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Today’s post examines that which we give up to practice our craft.
These opportunity costs may not all be fully apparent to you but should factor into your decision-making and impact how you choose to live your life.
Without further ado…
What's the Point of This?
Last week I encouraged you to say “yes” to less and “no” to mo. As physicians, we already have given and continue to give so much–a decade plus of our lives training, our nights and weekends, delayed starts to our families. The list goes on and on.
These many things we pass up on in order to practice medicine are opportunity costs.
Therefore, it’s imperative that we examine these costs and see the areas in which we are compromising on things we may not want to compromise on.
Then we can become more intentional and live more aligned with our values and priorities.
You Could Be Reading Something Else Right Now
Just so we’re all on the same page: an opportunity cost is the foregone benefit that would have been derived by an option not chosen.
Said differently, it’s the cost (loss of potential gain) of a missed opportunity vis-à-vis a decision made.
(See what I did there with the header for this section? So meta).
And every choice we make in life has an opportunity cost. This is because there are always alternatives we could have chosen instead; inherent to opportunity costs is a comparison between alternatives.
For example:
- Going out with friends (time traveling, money spent, possible hangover, enjoyable time, meet that special someone, etc.) vs. staying home and reading a book (no time traveling, no money spent, still possibly a hangover I guess, enjoyable time, personal enrichment [unless it’s romance novels 🙄]).
- Coupling up with someone specific (companionship, etc.) vs. remaining single (different type of life, finding the “right” person, etc.).
- Liking Star Trek (big mistake) vs. Star Wars (correct decision).
As your life experiences have taught you, it’s not always easy to determine which option amongst several will lead to the best outcome for you (except in the last example above).
This holds true for medicine as it does for everything else.
In fact, the opportunity costs associated with medicine are tremendous given the initial and ongoing commitment it requires (just like loving Star Wars).
There are three main categories of opportunity costs when pursuing and continuing a career in medicine. They are:
- Time
- $$$
- Wellbeing
There are many subcategories under wellbeing that we will explore.
1. Time
It’s no surprise that time tops the list in terms of opportunity cost. Time is our most valuable resource because it’s finite. That which we use up cannot be returned no matter our efforts or pleas.
We spend about 20,000 hours training clinically in the latter half of medical school and residency to become adept at caring for patients. For some of us, that figure is almost double with longer residencies or subspecialization fellowships.
That’s a lot of time, but it’s what’s required to be prepared to handle the breadth and depth of the ever-changing landscape that is medicine.
The bulk of that time takes place in our 20s (for “traditional” students), which is often labeled the “prime” of our lives. (I think it’s often a confusing decade for those whose paths are not so regimented and set in stone as those training to be physicians).
Even after the absurd hours we cram into residency, the average physician works about 50 hours per work, but that can vary quite a bit. And those figures often only count scheduled hours and not call from home, etc.
On top of that, we have CME, board exams, MOC (don’t get me started), and keeping up with the ever growing corpus of medical knowledge.
It all adds up.
2. Money
Physicians on average make good if not great money–well above the median income in the U.S. But that income often starts in our 30s or later, depending on training duration.
We often are considered as having lost a decade of earning and compounding due to our extended education in medical school followed by relatively low compensation for work done in residency. We get a delayed start on our nest eggs. And that lost time of compounding cannot be made up.
Moreover, we bear tremendous student loan burdens for this education and training; the average med student loan debt upon leaving med school is north of $240,000! This is a very large hole out of which physicians must dig themselves.
Those who match into residency and make it to attendinghood can work on chipping away at those loans. But there are those who don’t match into residency (given there are fewer spots than U.S. med school graduates…) and are left stuck with their albatross of debt without options.
I’m guessing this is what that situation feels like 😧
Then there’s malpractice costs, which can be quite exorbitant. OB/GYNs in some states have to pay over $100,000 for malpractice coverage!
We know women physicians make less than their male counterparts for the same work which reduces their lifetime income generated.
Physicians also often face golden handcuffs at work where signing/starting bonuses and even some designated retirement plan monies can be clawed back (in both employed and private settings) if physicians try to leave. Such arrangements often trap physicians in less than ideal work situations.
So while the money in medicine may be good, for the time and effort/stress put in (see below) it may not be worth it. Certainly I don’t recommend anyone going into medicine for the income. There are faster, less stressful ways to make money, if that’s your ultimate goal.
And especially in light of the past 1.5 years. Previously, it was thought that incomes and jobs in medicine were very secure. COVID-19 turned that upside down for countless doctors around the nation. You may even be one of them.
3. Wellbeing
This is a catch-all header as wellbeing encompasses so many facets of life so I’ll break it up with subheaders.
Warning: it’s going to be a lot. But this is why moral injury occurs.
3.1 Stress
Apparently, medicine is stressful–who knew?
Our jobs can be overtly high stakes–think ER, ICU, OB precipitous deliveries, surgeries, trauma, etc.
But other fields are also stressful–radiology, dermatology, or pathology not wanting to miss a diagnosis, the burdens of responsibility for seemingly everything in primary care.
