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

By Kevin Pezzi, MD


Is it worthwhile to become a doctor? Is medical school too long?

Doctor peering over her glasses
A magic wand, eh? :-)

Q: I want to ask you a rhetorical question. Suppose you have a magical wand, then you have to set the number of years of medical education. In another topic, you said: "It takes almost superhuman dedication to endure the many years of training in college, medical school, and residency. Personally, I do not think it is worth it." So, should medical school be four years? Should residency hours be reduced? I am eager to read your opinion!

Answer by , MD: Although medical school is already very arduous, I could make a case for extending it because patients could benefit if their doctors knew more general medicine and topics, such as nutrition, that affect the health and well-being of everyone. In medical school, we were repeatedly told that the education we received therein was intended to lay the groundwork for self-education that would extend throughout our careers, but too many physicians do not devote enough time to continuing medical education, nor do they truly master even basic subjects that affect a large percentage of their patients, such as how to achieve weight loss, and how to keep those pounds off, year after year, without the perpetual struggle that drives most people into the kitchen in search of something tasty to devour.

The picture of health
Obesity isn't just a cosmetic issue. Yes,
this model looks great, but she is also
more likely to be very healthy, too!

The weight loss advice given by most doctors is rather basic, and basically ineffective in almost all patients. Aside from the cosmetic effects of obesity, being overweight increases the risk of heart disease, high blood pressure, diabetes, cancer, arthritis, impotence, sleep apnea, depression, and dementia. Furthermore, obesity induces certain hormonal changes that can decrease libido and reduce sexual pleasure, as I mentioned in The Science of Sex. However, obesity imperils health via another mechanism that few people know about: a disease called nonalcoholic steatohepatitis (NASH). NASH is a common liver disease that can develop in people who drink little or no alcohol. The cardinal features of NASH are fat in the liver accompanied by hepatic inflammation and damage that can result in fatigue, weakness, fluid retention, muscle wasting, bleeding from the intestines, liver fibrosis, and liver failure that may culminate in cirrhosis and death, but NASH may also progress silently without any symptoms or signs—until it is too late. Although NASH primarily occurs in people who are middle-aged and overweight or obese, it can even occur in children. NASH is ignored by the media and even most physicians, which is only one of the thousands of examples I could cite that bolster my contention that average physicians simply don't know enough to be good doctors. Anyone who reads my weight loss book knows that losing weight doesn't have to be difficult, so doctors have no excuse for delivering the same old ineffective weight loss advice. And, frankly, if they give woefully incomplete recommendations about weight loss and NASH, it is no wonder that they aren't giving patients all the advice they need about less common problems, too. (If you have a medical problem for which you want help, you can consult me.)

This model probably got her body the usual
way: by eating right, exercising, and having
good genes. However, there is an easier way
to have a great body that you've never heard of
before unless you read my weight loss book.

Having said that medical school should be longer than four years, it may surprise you that I am also a proponent of limiting the number of hours that residents must work in the hospital. This may seem to contradict my goal of maximizing learning, but it does not. During medical school, the focus is on learning. During residency, the primary objective is to be a good little worker bee who will toil endlessly without protesting, even when the "scut work" is educationally meaningless. Learning is primarily an afterthought in postgraduate medical education. If you don't learn, or learn as much as you should, you can continue to skate by, but heaven help you if you stop working! Residency directors might contend that their residents will learn if they do their work. That is true, but the typical residency program is structured to eke the most work from their residents, not to maximize their learning. The way that learning occurs during residency is too helter-skelter to optimize medical knowledge. If I had the magic wand you mentioned, I would make the acquisition of information during residency a more systematic and structured process, and I would ensure that residents never frittered their time away doing scut work or something they already mastered when they could be reading books and journals so they could learn more—about NASH and myriad other topics.

Of course, none of the foregoing addresses your question of whether the years spent in medical education are "worth it." Whether medical education continues at its current duration or is extended as I recommended above, the payback that physicians receive (both financial and otherwise) during their careers is often judged by them (and me) to be a bum deal, to put it colloquially. If society and our brilliant leaders (ahem!) were smarter, they would realize that it was in their best interests to increase the rewards that doctors receive, and to take other steps to make medical careers less noxious. However, with every passing year, the practice of medicine is incrementally becoming less lucrative and more of a nightmarish hassle. Predictable result? Scads of doctors are studying real estate or countless other nonmedical topics, desperately searching for alternative ways to make money, either to supplement their medical incomes, or to get the heck out of medicine. Read my Doctors without Dollars blog posting, and then ask yourself if this diversion of interest is what patients needing the best possible care really want.

Incidentally, it's not just emergency medicine that leaves docs thinking, "There's got to be a better way to make a living!" In 1996, an orthopedic surgeon approached me in the ER and gave me his best sales pitch, trying to recruit me to work under him as an Amway rep. He had a busy ortho practice in multiple towns, yet still obviously yearned to do something else, and figured that selling Amway was better than mending broken bones. Thomas Edison once said, "There is a better way — find it." Selling Amway soap and whatnot is better than doing orthopedic surgery? Hard to believe, but for him it was. Others docs have said "sayonara" to medicine and are now doing everything from plumbing to bartending to painting, and much more.

UPDATE 2008: Medicine just became a much more desirable profession, thanks to the economic crash that devastated our economy in 2008. The profession of medicine offers one thing—job security—that is nice in good times but as precious as gold in bad times. I needn't remind you that things are bad now, and almost certain to get much worse (if you doubt that, read this). When times change, it is important to change with the times. I've used a lot of ink warning students in the past about the drawbacks of a medical career, and all of those reasons were quite valid. The cons are still there, but the list of pros just mushroomed in importance thanks to the inherent job security in most medical careers. Good luck trying to find another career that offers comparable job security.

UPDATE 2020 is markedly different thanks to the coronavirus that made work-at-home jobs much more enticing.

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