{"id":34440,"date":"2015-07-13T05:10:47","date_gmt":"2015-07-13T05:10:47","guid":{"rendered":"http:\/\/80000hours.org\/?post_type=career_profile&p=34440"},"modified":"2024-11-22T12:29:40","modified_gmt":"2024-11-22T12:29:40","slug":"medical-careers","status":"publish","type":"career_profile","link":"https:\/\/80000hours.org\/career-reviews\/medical-careers\/","title":{"rendered":"Medical careers"},"content":{"rendered":"","protected":false},"author":68,"featured_media":34441,"parent":0,"menu_order":20,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":"[fn 1] A [systematic review of the literature](http:\/\/www.bmj.com\/content\/324\/7343\/952.short) suggests extraversion and conscientiousness are an advantage in medicine:\r\n\r\n> Within medicine, extraversion predicted success in paediatric objective examinations (0.51). A recent study using the Big 5 has shown that conscientiousness is a positive predictor of preclinical achievement (standardised regression coefficient, =0.58), even with control for previous academic performance (A level grades).\r\n\r\nThe benefit of conscientiousness is widely replicated (although the benefit of extraversion less so). See e.g. [Ferguson E et al. Pilot study of the roles of personality, references, and personal statements in relation to performance over the five years of a medical degree BMJ 2003;326:429](http:\/\/www.bmj.com\/content\/326\/7386\/429.short)\r\n\r\n> Higher scores on conscientiousness were significantly related to better performance across most (78%) of the assessments. Students scoring higher on agreeableness performed better on 33% of the assessments. Those scoring higher on emotional stability or lower on surgency [extraversion] performed better on 17% of the assessments. \r\n\r\n[Lievens F et al. Medical students' personality characteristics and academic performance: a five-factor model perspective. Medical Education, 2002 36: 1050\u20131056](http:\/\/onlinelibrary.wiley.com\/doi\/10.1046\/j.1365-2923.2002.01328.x\/abstract;jsessionid=F110772AA9E66C5D3D8BF3B8C912AF4A.f01t03?systemMessage=Wiley+Online+Library+will+be+disrupted+on+11th+July+2015+at+10%3A00-16%3A00+BST+%2F+05%3A00-11%3A00+EDT+%2F+17%3A00-23%3A00++SGT++for+essential+maintenance.++Apologies+for+the+inconvenience&userIsAuthenticated=false&deniedAccessCustomisedMessage=) (Paywalled):\r\n\r\n> Medical studies falls into the group of majors where students score highest on extraversion and agreeableness. Conscientiousness(i.e. self-achievement and self-discipline) significantly predicts final scores in each pre-clinical year. Medical students who score low onconscientiousness and high on gregariousness and excitement-seeking are significantly less likely to sit examinations successfully.\r\n\r\n[McManus IC, Keeling A, Paice E. Stress, burnout and doctors' attitudes to work are determined by personality and learning style: A twelve year longitudinal study of UK medical graduates. BMC Medicine 2004, 2:29](http:\/\/www.biomedcentral.com\/1741-7015\/2\/29) Regress working style and satisfaction against personality traits, and find that conscientiousness, emotional stability, extraversion and agreeableness help, and there is some support that openness to experience might too.\r\n\r\n> The surface-disordered approach to work is associated with high neuroticism and low conscientiousness, the PRHO [first year doctor] correlations also being highly significant in each case. Neuroticism, both in 2002 [medical students] and as a PRHO, is also associated with a perceived high workload (although in contrast to its prediction of a surface-disordered approach, conscientiousness is not a significant correlate of workload). The deep approach to work and learning is associated with being extravert and with greater openness to experience, and again the measures taken six years earlier are predictive. Finally a supportive-receptive work climate is associated with greater reported agreeableness, both in 2002 and six years earlier as a PRHO.\r\n\r\n> Doctors who are most stressed showed higher levels of neuroticism, both currently and previously, and those reporting most emotional exhaustion also had higher neuroticism levels, as well as being more introvert. High levels of depersonalisation related to lower levels of agreeableness. A greater sense of personal accomplishment related to previous deep approaches to study and learning, as well as to being more extravert. Overall satisfaction with medicine as a career related to lower levels of neuroticism.