Dealing with life and death situations is tough, but so is managing others’ health and wellbeing. It can be very taxing and draining.
Add on the ever-present threat of malpractice suits, ever increasing burdens of charting (*cough*there’s a program for that!*cough*) especially as we transition to more value-based care reimbursements, and trying to practice good medicine in an era of immediate gratification and patient reviews.
Apologies if me listing all of that out gave you palpitations!
3.2 Years Off of Our Lives
The chronic stressors above (as well as stress from subsections below) have impacts on our lives.
Literally.
Probably through a cortisol-mediated pathway, chronic stress actually starts to kill us.
Those who work overnight know the toll that takes on their bodies, but there’s data to show that it also decreases life expectancy.
There’s the chronic sleep-deprivation and fatigue that can lead to injuries, work-place exposures, and even deaths (motor vehicle collision related).
Finally, we know that over 400 doctors tragically die by suicide annually, a rate much higher than the general public and other stressful occupations.
It may be odd to think of not dying by suicide (i.e., staying alive) as an opportunity cost of medicine, but I’d bet that you know a colleague, fellow trainee, or even friend who has died by suicide. Four come to mind for me. Three were med school classmates; two of them died within the first two years of med school.
3.3 Physical and Mental Health
Covered to varying degrees above, but additionally:
- anxiety, depression, trauma (from training and ongoing practice)
- burnout
- unhealthy coping mechanisms (alcohol, over-/under-eating, drugs)
- overweight/obesity, physical tolls on our bodies
- I mean, even maskne is real!
- I still have scars from being clawed by a panicky teenager in the ED during residency
- how many surgeons do you think have hemorrhoids and elevated creatinine levels from long cases and no time to use the bathroom?
- speaking of surgeons, this recent study showing a higher rate of miscarriages in female surgeons
This list could go on ad nauseum, but I’ll stop here.
3.4 Erosion of Emotional Intelligence
I separated this one out because I think this is often ignored or lumped in with burnout (appropriately), and is often a source of frustration for patients, who feel like their physicians don’t listen.
Functioning in a role that can be fraught with tension and high-stakes in a non-service industry and balancing that with showing compassion all the while carrying the accumulated weight of years and years of everything above is…challenging, to say the least. Oh yeah, and do that in 15 minutes, please.
Now repeat that 20-30 times a day, five (or more) days per week, with limited opportunities for rest and restoration. It’s not hard to imagine losing some degree of empathy, self-awareness, and social interaction skills in such scenarios.
I like the term “erosion” because it evokes imagery of slowly wearing away which is apropos for this situation.
The opportunity cost here is an alternate career that is not constantly assaulting your emotional intelligence.
3.5 Family and Social Affairs
Medicine can be isolating especially when considering those around us not in medicine. For many, it feels like non-physicians cannot understand our day-to-day experiences.
It’s hard for us not to think about medicine even when we’re away from work, and consequently we talk a lot about medicine.
(Some non-medical folks like hearing the gross or amazing stories, but it’s not everyone’s cup of tea!)
The time away from family and friends is taxing. Maintaining healthy relationships requires effort, attention, and time, which all can be in short supply.
How many holidays, weddings, and other milestone events have you had to miss?
Many in medicine often delay starting families, sometimes waiting until after residency training. This can mean fewer children due to reduced years of fertility or even higher rates of infertility due to advancing maternal age (I cannot say “elderly gravid,” sorry!).
Well, That Was a Doozy
All the aforementioned opportunity costs can take a toll because they are so all-encompassing and pervasive.
Yes, other jobs have their opportunity costs too, but the quantity (diversity), quality (severity), and duration of them in medicine is pretty extreme.
It is important to see that medicine always asks for (or demands) more. If you can give, medicine will take. Heck, even if you can’t give, medicine will take, like a maw or black hole.
That’s why it’s imperative to be intentional in your decision making. You get to decide if the costs are worth it to you. Even if you’re recognizing them now and are in the thick of it.
Nobody on their deathbeds wishes they spent more time working or earned more money. They usually regret having focused their attention on the wrong things like working constantly instead of on family and experiences and the like.
Echoing my call last week to say “no” to mo and in light of all the costs already borne, I want you to consider “what is the opportunity cost of doing X,” where X is a new request or petition for your time and attention.
If it doesn’t fire you up or align with your values and priorities, then you should probably pass on it.
Keep on walking, request. Keep on walking.
Heck, maybe there are things you want to cut out that are not aligning with your vision of your life. Maybe you want to explore new opportunities previously limited or prevented by practicing medicine.
My stated mission with Prosperous Life MD is to help physicians live their most prosperous lives. It is only from a place of understanding where we are now and where we want to go that we can start to build an intentional life.
I see around me and have experienced within my family the consequences of physicians struggling to prioritize their lives outside of and away from medicine. Physicians are very prone to this.
Don’t forget to make a life outside of medicine a priority. Think of how you can make medicine work with the rest of your life instead of the other way around.
This post became more somber than I intended, but I hope it illuminates the extent of what physicians sacrifice and put into their work. What resonated with you? Let me know in the comments below.
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