This question came by email and is sure to generate some comments. The submitter was especially interested in the “hive-mind's” opinion on this topic, so be sure to weigh in below. However, it's my website, so I get to answer first!
Q.
Both of my children are interested in pursuing a career in medicine, but I have mixed feelings. The profession has changed significantly since I was in med school. What would you say to your children if they expressed interest in going to medical school? Would you guide them towards your specialty or a different specialty? What about other health career professions such as nursing or physician extenders?
A.
As near as I can tell, physicians have been telling their potential trainees not to go in to medicine since the time of Hippocrates. In fact, Hippocrates himself said, “The life so short, the craft so long to learn.” And that's really the crux of the matter, isn't it? Training for a career in medicine, much less actually working as a physician for decades, represents a massive sum of time, effort, and their monetized equivalent. At a certain point, the investment simply does not make sense from an economic standpoint, and perhaps from a life happiness standpoint.
Major Commitment
Part of the reason physicians warn others against joining the profession is simply this- those who can be talked out of it should be. It requires such a commitment in order to be successful at it, that only those who are fully committed will ever get through the training. If you've always got, “I should have been a nurse/lawyer/hedge fund manager,” running through the back of your mind, you're going to walk off the job at 3 am as an intern when you're staring at that guy with two chest tubes, 4 splints, and a liver laceration and thinking you need that bed more than he does.
Everybody's Job Sucks
“Oh, you hate your job? Why didn't you say so? There's a support group for that. It's called everybody, and they meet at the bar.” — Drew Carey
Another part is simply that doctors, perhaps no differently from anybody else, like to whine and complain about their work. “We have it so bad bla bla bla….I have to wake up early in the morning….I have to stay up all night….Nobody appreciates what I do…..I'm underpaid….complying with government regulations sucks…..” Well, guess what? Pretty much every other profession has to deal with similar issues, and they get a lot less prestige and pay to do it. Do you know anyone who doesn't feel underpaid? Sometimes I sit there in the ED, surfing the internet, occasionally talking to a few anxious people about their aches and pains, maybe sticking a needle into someone's back (doesn't hurt me a bit) and realize that for some crazy reason, because I'm doing this, somebody is going to put fifteen, twenty, thirty or maybe even forty thousand dollars into my bank account at the end of the month. It's quite possible I have the best job on the planet. Are there downsides to my job? Sure. Rectal disimpactions at 2 am on a Sunday morning come to mind. But to argue there aren't enough upsides to outweigh them would be insane.
My pay is in the top 1% of Americans. Although my hospital contract is never 100% secure, it is highly unlikely that I would ever be out of work for more than as long as it takes to credential at a hospital. I average less than 30 hours a week at work. People respect, value, and pay for (well, at least 80% of the time) my opinions. I am not doing manual labor so I still have energy to do things I enjoy after work and my body won't be worn out preventing me from working in my 50s and 60s. Sure, my EMR sucks and my IT guys aren't particularly responsive, but does that really sound any different from anybody else's job?
There Was No Golden Age (Or At Least You Never Experienced It)
There is this idea floating around out there about the “Golden Age of Medicine.” There was a thread on Sermo, a physician-only forum, that explored this a bit. As near as we could tell, that golden age, if it ever existed, was over by the early 1990s when HMOs started popping up. That means anyone who has been out of training for less than 25 years, the vast majority of today's physicians, have never experienced this. Perhaps in 30 years people will look back on 2015 as the “Golden Age” before “fee for service” started transitioning to “paying for quality.” I don't know.
Decreasing Incomes Are An Issue
Will doctors continue to be paid as well as they have in the past? Maybe not. There are many factors that can contribute to decreasing incomes and many physicians are working harder for less money, both nominally and inflation-adjusted, than they did a decade ago. Some specialties get hit harder than others from time to time. But before bemoaning that fact too much, sit and think about how far those salaries can really fall. There is a lower limit, and it's probably still enough to have a very nice life with even a modicum of financial sense. I hope they don't fall too far, because then many talented people that would consider medicine and would be good at it, but who actually want to make a great living too, might choose something else instead.
The Cost of Education Is A Bigger Issue
But the bigger problem is that the commitment of time and effort is exactly the same to get that decreasing income as it has always been. And the money required has gone up exponentially. I ran into another doctor recently with $500K in student loans. I fear that by the time my kids get into their 20s that $500K will be the average debt burden for a graduating medical student and physician salaries will not have kept pace. A smart consumer will look at that cost and do some quick calculations. I can't imagine having $500K in student loans and taking a job as a pediatrician making $150K. But does it still make sense to run up a debt of $500K to be an orthopedist with a $600K salary? It probably does.
Comparing the Alternatives
Keep in mind that many of the alternatives you would encourage your children to pursue suffer from the same issues of stagnating salaries and higher debt burdens. I had an email from a public defender with a $50K salary and $250K in student loans recently. The average physician assistant debt burden at graduation is around $100K, about half that of MD/DOs, but their average pay is also about half that of MD/DOs. The numbers for attorneys are far worse. Maybe if you can get your kid to be a dot-com millionaire or a hedge fund manager then things work out better, but if you're looking for another upper middle class/high-income professional career that looks better than medicine, I don't see it out there.
What Would I Do?
I intend to encourage my children to follow their dreams with regard to their career path. I hope that between my planning and saving and their hard work that they can begin their careers with little if any educational debt. If they wish to pursue medicine, I would encourage that but would be very sure they went in with their eyes wide open. My daughters in particular, if they are also interested in being able to provide similar experiences to their children that their mother was able to provide by not working for pay in her late 20s and 30s, will need a warning of just how all-consuming a career in medicine can be. My wife teaches their PE classes, coaches their teams, runs the organizations that provide them opportunities (PTA, soccer league, church children's organization etc). It's a bit like college. In college, you can study, you can work, or you can play. You can actually do two of the three, but you can't do all three of them. As an adult, you can work full-time, you can parent, or you can volunteer in the community (or play.) But you can only really do two of the three. There's no way I could be in the schools three or four days a week on top of my career, even with as few hours as I work. And emergency medicine just doesn't line up with coaching soccer-too many evening and weekend shifts. So it really comes down to your values, whatever they may be.
Should Your Advice Differ by Gender?
