PLAN No. 915. THE PRACTICE OF MEDICINE AS A VOCATION

Acknowledgment

For the material of this monograph the Federal Board for Vocational Education is indebted to the J. Lippincott Company, Philadelphia, Pa., through its publication “Training and Rewards of the Physician,” and the Collins Publicity Service, Philadelphia, Pa., through its publication “Medicine,” School Edition, Teachers’ Auxiliary, Number One, of which this pamphlet is largely an abstract. The monograph was prepared by Dr. H. L. Smith under the direction of Charles H. Winslow, Chief of the Research Division of the Federal Board. Acknowledgment is due to Dr. John Cummings, of the Research Division, for editorial assistance.

Nature of the Physician’s Work

The work of the physician is twofold. It is his duty to cure those who are sick and to keep the well from becoming sick. Usually he is not called upon until there is illness, so that the bulk of his work is with the sick. There are two general fields of activity for a physician, that of the general practitioner, and that of the specialist. Physicians in rural communities and small towns and cities must be prepared to deal with any type of accident or disease. In cities the tendency is to specialize on some particular disease or on disturbances connected with some particular part of the body. Some specialists in large cities are able to confine their activities to office work altogether.

The work of the physician is difficult. There is a great mental strain connected with his work, for often even the life of the patient is at stake. With the general practitioner there is a great physical strain due to irregular meals and sleep, and trips in all kinds of weather. Particularly is this true of the practice of medicine for its curative effects. More and more thought in medical science is being directed in modern times to preventive medicine, that is, to ways and means of keeping well rather than of getting well. The preventive work can be done under conditions more nearly those that the physician himself chooses rather than under conditions forced upon him as is usual in the case of curative work.

Physical Characteristics Essential to Success

Of all the professions the practice of medicine makes the greatest demands along the line of a good sound body. In some professions a man with even severe physical defects can, through careful living, be successful. Good health, however, is essential to the physician in order that he may successfully withstand the long periods of strain, the irregular hours for meals and sleep, the bad weather he is often forced to go out in, and the dangers of infection.

Personal Characteristics Essential to Success

Not only must the physician be practically fit, he must have a natural aptitude and love for his profession. He should care more for medicine than for any other calling in life. By natural aptitude for medicine is meant certain foundation qualities which are essential.

It goes without saying that the physician, because of his close relationship with his patients, must be of the highest moral character in order to gain and retain the confidence of his patients. A kindly and tactful manner are essential also in gaining this confidence. One must be alert, too, particularly at the present time when rapid advances are being made in medicine—more rapid than in many other professions. Self-reliance is essential in medicine because unexpected situations are constantly arising, and emergencies, too, in which the help of other physicians can not readily be gained. To practice medicine successfully one must be constantly learning. Because of the rapid changes in medical science one’s apprenticeship is never completed. Each day some new method or means of treatment must be mastered. Moreover, one’s work is never ended. One great element of success is faithfulness to the patients one already has. This means love for the work and enthusiasm over the idea of service to mankind.

Among the characteristics that lead to failure in the practice of medicine are dislike of the work, inability to decide quickly and definitely, and lack of ability to get along well with other practitioners and with patients.

General Education Necessary as a Basis for a Course in Medicine

As a basis for a course in medicine one must have completed not only the eight grades of common-school work, but the four years of high school. Twenty-eight medical schools require two years of college work for entrance, and there is some tendency to require even four years of college work. This tendency, however, will probably not grow very fast. Certainly if the requirement is made it can not be a hard and fast rule, for the simple reason that it would raise the age of graduation from the medical school to a point higher than the age at which it is wise for one to begin practice.

The question of what subjects should be taken in premedical work is very important also. Not long ago some 300 graduates of the Harvard Medical School were asked to fill out answers to questions, giving their opinions in regard to the value of their premedical education. They were asked to state whether they thought it best in this premedical work to have a large amount of general culture—such as history, philosophy, economics, literature, and art—or a large amount of natural science—such as physics, chemistry and biology. Of the 300 reporting, 120 favored a large amount of science, while 110 favored a large amount of general culture. Seventy favored an equal amount of general science and culture. It would seem, therefore, that according to the present opinion there should be an equal amount of general culture and science in one’s college education previous to taking up the special training in medicine.

Available records show that in 1904 there were only 20 States that had made any legal provision for preliminary education to go before the definite education in medicine. Now 26 States have such a provision. At that time only 10 States required four years of high school as a minimum amount of preliminary premedical education and none required college work. Now 30 States require the four years, or an equivalent, and 8 of these 30 require either one or two years of college work in addition. At that time 36 States required that all candidates for license be graduates of legally chartered medical schools. Now 44 States make this requirement by law. At the present time 48 States require an examination to be taken by all those who are seeking license to practice medicine, unless they hold a license granted by some other State.

It is necessary, therefore, that the course of instruction taken in medicine shall include courses that will qualify the graduate to meet the requirements of the examination for license to practice in the State in which he wishes to locate. There is a tendency at present for the examination to consist not only of questions and answers, but of some practical test of one’s ability to practice medicine successfully.

The Length of the Medical Course Itself

At the present time one can not hope to get a satisfactory medical education without taking a full four-year course in the medical school. The course of study in American schools of medicine at present is definitely laid out, and one can know beforehand just what subjects will have to be taken. Even at the end of the four-year course in medicine it is not advisable to begin the practice of medicine immediately. Those who are looking for good positions in the profession should add to the theory gained in college some actual practice. The best way to get this practical work is to serve as an interne in a hospital. Appointments to such positions are often made on the basis of an examination. Such positions last sometimes for one year and sometimes for two years. During the first period of his work in the hospital an interne is directed to some extent by other physicians, but largely by his senior internes. During the last six months of his experience as an interne, however, when he is usually acting as the house doctor or surgeon, he is shown especial attention by physicians and surgeons who have patients in the hospital. There is generally no pay given the interne aside from board and lodging. The period in which one acts as an interne is considered as a further educational period. It has been said that the experience gained during the two years’ interneship in New York City’s largest hospital is considered equal to that acquired in 10 years of ordinary undirected practice.

