[larrys]

With a title of "Why I quit medicine" you would think somebody quit medicine because there is something wrong with medicine or the job of being a doctor.

What we have instead is a very well intentioned individual that is getting out of medicine because they want to run a startup. And that's fine. Maybe getting jealous because they see it as a path to riches and have been reading about to many outliers. Or maybe wanting to change the world.

But the job that he does is known as a "hospitalist" in this country. (Essentially Internal Medicine but not office practice).

http://www.hospitalmedicine.org/

My wife is one, and practices in a very modern hospital system. I've asked her many times about "the handoff (signout)" from the first time we were dating. Because it seemed outdated to me that when we were at dinner (and she was on call) she had to scribble down notes about sometimes 20 patients over the phone). But apparently the verbal interaction is important as well between two doctors and can't easily be summarized in writing. And I've overheard plenty of handoffs and can attest to the interactions between doctors and the nuance that can't be expressed in writing. (I even said why can't the other doctor just record something that you can listen to and a million other ideas and she shot all of them down very easily as not being practical. And she had every reason to support an idea like that if she thought it would make me money..)

Getting things done is difficult, and yes, they are very closed minded and it's hard to get change.

But drawing a comparison with "Considering I can talk to my smartphone and tell it to send a message to my dad or remind me to water the plants when I get home" doesn't take into account that whatever system is setup and accessed needs to be rock solid, dependable and can't fail in many degrees above your typical startup offering.

So this is a great ambitious idea that he has undertaken and I wish him well. But my guess is that he will have to partner with a health system in order to get adoption of this idea and work out the kinks and prove the concept.

[gautamsivakumar]

Thanks so much for your support.

You're right about how important face-to-face interaction is. That is not going to be replaced any time soon - nor should it be. But for the purpose of handover, you still need a written summary of all the patients on a ward that people can refer to. As I mentioned in the post, it would be useful to see who wrote what about each patient - so that you know who to talk to for further information. Having a handover application won't replace the morning handover meeting or a person-person handover - but it will definitely make that process less painful, more accountable and much more efficient.

(P.S. if I was jealous of the so called riches of being an entrepreneur - I would have focussed my energies on my medical career and right now I'd be driving my A5 from work rather than sleeping on a friend's couch thousands of miles from home :) I don't think anybody who takes this path should be under any illusion. Most start-ups fail and it's not an easy path. That said, I do love a lot of what building a company involves...)

[peterbessman]

Yeah... hackers are usually incredibly naive about compensation outside of their own world. For reference: http://www.medscape.com/features/slideshow/compensation/2011...

Bottom line: here in the US of A, your average doc (most certainly NOT an outlier) is making between $150k and $350k. Put that in your VC-backed pipe and smoke it.

(Debt? Between $150k-$200k for 4 years of med school. Post med school training, in the form of residency and fellowship, runs anywhere from 3-12 years and pays around the $50k mark. Basically, nobody went broke by becoming a doctor.)

Which means, of course, that the outliers can do very well. I have a friend who's Dad is an oral surgeon in the Eastern Shore of MD (what might be considered the "boonies" by some). He clears about $750k/year for a 35 hour work week. llimllib's wife above is probably around the $250k mark in the ER/ICU. If that ain't coin...

Anybody who thinks that somebody left medicine for the money knows very little about medicine.

[jonnathanson]

And that's to say nothing of big cities. $750k may be an outlier in Eastern MD, but it's not uncommon for specialists in NY or LA to clear $1M easily. True outliers can climb north of there.

Medicine is still an extremely reliable way to become everyday rich, if not outrageously so. It beats the pants off of corporate jobs, and it beats law on average (though law outliers tend to beat medicine outliers). It loses out to investment banking, but the lifestyle is far superior.

A smart person can do a lot worse than medicine.

[itmag]

I'm curious about those outliers. Are there any shared traits that can be identified?

[milesskorpen]

Most are likely specialist surgeons -- neurosurgeons and cardiothoracic surgeons and going to pull in big money. The trade off is a (really) long residency, of course.