If you don't get out of medical school until 27 or 28, and don't get out of residency until 30 or 32, and then need to spend five years consolidating clinical skills and paying off student loans, then you might not be able to hit the “mommy-track” until your late 30s. Your ovaries don't care about your career choice. But there are lots of alternatives to that traditional family. Stay at home dads are much more socially acceptable than in prior generations. Lots of working physicians find ways to 
successfully balance a full-time career with parenthood. And heck, lots of women have all their kids in their late 30s and even early 40s. But just as I probably didn't realize at 23 how important it would be to me to be home with my kids at 33 (rather than in the Middle East for months on end- the little one in the picture didn't know who I was when I came home from my first deployment,) I get the impression that many female physicians didn't realize at 23 how strongly they would feel the desire to only work half-time or less in their early 30s so they could spend more time mothering. It seems to affect my female colleagues, even those with a stay at home husband, more than I ever expected. Maybe I'm just selfish, and want those grandkids sooner rather than later!
I do expect to encourage my children, of both genders, to pursue entrepreneurial pursuits much more than I was ever encouraged to do so. They will certainly benefit from a solid financial education by the time they leave home. But if any of them decided that their career would include medical training and practice, I would be proud to be able to support that dream financially and emotionally. Medicine is a wonderful career with the potential to do much good above and beyond the ability it provides to support your family and meet your financial goals.
What do you think? Would you encourage your children to pursue a career in medicine? What about in your specialty? Would your advice differ between your daughters and your sons? How and why? If you would not encourage your kids to go to medical school, are you actively making plans to leave medicine? Why not? At what income level is medicine no longer worth it? Comment below!
I’d do it again in a heartbeat. About to finish EM residency and have a great job lined up. Not thrilled about spending 50% + of my time on shift typing charts, Not excited about learning to be a coder and a doctor with ICD-10, Not happy about paying off over 300k in student loan debt – But all things considered I have a dream gig. I’ll work less than 40 hours/wk get as many days off as on and get the satisfaction of helping those in my community during their time of need. I’ve got 2 sons and just welcomed a daughter a week ago. I’d encourage all of them to follow my path if they were interested – although I agree that I will heavily support any entrepreneurial ideas they have. If that business they start in high school gets up and running, I’d be more than happy to put any money I was going to pay for college toward that instead. I also agree that I will likely steer my daughter away from the long pipeline of being a physician for many of your reasons listed, but if she understands the commitment and would be most satisfied with 11+ years of training after high school I’d be proud to help any way I could.
Great positive vibes right here! What is your opinion on long-term ER physician burnout usually due to the shift schedule?
Interesting that you wrote about this. It is the #1 discussion topic in our home with our young children. We strongly oppose sending our children to medical school. The burden, stress, and years of training leave too much of a sour taste. Also interesting that you try to get into an understanding of the gender differences. You have taken a lot of heat in the past for your chauvinism so I’m not going to flame you.
We all have our belief systems though. Sometimes it is because of what we experienced, but other times it is just a feeling. Without any military experience, we also strongly discourage serving in the military as a preferred pathway.
Back to the question posed though, if the children are truly interested and capable then all you can do is support them. The highly motivated will make it. And as you said, the others should be talked out of it…which is truly what we attempt to do to 90% of people who ask for our advice.
I’m pleased that you addressed the biology of declining fertility. Ironic that women schooled in biology contort their thinking to deny their own biology.
I don’t think there’s denial so much as people who just want to fulfill all of their dreams. It just so happens that some dreams conflict with others. For example, I had this dream of spending my 20s living in a VW van as a Yosemite climbing bum. It kind of conflicted with some of my other dreams like going to medical school and raising a family. I had to make a choice. It’s like I tell my kids, you get to make your own choices in life, but you don’t get to choose the consequences of those choices.
Priorities change too. I thought being deployed sounded cool when I was 24. It wasn’t nearly as cool when I was 34.
I do not believe in the cost – value proposition of a medical career today. If the child truly sees medicine is a calling, I would not discourage it. However, I would not encourage it either, and I do not expect that my children will be drawn to the field of medicine.
My dad was a primary care physician and strongly discouraged me from medicine. Not only didn’t I listen, I went into primary care. I wouldn’t take this route again or at least I would have gone into a specialty which pays considerably more. If I didn’t have 4 kids I would be out by now. None of my kids want to be physicians which is fine with me. They are each following their own non-medical paths and I hope they will be happier than I have been with their chosen fields.
I love doctoring, but I hate the practice of medicine. And each year it seems to somehow get worse. It is very interesting that you mention “entrepreneurial pursuits”–or maybe not, given the topic of this website–but this is something that I have a strong belief in as well. Me and my six year old just did a loss/gain statement for our nascent honey bee business. More and more medicine seems to be following a bureaucrat’s recipe (do this to meet quality measures for sepsis, say this script to get good customer satisfaction scores)…basically the antithesis of an entrepreneur. Ultimately, we have a very useful skill set and people will always need doctoring. If my kid goes into medicine with eyes wide open, so be it.
Would be interesting if commenters would post their years in practice, since there are some data that suggest the older are less satisfied. I finish fellowship next year and will have above median income for about median QOL.
Being the “successful” kid from a small town I already get lots of questions funneled to me about ?going into medicine. I actively discourage those primarily seeking status or income (for themselves or their children). The time cost value just isn’t there. But if like you say they go in eyes wide open (and financial literacy is now mandatory), those are the exact people that I’d want as the next generation of physicians.
Although my understanding about the realities of being a physician has changed quite a bit since prior med school, I no longer minimize the “wow that must be amazing” that happens when talking about work at social gatherings. What I get to be a part of is pretty dang incredible, and although there are regulatory and market forces that impact it somewhat, I’m increasingly mindful there are very few people in my position (particularly when you take into account relative income and job security). Don’t know if I would get that from working at a hedge fund or in Silicon Valley.
Which specialty did you choose to go into?
Dad a doctor. Aunt and Uncle doctors. Grandfather was a Doctor. Grandmother was a nurse in an era that “lady Doctors” didn’t exist.
None of my generation are doctors, we were all highly discouraged from it. All of us are income-wise downward mobile. Medicine is the BEST paying career track, hands down.
Guess what, moving from medicine to law (half the median income) doesn’t help your problems, it just lowers your hourly bill rate. If you had the chops to be a 7-figure partner in a law firm, you’d have the jobs to be a higher 7-figure doctor. Your problem isn’t your field, it’s that you make a great income based on being a really good student from age 14 – 32, and don’t have the soft skills to get your above that.
If you have the soft-skills to make 10x the median income in your field, you’ll kill it in any field.
All of us have long hours, disrespect, under appreciation, and high costs.
