Hire people who aren’t proven

The simple truth is this: pay has been dropping like a rock, every public mention of doctors is about how much we suck, regulators and bureaucrats are telling us how to practice medicine (but we continue to carry the liability), we're given 5 minutes to see patients when we should be given 20 (and when we rush out the door, patients think it's because we don't give a shit), and and and. .

The worst of it is: everyone else has a "career" - they're allowed to worry about work/life balance, about trying to get paid for their time, about trying to build a nest egg. When physicians do that, well, medicine is a /calling/. You're not allowed to worry about paying for your kids' schooling, or paying off your debts, or etc. That stuff is for programmers and accountants; you're just working with "sick people in their worst moments," so you're not allowed to be anything but self-destructively selfless. No one is allowed to discuss physician misery (I hate the word "burnout" - those docs aren't a resource that came to the end of its useful lifespan, they're human beings in desperate misery) except when residents are throwing themselves off the roofs of hospitals. I've lost -two- friends in the last year. TWO in the last YEAR.

And the only people that pay attention to that are the residents who have to carry on and the attendings that go, "well, it was still better in my day, when residents didn't expect to sleep or ever go home. It was better for patient care continuity if their doc never went home."

Private practice is dead or dying for most specialties as well. The healthcare field is heavily concentrating into large regional networks.

I knew this all going in. So I can say to your wife what I said to myself: The only reason to become a doc is if you cannot, for the life of you, force yourself to become anything else. It has to be a fire in your goddamn marrow.

And for all that, I recommend choosing a residency in psych. They work 9-5 even in residency - call tends to be 9a-8p or 9a-11p (rather than 24-hour shifts like the rest of us) and every other weekend they tend to work 9-9 Sat and Sun. It's the lightest residency on the planet, and they still make - per hour - the same money as IM and FM. It's the best thing I've ever heard of for people that want to have work/life balance and a family. Unsurprising, as they're the ones who spend every day seeing stressors break people's minds in half.

So I want to clarify: what I said was that people who aim at medical school because "they're passionate about medicine" are mistaken. They're passionate about a fantasy of what medicine is, because you don't really know what it's like until it's there (and popular depictions of it are as unrelated to actual medicine as 1980s hackers movies are unrelated to actual programming.)

Many people are deeply hurt by the gap between fantasy and reality. They don't complain about it openly, but inside the doctor's lounge... oh yeah.

Some find a new passion, for what medicine actually is. Sometimes this is closely related to their original ideas, more often, it's only tangential. But they're on fire, and that's great.

Most just grow up, and find that they do a difficult but worthwhile job. They don't necessarily have a "passion" for it, but they appreciate the importance of what they do, and concentrate on doing it well. They work to take care of their patients, but also to avoid liability, and to earn their colleague's esteem. They're normal physicians.

I'm discussing the fact that what people think medicine is vs. what medicine is has a huuuuge gap. You can't be passionate for a thing when you've only seen its mirage. That doesn't mean enthusiasm is inherently bad. It's misplaced.

>it remains that there are young people that understand this

No, there pretty much aren't. That's rather the key point. I've never met a student, resident, or practicing doc that said, in retrospect, yeah, they had anything resembling an accurate clue about what medicine would actually be like.