So You Want to Be a Doctor?

by Brian Carty, MD, MSPH
10-27-2008

A couple of years ago I worked as an internist in a small town in Wisconsin and spent weekends in Madison, a college town, where the U. of Wisconsin is located.  While drinking coffee at Starbuck’s one morning, I noticed a couple sitting next to me, and the young man, in his late teens or early twenties, was studying organic chemistry.

 I made a friendly comment about organic chemistry and asked whether he had a test coming up.  He answered no; he was studying for the MCAT, the Medical College Admission Test, and was applying to medical school.

I suggested that medicine is a less attractive career than it once was.  His girlfriend had apparently heard this before.  She gathered herself up, her face contorted by rage, stood up and slammed her notebook on the table.  She said “I don’t want to hear it!  Don’t even talk about it!”  I apologetically mumbled that I was a physician and was only trying to be helpful.

She turned and stomped out into the snow-covered street.  Her boyfriend sheepishly collected his things and walked out after her.

For the past several months, Medscape, the online medical education website, has been running a blog titled “So You Want to Be a Doctor?”  There are hundreds of entries from practicing physicians on the subject of whether they would advise young people to pursue a career in medicine, and whether they would still become doctors if they knew what they know now.

From this series, there seems to be agreement among the physicians on several issues.  First, most of the physicians find medicine a rewarding (but not necessarily financially) and enjoyable profession.  Here is a representative post:

I do agree with many of the negative opinions expressed here, but I think about our message to younger persons who approach us asking if medicine may be a good choice for them. I’d tell them that “Medicine is a calling more than a profession” (William Osler). If the individual who is asking the question feels a calling for medicine, regardless of remuneration and demands on personal time for family and leisure, I’d say “Go for it, by all means, and there will be no greater happiness” for saving one life is like saving the entire world. I’d also advise those who don’t feel such calling or who wish to make money to stay away from medicine. And finally and above all: One should be prepared to serve people and have humility.

Second, most of the dissatisfaction in the medical profession is due to interference in the delivery of care and limitation of income by the government and by insurance companies.

Many physicians would not enter medicine if they had it to do over again.

That’s very nice, but I do not believe that any of these visionaries had working for serf-wages while Insurance company execs make millions off our collective toil, and Medicare unloads their burden on us - at our expense - in mind when they stated these platitudes. It’s hard to believe in a higher calling, when you can’t even pay the bills. I do not believe that it is somehow against a higher principle to be able to pay your mortgage, kids’ educations and put money away sensibly for retirement rather than proving a burden on the society you served, in your waning years. I am not a Plastic Surgeon, I don’t drive a Mercedes (it’s a Subaru and its 5 years old, my other car is a 20 year old Dodge hatchback) and I did not make even six figures much less seven. No, in my last year of primary care in internal medicine I made less than $30,000. No; rather, like 70% of my colleagues, I would steer the prospective medical student in another direction.

I wonder what happened to the young man I met at Starbucks.  Immediately after the couple left, I felt guilty.  Many physicians are ambivalent about recommending that young people apply or not apply to medical school.  Many of these docs give a lengthy, nuanced description of the pros and cons of a medical career, without clearly recommending or not recommending medicine.  I am usually, but not always, in this camp.

Maybe the premedical student from Starbucks is in medical school now.  When I was applying to medical school, I remember how hurt and indignant I felt whenever anyone suggested that there were other desirable careers besides medicine.  This is an obvious truth, but such comments were mainly meant to comfort people who weren’t accepted to medical school.  However, in the 70s, it would never have occurred to anyone that medicine might not be a well paid career.  I hope it occurs to people now. 

Still, no path in life guarantees against hardship.  Pope Benedict recently said that the current financial crisis shows that money is an illusory goal.  I don’t think he meant to minimize the sufferings of poverty.  He also said that “Whoever builds his life on this reality, on material things, on success…builds (his house) on sand.  Only the word of God is the foundation of all reality.”

 

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{ 3 comments… read them below or add one }

1

911doc 10.28.08 at 12:58 am

awesome. love this. medicine is a calling for me. tried to do other stuff but it was on my heart to be a doctor. as far as the money goes i’d say that my salary weights out at somewhere around 30% importance. the primary complaint i have about medicine in America today is that the inmates run the asylum and have been doing it long enough to both wreak havoc AND become insufferably arrogant.

best

2

Albert M. Balesh, M.D. 10.31.08 at 2:17 pm

U.S. physicians’ big bucks and opulent lifestyles were outsourced long ago to hungry, “eager-beaver” professionals in the riverside villages of the Indian and Pakistani Deltas. They latter were given access to the American Dream by a Silicon Valley juggernaut that thought more of profit margins than preserving a slice of the American pie for its own citizenry. Now that Pandora’s box has been opened, perhaps we would all be served in better stead by booking one-way fares on Air India or China Airlines. Thank you.

3

Brian Carty, MD 11.02.08 at 6:09 pm

Medicine is a great profession and always will be. Consider all those MBAs on Wall Street, no dummies I’m sure. Now it is obvious that what they have been doing for the last several years was not only useless, but destructive. That will never be a problem for the medical profession. I appreciate the comments of Dr. Balesh and 911doc. Foreign doctors have distinguished themselves in the US in clinical and academic medicine, but something is seriously wrong when US medical students will not enter important specialties. I am not well-versed on the issues surrounding immigration of highly skilled workers into the US, so I will not take a position on this at present. I agree that the inmates are running the asylum, and they are running amok and are off their medicine. It’s time to assign a big, burly orderly to each extremity and have the fifth person administer a big shot of Haldol.

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