Now many doctors chose a specialty based on what they liked studying instead of the field they want to practice in, but that’s a separate discussion.
P.A.s are a great example, lots of friends have re-trained into that field and are making a nice income. However, they work the same crappy hours that the Physicians to for 33%-45% of the income.
ugh, no.
Choice of field is extremely important to how much you get paid and what ooportunities there are. +-
uh, no. Choice of specialty has a large impact on potential and average earnings, not to mention your ability to leverage related investments. A pediatrician may start earning more and accumulate less debt interest when finished than an orthopedic surgeon but their earning potential, even run of the mill employed is vastly different. Private practice its even greater, now start adding in surgery center interests, etc…and the chasm grows.
EM, rads, anesthesia all good time/money/moonlighting value propositions. Even though I did a far too long of a residency Im in one of the last fields that has 100% cash pay as an option. I dont take call, dont go to the hospital, work 9-5 about 3.5 days/week (no weekends of course), and make what most would consider an excellent income. Now, its far less than I could make if I didnt have such a burdensome loan obligation and could be the owner of my own practice, but still not bad.
Other professions even if less income can have much less time until theyre earning so there is a balancing point even if superficially the incomes are greatly different.
As an aside, one doesnt have to be a fund manager to do well on wall street. Entry level analysts make around 85k and their bonus is about equal, move up a little bit and the average salary is the same as the average doc and the bonus is once again equal to that. Remember this is all decades earlier than a physician, and you’re actually getting paid at the time you have the most energy, as opposed to the opposite situation in medicine. There is definitely a difference in the way society values different sectors and it is not synonymous with how much work you put in. A youtube video or profitable website can well out earn a physician, and while there may be lots of work put in, it is no simple linear relationship. This is even more obvious when it comes to intellectual property or art (music, painting, movies, etc..).
Amen! I’m more than 50% into a radiology residency, supposedly one of the major income earners in medicine. I also, long before going back to school for pre-med, took courses to become an electrician. I kick myself for not finalizing the latter goal in favor of the former. Sure, I could eventually earn $400K/yr as a radiologist while working my tail off while under the constant threat of a lawsuit… OR I could get $100/hr as a master electrician (or more depending on the locality) and sleep a reasonable amount of hours per night while having more time for my family and little fear of litigation. If my 8-year-old daughter expresses an interest in medicine I will definitely discourage her.
Granted, I chose medicine over the electrical trades because I wanted a job that mattered, that made a meaningful difference in people’s lives. However, I would not choose ideals over common sense for my children. If sacrificing him- or herself for the greater good is your child’s dream, by all means include medicine as a viable opportunity to do that. If you just want your children to be successful and happy, look elsewhere.
Amen! I’m more than 50% into a radiology residency, supposedly one of the major income earners in medicine. I also, long before going back to school for pre-med, took courses to become an electrician. I kick myself for not finalizing my first goal in favor of the latter. Sure, I could eventually earn $400K/yr as a radiologist while working my tail off under the constant threat of a lawsuit… OR I could get $100/hr as a master electrician (or more depending on the locality) and sleep a reasonable amount of hours per night while having more time for my family and little fear of litigation. If my 8-year-old daughter expresses an interest in medicine I will definitely discourage her.
Ultimately, I chose medicine over the electrical trades because I wanted a job that made a more meaningful difference in people’s lives. However, I would not choose ideals over common sense for my children. If sacrificing him- or herself for the greater good is your child’s dream, by all means include medicine as a viable opportunity to do that. If you just want your children to be successful and happy, look elsewhere.
Excellent post Jim. Very thought provoking one. I have few additional takes to those already covered in the post.
1. Medicine is the ONLY profession, where experience matters in outcomes but does not translate into income. At least not yet while we transition from volume based to value based care. Very different from other licensed professions like legal and accounting. The rookie doctor and veteran in the same practice are paid the same per RVU be it Medicare or Blue Cross. Not so for lawyers and CPAs.
2. If somebody has IQ and perseverance to get through decade plus post college education, they will certainly do well in non licensed profession like business or engineering. Most of those jobs come with stock options, severance packages etc.
3. There has been good discussion about income and life style. It would be prudent to separate the practitioner and businessman in each physician. While those working for VA as an example, have lower incomes but good life style. However, private practitioner, is essentially running a small business and dabbling in HR, marketing, financing and host of other business matters – which eat into his /her discretionary family and personal time. Yes, they can justify it by higher incomes as I myself did.
4. Medicine offers trifecta.. Job security in up and down markets, being able to relocate across the country (to accommodate needs of spouse/ children) without having to relearn local laws or tax rules, (based on the branch of engineering, it may be hard to find jobs in half the states), cut back and then scale up the professional hours/ week (to raise children) without losing touch with the field. No other profession offers all three – something that pertains to gender discussion.
5. The personal satisfaction of helping other people and being a trusted source of health information for family and friends is very rewarding especially when professional satisfaction gets sapped with events like ICD-10, meaningful use, ACOs to name a few.
Would we do medicine again – may be, but not for financial reasons.
what do you mean “not for financial reasons”? What other job gives you a high income of 200k+ working 40 hours a week with the ability to adjust hours as you wish? Loans can be harsh, but if you work for a couple years out of college, then your loans can be much more manageable.
This is probably way off topic and I’m not a troll, though first time posting. (And I’m not a medical doctor.)
When I look at medicine, acute/emergency medicine–this is the stuff of miracles.
But most of medicine is chronic, diseases of lifestyle decisions. From children we’re taught from the dairy industry that milk, ice cream, cheese and butter is part of a necessary daily diet, and as we get older heart disease a normal happenstance.
BIL is doctor and I watch his lifestyle. He’s had hemorrhoids since his twenties but would not think of altering the types of food that he eats. I’ve seen the tests he has to take to keep his license. It seemed to me most of it was what medicine to prescribe in certain situations.
I’m a believer in T Colin Campbell’s statement that 70-80% of health care costs could be cut by eating a plant-based diet. Just as smoking was promoted by doctors years ago, it was not too long ago most doctors believed heart disease/cancer had nothing to do with diet.
Mike your post is a bit off topic but I agree with you 100% and you are only scratching the tip of the iceberg with your statement. T. Colin Cambell is considered controversial but the evidence for a plant based diet is undeniable as outlined in The China Study. Thomas Edison said ““The doctor of the future will give no medicine but will interest the patient in the care of the human frame, in diet, and in the cause and prevention of disease” and of course Hippocrates famously said “let food by thy medicine.” Yet we as doctors are literally clueless when it comes to nutrition and diet, most of what we think we know is wrong, and we are heavily influenced by the pharmaceutical and biotech industries. I am an ophthalmologist so believe me, I am as guilty of this as anyone. If you are interested in changing this and finally practicing medicine and approaching chronic disease in a way that makes sense, you may be interested in checking out The Institute For Functional Medicine, https://www.functionalmedicine.org.
