Response: How tough is medicine?

Monday 21 February 2011, 6.51am HKT


Friend of mine put this question to me on Facebook, and I thought a blog post would best answer it rather than spilling by beans there with a tl;dr response.

* * *

Question

Long time no chat … i rmb u said that u had a chance to be doctor while you were young. What medical subjects did you study? Is being a doctor really hard and tough?

Shredder, 20 Feb 2011

Reply

Dear Shredder,

What? You want to get into medical school now? Forget it, it’s too late. You’re too old to get in now, even with a dozen Distinctions in any subject.

Err, I think you meant TO BECOME a doctor — BEING a doctor means you’re already a doctor.

Honestly speaking, depending on the area of practice, being a doctor is most probably nowhere near as tough as going through the hell of medical school to become one, at least not according to my own hospital experience in the UK.

Money, money, money

For the pleasure and privilege of going to medical school, you (more likely, your parents) have to pay a phenomenal amount of money in tuition fees (plus living expenses if overseas). The British MBBS degree lasts 5 years on average, so the budget is:—

WAS:—

In my days, the costs were high but bearable:—

  • Home students (UK): £1,200 p.a. × 5 years = £6,000
  • Overseas students (non-UK): £4,300 p.a. × 5 years = £21,500

NOW:—

A helluva lot of cash for the whole 5-year programme:—

  • UK and EU students: Around £3,300 p.a. but actually totals up to £46,000 (HK$520,000) for the whole degree
  • Non-EU students: totals up to £158,000 (HK$2 million) for whole degree

Even if we equalise inflation and exchange-rate spreads between ‘my days’ and now, the value of the spend doesn’t equalise: it’s still 45%-65% costlier today than before.

(I do know how to calculate this kind of crap. You can back-engineer the calculations to work out which year was ‘my days,’ if it pleases you.)

The colossal debts taken on by medical students is deterring many school-leavers from choosing medicine as a career, thereby narrowing the social complexion of the profession: medicine is therefore increasingly drawn from the moneyed classes rather than any other. Ultimately, this affects the empathy for patients that future generations of doctors have compared with the other social classes.

(Just take this as it is — I’m not a professional sociologist but I do know something about this, but I can’t be bothered to explain it in detail.)

Don’t take my word for it — read what the British Medical Association has to say about it.

N.B. Look at the above figures again. UK/EU med students pay £3,300 (HK$42,000) a year. Wake up, you Hong Kong uni students on non-medical degrees: you’re actually paying the same price as a UK medical degree! Your precious bloody non-med Hong Kong degree is more expensive than a UK med degree! Is it f**king ever! Eat my shite. Only I can see this, and you can’t (or won’t).

(I vaguely recall someone telling me “the government is fairer,” i.e. the one in Hong Kong. I hope it wasn’t you.)

Getting ready

First off, it’s been a long time and I don’t know what the normal academic entry requirements are for medical schools today.

I can’t comment on the Hong Kong situation because I never studied here before. It’s probably the same, I reckon.

I’ll just make a general comparison:

WAS:—

2 or 3 GCE A-levels (the usual suspects: physics, biology, zoology, botany, chemistry, maths) and 5 GCE O-levels to get in. No need for preliminary higher education before entry (e.g. a first degree), whereas the U.S. system requires a first degree for entry.

NOW:—

Don’t know. Just check Wikipedia for the general situation. The UK changed its education system since I left — and not for the better, I might add. Now they have this crap called GCSE, NVQ-whatever and couple of other alphabet soups. Whatever might be the standard of those, I can’t comment — other than to say the O- and A-levels of my time were at the very least cheaper and faster.

In addition to the normal academic requirement, some medical schools (especially the top ones) also require applicants to sit an entrance exam (e.g. MSAT, OEE, etc).

Getting in

It’s the same all over the world: getting into medical school is super tough. Entry to British medical schools is extremely keen: around 10 applicants per available place. In the USA, it’s around 7 per place. These two countries have lots of medical schools, so their figures don’t reflect reality. In many other countries, there are 12 to 25 applicants fighting for just one place.

The way of getting into medical school in the UK has also changed. Just check Wikipedia for the general situation about entry into British or Hong Kong medical schools. Frankly, I don’t care and don’t want to do the homework here.

WAS:—

Only undergraduate. Five-year MBBS/MBBCh programme, standard for all, regardless of your holding a prior degree or not.

NOW:—

Two ways:— undergraduate (6-year degree) or graduate (4-year degree). Honestly, another government-inspired sleight of hand to grab more money from students. (Ever wondered why students in London rioted a couple of weeks ago?)

I believe Hong Kong operates roughly the same way.

If you’re one of the lucky few, the admission interview is absolutely nerve-wracking.

WAS:—

Admission interview is literally the chance of a lifetime. Screw up and you’ll never be able to apply for entry for life with any medical school anywhere in the UK.

NOW:—

Don’t know and don’t care. Just check Wikipedia for general situation. Probably the same as before.