But even after one actually begins the practice of medicine his education is not complete. In order to keep up with the times he must do a great deal of reading. He must attend district medical meetings, and also State and national meetings. Moreover, he should visit other cities and thus come in contact with the ideas of other practitioners in other communities.

An ideal standard of medical education is outlined in the following quotation:

“The American Medical Association’s ideal standard of medical education as set forth by the Council on Medical Education, after years of extensive study, research, and investigation, is given herewith:

“(a) Preliminary education sufficient to enable the candidate to enter our recognized universities, such qualifications to be passed upon by the State authorities.

“(b) A course of at least one year to be devoted to physics, chemistry, and biology, such arrangements to be made that this year could be taken either in a college of liberal arts or in the medical school.

“(c) Four years in pure medical work, the first two of which should be largely spent in laboratories of anatomy, physiology, pathology, pharmacology, etc., and the last two years in close contact with patients in dispensaries and hospitals in the study of medicine, surgery in its various branches, and the specialties.

“(d) A sixth year as an interne in a hospital or dispensary should then complete the medical course. Under such procedure the majority of students would begin the study of medicine at about 18 years and graduate from the hospital interneship at about 25.”[15]

The Income That Can Reasonably be Expected in the Practice of Medicine

The practice of medicine does not hold out the hope of any great financial reward. There are some medical practitioners who have made small fortunes in their practice, but such cases are few. The ordinary practitioner can not count on much more than a comfortable living, in accordance with the living standards in the community in which he lives. Not only is the physician’s salary generally small, but it is uncertain as well.

The following table gives the incomes of Harvard medical graduates, by classes and by years of experience, according to a study recently made:

Average Earnings of Harvard medical graduates, by classes and by years of experience.[16]

Years in practice Classes

1901 1902 1903 1904 1905 1906 1907 1908 1909 1910

First $866 $787 $541 $362 $625 $502 $350 $533 $425 $1,237

Second 827 1,089 790 995 773 826 588 1,250 874 1,083

Third 1,181 1,539 1,412 1,295 995 1,262 1,353 1,025 1,370 1,578

Fourth 1,505 1,694 1,720 1,566 1,559 1,765 1,963 1,575 1,632 1,835

Fifth 2,027 1,556 1,966 1,981 1,818 2,359 2,347 1,847 2,150

Sixth 2,341 1,837 2,333 2,277 2,347 2,997 3,202 2,360

Seventh 2,527 2,161 2,654 2,967 3,043 3,650 3,545

Eighth 3,003 2,491 3,155 3,043 3,337 4,332

Ninth 3,560 2,900 3,616 3,604 4,500

Tenth 3,524 2,963 4,135 4,535

Eleventh 3,885 3,691 4,604

Twelfth 4,422 4,130

Thirteenth 4,680

Maximum number of men 38 39 29 39 33 26 29 29 25 26

Other Rewards Connected with the Practice of Medicine

The fact that the physician’s work has a great effect upon the length of life of the patient is in itself a great reward. During the past three centuries medical science has made so great an advance that the average working life of the English-speaking people has been almost doubled. The things that have added to this increased length of life are physical comfort, medicine, hygiene, and surgery. Aside from the satisfaction of seeing length of life increased, the worthy physician enjoys the satisfaction of holding a position of trust and leadership in his community. As a result of this, he is in a position to teach others what they should know. Through his work also a physician has a chance to come in contact with all classes of people.

The Length of Time It Will Take to Establish One’s Self in the Practice of Medicine

If one decides to establish one’s self as a general practitioner he must count upon at least a year of patience and hard work with little income. At the end of the year, however, if he has been fortunate in the choice of location, and if he has a good personality, he can reasonably hope soon to inspire confidence and come into public recognition. Often he can hasten this public recognition by giving his services, free of charge, to those whom he knows to be worthy of such assistance and consideration. If it is necessary for the graduate from the medical school to become an actual earner immediately, he will probably apply for an official position in some public institution, such as health officer, teacher, medical missionary, or research worker.

The Extent of the Need for Physicians

It has been said that in America the number of doctors, in proportion to the number of people, is greater than in any other country. A recent study shows that there were in the United States 151,132 practicing physicians and surgeons, 16,920 students in medical schools, and 6,955 instructors in medical schools. Before the European war the supply of physicians in the United States was large—so large, in fact, that the income of physicians was being materially affected thereby. As a result of the war, however, new fields of practice will be opening up for American physicians in other countries, because of the fact that many physicians in those countries were either killed or disabled, and also because students have not been graduating from the medical schools in those countries during the past few years. It is said that it will take five or six years to develop or to train a new group of physicians in England, France, and in other warring nations.

How Much It Will Cost to Prepare for Practice of Medicine

If you are a soldier or a sailor discharged from the service since October 6, 1917, with a disability for which the Bureau of War-Risk Insurance will grant you compensation, and if a course in medicine is approved for you by the Federal Board, your education will be furnished free by the Government. The Bureau of War-Risk Insurance, through its compensation, will meet a part of the expense, and the Federal Board for Vocational Education will add to that amount to a minimum of $65 a month with the purpose of meeting all of your expenses for living, clothing, transportation, tuition, and incidentals.