Canadian money -canstockphoto2110984Many residents and medical students are making career decisions that will last a lifetime. Some are aware of the financial considerations while others avoid discussing the topic for fear of being seen as shallow. This month’s ALiEM MEdIC series case considers how we might help a learners as they consider money in medicine. Please join us in discussing the case this month, we would love your thoughts and advice.


P.S. Teresa Chan, Brent Thoma, Sarah Luckett-Gatopoulos, and I would also like to invite you all to register for the ALiEM MEdIC pre-conference workshop at SMACC.  Come out and be part of a LIVE version of the ALiEM MEdIC case development and release for a special SMACC version of the case series!

MEdIC Series: The Concept

Inspired by the Harvard Business Review Cases and initially led by Dr. Teresa Chan (@TChanMD) and Dr. Brent Thoma (@Brent_Thoma), the Medical Education In Cases (MEdIC) series puts difficult medical education cases under a microscope. On the fourth Friday of the month, we pose a challenging hypothetical dilemma, moderate a discussion on potential approaches, and recruit medical education experts to provide “Gold Standard” responses. Cases and responses are be made available for download in PDF format – feel free to use them! If you’re a medical educator with a pedagogical problem, we want to get you a MEdIC. Send us your most difficult dilemmas (guidelines) and help the rest of us bring our teaching to the next level.

The Case of The Finance Fiasco

by Alvin Chin (@AylC1989)

The end of summer approached and Kenneth reflected on his elective experiences as he walked to meet his classmate Jennifer for lunch. They were both transitioning into their last year of medical school training and it was time to make some seemingly difficult career decisions. They had both spent their summers exploring various fields of medicine and although many of his friends had declared an area of focus much earlier, Kenneth was still weighing his options.

“Hey Jenn! How was your summer?!”

“Nothing short of amazing! I was able to set up a few emergency medicine electives over the last two months and I’m excited to report that I’m officially an emergency gunner now!”, exclaimed Jennifer. “How about you? How were your electives? Have you decided between ophthalmology and ENT yet?”

Kenneth still wasn’t sure. He had very positive experiences in both electives and could envision a career in either field.

“Both electives were excellent. But I think I might be leaning towards ophthalmology…”

Jennifer Interrupted mid-sentence, “Baller! The money’s enticing isn’t it? I heard ophthalmologists could cap over a million a year. That makes the decision easier doesn’t it?”

Surprisingly, in his entire 4 week elective, Kenneth had never actually asked any of his staff about their pay. He knew the pay was good, but in all honesty, he had never realized it could be that much,,,

“I don’t know…. Do ophthalmologists really make that much? I just fell in loved with the balance of clinic and surgery. I’d suspect that it’s the docs who sit in the OR for most of the day that make that kind of money.”

“Wait, so you don’t have any idea of how much ophthalmologists make? Didn’t you ask questions about that on elective? ” Jennifer seemed shocked.

“I don’t know… don’t you feel like it’s such a stigma to talk about money and salaries in front of your staff?” Kenneth had always been afraid to talk about anything related to finance with his preceptors. All the information he had been getting up until now were from other medical students…. but how much more did they actually know? “How do YOU know how much you’ll make in emergency medicine?” he asked in retort.

“Well, my uncle is an emerg doc and he seems to do pretty well. But, yeah – you’re right, I’ve never asked before either! It’s interesting that we’re both in the process of deciding our future careers and we don’t really have an idea about the financial realities behind it all?”

“I just feel like people will think I’m doing it for the money if I ask about it you know? Money seems so stigmatized in medicine! I’m really having a hard time deciding between the two specialties but should money be a factor? And even if I wanted to know… who should I be talking to?”

Key Questions

  1. As a student, do you find it difficult to get reliable and accurate information about the lifestyles and monetary compensations of the different medical specialties? Do you feel comfortable talking to your preceptors about these topics?
  2. As an educator, do you think it’s appropriate for students to ask about the lifestyles and monetary compensations of the different medical specialties? How have you responded to students who have asked? Do you believe their questions have affected your impressions of those students?
  3. Should monetary compensation be an important consideration for students when deciding their specialty? How should educators respond to students with these kinds of questions?

Weekly Wrap Up

As always, we posted the expert responses and a curated commentary derived from the community responses one week after the case was published. This time the two experts are:

  • Dr. Gus Garmel, Clinical Professor (Affiliated) of Surgery (EM), Stanford University School of Medicine; Senior Emergency Physician, TPMG, Kaiser Santa Clara, CA
  • Dr. Edwin Leap, MD, West Virginia University Alumni (1990).  Completed emergency medicine residency, Methodist Hospital of Indiana (1993).  Diplomate of the American Board of Emergency Medicine.

On April 3, 2015 we will post the Expert Responses and Curated Community Commentary for the Case of The Finance Fiasco. After that date, you may continue to comment below, but your commentary will no longer be integrated into the curated commentary.  That said, we’d love to hear from you, so please comment below!

All characters in this case are fictitious. Any resemblance to real persons, living or dead, is purely coincidental. Also, as always, we will generate a curated community commentary based on your participation below and on Twitter. We will try to attribute names, but if you choose to comment anonymously, you will be referred to as your pseudonym in our writing.

(c) Can Stock Photo

Eve Purdy, BHSc MD

Eve Purdy, BHSc MD

Queen's University in Kingston, Ontario, Canada
Student editor at
Founder of