One of my residency classmates now does functional medicine and is happy doing it. The last thing I personally want to do professionally is “approach chronic disease” in any way, shape, or form!
Go veg or not this theme illustrates how frustrating it is to spend most of primary care trying to keep people from killing themselves via lifestyle. I guess other professional advisors have clients who won’t take their advice but most of those folks don’t seek an advisor.
Go into medicine if your parents can foot the bill
Where are all these foreign docs getting the money?
Dentistry is approaching 500k !!!!
What’s the breaking point
At least in dentistry you start so much earlier and will amass more $$$$$ just by the time factor and another compounding or doubling of assets
Lots of foreign docs attend medical school for free or close to it in their home countries.
500K would be on the far end of the spectrum (ie. insane). Average dental school tuition is under 40K a year. So graduating with a couple hundred thousand is understandable if you are single and had some fun, or married with kids. But 500K is a choice, single or married. The most expensive school is PACIFIC at 101,500 a year, but only 3 years, and least expensive is Maryland at $14,900 a year.
Wish they had this website when I was going to school. Tons of interesting information. http://dental-schools.startclass.com/
I can speak for dentistry and medicine because I am a dentist and both my sisters are MD’s.
Dentistry – wonderful profession provided you are willing to live in an area that hasn’t been over-run with corporate influence. In the smaller less desirable places to live you can still just set up shop, treat people well and make a great living on your terms without having to be an expert at marketing. In the larger areas I think the profession has declined. You can be successful in any market.. the difference is just that the skill set for succeeding in large areas with heavy corporate influence and a lot of competition are much more difficult.. and frustrating.
My friends that work in smaller areas like this love their job and would recommend children for it. I live in a medium to medium high competition area. It’s ok, I probably wouldn’t do it again though. In a high competition area I’d never recommend it.
Medicine – i have a sister in ER and in Anesthesia – like me they had their educations paid for, so the cost wasn’t an issue.. I don’t know what it would have been like had I had the 400k+ of loans. They both seem to like what they do and are satisfied with it. I think that being a generalist or peds sounds terrible.. but agree that the higher paying professions seem like a good value still.
They sure work a lot more than I do though. That is one thing dentistry has going for it.. choose your own hours.
As WCI points out and confirmed by most comments, the real issue in dentistry/medicine is the cost of entry has so substantially changed as make it very daunting from a value perspective. If you can get it paid for, well thats a whole different ballgame and the other very positive factors mentioned by a previous poster are hard to beat. When you’re working a lot and struggling to pay everything back it doesnt take much corporate, regulatory or negative public interest to make you feel like things are not so rosy.
What has to change is the cost, really for the whole US system, it just doesnt make sense in any long term view. Not for education or incentivizing the populace, and not even from a tax or production standpoint. The government would make more money writing off loans and allowing all those in debt to feel rich and go shopping in the broader economy than to anchor down a generation and breed a bunch of frugal and tax savvy folks. It would be simple to make all loan payments tax deductible, you could pay down aggressively without penalty, they get their money, and boom, soon youre making fully taxable income and spending in the economy (about 70% consumptive, no matter our personal views). Win win.
that’s a difficult question because medicine is a noble profession, the coincidence of both a love of science/biology and charity/service to fellow man. However, the economic realities of practice today, and the direction its heading under the heavy hand of government and third party payers, I think I’d have to say no to the question. UNLESS, the child absolutely LOVED medicine, and just HAD TO pursue medicine or wouldn’t be happy, then I guess I’d just offer the advice to try to carve out his/her way to re-discover the physician patient relationship, which is truly what makes it great, and to do so in a specialty amenable to such a relationship following these guidelines
http://www.aapsonline.org/index.php/site/article/opt_out_medicare/
Interesting topic. I love practicing medicine and hate to hear doctors complain. I am using my brain, treated with respect, help people, have a secure high six figure income, a pleasant work environment, etc. What else would you want? I think anyone who complains hasn’t worked another job. Now is the golden age of medicine as far as I’m concerned. The evidence is better than ever. The hours are better than ever. The pay is in the top 5% of income (in the USA which is already one of the richest nations). Let’s be grateful!
Oh, the hubris.
” I think anyone who complains hasn’t worked another job. ”
That is amazing. Granted, many docs get their first real-paying job as a resident and thereafter. But that is just silly that even a new employee cannot voice displeasure over the wrongs of the system.
I have worked many jobs (fast food, jeweler, athlete, teacher, IT, coach, research scientist, librarian…) and none carry the burden of being a physician emotionally or physically. We all get one go at this life.
I am glad that you are living it with gratitude.
Agree. There are plenty of jobs out there that make good money, and have zero of the issues doctors are dealing with. Just because you’re complaining doesnt mean you’re wrong. I’ve also done several jobs prior to medicine. There are pros/cons to everything. The level of disrespect and sometimes outright contempt, as well as being a favorite target for politicians as fraudsters and too rich, it can be a whole different level.
I dont think a lot of it is “worth it”, but part of that is our current social and political culture (hopefully that will change). If you’re determined enough to make it through residency and have the smarts the average doc does you can excel in most arenas. Its hard to find people as reliable as physicians, and a lot of success is simply knocking it out and not quitting when someone else would (provided your endeavor has any merit of course). Its amazing how many services companies wont take money that is just being begged to be grabbed. Its a small sample but I dont know anyone that doesnt have trouble with getting a lawn, pool, contractor, etc…to call back or even if they do show up to call back with the quote. They literally leave money on the table because theyre too lazy to follow up.