[localhost3000]

take an evening and go have drinks with some current med students / residents - here's what you'll hear (not from all, but from many): "Obamacare is killing my profession!"..."i should've gone to b-school instead"..."i could be working at GS but now i'm busting my ass for $50k"..."i'm getting screwed! this is sooooo unfair! how am i going to survive this debt?!"...so, the problem isn't that they don't make a great living - because they do. the problem is that they feel they're entitled to make as much as other 'smart people' (aka, their former undergrad classmates at princeton) in other professional careers like corporate law or banking - which they don't. they still make way more than 99% of the population, but those people don't matter as a basis of comparison. if you counter with, "...but, you're a doctor. you're not in it for the money - you want to help people, right?" you'll get an extremely exaggerated eye-roll and the conversation will end...so, in short - it doesn't surprise me at all that a doc is leaving medicine to chase $ in tech now that it's no longer cool to tell your cronies you work in finance... (there are many exceptions and God bless them but, I've personally run into too many self-righteous, woe-is-me med students to know what to do with...) - why do you think dermatology is such a competitive field? $$$$$$

[itmag]

Sounds like unworthy people who are just clamoring for status (which income is a proxy for) instead of figuring out who they are as individuals and what their life purpose is.

[wisty]

And, once Obamacare comes in, people who actually want to be doctors (and there are enough of them) will get in.

[llimllib]

My wife's still a fellow, but you're right in the ballpark on the salary for residents and fellows. When she was an intern, we calculated her hourly wage at <$8.

You're low on your med school debt estimate, remember that loans don't just need to cover tuition, but living expenses too. Furthermore, many of her fellow not-yet-attendings are sitting on undergraduate college debt that has been deferred until they become attendings.

Nonetheless! Your overall point is totally valid. I've out-earned her for the past 6 years, but she'll even it out in about 2-3 years as an attending, and doctors frequently work well into their sixties.

(Also: Baltimore represent!)

[carbocation]

Average student debt at time of graduation was $148k in 2010 I believe. Also, Baltimore represent!

[defen]

There's also the part where you spend your 20's in med school/internship/residency. Hard to put a dollar value on that. There's obviously nothing inherently wrong with it, but it takes a certain kind of person. And you had better be damn sure you want to do medicine before committing to such a program.

[vuvuzealot]

What lucrative or otherwise worthwhile profession do you not waste your youth toiling away in? Other than trust fund custodian of course.

[defen]

Tech? You don't even need to go to college to be a successful software engineer. No matter how smart you are, if you want to be a doctor you have to do undergrad, med school, residency. 36 hour shifts, 100+ hour weeks vs working at Google. With tech you can work from anywhere, you can choose your risk/reward exposure, and if 10 years in you decide you hate it, you don't have a mountain of debt.

In medicine's favor I will say that the median income is probably higher, the median social status is much higher, you have a much better chance of directly making a positive impact on many people's lives, and you work in a field with a more balanced gender ratio.

[peterbessman]

This. And resdency is not the life destroyer people make it out to be anyway. You can find plenty of single residents in the bars of Baltimore. Whatever the demands of their program may be, its not like they're spending a year on an aircraft carrier or whatever. There are certainly downsides to the gig, but the "overworked and underpaid" idea really needs a reality check.

[re_todd]

Good point. Even with a Bachelors in Computer Science, it can be hard to make the industry average until you have at least 5 years experience.

[narrow]

Really nice response, I think what most people often fail to realize is that it's not always about the money. True entrepreneurs are terrible at handling discomforts worst of one that could easily be fixed. I left a six figure salary in the medical field, sold my bmw and moved to SV from the east-coast to fix a problem that costs this country $300 billion annually in additional healthcare costs. It's about finding the best use of your talent.

[rdl]

I'm curious which $300 billion problem this is (there are several in healthcare...)

[larrys]

If you want you can email some links to the app and I will show my wife. Depending on her reaction I might be able to get in front of some people at her hospital system. I could probably also get the hospital magazine to review it or some PR there. No guarantees but when it's ready to review send me an email.

[jcampbell1]

When a hospitalist quits medicine I am never surprised.

* The job is boring

* The pay is average for a smart person

* The doctor spends a ton of time interacting with people that have sub-average critical thinking ability

These three things are something that one cannot admit in writing, but are all true. Some people just don't have personalities that can survive being a hospitalist. One way to cope is to have hobbies outside of work. Children are a particularly popular route. The author doesn't seem to be going down that path, so I think the startup world is a great way to escape a dead end job.

