It’s the lifestyle, stupid!

I was reading a NY Times article discussing the top residency choices for this year’s match (which I think is today – the day when graduating medical students find out where they will be going for the next 3-5 years of their training). The article follows a married couple from Harvard hoping to get into a dermatology residency, which, along with plastic surgery and ENT are easily the most competitive spots to snag.

Call me cynical, but the quotes from the med students about why they chose derm sound more like BS spouted within their personal statements and along the interview trail rather than what’s really motivating them. Consider this gem:

Ms. Singh said she initially planned to emulate her mother, a physician who focuses on treating major adult diseases.

A lecture on skin-pigment conditions like vitiligo changed her mind.

“Nobody can see if you have hypertension or asthma, but everybody knows if you have a pigmentary disorder and these changes are a lot more obvious and devastating to patients with skin of color,” Ms. Singh said.

I’ll tell you what changed her mind – she survived medical school and is probably graduating at the top of her class with multiple research publications. This means she can have her choice of specialty…add onto that the fact that she already has 2 young children – why in the world would she go into general surgery or family practice, when she can work 35-40 hours a week (or less!) and make good money? (let’s not forget she has six-figures worth of student loans to pay off) Unless she absolutely loved some other specialty, she would have to be a little crazy not to consider dermatology. I’m not trying to downplay the importance of dermatologists – appearance is obviously very important in our society even if it isn’t life-threatening, and they definitely treat people with more “serious” conditions like skin cancer. But there is no reason for dermatology to need all of our best and brightest, other than the fact that it is the epitome of a lifestyle specialty.

What I also find amusing, which is not discussed within this article, concerns forthcoming physician shortages. You would think that a specialty as lucrative and competitive as dermatology would see no shortage amongst its ranks – after all, they more or less have their choice of any medical student available and should have no problem keeping up with demand. Yet even dermatologists are facing similar shortages as other areas of medicine. It can take weeks or months to get a referral to a dermatologist. This is not the NHS, where such waits would be expected because of the role of the British government to cap spending – this is the US, with a supposed “free-market” healthcare system. And then you begin to realize (if you haven’t already) that we’re not a free-market health care system. The reason for physician shortages are due in large part to licensing restrictions (the MD monopoly, or “medical cartel” as it’s sometimes affectionately called)…medical schools keep their class-sizes low (though many are finally starting to expand), and lucrative residencies keep their available spaces artificially low. Doctors of those “chosen” specialties like derm get to work as much or as little as they want, and make some serious money. Specialists get their big houses, fancy cars, and afternoons free to play golf, while the regular folks get longer waits and higher prices (which means higher insurance premiums, which inevitably results in more uninsured folks because they can no longer afford to pay the high premiums). See how this all starts to fit together? You should start to ask yourself why physician groups oppose or place restrictions on other non-physician health care providers (“Minute Clinics” with nurse practitioners, chiropractors, optometrists, etc)…are they really only looking out for your best interests, or could it be possible that they are also concerned with their own pocketbooks and lifestyle? Just sayin…

~ Lily

1 Comment

  1. godlesscontrarian said,

    March 21, 2008 at 7:05 pm

    You make some good points. It’s times like this I wish I’d gone into med school. Problem is, when I was young and energetic enough I didn’t have the motivation. Now I’m motivated and conscientious, but older and a little tired. I probably would have specialized in immunology or something nifty like that.

    Maybe I’ll take that human physiology class at the local Jr college…


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