It was the spring semester. Being first year, medical school had novelty, excitement; eyes twinkled in the hallways. We were all figuring this out, and closing in on one year in the books. “No small feat”, we thought to ourselves, almost a quarter done (no one thought about residency yet). A lax first year curriculum allowed for a “Medicine Humanities” class in the afternoon. I signed up for a former medical school Dean’s course on literature and medicine, hearing it was more work but more interesting than others.
I loved those afternoons. Midway through a breakdown of something by Chekhov, the former Dean, now retired mentor, pined on medicine at large, with us in his sights.
“People go to medical school for one of three reasons: altruism, power, or money”, he declared, with certain boldness. The room was silent; we were gathering which defined our motivation. Weren’t we all altruistic?
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I sat in my seat, long after the discussion returned to Chekhov, wondering why I didn’t feel confident in altruism. Years later, I know my motivation, and I know it well. I reckon many other physicians fall into my company. I’d like to add a fourth category—in addition to the former Dean’s—but first I’ll review the big three reasons and my estimated percent of physicians in each.
(This is a discussion of motivations when entering medical school. These reasons are likely shifted by the sands of time, burnout, and financial needs later in life. I also recognize that people do things for many reasons, not just one, so this an exercise in looking at the primary motivation.)
1) Altruism (50%)
These are the physicians—learning, diagnosing, and treating. These people stay late. They often get voted chief resident. The Hippocratic oath is a blood oath. When I think about my classmates and fellow residents who really love their jobs, this is who I see.
2) Power (20%)
Face it, the scalpel feels good in the hand. The prescription pad fits nicely on the desk. People calling you doctor rings right. Patients thank you for saving their life, every day. There is real prestige and social capital in this job. It’s an achievement ranking near the top of the achievement hierarchy. A flex of all flexes for the National Honor Society alumnus.
It pays the success bills. And it’s a job that allows you to feel in control of life.
3) Money (10%)
I’ve got an investment for you: study for four years, costing you said time and $300-400K in loans, and receive a bare minimum $200K per year salary for the duration of your working life. On paper, who would turn down that investment? Including interest, your breakeven is five to seven years after residency. It’s a helluva investment (yes, there are risks, especially in time and income producing years, which are broken down at The White Coat Investor in more detail).
Money is gasoline, sending your vehicle wherever you’d like. For some, medicine is the best way to get that gas. It’s that simple and not altogether bad; another trade of time for money, no different than a stockbroker loving what the trade provides more than the trade itself—a means to an end. To the savvy and financially disciplined, medicine is a path to early financial freedom.
My Reason) Fear (20%)
It was easier to go to medical school, complete residency, and earn a board certification in psychiatry, than it was to go after my dream. Fear is the real deal.
What was I scared of? Ridicule and judgement were factors—I cared about people’s opinions—but the fear ran deeper; I was scared shitless to own my life. To own my life meant owning that I really didn’t want to be a doctor.
To be victorious in chasing my calling (then, it was moving to the mountains to write and snowboard), necessitated an all-in bet; a true gamble, with real risk and consequence. I risked approval, relationships, and social status, or so I thought (I’ve since seen the tribe moves on quickly to their own problems).
Losing was to not exist, so, I risked nothing (or so I thought) and played not to lose. As you know if you’ve ever lost a game after playing not to lose, those losses ache and ache and ache.
I’ve spent the last eight years processing that loss. My heart goes out to anyone (physician or otherwise) who knows that ache. If there’s solace to be had, I believe everyone enters this journey; a calling, dismissal of the calling, getting lost, and getting back to wholeness. Many have and will end up in the aching place we’ve known. The bell always tolls.
I get even more solace from this: there will always, always, always, be another opportunity to play to win. To face the fear. And this time, we’ll be better prepared; knowing our opponent, fear (no longer a motivation), well.
I think I can see myself in all four of these motivations. Looking back, I think altruism was my primary. I loved biology and had a service mindset, so I wanted to find my calling in using my God-given aptitude to help people. My father was chronically underemployed, so I also wanted something that would give me better financial security. I don’t recall power being a strong motivation, but I do appreciate the social capital that medicine provides me.
But I’m not sure that I understand fear in the same way you do. I had fear of failure in medicine — not getting into med school, etc. — and fear of the huge educational debt, fear of the unknown, and that kind of thing. But these fears tended to work AGAINST me going into medicine, not to motivate me INTO it. I’m not sure that I really understand this demon you are running from.
Appreciate the honest words about your journey! I believe all four find us somewhere and make up parts of our motivation, no doubt. Maybe I can elaborate on the fear aspect further, to see if it helps. I was afraid to admit, deep down, that I didn’t want to go to medical school, that I actually had another path I wanted to explore, but I feared the consequences and responsibilities of that choice. Thus, I went to medical school inspired by fear, as I felt it was a safer choice with less risk. What I didn’t understand was that going to medical school had different risks.
That makes sense. Your fear in medical education seems to be qualitatively different — directionally different — from mine. Very interesting to bend my brain around the idea of what it would be like to go through medical education reluctantly from day 1. That sounds absolutely miserable. It was hard enough for me when I really wanted it!
I just laughed out loud! Indeed, it was absolutely miserable at times. And ultimately, that’s what led me here. But, to say there weren’t beautiful moments would be regrettable. I loved the learning, teaching of medical students, and connecting with patients. It just never made up for what it wasn’t—not something I wanted. Appreciate you working to understand. Our qualitative and directional differences seem to make sense!