[Gatsky]

Job satisfaction amongst hospitalists is actually high:

http://www.ncbi.nlm.nih.gov/pubmed/21773849

Your contention that hospitalists actually hate their jobs and lie on surveys is implausible.

Medicine is lots of things, but it's never boring, especially in hospitals which are mad, mad places. Sure hospital work is not for everyone, but that isn't because it 'sucks'.

[larrys]

What are you basing your comments on?

"The job is boring"

A hospitalist deals with more difficult cases than an internist in a office based practice.

"The pay is average for a smart person"

Are you factoring in job security? And since when does "smart" equate to pay? There are tons of well educated "smart" people (who trained to be lawyers) who are unemployed or working menial jobs.

"The doctor spends a ton of time interacting with people that have sub-average critical thinking ability"

Are you referring to patients, nurses or? What do you think the entrepreneur running the local business interacts with? At least Physicians have other physicians as co-workers. Try running your own typical small business and see who you end up interacting with.

"One way to cope is to have hobbies outside of work. Children are a particularly popular route. "

Cope with what? Did it occur to you that there are people that like this job? (This is not a comment on what my wife feels by the way I'll leave that out of this discussion..)

[jcampbell1]

There are tons of reasons the job is rewarding, and many people who love it. People quit Google or Goldman Sachs for good reasons as well, just not the reasons I listed above.

You attacked his motives for quitting, and I think you were right, but there are also motives for quitting that can't be written publicly (unless you are willing to go Greg Smith).

A doctor can't write "I am dealing with a fatty with an asshole family and mismanaged diabetes thus now has renal failure and I have to deal with this shit" in a blog. It is a reason to quit being a hospitalist, but not something a person can blog. You can also quit Goldman because your co-workers call clients muppets. Some people love it, some people hate it. I am just not surprised.

[larrys]

"A doctor can't write "I am dealing with a fatty with an asshole family and mismanaged diabetes thus now has renal failure and I have to deal with this shit" in a blog."

Total upvote for that one! Yes that is true.

"AMA" patients are quite common and frustrating. I've heard the same or similar. And of course mentally ill patients as well. I'm actually amazed at the stories I hear about families and how they treat doctors (especially woman and minorities as opposed to tall white male physicians).

I can fully understand how frustrations with the job can cause discontent. But I think that viewing the success of others (as has been pointed out by a few others here) definitely magnifies that discontent.

It takes many many years of study to become a doctor. It seems strange to me that (given they run into the "fatty patient" in other phases and should certainly know of that prior to completing training, residency etc. or even going into medicine) you wouldn't think that would be a reason for them to bail. Although yes it is possible.

[llimllib]

My wife is an ER and ICU doc. I think you're crazy thinking this guy is getting into startups for financial reasons! Anyway:

1) She consistently asserts that handoffs are the most difficult and error-prone part of the job. They take up a large chunk of her time. Further, with work hour restrictions only getting stricter, the number of handoffs is only going up.

2) While face-to-face interaction is indeed crucial, surely there are improvements to be made! Let the doctors give crucial information face-to-face, secure in the knowledge that basic patient information is stored in a trustworthy system, and you should see less errors.

> they are very closed minded and it's hard to get change.

Obviously this is a huge obstacle! But even by your own argument, there are surely ways to improve, and an ex-doctor is the ideal candidate to figure out how to do so.

[larrys]

"I think you're crazy thinking this guy is getting into startups for financial reasons!"

I didn't say that.

I gave three possibilities:

1) "getting out of medicine because they want to run a startup."

2) "Maybe getting jealous because they see it as a path to riches and have been reading about to many outliers."

3) "Or maybe wanting to change the world."

I referred to "financial reasons" in only 1 case. And even in that case I used the word "maybe".

That's hardly "thinking this guy is getting into startups for financial reasons".

I didn't say improvements needed to be made. In fact if you re-read what I said you will see I questioned the issues with handoffs.

[llimllib]

Fair enough, I apologize for misunderstanding you.