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Information for people contemplating
a career in emergency medicine and
other medical specialties

By Kevin Pezzi, MD


Read this before you apply to medical school

Q: Hey Doctor Pezzi! I stumbled upon your website tonight while searching the Internet for more information on what it is like to be a doctor. You came off to me as an industrious and intelligent guy with a different perspective than I am used to getting. I thought it couldn't hurt to ask you for some advice.

Here is some background info on myself. Like many 22-year-olds, I have no idea what the hell I want to do with my life career-wise. I am working on my biology degree at UNLV right now, and for the last year or so, I have been desiring to get into med school and do the whole doctor thing. Before that, I was considering being a pharmacist, and before that, a million other things.

I am a perfectionist by nature and make sure that I am successful at anything I do. Unfortunately, I am also extremely indecisive when it comes to long-term commitments. That is why I am a 5th year college student with over 100 credits, only being able to apply half of them to my major.

And now for my conundrum. Upon reading your perspective on life in the ER, and the hell you had to go through to get there in the first place, it forced me to face some repressed thoughts I had been avoiding. I am a person that really loves their free time, traveling, and hobbies. I ultimately would love a career that I don't have to work more than three days a week at. I don't care about being rich. I just want to have the money to live a modest lifestyle and still have time to enjoy myself. It seems like becoming a doctor is the worst choice ever for my criteria. The med school is one thing. I can do that. But I don't know if I am willing to throw away an additional 4-7 years doing a residency, especially if the end result is a career that affords me no free time.

So my questions to you are: Do all residencies suck your entire life away while you are there? Is it practical for doctors to work part time and still afford to pay off their student loans? If so, what fields would be best for me? Would I be better off switching back to pharmacy? (I have a somewhat dubious perspective towards the pharmaceutical industry, and some of the people I talked to in pharmacies didn't seem too thrilled about the job.) Would I be better off doing some type of nursing instead? One of the pharmacists I spoke to suggested becoming a nurse anesthetist instead of a pharmacist.

Sorry for the essay, but I had a lot on my mind. Any advice would be much appreciated. Thanks in advance!

Answer by , MD: The cost of a medical education has skyrocketed, but physician reimbursement isn't keeping pace. Unless you have rich and generous parents, it likely will not be practical to work part-time until you repay your student loans, which could take many years. Like you, I went into medicine planning on working part-time, but I ended up working overtime.

Think of medical careers as vacuum cleaners: they suck up everything in sight, which rapidly disappears, never to be seen again. That's especially true of your free time during residency and even afterward. Coupled with the 1001 things doctors MUST do besides direct patient care (CME, attending meetings, dictating or signing charts, fighting insurance companies, defending themselves against frivolous lawsuits, running their business, pulling out their gray hair, etc.), doctors work about 50% more hours per week than an average person—often more to much more. An extra 20 hours per week may not sound like much, but folks working 40 hours per week with no occupational demands on their free time often feel even they have little free time. I'm going to help give them a big chunk of their lives back, but that's another story.

Let me put it this way: medicine is a great career choice for folks who get bored on their days off, twiddling their thumbs as they wonder what to do. As a doctor, you will always have something to do, especially if you are a perfectionist, as I am. Doing just enough to get by never appealed to me. That's why I devote about 1000 hours per year studying health (in addition to CME) to learn what doctors should—but don't—know about that subject. 99.9% of what doctors do is medical and surgical care, NOT healthcare! The difference is immense. True healthcare can obviate the need for most medical and surgical care in addition to helping people in ways that medicine cannot.

If you read my article on the flu vaccine, you will see how the practice of medicine overemphasizes drugs and underemphasizes or ignores natural ways to augment health even when they can do more than pharmaceuticals.

The technique of propaganda known as “Big Lie” was coined by Adolf Hitler and used by Reich Minister of Propaganda Joseph Goebbels, who wrote, “The English follow the principle that when one lies, one should lie big, and stick to it. They keep up their lies, even at the risk of looking ridiculous.”

The field of medicine looks more than ridiculous now the cat is out of the bag regarding the myriad ways in which the pharmaceutical industry has used sleazy tactics to make their products seem more helpful and less harmful than they really are. My flu vaccine article outlined the tip of that unethical iceberg. If drug companies weren't so tied at the hip to politicians addicted to their bribes disguised as campaign contributions, the Justice Department would seek justice, and their big shots would go to prison. Pharmaceutical manufacturers don't just lie; they lie through their teeth, and they do it repeatedly.

