Medicine has changed immensely over the past 40 years. Not only has the drugs, surgeries, and procedures changed, but the culture and economics of medicine have changed as well.

Radiologist and blogger Xrayvsn enlisted physician finance bloggers young and experienced to write posts on the common topic of generational perspectives of the past, present, and future of medicine:

1. Doctor of Finance MD: A Late-Career Perspective On Medicine
2. Xrayvsn: Medicine From A Mid-Career Perspective
3. Reflections of a Millennial Doctor: Beginning A Career in Medicine As a Millennial

Medical school is more expensive than ever

It is interesting to read about the days when medical school was less than 5 figures. Today, the cost of attendance for medical school tuition routinely is in the mid-5 figures, with some institutions now costing almost $100,000 per year to attend. I remember that my 4th-year medical school tuition bill was over 40% higher than the number given to me on my interview day.

It is almost impossible to avoid student loans without family assistance these days (although MD/PhD programs, military service commitment programs, tuition-free schools, and the rare merit scholarship are still options). And the average student loan burden for the class of 2017 is $192,000, according to the AAMC.

Pre-medical students are increasingly considering medical school cost when making medical school decisions. Indeed, many students are choosing to go to a less expensive state school over elite private medical schools because of cost.

Physician residency training time is longer than ever

Over the past few decades, residency training has gotten longer and longer. Radiologists now routinely have to do a 1-year fellowship after five years of residency. Emergency medicine residencies are often now four years instead of 3 years. A fellowship is increasingly necessary to become a pediatric hospitalist. Internal medicine residency used to be two years instead of 3 and fellowship was also often only two years.

Previous generations may argue that medicine is more complicated than it used to be and current residents work fewer hours than past residents because of duty-hour regulations. Whatever the reason, medical training is longer than ever. This means that current physicians will have fewer peak-earning years, and student loans will accrue interest for longer before they can be repaid.

Work-life balance is increasingly valued

In previous generations, medicine was everything for many doctors. Primary care physicians and pediatricians would round on their patients when they were admitted to the hospital. Long hours were expected and even encouraged. From a financial perspective, most physicians had ownership in their practice.

These days are long gone in medicine. Primary care physicians, family physicians, and pediatricians rarely round on their patients in the hospital, with hospitalists handling most inpatient care in internal medicine and pediatrics. Fewer and fewer physicians have ownership in their medical practice, instead choosing to be employed by a hospital system. Shift-work specialties such as emergency medicine, anesthesia, and radiology are increasing in popularity, as these specialties can allow for significant work-hour flexibility.

Is it still worth it to go to medical school? Yes!

Higher student loans. Longer residency training. Shorter hours in favor of work-life balance. Less physician ownership.

What all of these themes have in common is lower earning potential for this generation’s physicians. Some have questioned whether it is even worth it to go to medical school anymore.

But for all the pessimism about the current and future state of medicine, it’s important for us to remember why we went to medical school in the first place. There are so many reasons why medicine is an awesome career. It is a tremendous privilege to care for patients, and most patients are grateful for what we do.

To achieve financial success, the margin for error is lower than ever

Can today’s generation of doctors still achieve financial success and a secure retirement in the current healthcare environment?

Absolutely, but the margin of error is lower than for physicians of previous generations.

There are many financial errors that physicians can make to erode their potential wealth.

Not adequately saving for retirement. Paying too much in investment fees. Trading in the market. Buying inappropriate financial products from so-called financial advisors. Not investing in a tax-efficient manner.

Physicians who are currently retiring or near retirement could afford to have made many (or perhaps even all) of these errors, yet still achieve financial success. They were buoyed by high salaries, low student loan debt, and a bullish stock market.

Today’s generation of physicians can achieve financial independence, even early financial independence, through sound saving and investing principles. We can still afford to make big mistakes, but just not as many as previous generations. Financial education for the current generation of new physicians is more important than ever.

Conclusion

In my view, the practice and economics of medicine aren’t what it used to be. Today’s residents are taking on more student loan debt, finishing training later, and valuing work-life balance. As a result, today’s residents will not be able to afford to make as many financial mistakes as previous generations of doctors. But with early financial education, financial independence, and a secure retirement remains achievable for every graduating medical student and resident physician.

What do you think? How has medicine changed over the years? Is it still worth it to go to medical school? How many financial mistakes do you think the current generation of resident physicians can afford to make?

“Wall Street Physician,” a former Wall Street derivatives trader , is a physician who blogs at his self-titled site, the Wall Street Physician.

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