Zach,
My father owned a landscaping , nursery, and snow plow business. He makes similar to what physicians make, works 100+ hours a week, (sometimes 70+ hours straight when snow is falling), never feels like he can take a day off without the business falling apart if lots of money lost (the date of my wedding which was held locally nearly killed him: “I will lose thousands” Every season is his busiest time of the year.) , his body is shot yet the exercise keeps him healthy, and people often look down on him as someone who works with his hands, yet hit him up to donate to every cause because he is a business owner. I can guarantee he is not lazy. He often chooses not to call back on small residential projects that will cost him more in time (people love to chat and expect you to come in person, free) and resources (wear on his truck) than any possible pay off of the job could justify. When someone is a difficult client, he might learn not to deal with them again. It’s not worth having someone breathe down your neck while you work, having a crazy neighbor sue you for thinking you put some fungicide on their yard, or spending time and resources trying to get the client to pay months after the work is completed. Staying away from low-paying or problem clients is not lazy, it’s strategic and smart. His overhead is astronomical . He supports 3 properties, 8 expensive trucks and/ bobcats , 8 -10 employees, and pays over $100,000 in insurance annually. Responding to a call about a patch of grass that’s dying is not worth his time. I imagine that’s why people can’t get calls back and the people who do call back will be done with their unprofitable gig in the next turn of the economy.
In practice for 10 years now in a lower paying medical specialty living in a HCOL area and still would not change my decision to go into medicine overall. There tends to be a “grass is greener” aspect to this when I read physician comments on places like Sermo. Agree with wealthy doc above, we are fortunate to practice medicine and while any job has its headaches/annoyances, we tend to be well-compensated for it. Additionally, physicians still tend to be respected in their communities and just by having an M.D., it opens up various other opportunities if you are creative enough. If you don’t like seeing patients, having an MD will certainly not hinder other opportunities whether it’s writing, tech-based, consultation, big pharma, etc.
It’ll be interesting to see how medicine evolves with advent of big data, algorithms in other aspects of life. In certain thinking-based specialties (non-procedural), I can see algorithms taking a more prominent role so in that sense, it’s hard to encourage/discourage your kids from going into a field that may look completely different than its current state.
Finally, you make a great point about planning for family and potentially delaying kids, risk of infertility. I know my 25 year old brain thought very differently about these things than even my 30 year old brain.
New website format looks great!
If I had to do it all over again, I probably would.
If I were to recommend it to one of my children, I would highlight what I did right and ask them to compare it to the path they intend to travel:
– I did a combined degree program which meant I did not have to ward off the psycho premeds to get into medical school. It also did not take multiple tries to get in.
– I was spoiled, Mommy and Daddy paid the vast majority of the way, I graduated with <$50K of debt despite graduating from a private medical school. I'm hoping to at least help with this part for my kids
– I got into the field of my choice. Above average pay. Below average hours. Almost non-existent early mornings, nights, holidays, weekends, etc. It also did not take multiple tries to get in.
– I got into the fellowship of my choice. Even further above average pay. It also did not take multiple tries to get in.
So all in all, I'm pretty happy with my decision. I wonder if my kids will have the same fortune. And if not, will they grow to resent their decision should they decide to pursue medicine?
Unequivocally, yes, I am encouraging our three to consider medicine. Daughter considered medicine but opted for using her engineering degree in industry. Son #1 applying and interviewing now. Son #2 at age 14 already thinking medicine.
As a 33 year old previous pre-med, working years in research and now sales, I think about my decision not to go into medicine all the time. Your statement, “Part of the reason physicians warn others against joining the profession is simply this- those who can be talked out of it should be”, is particularly true for me. I made the “smart” choice not to pursue medicine. But I feel it was the wrong decision.
If I could go back, I would have hunkered down and got it done. The reason for me is that years later, my friends from college who are now doctors, are actually quite fulfilled. Sure they had to sacrifice allot time, money, but I also saw them having allot of fun celebrating completed exams, traveling the world during breaks and rotations, and most are in great relationships. They worked hard and payed hard. And I feel an immense sense of purpose when around them. They are out of the tunnel and the world is open for them to utilize this versatile medical degree.
A few years ago, the question I asked myself was, “On my deathbed, what would I have wanted to do with my life?” The answer was, “to save lives”, and I saw myself doing it as a doctor. And so I recently took the MCAT, did decent. But I am having doubts again about medicine. Especially with the statistics surrounding burnout, depression, and suicide in physicians.
The Steve Jobs quote below is something that keeps me coming back to it. If I don’t try, how will I know? Is it worth committing 7 years and finishing at 40 to find out? Maybe..
“You’ve got to find what you love. And that is as true for your work as it is for your lovers. Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle. As with all matters of the heart, you’ll know when you find it. And, like any great relationship, it just gets better and better as the years roll on. So keep looking until you find it. Don’t settle…
I think it’s wonderful if you can find a job you love as much as Steve Jobs apparently loved his. But I would bet that most never find it. For me, I’m going to settle for something I enjoy most of the time, where I can do a lot of good, that pays me well, and allows me to pursue my other interests. Then I try to get at least as much fulfillment from the other interests.
This is basically exactly how I think about things, and why I dont understand the fear of retirement and being..bored.
Although there is another side to things that is over looked and down played for simplicitys sake. I think there are probably several differing pursuits in life that would be equally, if not in different ways fulfilling. The older I get the more interested I am in everything, and the more obvious it is to me I didnt have to choose this specialty and I would have been just as fulfilled and happy in another, or even another field. The only reason we pigeon hole ourselves so much is there simply isnt time to really assess things and it has to be done to finish in a competitive timely manner. People are complex, and have an ability to find their place in many different situations.
I am blessed that I got into every school I ever wanted to attend, got my first choices in residency and fellowship in a high paying sub specialty and a good job in a nice area. I am very grateful and realize I have a good situation. I still will strongly discourage my children from medical school. Time, ridiculous costs, changing government regulations are all just part of it. I’m early in my career and feel like medicine has sucked the life out of me. It is a job. And if all I’m doing is a job I’d rather have one that didn’t require so much training, doesn’t take call, doesn’t work holidays and doesn’t deal with unappreciative people on a daily basis who only want to be off work. I realize no job is perfect but if your intelligent enough and have the work ethic to make it that far in medicine you can do a lot of other things that require a lot less from you. I will encourage my children to pursue any of those things.
This. Nailed it.
Agree that few people who complain about medicine do their due diligence to consider the downsides of other fields. In particular, you need to realistically consider the chances that you’ll actually land a stable, well-paying job if you go into medicine vs other competitive fields (law, the arts, finance, science).
