Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school

Many if not most people who go to medical school are making a huge mistake—one they won’t realize they’ve made until it’s too late to undo.

So many of the medical students, residents, and doctors tell the same story that they’ve inspired me to explain, in detail, the underappreciated yet essential problems with medical school and residency. Furthermore, most people don’t realize that nursing provides many of the job security advantages of medical school without binding them to at least a decade, and probably a lifetime, of finance-induced servitude.

The big reasons to be a doctor are a) lifetime earning potential, b) the limited number of doctors who are credentialed annually, which implies that doctors can restrict supply and thus will always have jobs available, c) higher perceived social status, and d) a desire to “help people” (there will be much more on the dubious value of that last one below). But there are numerous problems with these reasons: a) it takes a long time for doctors to make that money, b) it’s almost impossible to gauge whether you’ll actually like a profession or the process of joining that profession until you do, c) most people underestimate opportunity costs, and d) you have to be able to help yourself before you can help other people.

Straight talk about doctors and money.

Although many doctors will eventually make a lot of money, they take a long time to get there. Nurses, by contrast, can start making real salaries of around $50,000 when they’re 22. Doctors can’t start making real money until they’re at least 29, and often not until they’re much older.

Keep that in mind when you’re reading the following numbers.

Student Doctor reports that family docs made about $130 – $200K on average, which sounds high compared to what I’ve heard on the street. Student Doctor’s numbers also don’t discuss hours. The Bureau of Labor Statistics—a much more reliable source—reports that primary care physicians make an average of $186,044 per year. Notice, however, that’s an average, and it also doesn’t take into account overhead. Notice the table showing that BLS data indicates more than 40% of doctors are in primary care specialties. Family and general practice doctors make a career median annual wage of $163,510.

Nurses, by contrast, make about $70K a year. They also have a lot of market power—especially skilled nurses who might otherwise be doctors. Christine Mackey-Ross describes these economic dynamics in “The New Face of Health Care: Why Nurses Are in Such High Demand.” There’s an obvious reason for nurses’ market power: medical costs are rising and residency programs have a stranglehold on the doctor supply.

This is pretty sweet if you’re already a doctor, because it means you have very little competition and, if you choose a sufficiently demanding specialty, you can make a lot of money. But it’s pretty lousy for the healthcare system as a whole, which is lurching in the direction of finding ways to provide healthcare at lower costs. Like, say, through nurses.

Those nurses are going to end up competing with primary care docs. The New York Times recently published, “U.S. Moves to Cut Back Regulations on Hospitals,” which includes this:

Under the proposals, issued with a view to “impending physician shortages,” it would be easier for hospitals to use “advanced practice nurse practitioners and physician assistants in lieu of higher-paid physicians.” This change alone “could provide immediate savings to hospitals,” the administration said.

Primary care docs are increasingly going to see pressure on their wages from nurse practitioners for as long as health care costs outstrip inflation. For more on the subject, see “Yes, the P.A. Will See You Now,” which starts this way:

Ever since he was a hospital volunteer in high school, Adam Kelly was interested in a medical career. What he wasn’t interested in was the lifestyle attached to the M.D. degree. “I wanted to treat patients, but I wanted free time for myself, too,” he said. “I didn’t want to be 30 or 35 before I got on my feet — and then still have a lot of loans to pay back.”

To recap: nurses start making money when they’re 22, not 29, and they are eating into the market for primary care docs. Quality of care is a concern, but the evidence thus far shows no difference between nurse practitioners who act as primary-care providers and MDs who do. If you’re thinking about being an MD, you should study this issue carefully. You should also be aware that calls to lower doctor pay, like the one found in Matt Ygleasias’s “America’s Overpaid Doctors: We pay our doctors way too much,” are likely to grow louder. Note that I’m not taking a moral or economic stance about whether physician pay should be higher or lower: I’m arguing that the pressure on doctors’ pay is likely to increase, and Yglesias’s arguments are one form that pressure is likely to take.

One friend, who read this and who is a medical resident, simply said that she “didn’t realize that I was looking for nursing.” Or being a physicians assistant (P.A.). She hated her third year of medical school, as most med students do, and got shafted in her residency—which she effectively can’t leave. Adam Kelly is right: more people should realize what “the lifestyle attached to an M.D. degree” means. They should also understand “The Bullying Culture of Medical School” and residency, which is pervasive and pernicious—and contributes to the relationship failures that notoriously plague the medical world. Yet med schools and residencies can get away with this because they have you by the loans.

Why would my friend have realized that she wanted to be a nurse? Our culture doesn’t glorify nursing the way it does doctoring. So a lot of high achievers think being a doctor is the optimal road to success in the medical world. They pay attention to those eye-popping surgeon salary numbers and to the rhetoric about helping people without realizing that nurses help people too, or that their desire to help people is likely to be pounded out of them by a cold, uncaring system that uses the rhetoric of helping to sucker undergrads into mortgaging their souls to student loans. Through the magic of student loans, schools are steadily siphoning off more of doctors’ lifetime earnings. Given constraints and barriers to entry into medicine, I suspect med schools and residencies will be able to continue doing so for the foreseeable future. The logical thing for you, as an individual, to do is exit the market because you have so little control over it. Most prospective doctors who don’t exit the market live to regret it.

Sure, $160K probably sounds like a lot to a random 21-year-old college student, because it is, but after taking into account the investment value of money, student loans for undergrad, student loans for med school, how much nurses make, and residents’ salaries, most doctors’ earnings probably fail to outstrip nurses’ earnings until well after the age of 40. Dollars per hour worked probably don’t outstrip nurses’ earnings until even later.

To some extent, you’re trading happiness, security, dignity, and your sex life in your 20s, and possibly early 30s, for a financial opportunity that might not pay off until your 50s.

The higher social status thing is nice, but not nearly as nice when you’re exhausted at 3 a.m. as a third-year, or exhausted at 3 a.m. as a first-year resident, or exhausted at 3 a.m. as a third-year resident and you’re 30 and you just want a quasi-normal life, damnit, and maybe some time to be an artist. Or when you’re exhausted at 3 a.m. as a regular doctor who happens to be on-call because the senior doctors at the HMO know how to stiff the newbies.

This is where prospective medical students say, “I’m not going to be a family medicine doc.” Which is okay: maybe you won’t be (have fun in seven years of residency instead of three). But don’t confuse the salaries of superstar specialties like neurosurgery and cardiology with the average experience; more likely than not you’re average. There’s this social ideal of doctors being rich. Not all of them are, even with barriers to entry in place.

To belabor the point about money, The Atlantic recently published this: “The average female primary-care physician would have been financially better off becoming a physician assistant.” Notice: “Interestingly, while the PA field started out all male, the majority of graduates today are female. The PA training program is generally 2 years, shorter than that for doctors. Unsurprisingly, subsequent hourly earnings of PAs are lower than subsequent hourly earnings of doctors.” Although the following sentence doesn’t use the word “opportunity costs,” it should: “Even though both male and female doctors both earn higher wages than their PA counterparts, most female doctors don’t work enough hours at those wages to financially justify the costs of becoming a doctor.” I’m not arguing that women shouldn’t become doctors. But I am arguing that women and men both underestimate the opportunity costs of med school, and, if they did understand those costs, fewer would go.

Plus, if you get a nursing degree, you can still go to medical school (as long as you have the pre-requisite courses; hell, you can major in English and go to med school as long as you take the biology, math, physics, and chemistry courses that med schools require). Apparently some medical schools will sniff at nurses who want to become doctors because of the nursing shortage and, I suspect, because med schools want to maintain a clear class / status hierarchy with doctors at top. After all, med schools are run by doctors. But the reality is simpler: medical schools want people with good MCAT scores and GPAs. Got a 4.0 and whatever a high MCAT score is? A med school will defect and take you.

The underrated miseries of residency.

As one friend said, “You can see why doctors turn into the kind of people they do.” He meant that the system itself lets patients abuse doctors, doctors abuse residents, and for people to generally treat each other not like people, but like cogs. At least if you get a nursing degree and hate nursing, you can quit without having taken completely obscene student loans. You can probably go back to school and get a second degree in twelve to twenty-four months.

In normal jobs, if you hear about a better opportunity in another company or industry, you can pursue it. If you’re sufficiently dissatisfied with your university, you can transfer.[1] Many academic grad schools make quitting easy. Residencies don’t. The residency market is tightly controlled by residency programs that want to restrict residents’ autonomy—and thus their wages and bargaining power. Once you’re in a residency, it’s very hard to leave, and you can only do so at particular times, in the gap between each residency year.

This is a recipe for exploitation, and many of the labor battles during the first half of the twentieth century were fought to prevent employers from wielding this kind of power. For medical residents, however, employers have absolute power over you enshrined in law. Most other fields don’t have this level of coercion.

Once a residency program has you, they can do almost anything they want to you, and you have very little leverage. In a normal employment situation, if an employer turns out to suck, you quit. You work for three months, realize it’s not for you, walk out. Residency programs don’t let you. You don’t want to be in situations where you have no leverage, but that’s precisely what happens the moment you enter the “match.”

The match occurs in the second half of your fourth year of medical school. You apply to residencies in the first half of your fourth year, interview at various places, and then list the residencies you’re interested in. Residency program directors then rank you, and the National Residency Match Program “matches” you to each other. You’re then obligated to attend that residency program. You can’t privately negotiate with other programs, as you can for, say, undergrad admissions, or med school admissions, or almost any other normal employment situation. You can’t say, “How about another 5 grand?” or “Can I modify my contract to give me fewer days?” If you refuse to accept your “match,” then you’re blackballed from re-entering for the next three years.

Once I realized how nasty the residency match process is and how fundamentally unfair the labor market for residents is, I was shocked: residency programs have formed a cartel designed to control cost and reduce employee autonomy, and hence salaries. I only went to law school for a year, by accident, but even I know enough law and history to recognize a very clear situation of the sort that anti-trust laws are supposed to address in order to protect workers. When my friend entered the match process like a mouse into a snake’s mouth, I became curious, because the system’s cruelty, exploitation, and unfairness to residents is an obvious example of employers banding together to harm employees. Lawyers often get a bad rap in our society, and sometimes for good reasons, but a case like this looked ripe to me.

It turns out that I’m not a legal genius and that lawyers have noticed this anti-trust violation. So an anti-trust lawsuit was filed. You can read about it in the NYTimes, including a grimly hilarious line about how “The defendants say the Match is intended to help students and performs a valuable service.” Ha! A valuable service to employers, since employees effectively can’t quit or negotiate with individual employers. Yes, indeed, curtailing employee power by distorting markets is a valuable service. The article also noted this bit of regulatory capture:

Meanwhile, the medical establishment, growing increasingly concerned about the legal fees and the potential liability for hundreds of millions of dollars in damages, turned to Congress for help. They hired lobbyists to request legislation that would exempt the residency program from the accusations. A rider, sponsored by Senators Edward M. Kennedy, Democrat of Massachusetts, and Judd Gregg, Republican of New Hampshire, was attached to a pension act, which President Bush signed into law in April.

In other words, employers bought Congress and President Bush in order to screw residents.[2] If you attend med school, you’re agreeing to be screwed for three to eight years after you’ve incurred hundreds of thousands of dollars of debt, and you have few if any legal rights to attack the exploitive system you’ve entered.

(One question I have for knowledgeable readers: do you know of any comprehensive discussion of residents and unions? Residents can apparently unionize—which, if I were a medical resident, would be my first order of business—but the only extended treatment of the issue I’ve found so far is here, which deals with a single institution. Given how poorly many residents are treated, I’m surprised there haven’t been more unionization efforts, especially in union-friendly, resident-heavy states like California and New York. One reason might be simple: people fear being blackballed at their ultimate jobs, and a lot of residents seem to have Stockholm Syndrome.)

