{"id":6591,"date":"2011-10-05T12:54:42","date_gmt":"2011-10-05T16:54:42","guid":{"rendered":"http:\/\/www.bumc.bu.edu\/busm-news\/?p=1755"},"modified":"2015-07-08T22:30:51","modified_gmt":"2015-07-09T02:30:51","slug":"who-wants-to-be-a-doctor-and-why-new-busm-students-reflect-shifting-medical-landscape","status":"publish","type":"post","link":"https:\/\/www.bumc.bu.edu\/camed\/2011\/10\/05\/who-wants-to-be-a-doctor-and-why-new-busm-students-reflect-shifting-medical-landscape\/","title":{"rendered":"Who Wants To Be a Doctor? And Why. New BUSM students reflect shifting medical landscape"},"content":{"rendered":"

\"Members<\/a><\/p>\n

Who wants to be a doctor?<\/strong><\/p>\n

The BU School of Medicine Class of 2015 is being groomed for a respected profession now in financial upheaval and plagued by what many believe is a worrying trend away from the traditional, often nearly lifelong doctor-patient relationships nurtured by primary care. But despite concerns about health care access and future loan debt, interviews with incoming MED students reveal optimism about a career that will enable them to serve not just their patients, but their communities.<\/p>\n

Plucked from 11,400 applicants, the 173 members of the new class hail from 32 states and 19 nations. On August 8, at the storied White Coat welcoming ceremony, they recited the Hippocratic Oath, and then, lest the proceedings get too solemn, were reminded by Kitt Shaffer, a MED professor of radiology, that \u201cbeing a doctor is the best job on the planet,\u201d and that \u201cif you\u2019re not having fun, you don\u2019t have the right attitude.\u201d<\/p>\n

And then the grind began. Already confounded by the demands of gross anatomy, many first-year medical students are eyeing specialty medicine right off the bat\u2014it\u2019s not uncommon for even premed students to be planning careers not just in, say, orthopedic surgery, but in hand surgery.<\/p>\n

\"Heather
Heather Dehaan (MED\u201915): \u201cToday\u2019s doctors are seen as being more humanitarian, and more involved with public health.\u201d Photo by Vernon Doucett<\/figcaption><\/figure>\n

\u201cI always worry about people having a fixed idea so early, making decisions based on a very incomplete understanding of themselves,\u201d says Robert Witzburg (MED\u201977), a MED professor of medicine and associate dean for admissions. But in recent years, says Witzburg, MED and other medical schools that had routinely selected applicants most adept in the sciences are now choosing students based on a more holistic review.<\/p>\n

\u201cThat changes everything about the admissions process,\u201d Witzburg says. \u201cIt creates a structure in which every element of the application is considered in the context of every other element. The academic record is no longer looked at as a stand-alone item, but rather in the context of the applicant\u2019s life experience, the adversities he or she has faced, the advantages he or she may have had.\u201d<\/p>\n

He says adopting the holistic approach is part of an effort to \u201ceducate more students interested in community health and primary care specialties.\u201d But, he says, \u201cin essence we just don\u2019t know yet.\u201d<\/p>\n

While he acknowledges the need for specialists, Witzburg echoes a growing sentiment in his profession that primary care is slighted by the payment system, and accumulating medical school debt is pushing young doctors toward the more lucrative specialties. Because doctors are compensated more for procedures like diagnostic scopes, scans, and biopsies than for services such as counseling or dispensing prescriptions, core primary care services are difficult to quantify and reimburse. The income gap between primary care doctors and those in subspecialties has grown steadily in the last decade, with a difference in median income of as high as $250,000 between primary care physicians and those practicing diagnostic radiology and orthopedic surgery, according to a report by the Robert Graham Center<\/a> , which surveyed doctors\u2019 incomes between 1979 and 2004. The disparity is seen as the main cause for a drop, by nearly one half, in the odds medical students will choose primary care. And the report estimated a drop of 30 percent in the odds a student will end up working in a rural health center.<\/p>\n

\"Javier
Javier Rios (MED\u201915): \u201cI feel like, even during residency, you can have time for your family.\u201d Photo by Vernon Doucette<\/figcaption><\/figure>\n

The dramatic decline in primary care is compounded by an aging U.S. population and the expansion of health care access under the 2010 Patient Protection and Affordable Care Act, often referred to as Obamacare. A report by the American Academy of Family Physicians<\/a> predicts a shortfall of almost 40,000 primary care providers by 2020. At the same time, the American Association of Medical Colleges<\/a> estimates that among 2010 medical school graduates, average debt was almost $160,000, almost double the $87,000 in debt for graduates in 2002.<\/p>\n