In medical school

The study format varies between medical schools. Broadly speaking—

Years 1 and 2 are pre-clinical studies in an academic setting
Years 3, 4 and 5 are clinical studies at a teaching hospital
Year 5/6 as a house officer (‘houseman’)

Most medical schools mix pre-clinical and clinical studies, so all years are not strictly all-academic or all-clinical study. Quite a number actually stay on for Year 7 or 8 to finish ‘intercalated degrees’ on top of their MBBS.

Once IN medical school, you then realise you (or your parents) are paying through the nose to be in Hell.

You’re constantly pumped for information, always pressurised to perform better than your best (but in the worst-possible working conditions), and always under some form of justified or unjustifiable pressure from the faculty, the other qualified doctors, the rest of the hospital staff and your peers. In other words, you’re constantly abused in med school.

Then you’ve got to balance that hardship with the bat-shit crazy immature behaviour from fellow med students, plus their constant snide remarks and backstabbing while everyone scrambles to make it on the Dean’s List. Female med students are encouraged to sleep with everyone on the faculty in order to just keep going on the programme, never mind the Dean’s List.

‘Disturbing behavioural developments’

The neverending pressure, constant work, constant gossiping, constant squabbles, constant backstabbing and constant internal politics — they all add up and result in a lot of drug-taking and alcoholism.

To say nothing about altered personality traits like God complexes and disturbing behavioural developments like necrophilia or necro-cunnilingo-BDSM-camwhoring (developed from dissecting pickled cadavers).

Thankfully, they learn to hide their sick shite really well.

I don’t know about now, but in my day I knew of many male med students who got their most threatening/hated female med students pregnant in order to kill off their medical careers even before they had a chance to begin. Medicos are mostly not nice people.

This is from my own experience working in a London hospital. Medical friends say it’s more or less the same picture in Hong Kong, so you make your own judgment.

‘A real doctor’

After 5 or 6 years of suffering that abuse in med school (plus the one or two abortions already had during clinical studies, plus the semi-moonlighting as an abject high-class callgirl to pay the tuition fees or the drugs), you spend Final Year as a ‘foundation house officer’ (or FHO, a.k.a. farkin’ hopeless oaf).

An FHO is only one step up from the lowest form of animal life on this planet; the printer is the lowest.

Rack ’em, pack ’em, bleed ’em

As an FHO, ‘they’ continue to abuse you (though in a slightly nicer way, knowing that you’ll be one of ‘them’ in a year or two).

You still pay fees to the uni (when basically all your studies have ended).

You’re getting meagre wages (and still the taxman takes roughly 35% of it away).

The tropical disease specialist rings you up in the middle of the night to examine — touch — some sodding bastard with an unknown but highly contagious tropical disease picked up from the Amazon with no known cure.

By the time you graduate and you’ve become a ‘real’ doctor, you’re saddled with so much debt that there’s no way but to churn patients for money — two-minute ‘non-exam’ consultations, prescribe unnecessary medication or procedures, then send them off packing. Rack ’em, pack ’em, bleed ’em.

Final words

You decide if I’ve answered your second question, if it’s tough or not being a doctor.

Personally, I reckon it’s no easier and no harder than any other professional’s job.

Lawyers go through hell in law school. Architects go through hell (like Dad did). Priests go through hell. Accountants learn to love hell. Engineers ARE hell. Bloody hell!

Honestly, most of the hate and pain and suffering that I saw students go through in medical school are mostly self-inflicted, largely avoidable (especially if they put aside the God complex inherent in many of these people before they even entered med school), and mostly if they didn’t try to please so many people all at the same time.

__________

© The Naked Listener’s Weblog, 2011.

Images (all pilfered and used without permission): British Pound Money Tree (#10556767) via iStockphoto | Examination via Bideford College News | Interview Panel via Medical MasterMind Community | Medical Gloves via Journalism Now | Lady Byron wearing a BDSM-style collar that buckles in the back, via Wikipedia | Money Doctor via Dan Cleary: Political Insomiac | Skeleton and Skull on Desk via (unrecorded) (sorry!).

Updated 01 June 2014 (recategorisation, extra tag, split long paragraphs)

One Response to “Response: How tough is medicine?”

  1. Your last two posts are the best in a while mate! I couldn’t agree more about the BS that students have to go through to get a qualification nowadays. I came from one of those priviliged families that could afford the astronomical cost of tertiary education so my school life was kind of easy compared to those who scrimped and saved (and starved) just to go to college. In the end I didn’t use any of my expensive education in my chosen career- I followed my passion for food and became a chef- not an easy career path either (by the way). Now I turn up to stoke the fires of hell every day (Aussie summers can get pretty hot) to cook for people that are rude and impatient, I work long and inconvenient hours and never even hope to get the kind of money that doctors and lawyers make- but I feel that I do something real for my daily bread (which I often have to bake). In the end our career choice costs us everything no matter what path we choose.

    Liked by 1 person

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