Residency program directors will no doubt argue that residency is set up the way it is because the residency experience is educational. So will doctors. There’s a very good reason they argue for residency being essential: they have a stake in the process. Residency directors and other administrators make money off residents who work longer hours and don’t have alternatives. So we shouldn’t be surprised that they seek other legal means of restricting competition (indeed, so much of the fight around medicine isn’t about patient care—it’s about regulatory environments and legislative initiatives. For one recent but very small example of the problems, see “When the Nurse Wants to Be Called ‘Doctor’,” concerning nursing doctorates.)

I don’t buy their arguments for more than ad hominem reasons. The education at many residency programs is tenuous at best. One friend, for example, is in a program that requires residents to attend “conference,” where they are supposed to learn. But “conference” usually degenerates into someone nattering and most of the residents reading or checking their phones. Conference is mandatory, regardless of its utility. Residents aren’t 10 year olds, yet they’re treated as such.

These problems are well-known (“What other profession routinely kicks out a third of its seasoned work force and replaces it with brand new interns every year?”). But there’s no political impetus to do anything about it: doctors like limiting their competition, and people are still fighting to get into medical school.

When you enter the military, you usually make a four-year commitment. Even ROTC only demands a four- to five-year commitment after graduation—at which point you can choose to do something else. Medicine is, in effect, at least a ten-year commitment: four of medical school, at least three of residency, and at least another three to pay off med school loans. At which point a smiling twenty-two-year-old graduate will be a glum thirty-two-year-old doctor who doesn’t entirely get how she got to be a doctor anyway, and might tell her earlier self the things that earlier self didn’t know.

Contrast this experience with nursing, which requires only a four-year degree. At the same time, as John Goodman points out in “Why Not A Nurse?“, nursing is much less heavily or uniformly regulated than doctoring. Nurses can move to Oregon:

Take JoEllen Wynne. When she lived in Oregon, she had her own practice. As a nurse practitioner, she could draw blood, prescribe medication (including narcotics) and even admit patients to the hospital. She operated like a primary care physician and without any supervision from a doctor. But, JoEllen moved to Texas to be closer to family in 2006. She says, “I would have loved to open a practice here, but due to the restrictions, it is difficult to even volunteer.” She now works as an advocate at the American Academy of Nurse Practitioners.

and, based on the article, avoid Texas. Over time, we’ll see more articles like “Why Nurses Need More Authority: Allowing nurses to act as primary-care providers will increase coverage and lower health-care costs. So why is there so much opposition from physicians?” Doctors will oppose this, because it’s in their economic self-interest to avoid more competition.

The next problem with becoming a doctor involves what economists call “information asymmetry.” Most undergraduates making life choices don’t realize the economic problems I’ve described above, let alone some of the other problems I’m going to describe here. When I lay out the facts about becoming a doctor to my freshmen, many of those who want to be doctors look at me suspiciously, like I’m offering them a miracle weight-loss drug or have grown horns and a tail. “No,” I can see them thinking, “this can’t be true because it contradicts so much of what I’ve been implicitly told by society.” They don’t want to believe. Which is great—right up to the point they have to live their lives, and see how their how those are lives are being shaped by forces that no one told them about. Just like no one told them about opportunity costs or what residencies are really like.

Medical students and doctors have complained to me about how no one told them how bad it is. No one really told them, that is. I’m not sure how much of this I should believe, but, at the very least, if you’re reading this essay you’ve been told. I suspect a lot of now-doctors were told or had an inkling of what it’s really like, but they failed to imagine the nasty reality of 24- or 30-hour call. They ignore information that conflicts with their current belief system about the glamor of medicine to avoid cognitive dissonance (as we all do: this is part of what Jonathan Haidt points out in The Righteous Mind, as does Daniel Kahneman in Thinking, Fast and Slow). Many now-doctors, even if they were aware, probably ignored that awareness and now complain—in other words, even if they had better information, they’d have ignored it and continued on their current path. They pay attention to status and money instead of happiness.

For example, Penelope Trunk cites Daniel Gilert’s Stumbling on Happiness and says:

Unfortunately, people are not good at picking a job that will make them happy. Gilbert found that people are ill equipped to imagine what their life would be like in a given job, and the advice they get from other people is bad, (typified by some version of “You should do what I did.”)

Here are some other vital takeaways from Stumbling on Happiness: [3]

* Making more than about $40,000/year does little to improve happiness (this should probably be greater in, say, NYC, but the main point stands: people think money and happiness show a linear correlation when they really don’t).

* Most people value friends, family, and social connections more than additional money, at least once their income reaches about $40K/year. If you’re trading time with friends and family for money, or, worse, for commuting, you’re making a tremendous, doctor-like mistake.

* Your sex life probably matters more than your job, and many people mis-optimize in this area. I’ve heard many residents and med students say they’re too busy to develop relationships or have sex with their significant others, if they manage to retain one or more, and this probably makes them really miserable.

* Making your work meaningful is important.

Go to med school without reading Gilbert at your own peril. No one in high school or college warns you of the dangers of seeking jobs that harm your sex life, because high schools are too busy trying to convince you not to have one. So I’m going issue the warning: if you take a job that makes you too tired to have sex or too tired to engage in contemporary mate-seeking behaviors, you’re probably making a mistake. Medical students are signing up for three to six years of this condition, which may explain why so many of them are miserable and unhappy; they’ve failed to optimize the things that probably would make them happy, like getting more action. They’ve made bad trade-offs without really realizing that they’ve made them.

The sex-life issue might be overblown, because people who really want to have one find a way to have one; some med students and residents are just offering the kinds of generic romantic complaints that everyone stupidly offers, and which mean nothing more than discussion about the weather. You can tell what a person really wants by observing what they do, rather than what they say. But med students and residents have shown enough agony over trade-offs and time costs to make me believe that med school does generate a genuine pall over romantic lives. There is a correlation-is-not-causation problem—maybe med school attracts the romantically inept—but I’m willing to assume for now that it doesn’t.

The title of Trunk’s post is “How much money do you need to be happy? Hint: Your sex life matters more.” If you are doing a job that consistently makes you too tired for sex, you are doing things wrong and need to re-prioritize. If you’re a nurse, you can work three twelves a week, or thirty-six total hours, and be okay. But, as described above, being a doctor doesn’t let you re-prioritize. Proto-doctors screw up their 20s and 30s, sexually speaking, because they’ve committed to a job that’s so cruel to its occupants that, if doctors were equally cruel to patients, those doctors would be sued for malpractice. And the student loans mean you effectively can’t quit. You’ve traded sex for money and gotten a raw deal. You’ll also be surrounded by people who are miserable and uptight—and who have also mis-prioritized.

You probably also don’t realize how ill-equipped you are to what your life would be like as a doctor because a lot of doctors sugarcoat their jobs, or because you don’t know any actual doctors. So you extrapolate from people who say, “That’s great” when you say you want to be a doctor. If you say you’re going to stay upwind and see what happens, they don’t say, “That’s great,” because they simply think you’re another flakey college student. But saying “I want to go to med school” or “I want to go to law school” isn’t a good way to seem level-headed (though I took the latter route; fortunately, I had the foresight to quit). Those routes, if they once led to relative success and happiness, don’t any more, at least for most people, who can’t imagine what life is like on the other end of the process. With law, at least the process is three years, not seven or more.

No one tells you this because there’s still a social and cultural meme about how smart doctors are. Some are. Lots are very good memorizers and otherwise a bit dull. And you know what? That’s okay. Average doctors seeing average patients for average complaints are fixing routine problems and directing traffic when it comes to problems they can’t solve. Medicine, meanwhile, doesn’t select for being well-rounded, innovative, or interesting; if anything, it selects against those traits through its relentless focus on test scores and so forth, which don’t appear to correlate strongly with being interesting or intellectual.

You’re not necessarily associating with the great minds of your generation by going to medical school; you may not even really be associating with great minds. You might just be associating with excellent memorizers. I didn’t realize this until I met a fair number of doctors, had repeated stabs at real conversations with them, and eventually realized that many aren’t intellectually curious and imaginative. There are, of course, plenty of smart, intellectually curious doctors, but given the meme about the intelligence of doctors, there are fewer than I expected, and plenty who see themselves as skilled technicians and little more.

A lot of doctors are the smartest stupid people you’ve ever met. Smart, because they’ve survived the academic grind. Stupid, because they signed up for med school, which is effectively signing away extraordinarily valuable options. Life isn’t a videogame. You don’t get a reset button, a do-over. Once your 20s are gone, they’re gone forever.

Maybe your 20s are supposed to be confusing. Although I’m still in that decade, I’m inclined to believe this idea. Medical school offers a trade-off: your professional life isn’t confusing and you have a clear path to a job and paycheck. If you take that path, your main job is to jump through hoops. But it offers that clarity of professional purpose at great cost in terms of hours worked, debt assumed, and, perhaps worst of all, flexibility. Given that set of trade-offs, I think a lot of people who become doctors would be better off with the standard confusion, but they take the clear path out of fear—which is the same thing that drives so many bright but unfocused liberal grads into law schools.

I’ve already mentioned prestige and money as two of the big reasons people go to med school. Here’s another: fear of the unknown. I think a lot of people start med school because it’s a clearly defined, well-lit path. The problem is that such paths are becoming increasingly crowded. You can fight the crowd, or you can find another way. Most people are scared of the other way. They shouldn’t be, and they wouldn’t be if they knew what graduate school paths are like.

For yet another perspective on the issue of not going to med school, see Ali Binazir’s “Why you should not go to medical school — a gleefully biased rant,” which has more than 200 comments as of this writing. As he says, there’s only one thing that should drive you to med school: “You have only ever envisioned yourself as a doctor and can only derive professional fulfillment in life by taking care of sick people.” If you can only derive professional fulfillment in life by taking care of sick people, however, you should remember that you can do so by being a nurse or a physician’s assistant. And notice the words Binazir chooses: he doesn’t say, “help people”—he says “taking care of sick people.” The path from this feeling to actually taking care of sick people is a long, miserable one. And you should work hard at envisioning yourself as something else before you sign up for med school.

You can help people in all kinds of ways; the most obvious ones are by having specialized, very unusual skills that lots of people value. Alternately, think of a scientist like Norman Borlaug (I only know about him through Tyler Cowen’s book The Great Stagnation; in it, Cowen also observes that “When it comes to motivating human beings, status often matters at least as much as money.” I suspect that a lot of people going to medical school are really doing it for the status).Bourlag saved millions of lives through developing hardier seeds and through other work as an agronomist. I don’t want to say something overwrought and possibly wrong like, “Bourlag has done more to help people than the vast majority of doctors,” since that raises all kinds of questions about what “more” and “help” and “vast majority” mean, but it’s fair to use him as an example of how to help people outside of being a doctor. Programmers, too, write software that can be instantly disseminated to billions of people, and yet those who want to “help” seldom think of it as a helping profession, even though it is.

For a lot of the people who say they want to be a doctor so they can help people, greater intellectual honesty would lead them to acknowledge mixed motives in which helping people is only one and perhaps not the most powerful. On the other hand, if you really want to spend your professional life taking care of sick people, Binazir is right. But I’m not sure you can really know that before making the decision to go to medical school, and, worse, even if all you want to do is take care of sick people, you’re going to find a system stacked against you in that respect. You’re not taking the best care of people at 3 a.m. on a 12- to 24-hour shift in which your supervisors have been screaming at you and your program has been jerking your schedule around like a marionette all month, leaving your sleep schedule out of whack. Yeah, someone has to do it, but it doesn’t have to be you, and if fewer people were struggling to become doctors, the system itself would have to change to entice more people into medical school.

