Did you know that there are currently 101 doctorate of nursing programs in the United States accepting patients???? ONE HUNDRED AND ONE! This is nearly as many as the number of allopathic medical schools in the entire United States. Here is the official list according to the American Association of Colleges of Nursing. There is no escaping NP’s. They have even managed to make headway as far up and away as the Yukon!
Yes, you too can enter the Texas Woman’s University (just make sure you were able to crack a whopping 960 on the GRE to qualify) and a mere 46 credits later (don’t worry you will never have to take more than 9 credits a semester) and you too can call yourself DOCTOR. If you fear that 46 credits maybe too much of an academic burden, then you can always apply to the Frontier School of Midwifery and Family Nursing as they only require 33 credits to achieve the doctorate! Or maybe you hate having to sit in class. Well thanks to the the University of Cincinnati you can do your entire doctorate online (plus no GRE needed)! I had to pull out my old med school transcript to calm myself down since I knew working my butt off for a doctorate certainly required more than the above. Guess what? I can safely say that I did not lose my mind- just shy of 160 credits it was.
Oh and it gets better. There are another ONE HUNDRED additional noctor programs in the planning stages. So if you had concerns that your credentials were not competitive enough, you could always wait a couple years since there will be nearly double the spots.
Between greater govt control of healthcare in this country and the explosion of allied professionals, primary care salaries are not going up anytime in the foreseeable future while inflation and compensations in other occupations will only increase. This is chimpanzee economics. To add insult to injury, while your recently graduated med student is working like a racehorse in residency barely able to pay the minimum (assuming he is not in deferment or forebearance) on his quarter of a million dollar student loan balance, your noctor zipped through a one week residency (at the end of the first paragraph in this article) and is humming away making just shy of your future attending salary with a fraction of the loans. Actually, while you were sitting in lecture all day racking up those loans, your future NP was busy at work full time bringing in a nice salary. I will leave it to one recent NP grad’s remarks about her noctor program over on allnurses.com, “University of Cincinnati (UC) is 100% on-line, it allows me to continue to work!” Someone tell me how it is even possible to learn all there is to know in medicine entirely online and while holding a job? Please tell me I am dying to know, as are your future patients whom many of you will be independently treating.
It is no secret that pediatrics is the most underpaid of all medical specialties. It just goes to show you how much our country really values it’s youngest and most vulnerable citizens. Exactly how bad has it gotten? Check out and see for yourself on this forum where DC housewives congregate and discuss the matter.
“I left private practice as an internist because the money was awful and the hours were even worse. I made $110K and worked my butt off; on top of that I have to pay down $150K in student loan debt.
My friends are leaving practice in droves — esp. OB’s because of increasing malpractice premiums.”
“I always assumed that my sister in law who has a nice practice in Baltimore was doing well. Then I found out that she made 89k last year. That is after all the late nights and weekends, her pager is always going off.”
“I worked for an insurance company in claims, and at times (sadly) we laughed at the small checks we would send the docs.”
“I am a pediatrician. Full-time docs starting out make $90,000. I’m part-time, so I actually make proportionately less.”
“If you thought I had it made…I really HAD IT!!”
“I do not have any desire to go to the hospital anymore. It cost more to pay the malpractice insurance than what you collect for your services in the hospital”
“The problem is that you are on a treadmill to keep up with expenses in the face of lower insurance reimbursements — so the way to make up for it is to see more and more patients.”
“There’s no prestige left in it, and the salary is not that great. Last year, had I worked full-time, I would have made 1/10 what my non-physician husband made (who spent 9 fewer years in formal education than I did). And I’m a surgeon.”
“I doubt it will be too long before I stop going back to work.”
“My husband is a dean at one of the medical schools in town and while I don’t have an exact figure, I know that a daily concern of his is just how much debt his medical students are graduating with these days. Almost universally 100K+ and often $250K+.”
I have received several inquiries on a recent posting where I mentioned that I live under the poverty line. According to the 2009 poverty guidelines, for a single person in my state one needs to make under $10,830 to qualify. I am here to tell you that I do indeed live in “poverty” as my annual expenses throughout my working career since graduating from medical school have been under this amount. How is this possible and even if true, how could I allow myself to suffer like this?