[\/fn]\r\n\r\n[fn 2] [Gallup poll](http:\/\/web.archive.org\/web\/20150406191424\/http:\/\/www.gallup.com\/poll\/161324\/physicians-lead-wellbeing-transportation-workers-lag.aspx).\r\n\r\n> In the United States, physicians lead all major occupational groups in overall wellbeing, followed by school teachers and business owners. [\/fn]\r\n\r\n[fn 3] From the [Gallup poll](http:\/\/web.archive.org\/web\/20150406191424\/http:\/\/www.gallup.com\/poll\/161324\/physicians-lead-wellbeing-transportation-workers-lag.aspx).\r\n\r\n
<\/figure>\r\n\r\n
<\/figure>[\/fn]\r\n\r\n[fn 4] The raw data from the payscale survey is [here](http:\/\/www.payscale.com\/data-packages\/most-and-least-meaningful-jobs\/full-list). I have analysed the data to derive the average ranking and percentiles of medical jobs out of all careers surveyed. [Analysis spreadsheet](https:\/\/drive.google.com\/file\/d\/0B2kbwTsBB1fwejUyVmhaSldxZDA\/view?usp=sharing).\r\n\r\nFor the career satisfaction percentage, the data is not directly available, but was reported by [Wallstreet 24\/7](http:\/\/web.archive.org\/web\/20141130050356\/http:\/\/247wallst.com\/special-report\/2013\/03\/21\/the-most-and-least-satisfied-professions\/3\/).\r\n\r\n> 1. Physician\r\n> Job types: Internist, obstetrician, anesthesiologist\r\n> Well-being index score: 78.0\r\n> Obesity: 86.0%\r\n> Pct. with health insurance: 96.7%\r\n> Pct. satisfied with job: 95.5%[\/fn]\r\n\r\n[fn 5] [BBC report](http:\/\/web.archive.org\/web\/20150320221001\/http:\/\/www.bbc.co.uk\/news\/magazine-26671221).[\/fn]\r\n\r\n[fn 6] Our own analysis of the payscale survey data. See [here](https:\/\/drive.google.com\/file\/d\/0B2kbwTsBB1fwejUyVmhaSldxZDA\/view?usp=sharing).[\/fn]\r\n\r\n[fn 7] [Shanafelt TD et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. 2012;172(18):1377-1385.](http:\/\/web.archive.org\/web\/20150402061530\/http:\/\/archinte.jamanetwork.com\/article.aspx?articleID=1351351).\r\n\r\n> Compared with a probability-based sample of 3442 working US adults, physicians were more likely to have symptoms of burnout (37.9% vs 27.8%) and to be dissatisfied with work-life balance (40.2% vs 23.2%) (P < .001 for both).\r\n\r\nBut c.f. [Keeton K, et al. Predictors of physician career satisfaction, work-life balance, and burnout. Obstet Gynecol. 2007 Apr;109(4):949-55.](https:\/\/web.archive.org\/web\/20150526135608\/http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17400859)\r\n\r\n> This national physician survey suggests that physicians can struggle with work-life balance yet remain highly satisfied with their career. Burnout is an important predictor of career satisfaction, and control over schedule and work hours are the most important predictors of work-life balance and burnout.[\/fn]\r\n\r\n[fn 8] Mean US income from the [US Census Bureau](http:\/\/web.archive.org\/web\/20141026085823\/http:\/\/www.census.gov\/hhes\/www\/cpstables\/032014\/perinc\/pinc01_000.htm) (Worked, all races, both sexes).[\/fn]\r\n\r\n[fn 9] UK data taken from the Office for National Statistics' [Annual Hours and Earnings Survey for 2013](http:\/\/www.ons.gov.uk\/ons\/publications\/re-reference-tables.html?edition=tcm%3A77-337429). The average salary for doctors is in table 14.7a, the average salary in the UK is in table 1.7a.[\/fn]\r\n\r\n[fn 10] For the UK, percentiles by income (albeit for taxpayers) are given by the [UK government](http:\/\/web.archive.org\/web\/20150416213645\/https:\/\/www.gov.uk\/government\/statistics\/percentile-points-from-1-to-99-for-total-income-before-and-after-tax), US can be derived from [US Census bureau](https:\/\/web.archive.org\/web\/20141008041029\/http:\/\/www.census.gov\/hhes\/www\/cpstables\/032014\/perinc\/pinc11_000.htm). For men and women the $150 000+ income bracket comprises 4.04% and 1.1% of the population respectively.[\/fn]\r\n\r\n[fn 11] [OECD report of physician and nursing earnings](http:\/\/web.archive.org\/web\/20150705133329\/http:\/\/www.oecd.org\/health\/health-systems\/48832370.pdf).