One other, minor point: you should get an MD and maybe a PhD if you really, really want to do medical research. But that’s a really hard thing for an 18 – 22 year old to know, and most doctors aren’t researchers. Nonetheless, nurses (usually) aren’t involved in the same kind of research as research MDs. I don’t think this point changes the main thrust of my argument.

Very few people will tell you this, or tell even if you ask; Paul Graham even writes about a doctor friend in his essay “How to do What You Love:”

A friend of mine who is a quite successful doctor complains constantly about her job. When people applying to medical school ask her for advice, she wants to shake them and yell “Don’t do it!” (But she never does.) How did she get into this fix? In high school she already wanted to be a doctor. And she is so ambitious and determined that she overcame every obstacle along the way—including, unfortunately, not liking it.

Now she has a life chosen for her by a high-school kid.

When you’re young, you’re given the impression that you’ll get enough information to make each choice before you need to make it. But this is certainly not so with work. When you’re deciding what to do, you have to operate on ridiculously incomplete information. Even in college you get little idea what various types of work are like. At best you may have a couple internships, but not all jobs offer internships, and those that do don’t teach you much more about the work than being a batboy teaches you about playing baseball.

Having a life chosen for you by a 19-year-old college student or 23-year-old wondering what to do is only marginally better.

By the way, I’m far from the first person to notice that people don’t always understand what they’ll be like when they’re older; in “Aged Wisdom,” Robin Hanson says:

You might look inside yourself and think you know yourself, but over many decades you can change in ways you won’t see ahead of time. Don’t assume you know who you will become. This applies all the more to folks around you. You may know who they are now, but not who they will become.

This doesn’t surprise me anymore. Now I acknowledge that I’m very unlikely to be able to gauge what I’ll want in the future.

Contemplate too the psychological makeup of many med students. They (or “you,” if you prefer) are almost always good rule-followers and test-takers; they tend to be very good on tracks but perhaps not so good outside of tracks. Prestige is very important, as is listening to one’s elders (who may or may not understand the ways the world is changing in fundamental ways). They may find the real world large and scary, while the academic world is small, highly directed, and sufficiently confined to prevent intellectual or monetary agoraphobia.

These issues are addressed well in two books: Excellent Sheep by William Deresiewicz and Zero to One by Peter Thiel and Blake Masters. I won’t endorse everything in either book, but pay special attention to their discussions of the psychology of elite students and especially the weaknesses that tend to appear in that psychology. It is not easy for anyone to accept criticism, but that may be particularly true of potential med students, who have probably spent much of their lives being told how “smart” they are, or supposedly are. Being smart in the sense of passing classes and acing tests may not necessarily lead you towards the right life, and, moreover, graduate schools and consulting have evolved to prey on your need for accomplishment, positive feedback, and clear metrics. You are the food they need to swallow and digest. Think long and hard about that.

If you don’t want to read Excellent Sheep and Zero to One, or think you’re “too busy,” I’m going to marvel: you’re willing to spend hundreds of thousands of dollars and years of your life to a field that you’re not wiling to spend $30 and half a day to understanding better? That’s a dangerous yet astonishingly common level of willful ignorance.

Another friend asked what I wanted to accomplish with this essay. The small answer: help people understand things they didn’t understand before. The larger answer—something like “change medical education”—isn’t very plausible because the forces encouraging people to be doctors are so much larger than me. The power of delusion and prestige is so vast that I doubt I can make a difference through writing alone. Almost no writer can: the best one can hope for is changes at the margin over time.

Some med school stakeholders are starting to recognize the issues discussed in this essay: for example, The New York Times has reported that New York University’s med school may be able to shorten its duration from four years to three, and “Administrators at N.Y.U. say they can make the change without compromising quality, by eliminating redundancies in their science curriculum, getting students into clinical training more quickly and adding some extra class time in the summer.” This may be a short-lived effort. But it may also be an indicator that word about the perils of med school is spreading.

I don’t expect this essay to have much impact. It would require people to a) find it, which most probably won’t do, b) read it, which most probably won’t do, c) understand it, which most of those who read it won’t or can’t do, and d) implement it. Most people don’t seem to give their own futures much real consideration. I know a staggering number of people who go to law or med or b-school because it “seems like a good idea.” Never mind the problem with following obvious paths, or the question of opportunity costs, or the difficulty in knowing what life is like on the other side. People just don’t think that far ahead, and, even if they have knowledge like that contained in this essay, I’m not sure they’ll use it. I’m already imagining people on the Internet who are thinking about going to med school and who see the length of this essay and decide it’s not worth it—as if they’d rather spend a decade of their lives gathering the knowledge they could read in an hour. They just don’t understand the low quality of life medicine entails for many if not most doctors.

I’m not telling you what to do. I rarely tell anyone what to do. I’m describing trade-offs and asking if you understand them. It appears that few people do. Have you read this essay carefully? If not, read it again. Then at least you won’t be one of the many doctors who hate what you do, warn others about how doctors are sick of their profession, and wish you’d been wise enough to take a different course.

If you enjoyed this essay, you should also read my novel, Asking Anna. It’s a lot of fun for not a lot of money!


[0] Here’s another anti-doctor article: “Why I Gave Up Practicing Medicine.” The anti-med-school lit is available, if you care to seek it. Most potential med students don’t seem to. If you read the literature and understand the perils and want to go anyway, great.

[1] One could argue that many of the problems in American K – 12 education stem from a captive audience whose presence or absence in a school is based on geography and geographical accidents rather than the school’s merit.

[2] You can read more about the Match lawsuit here. Europe doesn’t have a Match-like system; there, the equivalent of medical residency is much more like a job.

[3] You should read Stumbling on Happiness; it did more to change my life and perspective than almost any other book. And I’ve read thousands of books. Maybe tens of thousands. Yet this one probably does more than any other to influence my day-to-day decisions and practices by clarifying how a lot of what people say they value they don’t, and how a lot of us make poor life choices based on perceived status that end up screwing us. Which is another way of saying we end up screwing ourselves. Which is what a lot of medical students, doctors, and residents have done; no one holds the proverbial gun to your head and orders you into med school (unless you have exceptionally fanatical parents). When you’re doing life, at least in industrialized Western countries, you mostly have yourself to blame for your poor choices, made without enough knowledge to know the right choices.

Thanks to Derek Huang and Bess Stillman for reading this essay.

112 responses

  1. Thank you so much for writing this article. I’m a nursing student in Houston who was up all night (and bombed a med/surg exam this morning because of it) tossing in my bed stressed about my future. I’m a smart guy, or so say standardized tests, and people around me are urging me into medical school because “I’m better than nursing”. The societal influences weigh heavily on me as well, perhaps too heavily. Your explanations of trade offs verbalized the a strongly felt but rarely discussed counter point to the arguments I hear for going to med school, like big money, women, glory, noble do-goodery, ect. In my limited experience with practiced medicine I can tell that is bull shit, but you explained why it is bull shit very clearly, and for that, youth like myself owe you many thanks. I am most happy when I am camping, reading for leisure, taking care of my still young and beautiful body, gardening, studying history, evolution, and astronomy, making art and making love and all at my own pace, damn it. Nursing will allow that; med school would not. I feel a genuine peace after reading your article, sir. Very illuminating stuff.

    • You’re welcome! The people around you, unfortunately, don’t know what they’re talking about—and they’re also not the ones who will suffer the consequences of your actions. You are.

      You’re probably not reading this, but if you are, you should drop me a line.

      • Thank you so very much for this essay. I am an incoming freshman in college. I want to be a PA but everyone keeps saying go on be a doctor. I didn’t know what to major in. As of right now I am a Biology major. Now, I think I want to major in nursing….I have been so confused. Thank you once again. I knew Med school would be too boring, time consuming, and hard for me. Thank you so much.

    • I too am finishing up nursing school and was urged towards medicine from friends. The more I do clinicals, the more I feel like I want to be the one ‘solving the problem’, not putting people on bedpans. But the reasons I entered nursing were because of the hands-on care- the IV starts, drawing up meds, and actually being at the bedside, relaying important assessment info to the residents who would then ask what I thought we should do (lol). Also due to the ability to change specialties whenever I wanted, without having to do an entire residency (maybe a couple mo’s of training at best) But in all seriousness, I’ve weighed the two sides. I really do want to go into medicine to show off to my high school class, to be the first in my family to be a doctor (or even get a bachelor’s for that matter), and to prove to those who doubted me that I can do it. I just don’t know if its worth that decade-long committment…

      An older lady I know is a retired physician who was an RN before. I asked her if it was worth it in her opinion and she said “Sadly, I don’t think it was…”. I’m going to try nursing for awhile and see how I like it. I’m definitely planning on doing some advanced practice (nurse practitioner or CRNA). However, if this Doctorate of Nursing Practice becomes a requirement for a nurse practitioner, I’d just as soon put in a few extra years and go for the MD/DO.

      Anyway, thanks for your insight- it was a fantastic article that really made me think about my future

  2. Interesting article. As a medical student, I thought I might add my 2 cents. During my interviews for medical school, each doctor I met asked me a question that centered around the same idea – why medical school and why not nursing or PA school. After all, you are right. There are much easier and less grueling ways to earn a living. The truth is, most people choose medical school because they want that, perhaps egocentric, burden that comes with being the one calling the shots.

    Just a little side note, In medical school, right at the beginning we are told that you will either have money to spend or the time to spend it – not both.

  3. Loved Loved Loved the article! I am also in nursing school and my father is an MD so I can understand your points.. I had no idea what these residents go through, although I am familiar with the continued struggles a doctor experiences throughout their career. My father is very dedicated and respected but I cannot say I would ever want to have his life. The constant stress and endless hours does not seem worth the money. Again, a riveting article…you really got me thinking.
    Thank you for this!

  4. Interesting read, but I think you missed a few points here. I am sorry that so many of your friends who are doctors or who are training to be doctors are unhappy and it is very unfortunate if this is because they did not know what they were getting into. However, based on my own experience and my conversations with my medical school classmates, I think that this is not the case for the majority of physicians in training.
    1. Many medical students and residents enjoy the process. I am much happier as a medical student than I was as an undergraduate even though I work much harder now. I am excited about what I am learning. I don’t resent the fact that I have less time for partying or that I now go on a daily 30 minute run instead of spending 90 minutes playing soccer every afternoon like I did as an undergrad. To me, the trade off is worth it. I think many of my classmates feel the same way. Although I have definitely interacted with some overworked, overtired residents, most of the residents and fellows that I interact with are still passionate about what they do and excited about their jobs. I would also like to add that about half of my class is in a committed, long-term relationship with a significant other. Quality of life is a subjective measure (they even teach you that in medical school). While the author of this article may think physicians have a poor quality of life, there are many medical students and physicians who think that their quality of life is excellent.
    2. While there is some overlap between what nurses, PAs, and doctors do, there are also some significant differences. I will use an example to illustrate my point. I was recently in clinic and my team saw a patient with a very rare disease. The PA on the team (who is truly excellent at her job) saw the patient first and did a basic physical exam. If you just want to see patients and do physical exams, then maybe becoming a PA is the right job for you. The doctor then saw the patient and, because the patient’s disease is very rare, was unsure what the best course of action was. He then went back to his office and started delving into the scientific literature, reading case reports and reading about clinical trials conducted in patients with a disease that has a different presentation, but a similar etiology. The doctor decided the patient should undergo genetic testing and then did some more research to decide exactly what testing should be done. Nurses and PAs do not get to go on information hunts like this. The reason I and many of my classmates have chosen to pursue an MD is because although we want to be involved in patient care, we also want to work through problems like this.
    3. Bench research. I have never heard of a nurse or PA who has a wet lab. If you want a balance of basic science or translational research and patient care, then you need to get an MD or MD/PhD ( although I know many physicians without a PhD who run labs).

