These are the worst reasons to go to medical school and become a doctor, from the perspective of a practicing urologic surgeon and real estate investor.
Introduction
When I was in college, I decided to become a medical doctor because I wanted a stable, well paid job that allowed me to help people. So I went to medical school and decided to become a urologic surgeon because I loved the idea of using lasers to break kidney stones. I talk about this journey in detail in my video podcast Generation FIRE.
I’ve been a physician now for over a decade, but in retrospect, I can’t say that my decision was incredibly well thought out. I can see now that a lot of my decision was influenced by a childhood marked by financial scarcity, plus strong cultural and parental pressure.
While some of my reasoning was sound, a lot of it was way off the mark. If an experienced physician had sat me down and analyzed my decision with me, I still think I would have made the choice to go to medical school. But I would have been a lot more prepared for the reality of medicine in the 21st century.
So today I’m going to serve that function for you. Below, I’m going to go through some of the top worst reasons to become a doctor. If you’re in high school or college and are still wrestling with your career decision, I hope this post will help you go into the world of medicine with your eyes wide open.
While I look critically at many aspects of healthcare today, it’s important to remember that I still love practicing medicine. It’s satisfying in a way that few careers can match. Even after a well earned break from medicine last year, I was happy to resume patient care this year as a locum tenens physician. There’s a special joy to helping patients that is hard to match outside of the medical field. But if you’re going into medicine for the wrong reasons, here’s my attempt to set you straight!
Here’s a table of contents in case you want to skip around:
- Bad Reason #1 – The Money
- Bad Reason #2 – Family Pressure
- Bad Reason #3 – Status
- Bad Reason #4 – The Glamor of Medicine
- Bad Reason #5 – Your Ego
- Bad Reason #6 – Grateful Patients
- Bad Reason #7 – The Love of Science
- Bad Reason #8 – Because You’re Smart
- Bad Reason #9 – Career Longevity
Bad Reason #1 – The Money
Let’s start out with a bang and talk about the money. We could have a dozen blog posts about money and medicine (in fact you can see some linked below). But I’ll keep it short and sweet here since we have eight other reasons to discuss. Bad reason number one to go into medicine is because it pays a lot of money.
“But doctors are paid really well!” you might argue. Relative to the average American income, this is absolutely true. According to the Bureau of Labor Statistics, in 2022 the median annual wage for physicians was $229,300. That’s a hefty wage and about five times as much as your median American wage, which is $46,310.
You actually might have thought that physicians make more money much than this. In fact, there was a Washington Post article from August of 2023 that boldly proclaimed that the average physician income is $350,000. This created quite a stir across social media.
But analysis of the data that they used from this article shows that this data is very skewed by a minority of physicians earning super high incomes, like neurosurgeons. The median total physician income in their analysis was only $265,000. That’s why it’s important to understand the difference between an average and median value. (That statistics class is finally coming in handy, right?)
About half of physicians in the US are primary care doctors, for example. The same data used by the Washington Post showed that PCPs make on average about $201,200 in their peak earning years (between the ages of 40-55). This is a far cry from the average figure of $350,000 for all physicians.
So clearly, the average physician income is not as simple as a single number. There’s a lot of variation based on age and specialty. The data is very skewed because of the super high earners at the top of the pyramid.
I’m a urologic surgeon, so my annual income (when I was full time) was on the higher side, around $500-600k per year. I also know urologists who make well over $1 million per year, which again demonstrates the extreme variability out there. I’ve since transitioned to a locum tenens practice to allow time for real estate investment, but I still expect to make about $400,000/year from medicine moving forwards.
But if you’re going into medicine to make tons of money, it might be sobering to realize that half of American doctors only make about $200,000 a year. This is why I try to be transparent as possible on my blog about money — I think it helps no one to hide the facts about physician income and spending.
Read more: The Darwinian Doctor’s 13 Monthly Expenditures (with real numbers)
Aside from the realities about physician income, there are two other major reasons why you shouldn’t go into medicine just for the money.
First of all, doctors only start earning a high income 7-10 years after they’ve committed to the journey. With four years of medical school and three to seven years of residency training, doctors are the definition of delayed gratification. This decade long delay in earning gives up many years of potential compound interest, making the total wealth accumulation for doctors much less than if they had gone into a field where the high earning starts in the 20s, like finance.
