Undergraduate Students in American Universities
PreMed Programs, Medicine Aspirations
Any State in the USA
Dear PreMed Student:
Greetings to you during this Holiday Season of 2013, my name is Joel Hassman, I am a graduate from the University of Maryland Medical School class of 1989, and have been a clinical psychiatrist for the past 20 plus years, practicing mostly in Maryland for my career.
I write to you now offering an unsolicited opinion to whether it is worth the commitments and expenses you will make these next 8 or more years, expenses not only in money but equally in time and energy, to earn a Medical Doctorate degree. I respect I am just one opinion in a sea of a million or so colleagues who have already traveled the path you now face, and many may not agree with what I will opine below. But, I feel I have a duty to advise, and more so caution any who are interested to weigh what are my observations, experiences, and expectations what physicians have been able to provide as health care professionals, and how those skills and efforts will be impacted hereon.
My concerns I want to impart from those years of observations, experiences, expectations, and collected discussions with colleagues during my career are simple: with the likelihood that PPACA, also dubbed “Obamacare”, is going to be a legislative intrusion of sizeable magnitude as envisioned now, medicine as practiced to this point in time will be forever negatively altered in ways that will not be appreciated until the consequences play out for all who participate in the health care system. And those participants include many players, be them patients, providers, associated supports to patients and providers, affiliated allied health supports, hospitals, outside medical technology and pharmaceutical industries, and even insurers in place as of now. I am sure I am forgetting others, so my apologies for not naming them all.
For those of you interested in becoming doctors for the simple, yet valuable reason to be a provider who can impact on peoples’ lives for the better, in efforts to heal, comfort, advise, and support, well, those were key reasons that drove me to choose medicine as a career. And an equally important part to my choice was to maintain a level of autonomy and independence that for me, at least, was a driving force in formulating such a career pursuit. While making a decent income also had some bearing in the decision, money was never a primary driving force to my choices throughout my career. You receive a decent income as a doctor overall, so money should not be a primary consideration to decisions what to do as a health care provider. If you are not already aware, the for-profit drive that has consumed much of the health care profession has wrought enough damage before what PPACA will surely do further.
Unfortunately, in my opinion, money, profit, financial gain, these are the driving forces to health care of late, until proven otherwise, and you need to be aware at least what some providers are offering as advice and direction in your contacts in formulating your plans to become a doctor will NOT likely be what you experience once you complete your training within the next decade. No, you will most likely not be asked to make decisions that are in the best interests of patient care, comfort, and resumption of health and function. Instead, you may risk being forced to practice to provide what is popular, easy, convenient, and for the system what is inherently cheap and redirects income streams to select peoples’ personal pockets. As for any interest in maintaining autonomy and independence, forget it, you won’t have it unless you are fortunate to be in a care setting outside the system being forged into stone now.
My intent in forwarding this open letter to those of you interested in becoming doctors now is simply this: I do not want to deter people who want to be a doctor for what the profession inherently intends; I want people to succeed me to provide future care that helps people the way medicine was and still should intend to be practiced. But, I want people to be well aware of what potential intrusions and disruptions await you in your developing education not only within the didactic settings, but encourage you be attentive to what are dubbed the “street smarts” no professor, mentor, or advisor will be able to provide within the system. Medicine has to be practiced with both mind and heart. I hope you won’t lose track of this simple expectation.
Become a doctor because you want to help people be healthy, or to regain health, offer further supports beyond what the patient’s own support systems can provide, and most importantly, advocate and defend what are the principles and necessary boundaries of what the needs and expectations medicine has to maintain to work and succeed. I feel the last part of that last sentence needs to be magnified: medicine needs people to be strong advocates and defenders from those looking to alter the system in inappropriate, irresponsible, and disruptive ways.
I think health care, and the practice of medicine more specifically, has now passed the proverbial “cross roads” of adhering to principles and needs for the society we commit to when accepting that “MD” title. But, passing this point does not mean health care is lost or forever tarnished. You just have to want and need to care and focus on doing what is right and responsible. If you listen to those who don’t understand or even don’t respect that basic premise, well, then good luck in your pursuits. I hope what drives you to want to be a doctor will guide you well and see you be successful and appreciated by most you work with, be them patients or colleagues.
I hope your journey will be enlightening and inspiring, as much as safe and valuable. Thank you for taking the time to read this open letter, share it as you see fit with others.
Sincerely,
Joel Hassman, MD