    In conclusion, I agree that one shouldn’t go to medical school to make a lot of money or if the only reason they want to become a doctor is to “help people.” But, if you are a curious person who finds medicine, pathology, and the human body fascinating and enjoys being intellectually challenged, then don’t let this article scare you away. While medical students, residents, and young physicians are not rich, most of us did not go into this profession with the intention of becoming rich. So shadow several physicians and talk to medical students and residents before you apply to medical school. Try working in a lab. It doesn’t take that much effort to get a pretty good idea of what life as a physician is like or what training to be one involves.

    • you the right guy for my answer, and my gratitude on behalf of the explanation. You inspired me with deeper understanding behind a MD/PhD and the significants. That is, the reason for why I choose to pursue the medical route. So, as of now I’m in my four semester obtaining an A.A.S Applied science degree in Medical Assisting, then to transfer to a B.S in Physician assistant. My goal is to enter to a Medical collage with a joint Md/PhD degree, my question is can I enter medical school? and would they accept all my credits-from my future B.S In PA?

    • I would like to comment on your discussion of nurses and PAs not researching up to date scientific literature. I am a nurse who spent a year in medical school before deciding I instead wanted to get my Doctorate of Nursing Practice. My program is very driven on researching up to date medical literature. We are taught from day one how to utilize scientific literature when presented with a chief complaint, history, and physical and are unsure of a diagnosis. We also have to present clinical practice guidelines to support every decision we make in clinical rotations and then provide justifications for anytime we do not follow those guidelines. I am not sure if all NP, PA, or MD programs are like mine, but from my experience working with a variety of providers most are at least trained in the basics of literature research.

    • Thank you so much for sharing your insights. Definitely helpful to hear this first hand from someone who is a med student. The example was clear as day and the main reason I would like to pursue med school vs. pa. While PA makes more sense in some ways, I fear the limitations of the field will outweigh the benefits for me. Again, thank you SO much for sharing this and taking the time for it, I can’t tell you how much this helps.

    • Thank you! I’m in the premed process, and had some worries about whether or not being a doctor would be what I really wanted. Thankfully, your post – specifically the anecdote you provided – has confirmed my decision. Nurses and PA’s do the routine procedures to ensure patient’s health, but the doctor does the research, diagnosis and coordination of treatment.

      • The above example is not entirely true of all PA – MD relationships. I work with some amazing orthopedic surgeons and I will fully admit that their 9 (all my docs are fellowship trained so 10) years of training give them a huge leg up on me. However, reducing the description of the PA to “doing the physical exam” and nothing else is selling the profession short. It really is practicing medicine, and we have all missed something that someone else has caught and vice versa. Each practice utilizes their PAs and NPs differently and that has a lot to do with job satisfaction. In our group the PAs run their own clinic including satellite clinics, but I have friends in other practices that share clinic with the MDs but then take primary call. It’s different everywhere

  5. This is an interesting article, and I think anyone who is unaware of the points you’ve made would be well served to ponder your perspective and logic. At the risk of oversimplifying:

    1. Don’t go into medicine to make a lot of money – because the numbers don’t add up.
    2. Even if you do make a lot of it, money doesn’t correlate well with happiness.
    3. You can help people in 1000 other professions, including several in health care.
    4. Medical care and training is burdened by powerful groups like doctors who act in their own interests, sometimes to the detriment of those of us still going through the process.

    These are all extremely important points, and one would be naive and foolish to not take them seriously as they consider a future as a doctor. But they don’t sap the profession of all its value for each and every person considering it. I know you concluded by saying you don’t presume to tell anyone what to do, but I think it’s important for your readers to know that, in spite of these problems, there ARE still legitimate reasons to pursue the profession.

    Much like Mr. Anonymous, I’m a current medical student, and my experience sounds similar to his/hers. Yes, it’s a huge commitment, and I’ve had to modify my lifestyle to make it all work. But it’s hardly joyless: I love the material, the perpetual challenge, learning to interact with patients and addressing illnesses, and developing the skills to be a leader and an authority figure in the medical field.

    Even though it’s a busy schedule, I prioritize the other things I love doing. I still play the piano and guitar a lot, I relax and listen to music, I exercise regularly, I spend time with my wife and we travel, I read a lot of books (and blogs like this one) and follow along with culture, politics, and sports. And I have found a lot of my classmates have a similar experience. I also know a big group of people who live a very unbalanced and stressful life, and another group of people who didn’t think through the whole process very well and their whining is relentless. Medicine is not alone in its challenges to your personal life and social livelihood. Every driven/ambitious person pursuing their passion in any professional field has to figure out how to pull it off, and each profession has different challenges in that regard.

    Here’s my perspective, it’s nothing new. Medicine is not for everyone, and it’s difficult, and imperfectly organized, and expensive, and you will lose flexibility. It depends on what your priorities are, as to whether or not going for an MD is a good choice. So be damn sure, as much as possible, before you commit. The onus of due diligence is on the applicant, though The System has a responsibility for honesty so applicants can actually make good decisions for themselves, (yet another issue). Unless you’re one of the simple few whose only motivation is either money or “to help people” (and this article does all your homework for you), you have a lot of work to do. Start by shadowing doctors and developing a rapport to the point where they’ll be honest about both the good and bad stuff.

    Thanks Mr. Seliger for your writing. I think I ought to track down “Stumbling on Happiness” and put it in the queue.

    • Thanks for your comment.

      Here’s my perspective, it’s nothing new. Medicine is not for everyone, and it’s difficult, and imperfectly organized, and expensive, and you will lose flexibility.

      I think that if someone really knows the risk and understands the limitations imposed by debt, and the cartel that residency programs have formed, and that they probably can’t judge their future selves, and so on, and they still want to go—then they should go.

      My real problem is that so many med students, residents, and doctors say that they didn’t know the risks, that no one explained them, and now they’re stuck doing something for a decade or more. Those are the people I’m really trying to reach, and there seems to be a lot of them.

      • May I suggest a different title for your article then? Maybe to “Why some aspiring physicians…” instead? If your purpose is to reach out to people that don’t know the risks (which is a great thing to do), then do that, instead of unintentionally offending people who have put a great deal of work and research into deciding between the jobs with its currently sensationalist title.

        I currently know a number of nurses and PA’s–*especially* PA’s– that are trying to go to medical school because they feel too limited in their positions. Just as it is certainly a shame when aspiring MD’s spend too much time and money on something they don’t really love, it is also a shame for those people that feel that they have still wasted yet more money and time having to do medical school later. I guess the message is, people have different personalities, backgrounds, and desires that need to be taken into consideration to make the decision between these things, even if the difference is between MD vs. DO.

        It’s not a bad article by any means. It’s really well written. But your all-encompassing title and use of “mosts” when a number of your statements have been a concern of the minority of medical students, doctors, and so on that I have talked with, drives me to ask for a little more balance given your goal stated here.

  6. As an MSII myself I would say MS-Anonymous is idealistic and knows few classmates well.
    I had plenty of doctors discourage me, as well as my non-doctor dad, from going to medical school. Although this is an excellent essay, even if I had read it prior to attending medical school I don’t think I would have yielded it’s cautions. I had three careers prior to entering medical school and I suppose my ego or stubbornness got in the way of sensibility. Instead of admitting the truth I think some people sugarcoat their life so they don’t look foolish for making a bad decision; they are just such good memorizers that they don’t require the amount of studying a normal person does and can spend time doing all the things Tim described; or they are okay with just passing. No matter which way you look at it we all end up in the “worse than military match” and the bullying society of medicine.
    This should be read by every premed and taken to heart.
    I already feel it is too late to escape. Admittedly, partly because of my own ego and partly because I can’t fathom paying off what “little” debt I have aquired AND being out of work.
    I was one that foolishly feel for the glossy veneer that our culture has created of the physician/surgeon with no good way to get out.
    Excellent writing!

    • Maria, I am sorry that you feel trapped in medical school and are not happy with this decision. Maybe you will enjoy yourself more once you are doing clinical rotations. If not, maybe you should start planning an exit strategy ( I do know a few people who have left medical school to pursue other careers). I will admit that I may be somewhat idealistic. I don’t see anything wrong with this. In fact, I think that trying to see things in a positive light and trying to see the world around me for what it has the potential to be is a strength. However, I am a little insulted that you assume I do not know many of my classmates very well. We clearly go to different schools. I won’t claim to know your classmates well, but I do know many of mine. I do think that the medical school you attend can have a big impact on your experience. I am lucky to be at a medical school that treats students very well. We are given a ton of flexibility during our first two years and most of our faculty are enthusiastic about teaching and mentoring medical students. Most all of the physicians at the academic hospital associated with my school spend a significant portion of time on research and are do not spend 100% of their time in clinic. This may give them more flexibility and improve their happiness level. I think it is also worth noting that the opportunity cost of medical school might be very different at different ages. Doing a surgery residency during your 30s while your children are growing up without you is very different than doing one during your late 20s before starting a family (if that is something that you even want to do).

  7. I’m a 3rd year med student at a upper tier school, here are my thoughts: It is grueling and you do go into debt, but having an MD also puts you in a very special place with respect to making those decisions that affect peoples lives, solving complicated problems and leading the healthcare field in general. It also makes a big difference when talking to patients because they generally trust and respect you from the get go (you can lose this by not having good bedside manner, but you get the benefit of the doubt first). Most doctors are not rich and do have pretty intense hours during training and beyond, but if you actually like medicine it’s not so bad. I like studying for medical school way more than undergrad and I’ll like continuing to learn about my patients and about what’s going on in medicine for the rest of my life. I think the only people who should worry are those who don’t want to work hard throughout their lives (even as an attending it’s hard work), those who want to be rich, or those who aren’t really all that interested in medicine or (more importantly) patients to begin with. Another couple of points: 1) given the economy it’s also reassuring to know you’ll have a job waiting at the other end of training. 2) even though residency can push 60-80hrs a week you get paid 50-60K during that time which is comparable hours and pay to other entry-level professionals trying to get ahead. 3)If you go to med school and realize you don’t want to be a doctor, with an MD you have credibility going into business, consulting, research, teaching etc. you aren’t as “locked in” as some might have you think. Every year a handful of graduates from my program go straight into consulting or academic research positions.

    • ^ This is what I have heard and seen from almost every physician. Doctors not only diagnose and heal, but they also console, advise, and [many] help keep off the strains of insurance issues when possible, in ways that the other staff members simply cannot. Especially excellent point with number 3 for people that are ultimately unhappy (because to be honest, the field is usually the problem, not the particular position of doctor instead of nurse or what have you) – if you are an MD/DO, you’ll be able to go into most fields with much less difficulty than if you were not. Also, the ease of getting another non-PhD degree on top in medical school is almost laughable, since associated schools will accept most of the students that are/have been in the medical program.

  8. Wow, you seem to have deleted my comment instead of responding to it. It’s both flattering (were you really feeling that threatened by my amateurish criticisms?) and a bit sad because it’s intellectually dishonest. I didn’t curse, I didn’t make lewd statements; I made completely legitimate observations of problems in your essay.

  9. A single male doctor in his mid-30’s can have sex with many more women than a male nurse of equivaleny looks at any age.

    But unless that is your goal, I concur with your financial analysis!

