A reader writes:

Thank you for such an excellent web page. I enjoy reading it very much.

I know you have addressed the issue of medical student selection of specialty in prior rants. I thought it would be instructive to give one more real world example of how strong the forces are on 4th year medical students preparing to make arguably the biggest decision of their lifetime.

I attended a medical university which left me $185k in debt. I am married, a bit older (32 years old upon graduation) and my wife was pregnant during my 4th year of medical school. I very much enjoy patient interaction and feel that my strong suit is certainly in formation of interpersonal relationships. I was attracted to internal medicine because of the ability to forge these relationships and help navigate the patient through a disease process. I do also enjoy teaching and research. All other things being equal, a residency in internal medicine and practice as an academic internist or perhaps subspecialist would have been the right choice. Unfortunately, I was lured by the short residency and financial prospects of emergency medicine. At the time, I intellectualized the decision in every conceivable way, but I realize now that it was really about making money as soon as possible to help pay off debt and support my new family.

About 14 months into training in emergency medicine, I have switched into internal medicine. I realize now that you cannot force yourself into a career based on financial security. Nonetheless, it is impressive to me how strong the force of medical school debt is when making that career decision. I can only imagine that many other students are in the same boat. Many will make the decision based on financial concerns and decide to continue in a specialty that is not suited for them. They may burn out, or worse, become jaded and bitter further eroding the public’s perception of physicians.

While I am satisfied with my direction, nothing has changed regarding the financial burden. I am fighting the anxiety and pressure that it places on me when deciding where to go from here. I am constantly online looking at loan repayment programs. Gastronenterology and Cardiology wink at me from time to time. Regardless, I will make this next decision with the knowledge that no career will be satisfying when
chosen for financial reasons alone.

Is it any wonder why we are seeing our brightest and most capable match in radiology and anesthesia?

Is it surprising that we are seeing a paucity of physician scientists being trained?

If we truly want medical students to choose the path that best suits them, something must be done about
medical student debt.

Amen!

Related posts:

1. Health care reform should address student debt
2. Medical student debt
3. Free market theory does not apply to medicine
4. Gawande’s New Yorker piece – ? Rorsharch test
5. Further thoughts on financially unethical physicians

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