Add onto this the average medical school debt of about $200,000, and you’ve got a situation where many doctors are less wealthy than you might think.
The Medscape Physician Wealth and Debt report from 2022 estimated that about a third of physicians are worth less than $500,000. Overall physicians are doing well, but perhaps not as well as you might think. Given the delayed earning in the medical field, it’s telling that the largest group of physicians in the survey are worth less than $500,000.
Bad Reason #2: Family Pressure
Growing up in a first generation Korean household, I often felt that there were just three career options open to me. I could become a doctor, a lawyer, or an engineer. According to the Korean community in the US, these were the jobs that had that special mix of income and prestige that made them acceptable career choices.
My parents never sat me down and told me that these were my options, but over time this truth became clear from the way they gossiped about the kids of their friends. They were admiring of their friends who had kids going to med school or law school, and disdainful of the friends whose kids wanted to become singers or pursue art history.
Looking back, I’m surprised they didn’t talk more going into the banking industry, but I think that was mostly out of ignorance. My parents were just like me – I had no idea that there was a huge industry where people made enormous sums of money by pushing money around.
Under the influence of this family and societal pressure, it was only natural that I decided to become a doctor. It seemed like the perfect way to fulfill my desire to help people and also live up to the expectations of my family.
But having gone through the medical training process, I can firmly say that becoming a physician based on family pressure or expectations alone is a recipe for disaster. It’s just too flimsy of a reason to sustain you through the many challenging years ahead of you.
If you’re only going into medicine to make your family proud of you, about 60 days into your intern year of residency you’re going to wonder if you’ve made a huge mistake. Because the long hours, firehose style learning, and emotional abuse prevalent in medical training is too much to withstand without multiple strong internal reasons to persevere.
By intern year, it’ll seem far too late to change course, though. You’ll probably just grit your teeth and slog through the rest of residency, only to wake up as an unsatisfied attending physician a few years later. (This isn’t true, by the way. It’s possible to change specialties or even leave medicine altogether if that’s what you decide.)
There has to be something else driving you to want to become a physician. Maybe it’s a burning desire to help people or a fascination with medicine or surgery, but it has to be something. It can’t just be a desire to make your family happy. It’s just not enough.
Bad Reason #3 – Status
Going into medicine for the status is also one of the worst reasons to become a doctor.
The desire for status is a natural human trait. We’re social creatures and therefore we all exist on a social hierarchy. You can get to the top via a number of methods, but two of the most common methods are to have a lot of money or have a prestigious job.
We talked about the income side of medicine above, so now let’s talk about the prestige or status of being a doctor.
Historically, doctors have been amongst the most respected professionals out there. This was true two decades ago and it’s still true today.
While nurses tend to come out on top as the most trusted profession, doctors are often number two, in close competition with pharmacists. This theoretically puts doctors ahead of teachers, priests, and even judges in terms of ethics and respect.
Having been a physician now for over a decade, I can say that it’s true – in general you do get a lot of respect for being a doctor. When it comes to medical advice and just advice in general, a doctor’s opinion is respected much more than your average Joe.
But it’s not always the case. I have run into hundreds of patients over the years that distrust or even dislike the fact that I’m a doctor. Most of these patients have had a bad experience with doctors in the past that has convinced them that all doctors are horrible. Ironically, many of these patients have medical problems that make them most in need of medical care.
Thankfully, most patients are respectful, but when you run into patients that are not respectful, it can be jarring.
If your entire motivation to go into medicine is to just have the respect and trust of everyone in society, you’re in for a tough career. The fact is that we live in a country where not all patients will respect you just because you’re their physician. For some, you’ll have to carefully earn their respect. For others, there’s absolutely nothing that you can do that will change their poor opinion of doctors. In their eyes, you will always be undeserving of their respect.
Unless you have other strong reasons to go into medicine, this duality can poison your entire career.
Bad Reason #4 – The Glamor of Medicine
As an elder millennial, I grew up watching ER, House, and Grey’s Anatomy. Medical dramas are some of the most successful and long running shows on television, but it’s important to remember that they are dramatic interpretations of reality. And if you’re going into medicine expecting that residency and attending life is going to be as exciting as your average day for Meredith Grey and Derek Shepherd, you’re going to be extremely disappointed.
When it comes to residency, it’s unfortunately true that it’s usually so intense and time consuming that there is little time for anything outside of the training.