Eg, I was a biologist to start and never even considered medicine until my mid-20s. Although I love science per se, our current system of science employment is a pyramid scheme, and I would never go back to it. I work roughly as many hours as an intern as I did in science, and the fraction of my time spent doing BS is roughly the same. But in medicine I will never need to accept a $35K/y salary for a fixed 1-year job appointment. I will not need to fudge data and do other morally questionable things in order to apply for grants that have a 90% chance of being rejected in order to feed myself. And there is not an army of smart, young, and hungry people from places with a much lower standard of living than here able to immediately replace me if I decide I need to scale back my hours a bit or refuse to publish some ridiculous research that isn’t even wrong.
hmm…none of that sounds any different than medicine whatsoever. Pyramid scheme…little bit, used to be in the open and the reality even, now they just call it “research years”. Fudging data for useless, worthless research…the majority of every journals articles and a great way to extend low cost production for your institution. Low pay for lots of work (scut has vastly improved in the last 10 years, thats just timing) and hungry lower standard of living emigrants to take your job, you better believe it.
While you may have more control in medicine and will likely be fine, if you wrote the same and we’re talking about residency no one would have batted an eye. There is BS and waste and a bit of pyramid everywhere, its all the other intangible and different aspects to different people that need to overcome that for any one job.
The difference is that medicine has higher barriers to entry on the front end, so that assuming you can get into med school, it’s not really a pyramid system, but more of a guild system. Ie, for most specialties, there are still at least as many good attending jobs waiting to be filled as there are residents. (I understand that pathology and general surgery might be exceptions.) If you work hard in medicine and don’t screw up too much, you are virtually guaranteed a lucrative and stable job if you want it. If you work just as hard in science, you are guaranteed nothing. The stable jobs in science go to the full professors, and if you are a grad student there is only a ~10% chance at best you will end up as one. Postdocs fare only slightly better.
I like Nassim Taleb’s framework from The Black Swan to explain the difference: medicine is from Mediocristan, while science (and law, and pro sports, and drug dealing) are from Extremistan.
I dont care what you do or where you work, in a capitalistic society there is always a pyramid. What I meant though was that residency programs used to literally be pyramids where people would be kicked out or released, this has luckily been changed. Im sure the great majority found different specialties but it was still pretty crappy.
You’re right about the relatively well paying and stable part, but of course thats after the high barrier to entry. The difference in pro sports (I have often thought of the parallels in sports and medicine) is the very strange disconnect between ability and compensation. Sure some great docs will make slightly more, but due to the compensation structure and of course difficulty of discerning what is better at all in doctoring, we all get paid the same basic way. Kind of odd.
I would never talk anyone into or out of anything – that’s how you become the subject of resentment. But I would note some things to an interested person:
– As mentioned, school is getting more and more expensive, and the system of paying for it WANTS you to be in debt to them.
– Some specialties can get by as reimbursements decline (derm) but the specialties society needs more of (IM, gen surg, etc.) aren’t likely to see their incomes keep pace with inflation (to say the least).
– PAs and NPs are getting such expanded autonomy and authority with each passing year that, if you really want to be a clinic-based primary care provider, you have to factor in the reduced educational debt and earlier time to full employment into your personal calculations. As doctors get bosses and become less autonomous and more subject to bureaucratic oversight and scrutiny there is really less and less of a difference from a practical sense. I have never understood the large number of (usually female) med students who want to be part-time pediatricians…that plan is not worth the money and effort going into it unless you have other sources of revenue (spouse/family).
– The frustration that is growing as people spend as much or more time doing paperwork as they do seeing patients is very real and will only get worse.
– I hope no one gives you grief because of the fertility comments, because I know first-hand (and plenty of second-hand) that this is a very real and unfortunate issue.
– The enormous burden of obesity in the population is making this job a lot less fun for anyone who does procedures. Nothing is routine or easy, and these patient expect deliver of healthcare the same as anyone else.
– As the tolerance for adverse events starts trending towards zero, I think the stress this puts on the providers ultimately responsible for these patients is underestimated.
If I had to do it all over again, I probably still would have gone to medical school – it would have been hard to talk me out of it. But I would have chosen a different specialty, following the very real trend of the smartest people in a med school class going into the least demanding fields.
As an internal medicine physician, I wouldn’t recommend your children or anyone’s children to enter medicine to become an internal medicine physician unless they have an extremely overwhelming desire to be that type of physician. Mainly because of financial reasons, it’s not worth it to become an internal medicine physician in my area (large east coast city). Now, in more rural areas of the country, it is more cost effective. As much as I love what I do (hospitalist and primary care physician), it’s impossible to ignore the financial aspects (280k in loans to make 150k starting primary care salary, 190k starting hospitalist salary in metro area where average house price is 514,000. If my children wanted to enter medicine, I’d encourage them to follow their interests but also take financial aspects into account and consider specializing in internal medicine or entering field in medicine that makes more sense financially.
If loans weren’t a problem, then would your opinion change?
Medicine is still a good white-collar gig with good job security. Law school students are the ones who are screwed – look up “law school scam” if you ever had a choice between Medicine and Law and chose the former. It’s good for a quick hit of schadenfreude-laden, “there but for the grace of God go I” style satisfaction.
I personally would only encourage my kids to go into Medicine if they can demonstrate a good propensity for academic research and getting results. It gives you such a big advantage when it comes to residency and fellowship matching. As someone who got into med school and residency by the skin of my teeth, I’m shocked by how the process is even more brutally competitive today. I’m sure we all remember the blog post from a while back about “Not a Doctor, just an MD”, but I don’t think most people consider the truly (economically) catastrophic outcomes that can happen.
I know you put it in quotes, but we doctors have to stop propagating the government marketing term “quality.”
The problem is that the massive baby boomers are aging and requiring more and more care. The government can’t afford to pay for that care. Instead of saying that, they market to the masses that the reduction in reimbursements to doctors is paying for “quality.” If they knew quality, then we’d all look to the VA system and the IHS system as the best of the best.
Dennis I feel you and understand where you’re coming from, but I suspect you are in a fee for service model and therefore I respectfully disagree. The fact is the fee for service model is outdated, doesn’t work, is responsible for the ridiculous rise in health care costs in this country, and if eliminated and abandoned in favor of the much more sensible capitated at risk model, would solve a lot of the problems that people have been discussing on here, in particular the problem of primary care doctors and non-surgical fields not being compensated fairly. The only way that we are going to be able to practice medicine properly, fix the problem of rising healthcare costs, maintain patient safety and quality and satisfaction, start focusing on health care and not sick care, and get compensated appropriately and fairly in the era of declining government reimbursements is if we agree that it makes sense to get paid not for the volume of our care but for value of our care. This is a big issue but just think about it–if you were sick, would you want your provider to get paid for volume that he or she sees and the number of procedures done unto you and others, or for the value and quality of the care you receive?