\u201cThere\u2019s no doubt that students and residents tend to gravitate toward highly lucrative careers that are respected by their colleagues,\u201d says Witzburg, an internist who as a young man turned down a prestigious cardiology fellowship. \u201cAnd it\u2019s common for people to turn their noses up at primary care after looking at primary care doctors struggling with paperwork and being paid poorly, and seeing other people doing high-class procedures, making disease go away in 60 minutes and being very well compensated for it. It\u2019s not lost on medical students that these specialists are sought after by hospitals, have big fancy offices and big fancy cars, and live a different life than primary care doctors.\u201d<\/p>\n

Lifestyle issues<\/strong><\/p>\n

But it\u2019s not just concerns about income that is causing the shift in the medical landscape, he says. There are lifestyle issues\u2014dermatology and ophthalmology, for example, have virtually no emergencies. Writing in the New York Times<\/a>,<\/em> surgeon Karen S. Silbert recently made waves by suggesting that women who want to work part-time\u2014there\u2019s an increasing trend for doctors to split jobs\u2014should choose a profession other than medicine.<\/p>\n

Heather Dehaan (MED\u201915), a University of Miami graduate from Nashua, N.H., thinks the attraction to lucrative specialized medicine has started to wane. \u201cToday, doctors are seen as not being so selfish,\u201d she says. \u201cDoctors are seen as being more humanitarian and more involved with public health.\u201d Dehaan hopes to be a pediatrician and is attending medical school on a U.S. Navy scholarship. Her lifelong resolve to be a doctor was strengthened as a college freshman, when her much younger sister became ill with cancer. \u201cCaring for my sister reconfirmed what I already wanted to do,\u201d she says. A biology major, she\u2019s always wanted to work with children and believes that a career in pediatrics will afford her \u201cthe most influence and the most input\u201d toward bettering kids\u2019 lives. Under the terms of her scholarship, she\u2019ll serve one year as a doctor in the Navy, beginning as a lieutenant, for each year of medical school. \u201cI\u2019m not going into this with the expectation of making a lot of money,\u201d she says. The income question hasn\u2019t come up in discussions with residents and fellow students, she says. Dehaan is engaged and would like to have children some day, but that will have to be put on hold until some point in the future. \u201cAnd I\u2019m okay with that,\u201d she says.<\/p>\n

\"Matthew
Matthew McAdams (CAS\u201910, GRS\u201911, MED\u201915): \u201cAccess to health care is the biggest problem we\u2019ll always face.\u201d Photo by Vernon Doucette<\/figcaption><\/figure>\n

Matthew McAdams (CAS\u201910, GRS\u201911, MED\u201915), of Vero Beach, Fla., believes that BU \u201cactively selected our class for more humanism.\u201d He and Luke Stevens (GRS\u201911, MED\u201915), of Winchester, Mass., completed BU\u2019s master\u2019s program in medical sciences, which they believe improved their medical school applications. They were thrilled to be accepted (it was McAdams\u2019 second try), and they are allowing themselves to dream a bit, while coping with the much-dreaded anatomy lab. McAdams is interested in neurology; Stevens hopes to specialize in emergency medicine. Both expect to be well-compensated for their work, but as McAdams puts it, \u201cif we wanted money, we\u2019d go into business.\u201d As for the prestige of being a doctor, \u201cit\u2019s not a bad thing,\u201d says Stevens.<\/p>\n

McAdams was drawn to medicine by his late grandfather, a general practitioner in rural Arkansas. He did house calls and sometimes took his grandson along. \u201cI saw the magic in what he did,\u201d says McAdams, who hopes to practice academic medicine, enabling him to have clinical hours, teach, and do research. He believes he probably \u201cdoesn\u2019t have the wherewithal to perform surgery for 10 hours\u201d and wants to work with people suffering from conditions like multiple sclerosis, neuropathy, and dementia\u2014all of which have affected friends or family members.<\/p>\n

\"Luke
Luke Stevens (GRS\u201911, MED\u201915): \u201cEven Superman couldn\u2019t know all disease symptoms and processes.\u201d Photo by Vernon Doucette<\/figcaption><\/figure>\n