I do concede that living so frugally is not for everyone. For starters, it is very anti-American to not spend spend spend. I will be perfectly honest with you when I say what you read on this blog you will rarely see elsewhere. Why is that? Well I am not getting paid to sell you something that you really don’t need! When you live in a capitalist consumer throw away society where advertisers are working hard to part you from your hard earned dollars, it can be hard to say NO. Wherever we look, we are being constantly bombarded with images of how we should be living the “American dream”. It is as if the media and society are programming us on HOW we should live. Everything from the kind of car we drive down to the brand of underwear that gets to caress our ass has now become some sort of status symbol. Are we that unhappy or insecure that we need to buy “stuff” to fill an empty void? Rather than looking at others for approval through the silly tokens of importance that we buy or the degrees after our name, we should instead realize that it is by being a good person at heart that inevitably leads to contentment and fulfillment. So part of the reason why I live this way is out of protest. The protest of turning into a person I do not want to become. I do not need “things” to validate myself to others. I will leave that to my actions, contributions, and the way I treat others. If you are throwing scalpels across the OR or belittling med students on rounds, I guess buying a lot of stuff is the only way you get to make yourself feel important.
Everyone has their threshold for what they can tolerate. As I’ve mentioned in the above posting, a major impetus for living below my means is to achieve financial independence. The cornerstone of my plan to get out of a highly toxic career is to break my golden handcuffs (aka student loans). If one is able to live below their means, one is able to live the life they always wanted. Think about that for a second. Ironically, it is almost tantamount to asking yourself if you won the lottery, what would you do for the rest of your life? It is incredibly liberating to know that you can spend your time doing whatever it is you wish if you are able to live in this manner. And this is the reason why I am happy as a clam living in poverty. I do not see it as suffering at all. Every dollar that I am able to save is one minute less that I have to suffer in the hospital. If this isn’t motivation than I don’t know what is. I know that one day soon I can walk away from medicine forever and pursue an alternative career that I will greatly enjoy. As if this wasn’t enough of a reason, by continuing to live under my means (spending less than what I make), over the course of time I will SAVE more money than I could ever imagine simply by refraining from buying into the American lifestyle trap. One day I hope to find myself in a position to upgrade my lifestyle (if I so wish) while many of my fellow Americans will drown further into debt.
So how do I exactly live under the poverty level? I will keep this brief as I don’t think the numbers are as important as the reasons which I discussed above. If you take the $10,830 annual amount and divide it up over 12 months, you are left with approximately $900. Here is the rough breakdown of my monthly outflow as a resident:
RENT: $550 -for an old small, but perfectly adequate, studio (found off craigslist) in a good part of the city 3 blocks from the hospital. Needless to say this is not NYC or LA but still a major culturally vibrant city in the top 20 in terms of population. Housing is the number one expense in anyone’s budget and this is the one place where anybody can save the most. If you are willing to live small in the right location, you can save big. Europeans already do this, I don’t know why we can’t???
TRANSPORTATION: $5 -I purposefully chose my apt near the hospital so I didn’t have to get a car and pay $9400 a year which is what the average American pays a year to own a car. No monthly car payment, no car insurance, no gas, no paying for a monthly parking spot. Everything I needed was within walking distance of my apt since it was literally in the middle of everything. I could always drop a dollar here and there to take a bus if I needed to hoof over to the opposite side of the city. I never took taxis. Taxis are for lazy people or those who don’t know how to use public transportation.
FOOD: $150- spent roughly 35 dollars a week at the local major chain grocery store. Whatever is on sale is what I eat that week. Online coupons help somewhat. I also got about 50 bucks a month to eat on call which also helped. I eat healthy and didn’t starve. Would eat out maybe once a month, and usually for lunch. Prefer cooking myself.
UTILITIES: $35- water and cable were free in my studio. Since my place was small, my electric bill was only 15 bucks on average. In summer, I would open the windows and turn on the fan- I only turned on the window AC unit if it went over 90 degrees and only for like 15 minutes since again my apt was small (notice a trend here). Another 20 bucks for gas to cook.
CELL PHONE: $42 with employee discount. My contract is now up and considering going pay as you go to save here.
INTERNET: $30 This is the one NEED in my life. I can’t live without it.