    • On paper, perhaps. In reality, most single male doctor in his mid-30’s often look like crap because they’ve had to suffer years of lack of sleep and exercise.

      Let’s do a quick mental experiment: imagine a pair of twins, both with equal intelligence and looks, both attended the same undergrad and studied the same major. After graduating college, one twin decided to go to medical school, while the other became a fireman. 12 years later, who’s richer? Who slept with more women? Who’s happier? It’s hard to say, but interesting to think about.

      • Truth. As a fairly attractive young woman, I’d take the fireman. Doctor personalities can be so flat sometimes.

    • As a good looking male nurse, I can assure you that you cannot be more wrong. The ladies eyes light up immediately when I say I’m a pediatric nurse. They don’t light up because they imagine my Maserati and vacation home, but because they assume I’m a great guy. I actually don’t volunteer the info in bars because it attracts too much unwanted attention for a happily partnered gentleman such as myself.

  10. Thank you for this detailed article. My 17 year old has already decided on Nurse Practioner route after interviewing many doctors, nurses and PAs during her four hospital internships. When she interviewed her own neurologist, her doctor admitted having to choose motherhood over continuing on to pediatric neurosurgery. She was quite honest about the trade offs (especially for women). Since my daughter wants to have a family and a life, she is very content with her decision. But it is interesting that EVERYONE who knows her and knows she wants to be a nurse practioner says to her…..”BUT YOU ARE SMART ENOUGH TO BE A DOCTOR! Why aren’t you planning on med school? (Like nursing is “less-than” or thinking nursing school is for people who are not smart enought to be doctors) This article has more information than even she considered or knew about. So thanks again for articulating it so clearly.

    • The people saying that “you’re smart enough to be a doctor” don’t have to go through med school and residency. They also don’t realize that many people are smart enough not to be a doctor.

  11. Im 3rd year med now, and I made it through surgery, IM, and peds. Ob/gyn is next and im dreading the call schedule and long hours. During surgery rotation I aged more in 2 months than I did in the 1st 2 years combined. My hair started to fall out. I was suicidal on bad days and extremely depressed or angry on “good” days. Im still angry now. I was not given enough information about the reality of medicine. My family kept pushing me into the field, even when I resisted; all I ever heard was “but you’re so smart! But you can help so many people. But it gets better! But once you get Into med school you’ll love it. But once you finish the 1st two years, you’ll love it!” I have never grown to love it. If anything, I’m only passionate about how very much I hate medicine, doctors, residents, other medical students, and sadly, sometimes patients. I’ve decided that a residency is not for me. I value my life, my time, and my sleep. I’m considering pharma, research, consulting, or academia… Pretty much anything I can do with this shitty degree to pay back the $250000 debt I’ve accrued chasing a dream that wasn’t mine. Thank you for your post. If you know of non-clinical options for med graduates, please email me.

    • Hi Mia,

      I’m a rising third year now and having serious doubts. I am also hoping against hope that I will love 3rd year despite thinking that M1 and M2 were the biggest waste of two years of my 20s. Death by PowerPoint? I think so. Also am struggling with the growing conviction that there is NO innovation and individualism in any career with an M.D. – if you don’t do XYZ to the patient, someone else will, so why do you matter? Any insight you can give me would be so hugely appreciated.

  12. As a pre-med student, this article is extremely valuable. It should be read by all pre-meds. I want to thank the current med students that gave feedback as to why they are still happy with their decision to pursue med school. Thanks to this article, I now feel capable of making more educated decisions about my professional future.

  13. I think the problem for many traditional medical students is their lack of life experience. Not all; I’m not making any sweeping generalizations or judgments, but most traditional medical students decided early in life that they wanted to become a physician. Many were influenced by family and friends, which, in my opinion, puts a dent in the validity of their decision to pursue such a rigorous training model. Most of the time, these students follow a direct route from high school to college, where they major in a science-related field, while jumping through the necessary hoops, such as MCAT’s, GPA requirements, and volunteering, and then they enter medical school. By the time they realize the reality of their choice and future path, usually between third year and internship, it’s financially unfeasible for them to alter their path. This would obviously lead to unhappiness and a feeling of “slavery”. Slavery, for the record, is involuntary and unpaid, and does not lead to pay or happiness, in most cases. Anyhow, by the time the student reaches intern year, they feel that they have made a mistake, and in many cases, I’m sure they have. Their decision was wrought at a young, impressionable age, and as an adult they suffer through it. I don’t know about you guys, but I don’t want my physician ‘suffering” through my diagnosis or physical. And, as mentioned in Jake’s article, many don’t leave the profession after realizing they are unhappy, depressed, or suicidal because it is so difficult to pay the loans with an average salary. Through my experience with friends in the medical field, an inordinate amount of med students, residents, and doctors are unhappy. I don’t know how true this is, as I haven’t spoken with large amounts of physicians. However, I have spoken with quite a few nontraditional students and doctors; they seem to be much happier and satisfied. I think it goes back to experience. In many cases, these nontraditional students have had children, spouses, jobs, other degrees, and myriad other experiences. Many of these helped them realize that medicine was their calling, and many of these experiences are really difficult. Working 60-hour workweeks is difficult, especially when your job is routine and doesn’t inspire satisfaction or creativity. Raising children is even more difficult; I have two children, and I can’t imagine many endeavors are much more stressful or draining, or, for that matter, satisfying and joyful. I think many nontraditional students are much more prepared for such a life-altering and rigorous training than most, not all, traditional students. Since, the majority of medical students are 24 or so, they fall more towards the traditional side, and they aren’t fully self-aware, and many are idealistic. This combination can lead to severe unhappiness in something as arduous as medical training. In addition the hours of medical training, it’s enormously stressful: People suffer immense trauma, people die, people are born, people are poor, on drugs, suicidal, schizophrenic, and hopeful. You, as a doctor, make decisions that affect patients, to the extremes of life and death. Medical students take all of this on, while studying for boards, shelf exams, and growing up. It’s a bad combination for many, in my opinion. I know for a fact that I couldn’t have handled doing a pelvic hemisection on a cadaver, watching someone die, or dealing with a crack addict in my young twenties; I could hardly grocery shop and remember to shut the lights off when I left my apartment. Maybe medical school should have an age limit. I think I would have been ready at 25, after I had a child, had worked as a recruiter, and suffered through job loss and tough financial times. But, like Jake said in his article, these memes and problems are much, much larger than me, and it is probably close to impossible to change the institution of medicine. However, I think there is some swaying going on with the influx of nontraditional students, who bring a very different perspective and approach to medical training. Those are my thoughts, but I’m not a medical student, so….

  14. A somewhat narrow point, on the NRMP:

    Note that it binds programs as well as residents, and that residents are expected to make their choices in part on the basis of hours/salary/etc. Certainly a degree of buyers’ remorse can take place if a resident finds that the program isn’t what s/he thought it was; similarly, the program might regret having chosen a particular resident after the resident comes in. Comparison of match markets to markets without the match (e.g. psychology) suggest that the match has little if any effect on salaries, though it may raise them slightly, perhaps by doing a better job of pairing the top programs with the top residents than other markets do.

    Residency admission operates differently from admissions to graduate schools (or even medical school) because the residency programs tend to be more rigid in the numbers they require. A graduate program that wants 16 students and typically yields 50% of applicants will accept 32, and some years will have 10 matriculants, with 22 in other years. Residency programs with 16 spots to a much greater extent really need 16 residents. Before the match, in the 1940’s, this resulted in students and residency programs scrambling to pair up in the students’ third years of medical school, as each strove to sign on earlier and earlier before spots or students were gone; the match was instituted to allow programs to see third year grades and students to gather more information about programs as well as their own personal interests without anyone worrying that, by waiting until the second half of the fourth year, they are going to be left in the lurch.

    The match ends up being equivalent (more or less) to a process in which a program that finds itself with too many matriculants can reject the excess number, who then are free to select their next most preferred program; what the match does that doing this literally could not is that it reduces the turn-around time to milliseconds. The computer can do all of this for 20,000 slots in a couple hours, while students and program administrators would have to spend weeks hanging around telephones pretty much full time as the last spots are filled. From a practical standpoint, for both sides, the difference is that you have to make your decisions hypothetically — you don’t know where you will be “admitted” before you have to decide how, hypothetically, you would choose among a set of programs — and you have to make your decision in January, which is later than it was before the match was put in place but is earlier than for some other markets for fall jobs.

    • Great comment, Dean Jens. Thanks for leaving it.

      I can see the efficiency argument about matching, but I still think a free system would still be fairer than the one we have now, even with the problems that it might entail.

      WRT this:

      Comparison of match markets to markets without the match (e.g. psychology) suggest that the match has little if any effect on salaries, though it may raise them slightly, perhaps by doing a better job of pairing the top programs with the top residents than other markets do.

      I’m definitely interested. Do you have a link to any of the papers on it? I’d like to read them.

  15. I think you undestimate one critical part of being a doctor.

    1) I realize the first two weren’t that compelling but this is the biggest reason: have you ever had a person really, seriously need you, almost more than anyone else in the world? It doesn’t happen very often, but it does in a hospital. Every single day. Unless you’ve been really sick you can’t really appreciate how much patients appreciate what (good) doctors do every single day. And I know it’s a power trip or self esteem trip or whatever, but unless you’ve felt that feeling before, you can’t sit there and say doctors are unhappy because they have to work a lot. It’s not a perfect system, sure, but it’s still a darn good job. And I highly doubt most other people, where jobs are all about creating equity, can come home every night and feel the same way doctors get to feel. You need some perspective that it’s a screwed up FIELD not a screwed up PROFESSION. /Endrant

  16. Thank you for this essay. I am a practicing paramedic for 15 years and contemplating med school or PA school. I love treating sick people but also love spending time with my kids and family. I’ve decided to persue the PA path mainly because I did not want to sacrifice my kids youth and quality of life for a dream I had 15 years ago. Once I educated myself on the PA profession I realized I can fulfill my dream and still have time for family and myself. When I removed the facade of the “MD” it all made sense. Thanks for the additional edvidence that I am making the best choice for myself and my family.
    Chris N.

  17. I am a board certified surgeon finishing up fellowship and I found this article interesting. I agree with many points that were made, especially those involving lifelong decisions being made by a 22 year old version of yourself. That being said, what I find more interesting is the responses I have read from medical students. I hated medical school because I found many of the students to be pompous and self absorbed while feigning love of patient as their motivation. Most of the time was spent discussing how great it was going to be as a doctor and how they were somehow “special”. More than that, what these students don’t realize is how the medical school indoctrinates them with its philosophy of “hard work and self-sacrifice” and how it is all worth it no matter the cost. This is done so that when you enter residency you will be a good little resident and survive whatever pain and suffering they may inflict upon you. It was not until later in my residency when I decided to be “myself” and stop playing the role they wanted that I found happiness with my career. These students do not know what their life will be like in the near future, but if it is in a surgical specialty I assure you it will be grueling. Love will be lost, divorces will happen, families will be left wondering where you are. It is the nature of the beast. When all is said and done, like many things in life, you ask yourself “is it worth it?” In my case I love my job and all the associated perils. I was able to maintain my marriage thanks to a very understanding wife. If I could do it again I would because most days I feel as if I have truly benefited a patient and made their life better. Society will never understand the emotional and physical toll this path takes on a person and will not accept complaints about our lifestyle due to our perceived financial rewards. That being said I believe you did a relative good job expressing many of the downsides. I promise you however, if it is done by the right person for the right reasons, it is still a very rewarding profession in ways no other profession can understand.