\u201cI\u2019m committed to doing emergency medicine,\u201d says Stevens, who completed EMT training as an undergraduate. \u201cI have a short attention span.\u201d And with an ER doctor acquaintance estimating he\u2019d see 40,000 patients by the end of his four-year residency, Stevens decided the specialty would be a good fit for him. \u201cThey see about three patients an hour; they see everything,\u201d he says, and they usher patients through initial diagnosis and treatment. With median salaries of nearly $247,000, ER doctors have an added lifestyle benefit. \u201cIt\u2019s shift work,\u201d he says. \u201cYou\u2019re not committed to be on call for 100 hours a week or anything crazy like that. You work as hard as you can for the hours you work, and then you go home.\u201d Most important to him is the notion that \u201cin the ER you have a really big chance to make an impact on each and every patient\u2014it\u2019s an intersection between public health and medicine.\u201d<\/p>\n

Javier Rios (MED\u201915) and Deirdre Rodericks (MED\u201915) have their eyes on orthopedic surgery, which, along with radiology and invasive cardiology, is among the top-earning medical specialties<\/a>, followed closely by cardiology. For Rios, from El Paso, Tex., and Rodericks, who grew up in Coles Neck, N.J., the specialty\u2019s pull is less about income and more about results: both see orthopedists as doctors with great physical competence and as clinicians who fix people. Rodericks, the daughter of a Mexican-American mother and Egyptian-Indian father, was recently in India shadowing orthopedic surgeons. \u201cI wanted to be a mechanic when I was really little, and it\u2019s like being the mechanic of physicians\u2014you use drills and saws, and can see an immediate effect,\u201d she says. She wants a family and hopes that while she\u2019ll restore flexibility in her patients, her profession will afford her some, too. \u201cI\u2019ll have to plan really meticulously,\u201d says Rodericks. \u201cUpperclassmen have been a really big help. Though the surgeons I spoke with are all men, BU\u2019s residency program is now about half and half.\u201d<\/p>\n

A weight lifter and soccer and basketball player, Rios is drawn to orthopedics, specifically sports medicine. \u201cIt\u2019s really fascinating to me,\u201d he says. Rios envisions working with professional athletes, maybe being a team physician. But he also expects, as he puts it, to \u201chave a life.\u201d Marriage and family were not among the most urgent concerns of the male students interviewed, but they were discussed often by female medical students. \u201cWe have been talking a lot about what we\u2019re going to do about having a husband and kids,\u201d says Rodericks. \u201cIt\u2019s a really big concern. We\u2019ve joked about hiring surrogates. With so many women doing surgical residencies, you\u2019re talking about nine more years of your life.\u201d<\/p>\n

\"Deirdre
Deirdre Rodericks (MED\u201915): \u201cI\u2019m really into preventive care and dealing with the obesity epidemic.\u201d Photo by Vernon Doucette<\/figcaption><\/figure>\n

Committed to doing medicine<\/strong><\/p>\n

When their conversation alights on issues beyond their new regimens and surroundings, the students share many concerns, and one that\u2019s foremost in their minds is the lack of access to health care. \u201cAccess is a big deal for me,\u201d says McAdams. \u201cI have a brother who doesn\u2019t have health insurance, and when he has an issue, he comes to his younger brother, who\u2019s not a doctor yet, for advice. Access is the biggest problem we\u2019ll always face.\u201d Dehaan, too, worries about access, especially for children. \u201cI didn\u2019t have health insurance for a while when I was growing up,\u201d she says. \u201cMy mom doesn\u2019t have health insurance.\u201d<\/p>\n

Just moments after explaining their plans to enter specific fields, all the students interviewed conceded that everything could change. \u201cI\u2019m told every day that in four years I might be doing primary care,\u201d says Rodericks. McAdams often hears that he \u201cmight come out on the other side wanting to do something completely different.\u201d<\/p>\n

But as Stevens puts it, what\u2019s important is that \u201cwe\u2019re all committed to doing medicine in some way.\u201d<\/p>\n

This BU Today<\/em> story was written by Susan Seligson. She can be reached at sueselig@bu.edu<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

The BU School of Medicine Class of 2015 is being groomed for a respected profession now in financial upheaval and plagued by what many believe is a worrying trend away from the traditional, often nearly lifelong doctor-patient relationships nurtured by primary care. But despite concerns about health care access and future loan debt, interviews with incoming MED students reveal optimism about a career that will enable them to serve not just their patients, but their communities.<\/p>\n","protected":false},"author":903,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[91],"tags":[],"_links":{"self":[{"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/posts\/6591"}],"collection":[{"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/users\/903"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/comments?post=6591"}],"version-history":[{"count":3,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/posts\/6591\/revisions"}],"predecessor-version":[{"id":20499,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/posts\/6591\/revisions\/20499"}],"wp:attachment":[{"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/media?parent=6591"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/categories?post=6591"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/tags?post=6591"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}