GRAND TOTAL:$812 which is well under 900 dollars as you can see. This left me with an extra 90 dollars a month that I could use as I pleased for MISC EXPENSES. I would usually bank this into my “vacation fund” so I could put as many miles as I possibly could between me and my residency program during my four weeks of allotted vacation time. Here’s an actual pic from a recent domestic excursion to illustrate this point ==> [Yes, I felt more relaxed being a mere earshot from communist Cuba than remaining within a thousand miles from the hospital]
Interest earned off my savings helped supplement this expense but I am quite the budget traveler as you could probably guess. Per year, I averaged one international trip, one domestic trip, and two visits home which was about 200 miles away. I love to travel and this is where I will be spending more and more money in the future as my debts begin to quickly erode away.
On one last note- someone suggested that I must moonlight in order to be able to do this. Absolutely not! No amount of money was enough to entice me back into the hospital after already being there 60-70 hrs a week. My coresidents who lived in their 1500 a month one bedroom apts and had expensive car leases had to. I felt sorry for them while I ate bons bons in my pajamas watching a free movie on hulu.com. Only if they knew about this blog.
Music and Life – Alan Watts
“In music, one doesn’t make the end of the composition the point of the composition”
Stumbled upon this really great video posted this week over on the millionairemommynextdoor Blog. I think it so nicely encapsulates how one ought to enjoy the journey of life rather than focus on the supposed destination. It has been said that after climbing the tallest of mountains, it can be pretty damn lonely at the top. In medicine, which is ONE hell of a long road, you can easily find yourself wondering if it was all worth it when you come out on the other side. After years of being buried in medical tomes, abused by senior residents and attendings, and deprived of your sleep and time, you may just come out on the other side yelling, “I went through all THAT for THIS!!!” Don’t be like Linus and Sally who wasted their entire Halloween night out in the Pumpkin Patch waiting for the Great Pumpkin. While everyone else was out having fun trick and treating, they could’ve been as well. Here’s Sally flipping out after she finally realizes what a crock the pathway to becoming a doctor is-
As you can see, sometimes the endpoint doesn’t turn out exactly how one initially envisioned it to be. This is why it is so imperative that one spends their time on this earth pursuing something that they are passionate about and brings them joy rather than zooming from one goalpost to another in a field of misery. Your hours on this planet are a limited resource. Once they are spent, they can never be gotten back. I would personally rather spend those hours “dancing” than wishing them away or just plodding along and trying to just get by all to reach some nebulous end.
As I was reading through the comments section on a student advocacy site I frequent, I came across the following. Apparently the cost to attend medical school in the United States has risen so “astronomically” that it is now cheaper to go to outer space! Unbelievable isnt’ it? For a cool $200,000, you can secure a spot on Virgin Galactic and go where few have gone before. How can anyone turn down the opportunity to experience several minutes of celestial bliss and zero gravity versus spending year after year getting tortured in our healthcare system? Furthermore, when you are old and gray you will have one awesome story to tell your grandkids rather than explain how you got to disimpact the 90 year old nursing home admit when you were a lowly intern. Need another reason? Victoria Principal has booked a seat and could be your co-astronaut! Anyone interested in putting down a deposit?
Over on SDN today , someone asked “what specialty will give you the most power?” I would have to say NONE. Some doctors project an image as if they are the coming messiah. Don’t be fooled. Trauma attendings can beat their chests all they want and intensivists can gallant through the ICUs but it is all just a charade. Need you ask why? Well, you will be the govt’s bitch, HMO’s will dictate how you practice medicine, administrators and regulating agencies will ride you, malpractice lawyers will be circling above, patients will freely tell you what they want and will sue you at the drop of a hat, allied professionals will continue to needle their way onto your territory, and Sallie Mae will want a piece of you too. Sounds almighty powerful to me! If you are looking to go on a power trip than don’t become a physician. If so you are in for a rather rude awakening. Otherwise you will turn into that surgeon who pitches a fit in the OR like a 2 year old when he doesn’t get his way.
The Student Doctor Network (SDN) continues to hate on me. Apparently, the cartoon that I featured on my last blog posting was considered to be too “sexual” since “naked women” are not allowed on SDN. I was asked to remove it. I don’t even think the Puritans were this prude! And than today, a really great thread that I stumbled upon for the first time that I posted in the Allopathic Forum was pulled down without explanation. So what was my response? To post it here so even more people can read it! Anyways, right below is the involved link. Apparently, everything is supposed to be peaches and cream in med land. Clearly, it is not.