[\/fn]\r\n\r\n[fn 12] [Sumner DM, Li DP. The (Paper)Work of Medicine: Understanding International Medical Costs. J Econ Persp 2011;25(2):3-25](http:\/\/pubs.aeaweb.org\/doi\/pdfplus\/10.1257\/jep.25.2.3), Table 2 on page 12. The paper also has useful analysis of health spending, particularly when looking at international differences of physician income.[\/fn]\r\n\r\n[fn 13] [Annual Hours and Earnings Survey for 2013](http:\/\/www.ons.gov.uk\/ons\/publications\/re-reference-tables.html?edition=tcm%3A77-337429), table 14.a.[\/fn]\r\n\r\n[fn 14] The 'inverse care law' was originally coined in [JT Hart in 1971](http:\/\/ac.els-cdn.com\/S014067367192410X\/1-s2.0-S014067367192410X-main.pdf?_tid=143d91e6-2322-11e5-adc1-00000aacb360&acdnat=1436106678_85f75e6ee2691216f5a379833f841433). For supporting evidence, see (among many examples) [Hann M, Gravelle H. The maldistribution of general practitioners in England and Wales: 1974\u20132003\r\n Br J Gen Pract. 2004;54(509):894\u2013898](http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1326105\/).\r\n\r\nTable 1 (note how the inequality measures in allocation increase when accounting for wealth, and increase further when correcting for morbidity and mortality).\r\n\r\n
<\/figure>\r\n\r\n[Mercer SW, Watt GC. The inverse care law: clinical primary care encounters in deprived and affluent areas of Scotland. Ann Fam Med. 2007 Nov-Dec;5(6):503-10.](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18025487).\r\n\r\n> Compared with patients in least deprived areas, patients in the most deprived areas had a greater number of psychological problems, more long-term illness, more multimorbidity, and more chronic health problems. Access to care generally took longer, and satisfaction with access was significantly lower in the most deprived areas. Patients in the most deprived areas had more problems to discuss (especially psychosocial), yet clinical encounter length was generally shorter. GP stress was higher and patient enablement was lower in encounters dealing with psychosocial problems in the most deprived areas. Variation in patient enablement between GPs was related to both GP empathy and severity of deprivation.\r\n\r\n[Mclean G, Sutton M, Guthrie B. Deprivation and quality of primary care services: evidence for persistence of the inverse care law from the UK Quality and Outcomes Framework\r\n J Epidemiol Community Health 2006;60:917-922](http:\/\/jech.bmj.com\/content\/60\/11\/917.short).\r\n\r\n> Little systematic association is found between payment quality and deprivation but, for 17 of the 33 indicators examined, delivered quality falls with increasing deprivation. Absolute differences in delivered quality are small for most simpler process measures, such as recording of smoking status or blood pressure. Greater inequalities are seen for more complex process measures such as diagnostic procedures, some intermediate outcome measures such as glycaemic control in diabetes and measures of treatment such as influenza immunisation.[\/fn]\r\n\r\n[fn 15] Several summary measures which point in this direction would be looking at the relationship between [health spending and life expectancy](https:\/\/web.archive.org\/web\/20150429163652\/http:\/\/ucatlas.ucsc.edu\/health\/spend\/LEvsSpend2_75.gif) and the (implied) diminishing returns. Another important figure would be the UK's [unofficial marginal health spend](http:\/\/publications.nice.org.uk\/how-nice-measures-value-for-money-in-relation-to-public-health-interventions-lgb10b\/nices-approach-to-economic-analysis-for-public-health-interventions) of ~\u00a320 000 per QALY, and how is much higher that almost all [developing world health interventions surveyed in DCCP 2](http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK11784\/figure\/A307\/?report=objectonly).[\/fn]\r\n\r\n[fn 16] WHO data from 2004 (or latest available year). DALYs per 100 000 versus doctors per 100 000. Line is the best fitting hyperbola determined by non-linear least square regression. Note the negative trend (greater doctors go along with less disability burden), and the sharply diminishing returns (above ~150 doctors per 100 000, there is little incremental decline in DALYs per 100 000 with further doctors). Full explanation in my [draft paper](https:\/\/80000hours.org\/wp-admin\/upload.php?item=38037).\r\n\r\n