While health care reform can be debated until the cows come home, and nobody truly knows exactly what the best solution is, I think I lean more Dennis’s way on this one. Fee for service has its flaws, but I think they’re better than the flaws of the alternate systems. For example, paying for “quality” has been a terrible idea thus far. I mean look at what quality has been defined as- whether I give an ASA to AMI patients (the difference between a good hospital and a bad hospital is 99.8% and 99.7%) and whether I do a blood culture in an admitted PNA patient (good data showing it’s a waste of money.) And since more reasonable measures, like readmissions after discharge, are arguably more in the patient’s control than anyone else’s, it seems unfair to penalize the physician or hospital for that. The doc should be incentivized only for what he can control.
We’ve tried capitation. What it does is incentivize doctors to do less, instead of more. While I agree that doing less is often EXACTLY what high quality health is, it puts patients and their doctors on opposite sides. Patients want more tests, more treatments, more days in the hospital etc etc. So they become LESS satisfied as doctors try to do less in an effort to improve the quality of care and to make more money. These now less satisfied patients are also more likely to sue when the inevitable bad outcome occurs. The truth remains that docs don’t get sued for ordering another CT scan or admitting another patient or doing another procedure. Suits are almost all “failure to diagnose” and “failure to treat” issues.
We, as a nation, can consume more health care than we can afford to consume. Like anything else in life, rational economic forces must be brought to bear. I would argue that the best way to ration care is the same way we ration food, housing, vacation, transportation etc, with money. There is no inherent “right” to health care any more than there is a “right” to food. Unfortunately, due to the fact that healthcare is very expensive (and will always be so due to expensive technology, inability to automate, and highly educated and trained providers) and thus we have the presence of third party payors, there is not a functioning market in health care.
However, you’re arguing to abolish the market, whereas I’m actually in favor of creating a functioning one. In order to get a functioning market, where various providers are truly competing for patient dollars, and patients are making rational decisions about how much care they choose to consume, we need several elements currently missing for many people:
1) Some skin in the game. Every item you consume should cost you something. If it is free, you’ll take as much of it as you can get.
2) Cost transparency. Those making decisions about how much to consume (generally doctors and patients) don’t have the data they need to make rational decisions. Most doctors don’t even know how much their own services cost, much less the cost of the tests and treatments they order.
Is there a place for a social safety net? Sure. Should it provide every possible medical treatment and test for every person for minimal cost? Rational people can disagree, but I would argue that no, it shouldn’t. The big expenses in our health care system are beginning and end of life care, expensive surgeries (think joint replacement with several days in the hospital and weeks in rehab) and ongoing prescriptions for chronic conditions. When patients have to pay four times more to be on Inderal LA instead of Lopressor, they’ll choose Lopressor more often. When families have to bring in $500 a day to keep grandma in the ICU for another week for what is probably futile care, they’ll think twice about doing so. When you have to pay $200 for your MRI, you’ll be more willing to wait 4 weeks before getting it.
At the end of the day, the way to make health care cheaper is to consume less of it, not more of it.
Like I said, fun to debate and plenty of room for disagreement on this political question.
I agree with most of those points and this is a complex issue that can be debated from many angles, and I’m no expert, I’m just another clinician like everyone else here, but I respectfully disagree with most of the second paragraph above.
As you said, doing less is often exactly what high quality health is, but I wouldn’t say that a capitated model incentives doctors to do less, and it definitely doesn’t put patients and doctors on opposite sides if done correctly. Putting patients and doctors on the same side has much more to do with communication and understanding of shared goals and aligning interests rather than what payment model you are under. In general all of us as clinicians are going to do what is appropriate no matter what–it’s in our blood long before taking the Hippocratic Oath, and any physician that deviates from the standard of care due to the payment system he is under is, needless to say, an outlier. Yes a lot of patients seemingly come in wanting tests, but that’s because they are in fear and don’t know what they are talking about, and have misinformation, and study after study has shown that the best way to approach this is not to order the test just to please the patient, since this has been shown to (not surprisingly) not only be dangerous, but to result in unsatisfied patients anyway, which is the exact opposite effect of what is intended. The evidence shows that the best practice is to identify the underlying reason why the patient wants a test done (ie I have a friend that was just diagnosed with a brain tumor, etc) and to address that concern-. Not easy to do, and trust me, when I’m busy I hate having to sit their and actually talk these things through with patients too, it eats up time, I have 10 patients waiting, and it’s actually easier to just order the damn test and get it over with, but this is another reason why the fee for service model is flawed–we don’t get paid for the time it takes to have these conversations, to counsel patients, which I think we can all agree are often times are exactly what the patient needs from us–not another MRI or LP. Patients don’t become less satisfied as doctors try to do less, they become less satisfied when there is lack of communication and explanation, this is a known fact. We all know that patient satisfaction (not surprisingly) has nothing to do with the actual quality of care that they receive (since patients who are not physicians themselves cannot judge the quality of care) and everything to do with the measures that patients use as proxies for the quality of their care, namely how much they feel listened to and cared for. Trust me, I hate that reality as much as anyone, my patient sats are not all that great, it’s frustrating but it is the reality according to the literature. True, docs don’t get sued for ordering another CT scan or admitting another patient or doing another procedure, but they don’t generally get sued even for failing to diagnose and treat–ultimately the underlying reason they get sued is for lack of rapport and not communicating–all the literature shows this over and over.
Definitely agree, at the end of the day, the way to make health care cheaper is to consume less of it, not more of it, and if we are to survive, eventually we as a society will need to find a model where we can focus on and get paid for preventative care and health care rather than sick care.
I’m not sure I see anything in there I disagree with, but also didn’t see an argument for a non-fee for service model. I agree that docs ought to be paid well for counseling/communicating also.
Ultimately, I’m a lover and not a fighter (so to speak). You certainly are entitled to your own opinion. However, I think you just made my point.
“We all know that patient satisfaction (not surprisingly) has nothing to do with the actual quality of care that they receive…”
If we all know that, then why is the government mandating patient satisfaction surveys? The studies show that higher satisfaction is associated with higher morbidity and mortality. Mandating something that is associated with doing harm is NOT my definition of “quality.” And yet they mandate it.
They know nothing about quality. That word is thrown around to market what their real intention is and what the WCI eloquently talked about above – rationing care. We can all argue whether rationing is good or bad….All I want to see is people STOP using the word “quality” and call it what it really is “rationing.”
As a single 3rd year female med student, I have to say that I can’t think of any better career than medicine for a driven, scientifically minded young soul who is also interested in serving humanity. For me and for many of my colleagues, medicine is a calling, and for myself it is the most powerful calling I have felt in my whole life.