In case you are short of time because you have to begin a six hour study session, I thought I would give you some of the highlights-
“i feel stupid multiple times a day and i want to punch my resident in the face”
“I liked the first two years of med school, but then it was downhill from there”
“Basically finishing my fourth year at Pritzker, UChicago. And am going to quit”
“i want to quit so badly, but the loans scare me so much.”
“I have just completed my first year of medical school, and I am quitting”
“I feel relieved, I’m now free to do whatever else I want, to explore, to spend time with family, friends, and to start building a life instead of burying myself in debt and spending the majority of my 20s in a library.”
“Med school has turned me into an extremely anxious and depressed person, when I used to be such a smiley optimist”
“I hate the fact that i’m too afraid to quit right now. My heart is not in it.”
“I live for weekends off and vacations. I hate that. I feel like I’m wishing my life away.”
“I’ve got a taste of life out school and I don’t want to ever feel trapped gain. It takes more courage to leave med school than to suck it up.”
Geez Louise! And we haven’t even entered residency yet! I was simultaneosly amazed yet not surprised at the volume of posts from disgruntled med students. By posting this link I was hoping to convey to others having doubts that they are not alone. I can’t tell you how many emails I get from pre-meds all the way up to attendings well into practice asking for advice on how to “get out”. Sadly, there is somewhat of a shame in the medical community to openly discuss such thoughts which is nonsense. You know what is shameful? How our healthcare system mercilessly abuses those in it. I can fully relate to many who generously shared their innermost misgivings and concerns in the above link. I never thought it could happen to me as I can always remember wanting to be a doctor going back to elementary school. However, I found that my dissatisfaction with medicine started to emerge third year of med school and only grew from there. Residency is where my feelings REALLY began to sour and I got to see medicine in all its horrid glory. I somehow made it through residency graduating several months ago. As I’ve recently shared, I am diligently working on my escape plan and hope to be out of medicine forever someday. I have compared this to almost like being in a marriage that has gone horribly wrong that is beyond repair. As each day goes on, it only gets worse and I want a divorce. Especially since I found something else I fell madly in love with (yes, I confess that I had an affair with another career for a year in between switching residencies!) There is only so much physical and mental abuse one can take. Why stay with a zero when you can be with a hero?
(Needless to say this mug is not in my kitchen cupboard)
Of course, work should not be the core of one’s life where you love it to the exclusion of everything else. Medicinesux is all about striking a balance between work and personal time. However, work IS an important component of one’s life and does provide one a sense of purpose. To deny that fact is outlandish. As a physician, you will easily spend more than half your waking hours on the job. Let’s do the math to drive this point home:
There are 168 hours in a week. You “should” spend 33% of that time asleep to maintain sound body and mind (56 hours a week), roughly 36% “on the job” (60 hours a week for avg physician), and 31% “off the job” (52 hours a week). Please keep in mind that when you are pulling ten hour days, you have to factor in such things as waking up at the crack of dawn, showering, shaving, primping, getting dressed, making breakfast, COMMUTING all which can take away 1-2 hrs every day out of your precious 52 hours of “off the job” time. And then you need to factor in time at the end of the day where you get to languish in traffic again or take the train (“meat cart”) and also the countless hours you need to recuperate after going to battle for the day. This is yet another 2-3 hrs that you can subtract from “off the job” time. And let’s not forget all the extra hours where you need to be constantly reading medically relevant literature to keep yourself up to date on your field and not turn into a medical numb nut. Now revising our numbers, we can STEAL 20 hours out of “off the job” time and ship it right on over to “on the job” time. Doing this new math we have the following:
80 hrs involved with “job related activities” (48%)
32 hrs of “free time” (19%)
56 hrs asleep (33%)
If we just count the time we are awake, then you are roughly spending a whopping 71% of your time (80 out of 112 hours) performing physician related activities!!!
Also, ask yourself if you are able to keep those 32 hours of “free time” unadulterated, where you are able to completely divorce your mind and NOT think for a second about work? Good luck on that one.
So the driving point from this analysis is that you damn better pick a profession that you are going to enjoy and be happy doing. Is any amount of money worth being miserable, discontent, or just biding time 70% of your waking hours for the next 30-40 years??? Or to put in other words, how much a year would you be willing to pay to be happy 70% of your waking hours? Everything in this world has a price. How much is happiness worth to you?