    Jeremy H

  18. Found it, read it, understood it, and am implementing. In just my preliminary research of MD vs PA, your essay has been so helpful. Thanks!

  19. I will also add my thanks that you have written this article and will pass it on via all my social networks etc.
    I am also considering med schoo’ and I am having a very difficult time actually making a decision so I googled “should I go to med school” and I am reading everything that google offered (including extensive comments!).
    I am the stereotypical good student that partly wants to go for the intellectual challenge. I am not so stereotypical in that I studied lots of non sciencey things, have spent multiple years abroad blah blah blah. I also decided quite late in life (relatively) that I wanted to be a doctor. The main impetus was a fantastic volunteer opportunity which has led me to make some big life goals but I am starting to wonder, can I achieve them with a different route? Especially one that is easier, cheaper and might make me happier? I was thinking of doing psychiatry but I really do not see what is the difference with studying psychology when you compare the “helping people” side. Furthermore, many psychologists make good pay, and with a phd, I would be a ‘Dr.’ too. I am also looking carefully at the lifestyle side, I do want to be a mother, I do want to find a life partner and hopefully get laid too sometime! I also want the flexibility to set my own hours and to be my own boss.
    But I liked the supposed “stability” of becoming a doctor, a secure job at the end! Yet the provincial government has just released a report that says other than family docs willing to live in the middle of nowhere, we have too many doctors! Apparently, students are struggling to find jobs in their chosen specialties, the only other way to guarantee one is to go for a very unpopular choice, with much less pay, meaning longer to pay of debt etc etc.
    However, I do struggle with the status/respect issue. I have long lived under the shadow of my older sister who is a doctor and I still immaturely feel the desire to prove I can do anything she can. But then I find out that as a 3rd year resident she still has doubts about if she made the right choice and she is on anxiety medication because of the stress… so probably not a good reason.
    I thought medical school would mean getting into contact with other intellectual people like me, that I would finally find my “niche”, but as you mention most are just good memorizers, which partly makes me think I would be a poor med student as I am having trouble memorizing even what I need for the MCAT. I have watched my sister’s fellow classmates doing unbelievably stupid things, not to mention mean as well and I have heard that in the more conservative yet prestigious the top down bullying is ridiculous.
    And I find the time commitment so daunting. I shudder to think how older I would be when I finish and that’s just if I get accepted my first time applying! One friend applied 7 times before being successful, I wonder how anything can be worth such a wait and how you can put your life on hold for so long.
    As for the “information asymmetry,” I think this applies to university in general, not just Med School. In high school, I thought that after I got an undergrad I could get a great job! I thought the people with degrees working at Starbucks just had to be really bad students or perhaps lazy, not the reality of people who graduate and find no opportunities in their field or crazy competition. I chose not to go to community college because my peers asked if I was not smart enough to go to university, and now I find myself still considering going as the colleges in my area have over 90% employ rate at graduation! Big difference to over 50% university drop out rate. I feel like no one tells us what we are getting into, I feel so cheated in so many ways. I thought University would be such a place of higher learning and was shocked to pay 1000$ to sit in a class and relearn what nouns are, and even how to handwrite!! I am sick of our culture of gloss and lies and I wish more people would tell the truth like you so that if down the line I am unhappy, at least I had made an informed decision.
    I am definitely going to read Stumbling on Happiness. I do not even know what would make me happy right now, how can I even begin to guess about the future?
    Sorry this is so long, but your essay has really made me think! One more note, I also think it would be great if med schools had to compete for students a bit and raise their standards. I visited one American school and the Dean of Admissions looked down his nose and said “we don’t need to look outside of our borders for students, we already have enough applicants.” I was shocked by how little he seemed to care about getting the right students, just by how popular his school was.
    Thanks again!

    • Hey. Thank you so much for writing this article/essay. Wow. A lot of my pre-med friends NEED to read this. Seriously, the line that had me taken aback was regarding your friend, who let her high school self choose her life career.

      Thank you thank you thank you.

  20. Amazing piece! This article has really given me some perspective about the “goals” I have set. Thank you so much for writing this. It is very long but worth ever minute to read. Impressed…

  21. I’m a 29 year old Male RN and I would like to say that I love my job. Being an RN is difficult but very rewarding. It is true that and RN does not get the recognition that an MD gets; however, one should not have to seek constant praise from others to be satisfied with his or her occupation. I think people forget that personal recognition is what really matters. The RN profession is amazing because RN’s have to use critical thinking and maintain beneficence when caring for multiple patients for 12 hours straight. Also, RNs do not have to go to school as long as MDs; however, the shorter length of school is not a direct correlation of intelligence. I, for example, was a pre-med student initially in and was ranked 4th in the Biology department as an undergrad. I decided to no pursue medical school because the dept scared me after it researched what I would be getting myself into. I decided to get a second bachelors degree in nursing and now I am almost 2 years into my career, engaged to be married to a beautiful woman, own a great home, and make over 100k (RNs make better money than most people think!)

    • I’m also curious to know what type of nursing you do. I am looking into PICU and CVICU work when I get some experience under my belt post-BSN. Any plans of doing advanced practice?

    • If you’re making over 100k in your second year of practice then you clearly do not live in the Southern US. I have been an ICU RN in a VERY intense & high acuity, catch all ICU (neuro,cardiac, transplant), for 8 years and I don’t make anywhere near that salary. Sadly, here in Florida, we get a huge majority of the elderly population but make the least amount of money. To make any substantial income here you have to become a neurosurgery ARNP or a CRNA.

  22. As a 9th grade girl thinking about my future in medicine, this essay was very illuminating. No one, absolutely no one, has ever told me anything about the downsides of becoming a doctor or attending medical school, even people who I know have knowledge on this topic. When ever I tell adults that I am interested in medicine, I simply receive the “good for you” pat on the back. I know that, at this age, it would be silly to try and make a plan and stick with it for the rest of my life, but it gives me confidence knowing that I have found something that I feel I belong in. I have been thinking about this for a very long time, and will probably think about it until I apply to college: Nurse or Doctor? Because I am a overachieving student and look good on paper, adults encourage me to become a Doctor instead. This essay is the first thing to give me any actual advice, so thank you very much for writing this. It has given me a lot to think about.

  23. This article has listed several great reasons to NOT be a Doctor, but that doesn’t necessarily make nursing the better option. Doctors are overworked, underpaid, and treated unfairly for 3 to 8 years while in a residency program; most nurses get treated like that everyday for their entire working life.

  24. I’m going to be honest, I’m a sophomore premed in college who was caught in the trap you described here of trying to get into med school because it seemed like a good idea. I don’t have any interest in my premed course material; I’m just taking the requirements and majoring in a completely unrelated field because it interests me more. Hell, I don’t even have an interest in providing medical care, I think I just wanted the job for the prestige.

    I have admittedly been on the fence about this for quite some time, but I just lacked any sort of certainty of any other fields I’d be interested in going into, so I’ve been sticking with the premed track because it’s so clear cut. But that’s a really shitty reason to mortgage a decade of my life. Anyway, I’d just like to let you know that this article has been very illuminating, and while I’m not willing to just jump off the track without any thought put into it, I’ll definitely look back on this article while making my decision.

  25. A good collection of links, but unless you’ve actually attempted med school or are close to it, Id feel uncomfortable trying to make Anything conclusive from it, other than just summarizing and aggregating all the stories and data. Because the people best qualified to decode this information are the ones closest to the situation with the most personal experience.

      • Don’t worry about his comment. He/She clearly read the title and maybe the opening paragraph then skipped to the comments. I enjoyed this article (read the whole thing). This article only reconfirmed my decision to become a PA. Every PA I have shadowed over the past year absolutely loves their profession and they have a life outside of the office too. Hell I enjoyed just shadowing my orthopedic PA. I can’t imagine the satisfaction I will get from the profession once I begin my career. Not to mention I will have my career started 5-10 years before other people my age pursuing a MD and I won’t have a pile of debt so high that I could climb it and claim it as a geographical landmark. I have the same generalized desire to practice medicine as doctors… I love helping people and critically thinking to solve problems. I know I can do every bit of what a doctor does in that regard without all the bullshit bureaucracy that is involved during med school/residency. I still have many people telling me I am exceptionally smart and pressure me to pursue a career as a MD purely based on monetary reasons (messed up I know). I am not in it for the money, I genuinely love helping people. This article addresses all of the points I argue in favor for becoming a PA vs. MD when trying to fight off the attacks of people pressuring me into a profession I think has a terrible outlook over the next twenty years given America’s current trend in healthcare.

  26. I’m a nurse practitioner student and I want to thank you for this article. People really overestimate the role of a doctor (compared to NP or PA), especially in out-patient. We all do pretty much the same job when we work in out-patient. Only the NP/PA typically has less debt and more of a life. And maybe less of an ego. ;)

    • Jamie, how are you liking NP training so far? I’m currently blazing a trail (working on accelerated BSN in 2014) and would love to hear your experiences and thoughts.

  27. Pingback: When Doctors Become Nurses

  28. Thanks for the article. I actually stumbled upon it for the OPPOSITE reason as most — I’m trying to convince myself that medical school is NOT a good choice. I agree with most of the points you and others have highlighted. The reality of the situation is that medical school, residency, and healthcare are all very flawed systems. I’m in my 20’s, have an advanced degree, a solid career, and virtually no debt; unfortunately, I still want to go back for medicine.

    My point is this — you can’t put a price tag or rationalize anyone’s dreams or ambitions. Becoming a PA, a nurse, or even sticking with your current career is likely the most rational choice for those considering medical school. Sometimes, though, medicine is what you’re actually meant for. My suggestion to people on the fence (or even those set on medical school) is this: try something else, become successful at it, and see if you’re content. If you’re not, then go to medical school. You’d rather be thankful you went back to medical school then afraid you made the wrong decision by going.

  29. I’m in high school right now finishing up my junior year and before I start applying to college, I have to really think about if I will apply into specific nursing programs or pre-med. All of my friends want to be doctors and when I say I want to be a nurse they seem to look down at me as though I am choosing a life that will be below theirs in the future. For a while I believed them and thought I should become a doctor- after all, nurses are just like maids in a hospital, right? No its not. Perhaps I won’t have all of the “benefits” (money) and the “glory” that you will have, but I will have benefits that are much better in my mind. While you are slaving over textbooks when you are 25, I will be making money and having the time of my life. Thanks so much for this.

  30. This article was the first of many resources that allowed me to re-evaluate my future as a medical student, and has led me to revisit prior ambitions and goals. After a few months of soul searching and practical comparison of varying fields, I believe I’ve found what I’m looking for in the nursing realm, particularly as an Nurse Practitioner. The style of practice, the semi-autonomous nature, the increased face time with patients,the ability to balance my late 20’s/early 30’s much better, to be ready for children sooner, as well as a myriad of other reasons, all seem to fulfill the role I’d like to play in healthcare, as well as within my family. After gaining admittance to medical school, a flood of thoughts washed over me in regards to what my short and long term future would develop into. This is not to say that all would have been negative, but from the multiple discussions with doctors, nurses, etc. in the field, it seemed the deck was stacked against me. I desire to fulfill too many personal goals (e.g. “worlds best dad/husband”) and dreams (e.g. children, learn cello and piano, strongman/bodybuilding, missions trips, etc.) that I feel the extreme demands of being a physician would not allow for. I came to the realization that I TRULY CAN do incredible good as a nurse practitioner while working as part of a TEAM within the medical community, all the while freeing years of my life to enjoy family, friends, hobbies, personal achievements, etc. I believe that there are some for whom medicine could allow for total personal and professional fulfillment, but from what I’m seeing and hearing, I’m not one of them and that’s okay, no bitterness. I am, however, more excited than ever to have a wonderful career prospect coming to fruition, one that allows for my goals and dreams to (hopefully) be fulfilled. One tip to those weighing the options, try to stop thinking only in terms of “What will I miss/lose if I don’t go to med school?”, but ask also “What will I miss/lose if I do go to med school?”. This can really help clear things up initially as you start to evaluate your plans for your life overall. This helped me differentiate more and more clearly whether medical school will be a hinderance or an asset. Also, young people, I implore you to stop thinking of physicians (or PA’s, NP’s, RN’s, PT’s, etc. for that matter) as being the only people who can help people and do it well. There are countless examples of people with little to no formal training doing more good than numerous healthcare workers combined (e.g. George Muller, Mother Theresa, Louis Pasteur, Gregor Mandel, Srinivasa Ramanujan, take your pick!). The idea is to have an “attitude” that exemplifies service to those who need help. Often this attitude is considerably more important than all the specialty training a person could accomplish in their lifetime. Good luck to all who are pursuing their passion, and remember: there is more to life than careers and education.