I know that I am lucky in some ways. I have no partner to feel guilty about ignoring on weekends when I am on call or studying for shelf exams. I have no children to take care of or worry about as all parents do. I have no real responsibilities right now outside of my pursuit of clinical excellence, and that is really a very freeing feeling.
I know that I am also very lucky to be growing up in an era where 50% of medical students in my class are women as well. For millennia, women have been relegated to roles such as wife, mother, and homemaker. For millennia, women have been denied opportunities such as the ones that I have today, even simple things that I often take for granted, such as the ability to live alone as an unmarried woman with no overbearing male relative around to “protect” me. It is easy to lose sight of these privileges sometimes…but then I read a post like this, where a male physician would sternly “warn” his daughters (but not his sons!!) about the difficulties of work-life balance in medicine…and suddenly, my gratitude and respect for the feminist movement that paved this path in life for me comes rushing back to me!
It is a privilege and an honor to be able to serve humanity as a physician, and as such I do not take that role lightly. It helps that I have no interest in childbearing — not now, not ever — and that I am not particularly concerned with getting into a serious relationship or marriage any time soon (certainly not during my upcoming residency!). However, even if I did have such interests or concerns, as the majority of my female classmates do, it still would not have dissuaded me from pursuing a career in medicine. And the proof is in the pudding: obviously it did not discourage my female classmates who are wives and mothers in addition to being student doctors. You see, I’ve had a previous career where I could have balanced work and life much more easily than most physicians, male AND female, are able to. However, I really can’t imagine being this happy or feeling this fulfilled every day in any other career than medicine. And neither can many of my other female colleagues.
For all aspiring physicians reading this post, regardless of gender:
– Do NOT pursue medicine for money or perceived “prestige”
– Do NOT think that you will be able to “have it all”; there’s really no such thing in life, not even for the richest or most powerful!
Always remember that medicine is a calling. If you could be just as fulfilled and happy, or even more so in another career, then you have your answer as to whether to pursue medicine or not. But if you’re like me and you really can’t imagine being anything other than a physician, then you absolutely OWE IT TO YOURSELF TO PRACTICE MEDICINE. Remember, you only get one life, and you don’t want to regret anything on your deathbed.
For any aspiring female physicians reading this post in particular:
– Seek out female physician mentors. They will be able to answer your questions about work/life balance in a way that makes more sense to you than male physicians will be able to do.
– Medicine affords you a career filled with lifelong learning, satisfaction, and the pursuit of excellence every day. We are very blessed to be able to enter this profession in droves. We still have a long way to go in terms of achieving equality with respect to salaries and positions of power, but every future female physician has the opportunity to contribute to our fight for equality.
– It is OK to remain childfree if you so desire. Don’t fall for “peer pressure” or parental/familial pressure to get married, have kids, etc, unless YOU want to. Thanks to advances in birth control, we have the ability to pursue relationships without ever having to get married or have kids unless we WANT to. That is a VERY powerful feeling and a VERY important step towards equality: don’t let go of it!!
Stay well, and stay caffeinated!!
CF, that was extremely well-written and heartfelt. It took me back to a time, 27 years ago to be exact, when I felt exactly the same as you do (though I am a male, so minus the gender-specific stuff). I could not believe how fortunate I was, learning the mysteries of the human body, what may afflict it, and how to fix it, all the while serving and helping humankind. Such a noble pursuit…or so it seemed.
Fast forward 20+ years, and life and experience have provided many such lessons. One has seen, and lived, the darker side of humanity and the practice of medicine. I will not go into details but in the end, you have a job, not unlike the professor next door, the accountant across the street, or the independent small business owner three doors down. You go to work, get a paycheck, have financial obligations, and hopefully you can meet/exceed them.
I thank you for sharing your spirit and enthusiasm, and I hope you can carry it with you for as long as possible. The career of a physician has a way of wringing it out of you over time, and this is why many of us are far less sanguine for our children in a medical career, especially given the absurdly high cost of entry.
THanks for that! I agree Jim is a tiny bit sexist… As a feminist/ nonsexist I want men as well as women to have time with their kids, perhaps even time off- I especially want both parents to only be working 40-60 hours for most of their children’s lives at home. (My biggest bugaboo in the South/ heavily religious culture is men working 3 low wage jobs so their wives can stay home with their kids, instead of both juggling 2-3 jobs so they get to SEE their dad awake. Overworking doctors of either gender should likewise take a pay cut to spend less than 60 hours away from home every week if they have a family.)
I just got advice from a USUHS grad male who is at home (didn’t ask him how long etc) with his kids while his USUHS grad wife is a LTC/COL at work for the Army still. Sort of like I did (stay home with the kids at times while hubby stayed at work in the Army) except opposite gender. And in fact had I also been USUHS not HPSP we might’ve made the opposite gender choice- maternity benefits in the service are better than most civilian, and better than the paternity benefits back then so maybe he’d’ve gotten out of the service. And would’ve been good for both of us- while he relished the expensive toys (jets, helicopters…) he got to play with on the Army’s dime, I am more the soldier type. (Though he was better at leaving work on time to get home to us than I would have been!)
I wish I could bottle that idealism. I would have kept cases of it down in the basement and pulled out a can prn.
But I think your points are all absolutely correct. You cannot have it all, so must choose what is most important to you. If you have no interest in marriage/kids then balancing your outside life with medicine is relatively trivial.
I doubt my son will pursue a career in medicine. He’s only a first grader, so who knows. But that’s the fun thing about parenting, you get to teach your own values to your kids. We think the most important thing we’re doing is raising kids, so you can see why we would pass that value on to our children. That’s obviously not an important value to you, at least at this point in life. That’s fine, different strokes for different folks. My children are certainly aware they can do anything they want in life and get our support doing it. But we hope they will include raising a family as part of their future lives. And if raising a family and being a doc are both important values to you, you should be warned they can be difficult to balance, and are more difficult to balance if you are female than if you are male due to biological and cultural reasons.
Kudos. Thanks for a lovely and well written comment. As I have said before, you can “have it all” just maybe not at the same time. I started my peds residency in 1997 with a 6 week old and a 16 month old. It has been an amazing ride. I would encourage any woman reading this to pursue medicine. I agree with your points about finding and following what is meaningful to you as an individual. I also find keeping cynicism in check to be very helpful. Best wishes for a fulfilling life and career!
Oops. Started in 1994 with the babies. Finished in 1997.