuals as well.  We recommend you write down and discuss with family, friends, colleagues, and loved ones the pros and cons of being a doctor before you dedicate your life to it.

Practicing medicine is a calling. It is a life of service to others.  It is a great sacrifice. Doctors are teachers.  The word doctor is derived from the Latin word docere which means "to teach."  A doctor must continue educating him-/herself in order to teach others.  The learning and teaching are a lifelong commitment. The first half of medical school you predominately learn from your books, professors, and colleagues.  While the second half of medical school, you start to learn from patients. Your patients are your most valuable learning tool.  

Residency training (first job as a doctor) is where the practical medicine comes to life - with real patients who have real problems.  Depending on the chosen specialty, you have the opportunity of working with experienced physicians in their field. We mentioned doctors are teachers and life-long learners, but really they are much more than that.  They are kind, patient, and giving.  They give their time, knowledge, energy, and have your best health in mind.  This holds true for the many caring physicians out there.  Thank you for them!

Unfortunately, reality checks in and realistically speaking, doctors have lost control of their business.  Today healthcare is run by insurance and pharmaceutical companies whose power and profits are much greater than that of any physician.  I should not have to write this, but if you decide to go into medicine for the money, you are doing it for the wrong reason.  At the same time, this is not to say that physicians should not get paid for the work and services that they do provide.

This brings me to another big point - medical school is expensive.  It is even more expensive to fail.  Added costs and additional testing for medical school causes financial and mental strain respectively.  On top of that, it is extremely rare for one to be selected for a residency position in a non-competitive specialty when a candidate fails a United States Medical Licensing Exam (USMLE), too many years have passed since graduation, or has another red flag.  The even tougher part is that you cannot practice medicine in the U.S. without having done a residency.  This means that if you complete medical school and USMLE Steps 1, Step 2 Clinical Skills, Step 2 Clinical Knowledge, and Step 3 and are not accepted into a residency, whether you want to practice medicine in the U.S. or not - you cannot.  You must complete a residency in order to apply for a state license.  Keep in mind each state has individual rules which may prevent some residency trained physicians from practicing in certain states because of multiple tests attempts, location of medical school, or some other reason.  In addition, the requirements for U.S. medical graduates differ from International Medical Graduates (IMGs).  If you are interested in the requirements for initial medical licensure for each state, click here: State Specific Requirements for Initial Medical Licensure.

Which brings me to another very important point - If you choose to embark on becoming an M.D. in the U.S., you are better off attending medical school in the United States.  This is NOT to say that the education of U.S. medical schools is better than off-shore medical schools (ultimately your learning is up to you).  Some off-shore medical schools used to cost less for tuition, but in the long run - the costs add up for living on an island for example, or buying imported food and other goods, and particularly if the student struggles (repeats classes/needs additional time to complete the curriculum).  We strongly recommend that students living in the U.S. who attended college in the U.S., apply to medical schools or osteopathic medical (DO) schools in the U.S.  If you do not get in and really want it that bad, reapply to U.S. medical or DO schools.  We discourage applying to schools out of the country.  

U.S. medical students are far more likely to obtain a residency position than an International Medical Graduate (IMG). The charts below compare the PGY-1 match rates for U.S. seniors, U.S. and Non-U.S. IMGs, Osteopaths, Others, and All Applicants from 1982-2019. The match rates for U.S. seniors seems to have held steady with percentages in the low-mid 90s, while the match rates for U.S. IMGs and non-U.S. IMGs have been significantly lower (not ever reaching 60% in either category over 38 years).  Based on the data it is more likely for a U.S. medical graduate to obtain a residency position.  If you are interested in learning more about the 2019 Main Residency Match results, click the following link: Results and Data for 2019 Main Residency Match

Here is a non-comprehensive list of what to consider before deciding on becoming an M.D.:

1. The cost (Can you or someone else who financially supports you afford it)?
2. It costs more to fail and continue school (transferring schools, retesting, etc), than to  fail and drop out early on.
3. The mean debt for medical education (public and private) in 2018 was $196,520. A public 4-year medical school's average costs is $243,902 (or $322,767 for private school).
4. Your ability to perform on standardized test is critical from the start (MCAT scores for medical schools and USMLE scores for residency programs).
5. Selection committees for medical school will base your matriculation into their school on your test score despite when they say they look at your overall application. Be aware.
6. Where you attend medical school matters.
7. Completing your medical degree and all the testing required for residency, does not mean you will obtain a residency. There are far more applicants than positions available. In 2019, there were approximately 45,000 applicants and about 33,000 PGY-1 positions available. This means roughly 12,000 qualified people did not get a job and have to wait another year for another opportunity.
8. Residency training is required in order to practice medicine in the U.S.
9. Residency programs are largely funded by Medicare (government funding). The average resident salary is $50,000 (2016 data) whereas the average cost to train a resident is in the 100,000s.
10. Physician shortages will remain if Congress continues to limit the number of residents it is willing to fund as it did in 1997 when the cap was 100,000 positions. This means many qualified individuals may not get a job.
11. The further along you advance in your medical training from pre-med to med school to residency, the less time you will have for anything else (including taking care of yourself). Be conscious of taking care of your own needs, so that you will be able to care for the needs of others.
12. The United States Medical Licensing Exam (USMLE) for U.S. and Canadian medical students/graduates are offered through the NBME. The USMLE for International Medical Students/Graduates (IMGs) is offered through the Educational Commission of Foreign Medical Graduates (ECFMG). The tests are the same, but the cost are higher for students attending school outside the U.S. and Canada. Refer to the chart below for the breakdown.