I was incredibly grateful to have married my college sweetheart before I started residency training. Because once I started residency, I usually worked about 80 hours a week and had very little time or energy for anything outside of the training itself.
My wife and I had moved to Los Angeles weeks before my intern year started. She was starting a new job at the county museum at the same time I began my training. That first year was an especially lonely year for her because I was often on call or at the hospital for 12-14 hours a day even on weekends. Before she developed her own friend group, she often spent her weekends exploring Los Angeles with a mutual college friend who was in LA doing a judicial clerkship for the year.
And while there was tons of drama at the hospital, it was almost all related to the work itself. Sick patients, challenging OR cases, and the education provided just about all the drama I could handle. When I did have drama with my senior residents, it was almost universally negative.
I do know of a few people who met and married co-residents during training, but this was a pretty rare occurrence.
After training, you’ll become an attending physician. According to Grey’s Anatomy, this is when your life will transition from the rigors of training, leaving you with more time to fend off romantic overtures from your medical team. It is true that as an attending, the work itself can be very interesting and rewarding.
However, after you’ve mastered the ins and outs of being an attending, the majority of your day to day activities will feel like what it is: a job. I actually enjoy patient care and surgery in general, but I’d estimate that as an attending physician, I was only truly enjoying about 25% of my day to day activities. Fifty percent of my time was somewhere between tolerable and mildly pleasant, and the rest of the time was full of active annoyance. Overall, the charting, the grind of clinic, and various other administrative tasks inherent to medicine these days made the entire affair less glamorous than I expected. Think more like “The Office” and less like “Grey’s Anatomy.”
To sum it up, going into medicine for the glamor is a pretty bad reason!
Bad Reason #5 – Your Ego
Yet another one of the worst reasons to go into medicine is to satisfy your ego. I hate to tell you this, but medicine can be a very humbling profession.
I think this is less true in the early years of a medical career. To even get into medicine, you have to prove yourself in a number of ways that can actually be very satisfying to your ego.
For example, you have to be at the top of your class in high school and then survive all the pre-med requirements in college to get into medical school. Then in medical school, you have to perform well enough to get into the residency program of your choice.
These are all accomplishments that can be very validating to your ego.
But when I tell you that residency is humbling, please believe me. Surgical residency programs often pride themselves on breaking down their trainees. Although times are changing, programs will often justify their traditions of debasement and humiliation by arguing that trainees must be broken down before they can be built up into competent surgeons.
I can’t speak as much about the non-surgical residency programs, but I’ve spoken to enough colleagues to know that they’re no walk in the park either.
If you’re going into medicine to satisfy your large ego, the training process is going to be incredibly difficult for you, since your day to day experience will be in conflict with your inflated perception of yourself.
I struggled with this myself during residency training. I was valedictorian of my high school class, went to an Ivy League college, and was president of my medical school class. When I got to residency for my intern year of general surgery, I thought I was pretty hot stuff. My ego was swiftly crushed under the realities of training. I quickly learned that I had a tremendous amount to learn, which was a fact that my senior residents emphasized as often as they could, bless their hearts.
This conflict between my lifelong high ego and the ego-crushing realities of residency training created one of the more difficult mental hurdles of my life. Thankfully, time, perseverance, and most importantly graduation from residency have allowed me to regain my generally high opinion of myself.
Bad Reason #6 – Grateful Patients
Another bad reason to go into medicine is for the gratitude of your patients.
Don’t get me wrong. Grateful patients are one of the biggest perks of the medical field. If you’re in a patient facing specialty, you’ll inevitably experience the rush of heartfelt gratitude when a patient thanks you for your care.
When this happens, it’s often the highlight of my day. Perhaps this happens a bit more often when you’re in a surgical speciality like I am. When you’ve intervened in a way that improves your patient’s life, patients can show gratitude with their words, handshakes, hugs, and even little gifts. I treasure the memories of my grateful patients. I can easily remember their happy tears, hugs, and handshakes as bright sparks scattered throughout my medical career.
But for every grateful patient I have had, I estimate that I have had at least as many incredibly difficult patients that made me question my life choices. It’s hard to know what motivates the actions of difficult patients. Perhaps it’s due to frustration with the American healthcare system, complications, or a borderline personality disorder. But even one difficult patient can produce enough mayhem to cancel out the emotional benefit of five grateful patients!