    • This post was so encouraging and I thank you. As a 22 year old undergrad still trying to see what God has in store for my life I have been looking at articles such as this. You put into words exactly what my desire is. I want to help people in some med field but also be a great dad.

  31. Hello there,
    I am a first year student halfway through doing pre-med in New Zealand. This article has placed into words exactly what I’ve been thinking, and is exactly why I can’t sleep at night. You’re so right about medical students being “good memorisers”. I’m finding all I’m doing is memorising complete textbooks. Your article has put my confusion about my future into a wonderfully clear perspective: that I can’t carry through with this, and my heart’s not in it. This type of thing happens all over the world. I am only doing pre med and I feel socially detached, drained, mentally and physically unstable. Why put this upon myself for a decade, when I could be living the best years of my life instead? I feel blessed to have stumbled across this article. Thankyou!

  32. To be honest. As I’m reading through all I’m seeing is money, money, and money. People seems to forget why doctors are doctors :/ If thats the case then there will be no doctor but I guess there are still people out there who become doctors for a legit reason. o be honest. The person who wrote the article Pretty much just focus it on money but forgetting the fact that when you’re a doctor its not always gonna be about you. You sign yourself up to make it about the patient. Like she’s kinda like “Nurses earn this much already whereas doctors… blah blah blah” Its sad how society just care about the money. What about the will to help people? People are still sick. People still need help. If money was your biggest concern then yeah you’re probably not the right person to become a doctor but don’t go tell other people that med students are making mistakes. Just because you don’t think there is anybody who doesn’t give a damn about money as much as you do doesn’t mean these people doesn’t exist (talking about her btw, the author). There are people out there who are looking into studying medicine for the skill it gives you so that you can then help people and explore the medicine field so that we can improve everyone’s well beings. “The bullying culture of Medical School” ?? thats disgusting c’mon. Weren’t they the one who made the decision to apply for med school? and work hard for it? Oh then you realise it’s too long and you can’t take it anymore it’s their fault? You gave them your word. Probably signed a contract too and you think it’s all them? that’s making your life miserable? What about the fact that you were supposed to be here to help people? People need doctors thats what it is. If you’re not prepared to be there then don’t get into med school!! Don’t go write articles about why med school is such a big mistake. You think that cause you forget why you did med. I guess people are who they are and they can put as many masks on as they want, at the end of the day they will show their true self and remember that deep down they really just wanted the money because you can’t lie to yourself and then they write this article. She needs to get a proper definition of A doctor.

  33. Pingback: What to consider before applying to Medical School | Medical School Trap

  34. Was considering a career change into medicine…Thanks for this. My decision, if one is to be made, is at least now focused into medical research or possibly nursing.

  35. I only considered becoming a doctor briefly in high school but I was not impressed my chemistry grades so I did not even think about pursuing it in college. After being laid off after college several times I decided to make a career change and went back to health care. After a lot of research I decided on nursing, and I loved all of my prerequisites including chemistry which I was sure would break me. My 16 year old smart aleck self is much different than my 37 year old pay out of pocket so get it done self. That being said things happen for a reason, had I aced it in high school and gone onto premed in college I probably would have ended up as one of those third year students or doctors who hate their jobs. For one thing I love to travel too much. I don’t really need much besides a passport and a get out of jail credit card, and I am not so financially driven that I am willing to give up a good balance in lifestyle. Even before reading this article I’d come across doctors who hated their jobs and I was really shocked. The cardiologist I dated said that he felt like his job served no purpose because you are dealing with an 80 year old who still wants to smoke. Now maybe he could have gone into a different specialty but in general he seemed disgusted with the profession.
    Side note: He was divorced, but I don’t think it was due to sex because he has four children by his ex wife and he was a great lay at 50.

    Thanks for the info Jake, I was looking for info to spice up my grad school essay and I found your article helpful beyond that. Good luck to everyone whatever your path may be because I am too much of a sunshine to be dealing with doctors acting like they are the only one with a writing an alimony check to Sallie Mae.

  36. I just finished reading your article and I have to say its one of the best ones I’ve read on the subject so far. I recently wound up on the path of becoming a PA instead of going through the intensive labor of becoming an MD. After finishing just four years of undergrad in May 2012 the idea of having to give up that much more of my life before starting my career really started to weigh me down. I had always wanted to become a doctor and I was in the thought process of all or nothing. I thought that if I were not a doctor I would be the lesser for it. After seeing all these underhanded practices described it just completely diminishes my wanting to attend a medical program. It has truly lifted a lot of pressure off of me and the best part I’ve discovered so far: I won’t need to retake organic chemistry, which is the worst class experience I have ever had trying to commit all that useless stuff to memory. I have also added this to my favorites tab in order to look back on this in the future just in case I need a huge backhand to the face. Plus if I wanted to be known as “The Doctor”, I could always wind up going back for a PhD in a related field instead of enduring the hell of residency.

  37. One thing struck me about this article: your supposed motivations of people studying to be a doctor. Quote:”The big reasons to be a doctor are a) lifetime earning potential, b) [...] always have jobs available, c)[...] social status, and d) a desire to “help people” .

    Does this reflect the current situation in the US? If so, the health care system is even more broken than I thought… A good doctor is a caring doctor.

  38. a million thanks!! i did find your article, read it thoroughly, and understood it. And i will implement it! Thank you so much!

  39. Jake – A fantastic article. I’m a non-practicing MD, MBA from Cornell – a decidedly old school medical school. I hadn’t heard Paul Graham’s quote concerning “now finding yourself living the life a 22 year old chose for you” but that’s incredibly true.

    I ended up choosing to not practice medicine, I didn’t do residency and chose to do an integrated MBA at the end of school to “balance out” the MD so that I might have more career options outside of medicine and healthcare in general. I chose that path because I was offered scholarships and guaranteed financial aid to cover a lot of my 4th year of school – about $100k in all. When the school caught wind that I had decided to not practice, they revoked all scholarships and financial aid. Talk about a massive financial swing. It was pure retribution and misunderstanding. To me, it adds to your story about medicine using finances as a massive lever to “keep you in line.”

    Healthcare, as I’ve been working with data, clinical practice and health systems, is just as much a miserable cluster.

    There’s another part that once you have an MD, and you’ve dedicated so much of your 20s and your career to date in medicine/healthcare that when you decide to branch out and do anything but medicine or healthcare most folks in society don’t seem to understand how to think about you. You’re treated as if there MUST be a reason you’re not practicing (like you weren’t good enough) or that there’s something flippant about you. Why else would you give up all that time and effort? It’s really an odd position to be in – searching for what to do once you give up medicine.

    That said, my solution to date is to place the financial concerns aside so that they don’t obfuscate my own thinking about next steps/moves. I’d rather have the debt and choose something else than to be completely locked in to medicine and healthcare. It’s all one big trade off so that this 34 year old can begin to undo what the 22 year old did to himself.

    Thanks for your article – great job!

  40. I love this article… I’m a 19 year old currently freaking out over making this decision. However your article is truly helping me see that MY happiness is more important than my status or the money that I’ll make being a doctor. Not to mention, I kind of am a social butterfly… and love being one.

    Thank You!
    Lindsay

  41. To whoever wrote this essay. For as long as I can remember, I wanted to be a Doctor. Recently me and my girlfriend have both decided on going to Nursing School for the exact reasons you discussed above. It was only after reading this essay that I knew I made the right choice. I have re-posted your essay on the Canadian Premed website. “Premed10.” I want this essay to be seen by aspiring doctors as well as nurses. I believe this essay will allot people to reconsider their dreams of becoming Doctors.

    Thank you so much for this.

  42. As freshly completing my residency program and passing my orthopedic surgery exams I thought I’d leave a comment of 2. I started reading the comments and soon noticed it was mostly medical students leaving comments. No residents, why? They don’t have time, they don’t have the energy, and if they actually got to reading this article they are probably crying. Medical school for me was quite easy. Most people entering medical school are good at exams, and while there are a lot of big exams our skill set is generally well adapted to deal with them. Residency on the other hand is a completely different game. The residents that adapt well are those who are generally over-confident in their skills and knowledge. This article doesn’t address the stress associated with the long hours. It is not only a matter of the time that is involved, it is what is expected in this time. The pager goes off non-stop. You are expected to manage situations where you continually feel in over your head and peoples lives are at stake. As a junior you are often bullied by any staff who has been around longer and feels entitled to put you in your place which leads to a cycle of resentment as junior residents become senior become bitter and once they reach a level of seniority will then bully others (just like children who were abused often become abusers when they are adults). When you do have free time it is spent reading to gain the knowledge that is needed. You are put through several rotations which is like essentially starting a new job every 6 weeks to 3 months. You have to learn the ropes of the new ward, new staff, new attendings. And just once you have things figured out a bit you start over again. You then have the stress of at the end a big big exam that you’ve essentially have been working up to over the last 10 years.
    Would I do it again? I’m not sure. I have to say I do love what I do. However, I’m sure there are may other jobs I could have loved as well. I definitely did not know what I was getting myself into. Would I have listened, probably not. All I can say is I am glad its over and I survived.
    Now I just have to set up a practice…..

  43. I feel like I should post my perspective as a senior surgical resident.

    My advice for young people considering a career in medicine, especially medical or surgical specialities. TRUE – it is a sacrifice. It will affect your life in ways you didn’t think possible. It doesn’t end when you finish residency at 30 or 32. That’s when the real work begins. But it is extremely rewarding for many reasons and you will be proud to have the opportunity to serve in unique ways.

    A career in medicine is a ticket to a lifetime of adventure. There are incredible ups and tragic downs. You are truly strapped in and along for the ride. It is not an average career by any means. If you want something easy, predictable, safe – then heed this author’s advice and choose a different career. If you think it’s worth the sacrifice and can tolerate the risks of not getting in, not matching, or not getting a job, then boldly follow your dreams.

    As a fourth year surgery residency, I can honestly say I am extremely happy with my career choice. I am challenged every day and will be for the rest of my life. There’s never a dull moment. I go home feeling like I’ve made a difference. My social life (and sex life if anyone is interested) is extremely healthy. People can tell when you are passionate about what you do. Frankly, it’s attractive. So is working hard to accomplish something you believe in.

    The vast majority of people I know in medicine are happy. I don’t know these hoards of people with regrets. I never met them in med school, and I don’t know them in residency. Everybody has second thoughts, considers quitting, etc, at some point. But very few people do because we realize how lucky we are to have such fulfilling careers. We support each other through the tough patches, and in the end it’s worth it.

