Is Becoming a Physician Really a "Million Dollar Mistake?"

As an editor, one of the things that excites me most about my job is writing, and helping reporters write, enticing headlines that draw readers in. I came across a headline last week that stood out to me as one of the best I've seen in awhile: "$1 Million Mistake: Becoming a Doctor."

The article from CBS News highlights the financial commitment future physicians take on in return for obtaining the education required for their chosen career.

Initially the headline seemed overblown, because the first thing I thought when I read it was: Med school doesn't cost a million dollars! I was partially correct. While medical school tuition is expensive, it doesn't cost a million dollars. Instead, that figure represents the cost of medical training and opportunity cost.

Let's take a closer look at the first part of the calculation — training cost:

Average medical school debt = $166,750
x 7.5 percent interest
= $419, 738

While this represents the average, total debt could be quite higher for many individuals. For example, the tuition to attend the Feinberg School of Medicine at Northwestern University for the academic year 2013-14 is $50,273. And that's just for tuition! Even living frugally, another ten or twenty thousand dollars a year is needed for cost-of-living expenses in the Chicago area. Harvard Medical School is priced pretty similarly at $52,100 a year, but additional fees for health coverage, educational materials, etc., total $7,600. Plus, you'll need to have another $14,000 for housing and food, according to the school's estimates. That's almost $74,000 you'll need a year. If you didn't save enough money working part time during undergrad (for which you or your family also probably spent a lot of money on), you'll likely need to take out loans to cover this amount each year, or roughly $222,000 plus interest, which is a lot more than the average med school debt of $419k.

Now, let's address the other part of the calculation — opportunity cost.

What is opportunity cost?

Opportunity cost is the cost of alternatives that were given up when a decision is made. So, in order to pursue medicine, a person gives up the years' experience of a different career, as well as the salary that goes along with it.

The concept of opportunity cost has been on my mind lately, even before I saw this article, because I'm currently reading "Decisive" by Chip and Dan Health, brothers turned management gurus. The book explains why individuals and businesses often make bad decisions, and one of the key mistakes they say we make is having a "narrow lens." That is, we ask, "should I go to medical school?" rather than framing the question as "what is the career and lifestyle I want, and is the cost of achieving it worth it to me?" You certainly don't hear many college juniors studying for the MCAT saying that!

According to the CBS News report, considering time in med school, residency and fellowship, "the typical doctor doesn't earn a full-time salary until 10 years after the typical college graduate starts making money." It explains that if a would-be med schooler earned an average of $50,000 for those 10 years, that's another $500,000 passed up by the doctor.

The math is a little fuzzy, but the gist of the calculation makes sense. First, this calculation assumes doctors make no money in 10 years of training. But, resident and fellows receive compensation for their work, though certainly it may fall below some of their college peers who pursued different lines of work.

And, after completing residency and fellowship, most practicing physicians will out earn their college peers by leaps and bounds, particularly if they pursue a surgical specialty. For example, an orthopedic surgeon can earn in the high $400ks, as can gastroenterologists and urologists.

Family practice physicians earn less, and that, combined with high student loan repayments, could create financial strains for a young family practitioner. This of course explains why so many physicians seek out specialty training.

So, is becoming a physician "worth it?" The key factor is this: opportunity cost must be thought of beyond monetary terms.

You could do a million different calculations: If I spent 10 years as a neurosurgeon and 10 years in training vs. 20 years as an accountant, senior accountant and then partner in an accounting firm, how does that compare? Or, what if instead of an accountant, I became a programmer? The comparisons would be exhausting.

Instead, you have to think outside of money. Will you be happy as a physician? Do you understand what the day-to-day work of a physician is like? Do you understand the typical hours? Duties? Will you enjoy them?

The whole impetus for the CBS News report was a recent survey that found that just under half of physicians would choose not a career in medicine if they had to do it over again (the survey also broke out data by specialty).

I wonder, though, the reasons those 48 percent pursued medicine. Did they ask: 'Should I go to med school?' and think: 'Yes, I'll earn way more money in the long run than anything else." Or, did they widen their framing of the question and consider all possible alternatives:' Will the extra money be worth the long hours?' 'Will I like treating patients?' 'Would I be happier doing something else slightly less prestigious?'

I hope the physicians of tomorrow view the question with a wide lens and pursue medicine because of an overwhelming desire to study science, help patients and cure disease.

Medicine is profoundly personal, and so is the decision to pursue it. My guess is that the happiest, most satisfied and accomplished physicians are the ones that went into it for many reasons besides the money. My guess is they wanted to help others.

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