<\/figure>[\/fn]\r\n\r\n[fn 17] See for example this regression analysis from Table 6 of my [draft paper](https:\/\/drive.google.com\/file\/d\/0B2kbwTsBB1fwZThKLVEtME5idU0\/view?usp=sharing). (Data from WHO and World Bank).\r\n \r\n
<\/figure>\r\n\r\nThe standardized coefficient for doctors is lower in magnitude than either GDP or a proxy for education, and thus (a fortiori) smaller than a combination of social determinants including these.[\/fn]\r\n\r\n[fn 18] See my [draft paper](https:\/\/drive.google.com\/file\/d\/0B2kbwTsBB1fwZThKLVEtME5idU0\/view?usp=sharing) for more recent numerical work. I am working on a more up to date analysis currently.[\/fn]\r\n\r\n[fn 19] Approximated from [rank-based ('grading on a curve') GPAs](https:\/\/en.wikipedia.org\/wiki\/Academic_grading_in_the_United_States#Rank-based_grading), and thus may overestimate percentile, given other systems of allocating GPAs may be more generous. [MCAT percentiles are for 2012](https:\/\/en.wikipedia.org\/wiki\/Medical_College_Admission_Test#2012_percentiles).[\/fn]\r\n\r\n[fn 20] This should not be compared to the US acceptance rate, given the likely varying pre-selection involved. [\/fn]\r\n\r\n[fn 21] Average tariff data taken from the [Guardian Good University Guide](http:\/\/www.theguardian.com\/education\/ng-interactive\/2015\/may\/25\/university-league-tables-2016#S010), [analysis here](https:\/\/drive.google.com\/file\/d\/0B2kbwTsBB1fwTDVtQjNhcEl3bGs\/view?usp=sharing). The data on A level proportions are from [this Freedom of Information request](https:\/\/www.gov.uk\/government\/publications\/a-level-grade-combinations\/a-level-grade-combinations). (N.B. There seems to be an error in how it is reported, as 'AAA' or better is reported twice. I am assuming that the options are ranked from A*A*A*, A*A*A, A*AA, AAA. If not convinced, a more conservative measure would be looking at AAA or above, which is ~13%).[\/fn]\r\n\r\n[fn 22] All taken from the [Guardian Good University Guide](http:\/\/www.theguardian.com\/education\/ng-interactive\/2015\/may\/25\/university-league-tables-2016#S010).[\/fn]\r\n\r\n[fn 23] This is adduced from the score distributions of the [UKCAT](https:\/\/web.archive.org\/web\/20131008043150\/http:\/\/www.ukcat.ac.uk\/App_Media\/uploads\/pdf\/UKCAT%202012%20Technical%20Report_abridged.pdf) and [BMAT](https:\/\/web.archive.org\/web\/20140110183122\/http:\/\/www.admissionstestingservice.org\/images\/104532-bmat-explanation-of-results-2012.pdf), which suggest an average UKCAT score of 2520 with an SD of 280, and an average BMAT of ~5 for sections 1 and 2, and an SD of ~1. Medical schools tend to be coy about how exactly they use the UKCAT or BMAT. This [collation of statements from UKCAT-using medical schools](https:\/\/web.archive.org\/web\/20150706002119\/http:\/\/www.ukcat.ac.uk\/App_Media\/uploads\/pdf\/How%20the%20UKCAT%20is%20used%202014.pdf) suggest many use 'cut offs' or have minimal scores of applicants at just below the average score, and the one school that reports averages of accepted applicants (Dundee, 2720), suggestive of selection at around the +1SD level. For the BMAT, I could only find Oxford who [reports BMAT scores of successful applicants (albeit with its own reweighting)](https:\/\/web.archive.org\/web\/20150707235232\/http:\/\/www.medsci.ox.ac.uk\/images\/study\/medicine\/admissions-statistics-distribution-of-bmat-scores-1), the successful applicants seem to have a mean 1SD higher than the total population. \r\n\r\nThis data should be extensively caveated. Due to the limited number of applications, students are likely to self-select: given the competitiveness of medicine, only particularly strong students are likely to apply to medicine (and hence take the BMAT or UKCAT) in the first place. Further, there will likely be self-selection within the pool of medical applicants, with stronger applicants selecting themselves to apply for especially competitive courses. Also, generally the more prestigious medical colleges (e.g. Oxford, Cambridge, Imperial, UCL) use the BMAT in preference to the UKCAT.[\/fn]\r\n\r\n[fn 24] [From Carson SH, Peterson JB, Higgins DM. J Pers Soc Psychol. 