This isn't just my opinion. My article gives links to some of the many physicians and other experts who now realize how modern medicine is the Big Lie about health. Yes, some drugs do indeed work wonders, and surgery is often necessary. I am not advocating doing away with it, but putting it in its proper place. If people received the healthcare they need, their medical and surgical needs would be so infrequent that so-called health insurance would be easily affordable.

True healthcare can be much less expensive than medical and surgical care, so focusing on health would reap a staggering net savings in addition to producing inestimable other benefits such as improved mood, enhanced brainpower and appearance, more sexual pleasure, and a longer life.

We need a new medical specialty or an entirely separate doctorate program that focuses on health. If people knew even half of what I know about health (not medicine), they would scream for it and get it from politicians and universities who cannot afford to anger all voters. Everyone cares about health.

Unlike drugs, which often just mitigate misery, true healthcare can make you feel wonderful. That immediate benefit is often so pleasurable that once you experience it, you won't want to go back to the old way, relying on medicine and surgery.

Is this just another Pezzi tangent? No, it is something that every prospective doctor should consider. When people finally wake up, we will quickly go from a doctor shortage to a massive surplus, with many doctors begging for food or doing what they should have done in the first place: study health.

Doctors in the United States worry about medical outsourcing, but what will really hit them is something they don't see coming. That will take the golf clubs out of their hands and replace it with tin cups.

There will always be a need for ER doctors, but most other specialties will be hit hard. One of my primary goals in life is to put doctors out of business by making people so healthy and happy they don't need doctors. I stand a good chance of succeeding because I have two entirely different yet complementary ways to achieve that result. I don't hate doctors; I hate disease, and doctors are not doing an adequate job of preventing it. What they do in regard to prevention is less than 1% of what they should be doing.

One of my friends was on Vice President Al Gore's staff. Her job mandated that she accompany him everywhere (they'd even jog together), so she went to the White House and attended meetings with him and President Clinton. During one meeting, Clinton was yukking it up so much that Gore lost his patience, screaming at him to “Get with the %*@%#&^ program!”

I have a similar message for doctors: Get with the %*@%#&^ program! When I study health, I am not reading the ramblings of hippies advocating that folks eat pine cones; I read research conducted by reputable scientists, not the medical whores paid to lie by drug companies. There is an overwhelming amount of SCIENTIFIC evidence suggesting or proving natural ways to health, so any doctor oblivious to this mountain of evidence needs to step into the 21st century and get with the program, stat. People are suffering and dying from a lack of health, and most doctors are still getting in bed with drug companies. (Read my flu article to see how sex is used to sell medicine.)

If you're still brave enough to pursue a medical specialty other than emergency medicine, read on. I've heard that some residency programs offer half-time positions that take twice as long to complete, but enable residents to live a more humane life. However, being a perfectionist myself, I don't think ER is a good career choice for docs like me who want to do a perfect, thorough job on every patient. Finding a slow ER to work in is now very difficult, but at the beginning of my career, I was paid for working shifts in which I didn't see a single patient!

prescription drugs
The path to health isn't paved with pills

Pharmacy is a good career choice, but even that would be impacted once people focus on health, which they likely soon will.

Years ago, I went to the Sam's Club pharmacy to buy some injectable vitamin B12 for my brother with pernicious anemia and subacute combined degeneration of his spinal cord. I spoke with a cute pharmacist who'd recently graduated. She didn't seem very happy, nor did any of the other pharmacists I've seen. Being a doctor can be immensely more stressful than being a pharmacist, but the rewards can be immensely more gratifying, too. I've received hugs, thank-you notes, and many gifts from people whose lives I saved in the ER. Pharmacists save lives, too, but not in the high adrenaline way that ER docs do.

Being a nurse anesthetist is a good choice, but it could also be impacted once healthcare supplants most medical care and a significant amount of surgical care.

Bottom line: the wave of the future is health. My advice? Ride the wave and prosper, or ignore it and risk being drowned by a tsunami.

healthcare is the wave of the future

Now, speaking of free time . . . . :-)

PS: Regarding your comment about the hell I had to go through to become a doctor. That hell was likely worse than you imagined. I revealed some of that years ago in responding to a reader, and even more yesterday in a blog article that divulges more than I ever thought I would. Mentioning the difficulties I faced is less important than how I overcame them and how others could learn to avoid or minimize problems. After reading those articles, you will see why I stress that “if I can do it, you can, too.”

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