WASHINGTON – While young people may know they want to be doctors from a very early age, not many go around telling friends and parents that they want to become internists or gynecologists.

Most people still have nostalgic images of the doctor with the little black bag – the Marcus Welby character. But today, even if students in med school want to pursue a career as the quintessential doc, being one is not as glamorous as it once was.

In a country where medical school is more competitive and expensive than ever, often students have to make a decision on whether they want to do something they love or something that will make them more money.

Dr. Marilee Cole, a professor of medicine and internist at Georgetown University, said the nation needs more primary-care physicians than ever before, but doctors in that field don’t have the most glamorous lifestyles.

“I’ve had so many residents say, ‘I want to be a primary-care doc, but it’s so expensive, or you guys don’t have the good furniture, if the lifestyle wasn’t so stressful, if the hours were better, I’d do it,’” she said. “The ones that go for it, they come back and say, ‘I love it, but it’s really hard.’ ”

On average, starting primary-care physicians make around $120,000 while most other doctors make something in the range of $200,000 to $300,000. According to a study published in 2006 by MedGenMed, the average loan a med student must pay off adds up to about $120,000.

In a world where primary-care physicians are not considered as prestigious as they once were, Cole said that makes things a lot harder for the students who take such a path. Cole said she doesn’t discourage those on the primary care path because of the tremendous intellectual and personal satisfaction that comes from providing simplified, coordinated care to patients. But she doesn’t push it.

“It’s not a cake walk,” she said. “It’s like going into a foxhole and getting shot at from every direction -- by insurers to cut costs, by treatment guidelines to do more, by financial pressures to see more patients in shorter visits, by patients demanding costly and/or futile interventions, by the threat of legal action, by personal life.”

That may be, but that isn’t stopping all students from pursuing their interests.

Adrienne Hampton, 26, is a fourth-year med student at Northwestern University’s Feinberg School of Medicine. Although she originally wanted to be a gynecologist, after doing a rotation involving family medicine, she changed her mind.

“I’d rather take a really macro approach to health care,” she said.
Hampton said she can count on one hand the number of students going into primary-care in her graduating class of about 170.

“I think a lot has to do with med schools wanting their graduates to go on, be really specialized and publish as much as possible,” she said. “It’s pushed because the medical culture values specializing more than the broad-spectrum general practitioner.”

Claiborne Childs, 29, a third-year medical student at Georgetown, also decided to go against the social norm and become a primary-care doctor.

“I like learning about people’s lives, their background. I love talking to people, so I wanted to pick something where I got a one-on-one,” said Childs, who already considered this route as an undergrad at Yale University. “It’s not to say that surgeons don’t talk to people, but their focus is the OR (operating room) so they don’t talk to people one-on-one for most of the day.”

Although he admitted the loans accumulate and it can get tough for some students, Childs said young med students need to think about job satisfaction in the future.

“I’m not going to choose something that I don’t want to do for the rest of my life where I would be making more money but be miserable for the rest of my life,” he said.

Cole said she once supervised “a resident once who went into pulmonary critical care and had $350,000 in loans.

”She wanted to work in third-world countries, but decided that she couldn’t afford to do so because she would make a lot less. When confronted about why she was adding yet more debt to her already high loans,. she said, ‘my loans are so high, it doesn’t make any difference [if I add more],’ thinking she’ll be paying them off for the rest of her life anyway.”

While many still attribute the lack of primary-care doctors to the lack of income one makes, Aaron Laviana, 24, said he’s pursuing orthopedic surgery at Georgetown because he thoroughly enjoys it.

“For one, I really like being in the OR opposed to giving guidance all day long,” the third-year med student said. “I feel like I’m using my hands – that’s always the way I’ve been.”

Laviana said his reasoning for going into orthopedic surgery, which is a hot specialty right now, had little to do with the money factor.

“You’re going to be in debt no matter what you do,” he said. “With this economy now, there’s definitely a little influence [for going into surgery] when you’re $300,000 in debt and it’s going to take 20 to 30 years to pay off the loans, but you know, if I chose a job for financial reasons, I would have done something else.”

According to a 2009 report filed by the National Resident Matching Program, most med students choose their specialties based on the on-call hours, work schedules, opportunities to perform specific procedures and consideration of significant others. General surgery remains the most popular specialty.

Sandra LaBlance, the director of Academic and Career Counseling at Northwestern’s medical school, said that she sees a lot students gravitating towards particular specialties because of outside influences.

“In the five years that I have been here I have seen a trend toward some of our surgical specialties, but I believe that has more to do with the faculty who are teaching,” she said. “When students find good mentors, they may choose to follow their path…also, students become close friends throughout the medical school experience and will choose a specialty path similar to that of their friends.”

According to Dr. Cole, primary care internal medicine was actually one of the more prestigious and competitive “specialty” for new docs.

“Primary medicine was more in vogue about 15 to 20 years ago when the problem was everyone going into subspecialties, kind of like now,” Cole said. “Did the government forget about them, did we forget, because then we look up and go, hey where did all the primary-care docs go?”

Especially with health-care reform under way, Cole said more people than ever will finally have the means to get care.

“There will need to be more primary-care doctors, because we will have a huge crisis on our hands without them, especially with the baby boomers getting older,” she said. “It really honestly scares me where we’re heading, if there isn’t health care reform.”