Year: 2019

US & Canadian Medical Students International Medical Students

Step 1

$630 $940

Step 2 CS

$1,290.00 $1,580.00

Step 2 CK

$630 $940

13. Step 3 is offered through the Federation of State Medical Boards (FSMB) and is offered to medical graduates only. The exam is only offered in the U.S. and costs $875. (through 2019). Currently Step 3 is not required to apply for residency; although, it is best to complete it before starting residency.
14. There is a high rate of depression and burn out in the medical field particularly when one starts neglecting him-/herself to try to meet the demands of others.
15. Your classmates and/or colleagues will compete with you whether you think so or not.  Just keep that in the back of your mind.
16. In medical school, some students will NOT attend class to study, have more free time, etc.  This does not make them bad students. Everyone learns differently.  We are not suggesting you not attend classes, rather, do what you feel is going to help you learn best.  Sometimes mandatory attendance prevents some students from not attending class, while others are fine with ignoring the mandatory factor and still succeed.
17. Medical research and studies have flaws.
18. Major organizations (including Food and Drug Administration, US Department of Agriculture, etc) determine some of the guidelines that physicians use to care for their patients. These recommendations may NOT be made with the best health of the patient in mind. Unfortunately, money is a big driving force in medicine. Here are a few examples. Big Dairy paid the government big bucks to change the MyPlate dietary guidelines (previously the Food Pyramid) to recommend 3 cups of diary a day for anyone 9 years old to 51+ years when there was no evidence that consuming dairy builds stronger bones and bettered health. The sugar industry paid Harvard Scientists to publish an article in the New England Journal of Medicine in 1967 to cover up the ill effects of sugar and distract people by putting the blame of poor health on fat.  It took almost 50 years before the conflict of interest between the Harvard Scientists and Big Sugar was uncovered and identified. The discovery was revealed in Jama in 2016. Let's not forget what the tobacco industry did. Here are some of the ads from the 1950s:

If you are interested in learning more about the food industry click on our prior post here: A Book Review of Food: What the Heck Should I Eat
19. There are many pressures put on you during your training to become a physician - one being seeing as many patients as possible in little time.  Working fast has it benefits, but also increases the margin for error. Haste makes waste.  There are situations when it is necessary to act fast such as in acute care situations or when someone is having a heart attack, but most situations are non-acute which means we could slow down, learn better, and treat people more efficiently.
20. As cliché as it sounds, most people go into medicine because they want to help people. While this is true, you may often find yourself limited in the help you can provide. You can make recommendations to patients, but ultimately it is up to the individuals to follow through and make positive changes for themselves.
21. Just because you can, does not mean you should. If you chose to pursue a medical doctorate, the final decision should be yours. Many individuals are pressured into becoming physicians because their family members are or others want them to do it for various reasons - don't let this be you. Own your decision whatever that may be.  We sincerely wish you the best in making a decision of what career path to choose.

Sources:
Budd, K. (2018, October 8). 7 ways to reduce medical school debt. Retrieved from https://news.aamc.org/medical-education/article/7-ways-reduce-medical-school-debt/docere. (n.d.) Jonas: Mosby's Dictionary of Complementary and Alternative Medicine. (2005). Retrieved May 21 2019 from https://medical-dictionary.thefreedictionary.com/docere
Doctors, Nurses and Smoking: Smoking Among Medical Professionals. (2016, July 19). Retrieved from https://tobaccofreelife.org/resources/smoking-medical-professionals/Fees Overview. (n.d.). Retrieved May 23, 2019, from https://www.ecfmg.org/fees/index.html
FSMB | State Specific Requirements for Initial Medical Licensure. (n.d.). Retrieved May 24, 2019, from https://www.fsmb.org/step-3/state-licensure/FSMB | Step 3 FAQ. (n.d.). Retrieved May 23, 2019, from https://www.fsmb.org/step-3/step-3-faq/
Hyman, M. (2018). Food: What the Heck Should I Eat? New York, NY: Little, Brown and Company.
Medical Student Education: Debt, Costs and Loan Repayment Fact Card 2018 (PDF). (2018). Retrieved May 23, 2019, from https://store.aamc.org/medical-student-education-debt-costs-and-loan-repayment-fact-card-2018-pdf.htmlNBME.
(2019, May 22). USMLE Exam Fees | NBME. Retrieved May 23, 2019, from https://www.nbme.org/students/examfees.html
Now Scientific Evidence on Effects of Smoking! (n.d.). Retrieved from https://popperfont.net/tag/medicine/page/3/PGY-1 Match Rates 1982-2019 [table]. (2019). Retrieved from https://mk0nrmpcikgb8jxyd19h.kinstacdn.com/wp-content/uploads/2019/04/NRMP-Results-and-Data-2019_04112019_final.pdf
Weiman, D. S. (2016, November 15).
Who Pays for Resident Salaries. Retrieved May 24, 2019, from https://www.huffpost.com/entry/who-pays-for-resident-sal_b_12967008