2003 Sep;85(3):499-506](http:\/\/www.researchgate.net\/profile\/Jordan_Peterson2\/publication\/5995267_Decreased_latent_inhibition_is_associated_with_increased_creative_achievement_in_high-functioning_individuals\/links\/02bfe50ef2db07d099000000.pdf).\r\n\r\n> The mean IQ of the sample was 128.1 points (SD 10.3), with a range of 97 to 148 points.\r\n\r\nThis may seem surprisingly low given how selective Harvard is, and that Harvard students tend to average top percentile SAT scores (which correlates strongly to IQ). This is less surprising when one considers [regression to the mean](https:\/\/en.wikipedia.org\/wiki\/Regression_toward_the_mean): Harvard students are selected (in part) for their high SAT scores, and thus people who overperform on the SAT relative to their 'real' IQ will be adversely selected.[\/fn]\r\n\r\n[fn 25] [Gibson J, Light P. Intelligence among University Scientists Nature 213, 441 - 443](https:\/\/web.archive.org\/web\/*\/http:\/\/www.nature.com\/nature\/journal\/v213\/n5075\/abs\/213441a0.html) (Paywalled). Raw data referred to in [Dutton E, Lynn R. Intelligence and Religious and Political Differences Among Members of the U.S. Academic Elite. Interdis J Res Relig 2014;10:1.](https:\/\/web.archive.org\/web\/20141127071008\/http:\/\/www.religjournal.com\/pdf\/ijrr10001.pdf) (page 6)\r\n\r\n> Social scientists: 121.8\r\n> Agricultural scientists: 121.6\r\n> Mathematicians, biochemists, and chemists: 130.0 \r\n> Biologists: 126.1 \r\n> Medicine: 127.0 \r\n> Physicists: 127.7[\/fn]\r\n\r\n\r\n[fn 26] It is perhaps disheartening to note that the most significant political figure among doctors is probably [Bashar Al-Assad](https:\/\/en.wikipedia.org\/wiki\/Bashar_al-Assad#Medicine:_1988.E2.80.931994).[\/fn]\r\n\r\n[fn 27] In very broad strokes, our view is that there is an oversupply of human capital to medicine: it attracts too many intelligent driven young people relative to its importance in the world. Hence, if we think on the margin, there should be better opportunities elsewhere for people to apply themselves.[\/fn]\r\n\r\n[fn 28] Health services should act to correct misallocations by location or workforce specialization, so that areas or specialities are not grossly under- or over-supplied. These systems are not perfect (c.f. the inverse care law), but the centralization of services in the UK gives it a chance to detect and correct these misallocations (and has a track record of making such attempts with medical staffing). It would therefore be surprising to see a ten- or hundred-fold difference in the marginal impact of (e.g.) an a cardiologist versus a neurosurgeon, or a doctor in Essex versus in Wales.[\/fn]\r\n\r\n[fn 29] [Fazel S, Ebmeier KP. Specialty choice in UK junior doctors: Is psychiatry the least popular specialty for UK and international medical graduates? BMC Med Educ. 2009; 9: 77](http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2805648\/) hows good correlation between applicants per place of specialty and consultant salary.\r\n\r\n> We examined the correlation between mean income levels by consultants in each specialty and their applicants per place by UK graduates and IMGs. Estimated annual NHS consultant salaries within the specialty groups varied from \u00a3108 k (Psychiatry) to \u00a3123 k (Surgery). Expected consultant salary correlated highly with specialty popularity in UK graduates, but not in IMGs (rs = 0.85, p = 0.006 in UK graduates; rs = 0.44, p = 0.25 in IMGs).\r\n\r\nData from [physiciansalary.com](https:\/\/web.archive.org\/web\/20150706222548\/http:\/\/3.bp.blogspot.com\/-CMjkTuAOzF4\/UQTOxSnmytI\/AAAAAAAAAC8\/tVsgxUD9vl0\/s1600\/usmle+and+physician+salary.jpg) in the US shows a similarly strong correlation between USMLE1 scores and earnings of a specialty.[\/fn]\r\n"},"categories":[342,1214,379],"class_list":["post-34440","career_profile","type-career_profile","status-publish","format-standard","has-post-thumbnail","hentry","category-careers","category-doing-good-in-your-current-job","category-medicine"],"acf":[],"yoast_head":"\nMedical careers - Career review<\/title>\n<meta name=\"description\" content=\"If you want to save lives, should you become a doctor? Surprisingly: maybe not. 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