    So before you accept this essay as gospel, compare to some opinions of people who have actually gone through the medical education process. Decide for yourself what kind of life you want to pursue with honest facts about the pros and cons. Speculation from an outsider with a collection of anecdotes is, in my mind, irrelevant.

  44. I have been a Nurse Practitioner for 13yrs. I have a BSN and an MSN. I want to change to a Physician Assistant. Question: will my MS make it easier to get into a PA program and will the fact I have an MSN shorten my time in a PA program ? Thank you.
    Linda

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  46. Very very well written article. As a previous Pre-med student struggling to decide if Med School was truly worth it, I can tell you that this has really given me the reassurance that I’m making the right choice to persue a career in nursing instead.

  47. I am a nurse practitioner and worked as an RN for 10 years prior to that. I can tell you that I work in a specialty clinic and work the same hours as the MDs, take the same call and see the same patients. I make 97,000 per year, the MD’s make 300,000-400,000 per year and the RNs in our hospital make over 100,000 without the liability. If I had it to do over again I would not have gotten my NP. I have been an NP for 13 years.

    • Linda, I’m very curious as I’m looking into nursing myself at the moment, including the possibility of becoming an NP. You say you would not go into NP again, but I’m curious to know what you would have chosen instead?

      • I would have continued floor nursing or gone into nursing informatics. If I went for my masters I would have gotten MBA. I do love my patients , love my families – that is the great part. Financially it was not a good decision. My malpractice risk combined with my lower salary makes being a nurse practitioner a terrible financial decision. I could almost twice my salary working nights as an RN in the ICU

  48. Trust me – as a nurse practitioner you will be treated as a second class citiizen. The hospitals and clinics care about doctors thoughts concerns ect but as a nurse practitioner you are invisable. I am excellent at my position and in my clinic doctors ask my advice. Because ” I am very smart for only being a nurse” or ” Wow you are only a nurse and you know more than some of the doctors”. These are comments from MDs. This is daily- same job, same call, higher patient satisfaction ratings than MDs. I work in the Los Angeles area so not in a backwards town.

  49. Interesting to say the least. I am a 46 year old going back to school, starting from scratch, aimed at becoming a doctor. I have my nursing assistant and medication aid classes done and am starting the LPN class in January 2013. I plan on working my way up the medical ladder through RN and then decide weather to continue. My only hesitation in my age and the number of years to get through Med school. This article and the comments was a lot of food for thought. The only thing I can say is you don’t take on 10 years of schooling at the age of 46 if you don’t love what you are doing. So far school only tickles my thirst for more knowledge in Medicine.

    John

    • Interesting to say the least. I am a 46 year old going back to school, starting from scratch, aimed at becoming a doctor. I have my nursing assistant and medication aid classes done and am starting the LPN class in January 2014. I plan on working my way up the medical ladder through RN and then decide weather to continue. My only hesitation in my age and the number of years to get through Med school. This article and the comments was a lot of food for thought. The only thing I can say is you don’t take on 10 years of schooling at the age of 46 if you don’t love what you are doing. So far school only tickles my thirst for more knowledge in Medicine.

      John

  50. Thank you for writing this! I have wanted to be a Dr and recently working on my major preparation classes i have been really trying to think about my future and if this is the path i indeed want to take. Your insight really helped me.
    Would you be able to point me in the right direction for PA schooling info?

  51. I see nurse practitioners screwing up patients almost everyday by bad care. Problem is poor patients don’t realize it until its too late. Even a monkey can do check box office visits. They just don’t have the underlying knowledge, rigorous training and broader insight into health and pathology in a complex environment. Anyways, everyone gets what s/he has paid for…

  52. I see doctors screwing up.patients every day. if doctors were such perfect geniuses about disease and pathology , they would not have to purchase malpractice insurance nor make a buck from hiring and paying PAs and NPs to do the work they could perform so quickly and flawlessly themselves.

  53. Thanks for the article
    My parents are doctors and suffered a lot to get in and to work.
    They discouraged me from going into medicine, essentially saying what you said (except for the sex life part). They were foreign educated meaning they had to jump through even more hoops to practice in the US. They encouraged me to pursue another medical career path so I have time for family but also room to grow and get higher education.

    I sometimes doubt if I should have done medicine because a lot of people say “your parents are doctors and you’re not taking the medicine path? What’s wrong with you?” And a lot of old doctors who are from the “golden age” of medicine (making pensions and actually able to retire) constantly tell me that I am going to regret not pursuing medicine.

    But you know what? The grass is always greener on the other side. Yeah I sometimes regret not pursuing medicine but at least I’ll make enough to afford the rent for a nice apartment at age 23. And at least I can go to grad school and make a very comfortable salary (but not wealthy). At least when I have kids I don’t have to choose between my career and being with my children. At least I can sleep 8 hours every night and work out a few times a week. And if I hate my life I can go back to school and pursue medicine.

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  55. Would you give up your 20’s to pursue a career that you know would allow your family to be financially stable for the rest of your lives? Or, would the better option be to become a PA, and still make great money, but actually have some time left in your 20’s. It’s such a hard decision, with so many variables. If I went into Medicine, my first choice Residency would be Ophthalmology, but I don’t even know how realistic that would be to match into that. I’ve heard it’s pretty competitive.

    Also, which would I regret more? Missing out on my 20’s, or having to work alongside Physicians for the rest of my life knowing that I could have become one of them?

  56. wow its almost like I was supposed to read this article! You outlined every question I had in my head. Although medicine interests me greatly, I feel I would be better suited for a career as a NP

  57. I just want to say thank you so much for writing this essay!! In simple terms, you helped me make a really important decision. I know I am still fairly young, I’m in year 11 and I have been talking with my career counsellor about persuing a career in medicine. EVERYONE I know told me to become a doctor because I am very smart and that I’m better than nursing, but I never wanted to waste 11 years of the prime time of my life. Reading this helped me decide that I don’t want to waste my life in medical school and funny story- the next person who told me to become a doctor (my mother) I lost it, had a rant and ended up swearing at her face…. Haha anyway, thanks for helping me make my decision and I know you probably won’t read it, but you have helped me and I couldn’t be happier with my decision.

  58. What hasnt been discussed is how a Physician Assistant has the flexibility and opprotunity to enter any specialty they want, or that is available. Thr fact that a PA can also own their own practice too. For a PA when they are sick of a field thry can look for alternative fields of interest where they can learn and be challenged. Most of the time a Physician ends up in one field of medicine for the rest of their lives and sometimes its not even the field they intended to enter since some fields are extremely competitive in terms of residency. They become “masters of their craft” while PAs are more the “jack of all trades”.

    What many people also dont consider is many PAs get paid well above what isdeemed “average”. I know dermatology, ortho, and neurosurgery PAs who make upward of 200,000 and work no more thsn 40 hours a week with no on-call. The money issue for PAs is more so determined on what they bring to the table and how much revenue is increased using them. Physicians in outpatient settings love PAs and NPs because thry increase patient load and profit for them, notto mention time they can spend outside of practice. If youre goodat what you do as a advanced care practitioner you have leverage for sure. They woukd rather give you a big raise then spend 6 months training a new PA or NP who might pan out to be a dud. Your level of practice and scope depends on how much the doctor trusts you. So if you are good at the craft you can make complicated diagnoses as well most experienced physicians actually let PAs do this because all they have to do is sign off on it.

    In terms of physicians saving lives im sick of seeing so many med students talk like those feelings are only to be felt in their shoes. So your telling me they know what its like to be a nurse in the ER when a patient ia dying, or the CNA, or the mother of the patient. Yes its very fulfilling we all know it can be! But usually there is a PA “assisting” in command during surgicsl procedures that save lives and nurse giving meds, a resp therapist intubating maybe, etc. Some doctors, specifically surgeons tend to forget the entire team in the room including nurses, PA, respirstory therapists, CNAs, etc. helping to save lives. They can go home with the exact.same feeling without the inflated ego. In fact many go home with an even greater appreciation for what they did than the doctor. Quite frankly a doctor couldnt do jack $!@? Without the team. They forget that a lot of times– which is probably due to the medical school process of getting crapped on for so many years. That is where the healthcare system also fails in many instances – with the doctor forgetting its a team effort and those actions that save lives, and the feelings associated with it are not their “special feelings” only. Physicians also make the wrong diasnosis many times on simple things. For every life you think you save you also probably made a small mistake in ur mind that costs a patirnt their life down the.line… but u dont think about that i bet. Its a team effort for the med students here who seem to have forgot. You aint special. You dont get special feelings just because ur a doctor. You get a special feeling being apart of something bigger than urself.

  59. Thank you for writing this. It’s given me a lot to think about.

    Unfortunately, for those of us who don’t come from highly-ranked undergraduate institutions with robust finance/consulting recruiting systems in place, medicine is the only sure-fire option to earn a $250K+ income. I’m not quite sure I’m brave enough to buck the trend, simply because I don’t have a plan B in mind. I honest-to-God can’t think of anything else I could do besides practicing psychiatry.

    • As a practicing physician who’s relatively new in practice, let me first assure you that medicine is no guarantee of a $250K+ income, even for many specialists. That is a myth. The average is far lower overall and certainly guaranteed to go down in the future as the government (i.e., CMS) attempts to reign in health care costs by ratcheting down payments to providers even further.

      Secondly, a career in medicine is no guarantee of job security. This is also a myth perpetuated by those largely outside the profession. Look up the number of US med school grads this year who failed to obtain a residency. This number is guaranteed to go up in the future, not down. A medical degree without subsequent residency training is a worthless and very expensive piece of paper. Also do some research on the job markets for certain specialists including pathologists, radiologists and nuclear med docs, for example. Ouch.

  60. Thank you! This is the first time I’ve actually read the truth in this manner. I’ve been doing my research on this whole health professional school route for a few years. I’ve only seen the numbers and statistics of how discouraging entering the field can be, and also the opportunity costs associated with the schooling of a physician or dentist. When I started my undergrad career I originally was a nursing major, but then I got this whole idea that since I liked science so much I wanted to immerse myself in it. I switched to Biology and I had some very fun and challenging times with it and the next phase was to apply to medical school….I got sick with Graves disease and that changed the whole game and the way I wanted my life to be. Then I got this whole idea to go the dentistry route because it would allow me to not have to face residency and have more freedom outside of work. So now I’m back at day one (nursing) because I know this is the best option for me to give people optimum care and not have to accumulate a ton of debt. I can use my Biology degree and do an accelerated nursing program. I also want to be able to move to different areas of health care and different specialties without feeling like I’ve invested so much time that I feel stuck . Bottom line :I want to have a life, and I don’t want my career to define who the hell I am.

  61. Thank you for this article. I’m a 4.0 pre-med student with a 32 MCAT in the process of applying to medical school. It only seemed natural for me to go to med school. I have been under the illusion of the assured “well-lit path” of med-school. I just thought I would get in and then everything would be okay. I would think “I’ll make plenty of money and I’ll repay the debt in no time because I’ll be making enough money after residency.” I backed my decision based on my parents and every other person who doesn’t have the slightest clue about medicine. I would look at statistics and see how terrible of a financial decision it would be, and just ignore it out of fear that I’ve made the wrong decision in life. This article explains (past tense) me perfectly. I can’t say thank you enough for altering my course before committing to med school! I wrote this quickly. Don’t let my grammatical errors undermine what I’ve said.

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  66. Also, you did not mention that most nuruses start on the overnight shift (have to) and many get sick as a result of the brutal sleep transformation.

    A pathologist would not do this. For someone who wants to be in medicine but can’t risk their back to lifting patients or deal with a terrible circadian rhythm shifting, nursing is not a good option!!!

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