Read more:
- Bulletproof Vests, Doctors, and Angry Patients: the Problem of Violence in Healthcare
- Will Healthcare Survive The Great Resignation?
One of my most difficult patients had a large renal mass that was biopsy proven to be renal cell carcinoma (kidney cancer). It was over 10 centimeters in diameter and clearly was an imminent threat to his life. I suggested a nephrectomy as the obvious course of action. In the months that followed, this one patient stole countless hours of my life demonstrating his unique mix of racism, paranoia, and magical thinking. No matter how hard I tried, I couldn’t convince him to agree to accept our medical care. Instead, I endured countless deranged lectures and messages accusing me of a litany of ridiculous assertions. I shudder even now when I remember the experience.
So don’t go into medicine just because you think you’ll have patients crying in gratitude every day. It definitely happens and it’s amazing, but it’s hardly the rule. Most patients will be silently thankful, and that has to be enough for you.
Bad Reason #7 – The Love of Science
I know plenty of doctors that went into medicine because they loved biology during high school and college, and it was therefore an easy transition to pre-med. A lot of science majors find that by the time they’ve fulfilled the requirements of their major, they’ve already taken half of the courses they need to go to medical school. So, lacking any other career direction, they decide to take the plunge.
But there are a number of reasons why the love of science is a bad reason to go into medicine.
First of all, as a practicing physician, you’ll never use most of the basic science that you learned as a pre-med. Sure, it helps to have an understanding of cellular biology to understand how antibiotics work. You also need a basic understanding of physics and chemistry to understand the way the body functions.
But you certainly won’t need BC calculus or most of the advanced physics you’ll learn. As a physician, you’ll have a select portion of scientific knowledge that will be relevant to your day to day practice. The vast majority of the rest of the science that you learned will just fade away as irrelevant information.
You’ll realize that a lot of the science and math classes were just obstacles used to weed out people on the way to medical school.
And when you do become an attending physician, you’ll realize that the hallmarks of a good physician rest much more on emotional intelligence and other soft skills, as opposed to pure scientific intellect.
If your major reason to go into medicine is your love for science, I honestly believe you’ll be happier as a PhD researcher.
Bad Reason #8 – Because You’re Smart
As I mentioned above, the actual practice of medicine is different from how it appears on TV. Unless you’re an infectious disease specialist, you’re not often going to be sitting around a table, using your vast intellect to solve a puzzling medical mystery.
In fact, 80% of what you’ll do as a surgeon or medical doctor will revolve around a short list of a half dozen diagnoses. After a few years as an attending physician, you’ll know these six pathologies so well that you can diagnose and treat them with your eyes closed.
It’s only the rare zebras that you’ll occasionally encounter that will require that sparkling intellect that was required to get into medical school. While you definitely need to be smart to pass all the testing and knowledge barriers that exist for a career in medicine, I’d argue that the day to day reality of medicine (for most doctors) doesn’t take a super high IQ. Instead, by the time you enter the second decade of your medical career, it’s more about pattern recognition and execution of decision making trees.
Instead, I’d argue that the true mastery of a career in medicine lies in skills that are decidedly un-intellectual. For example, having empathy for your patients, being a good listener, and good communication are all just as important as being smart. There’s good evidence that it’s these soft skills that determine much patients like their doctors. These skills are what lead to a quality doctor-patient relationship, which is the most important factor that determines the happiness of your patients and therefore the incidence of doctors getting sued.
So if your whole reason for going into medicine is to exercise your prodigious brain, I think that there is a real danger that you’ll eventually grow bored of the reality of a medical career. And as we discussed, raw intelligence isn’t the most important part about being a doctor. It’s the ability to connect with your patients!
(Disagree with me about this one? I’m expecting some strong comments from my neurologists here. Let me have it in the comments section below!)
Bad Reason #9 – Career Longevity
The final bad reason to go into medicine is for the career longevity.
I think there’s a stereotype that doctors will die in their white coat while on rounds at the hospital. I’m sure you can picture it: It’s the 92 year old white haired cardiologist shuffling around the ward with a curved back but animated face, happily seeing patients on a Sunday morning, when he suddenly drops dead of a myocardial infarction with a bemused expression on his face.
I’ve met a few of these physicians during my career, and I do think that their lives are enviable. I imagine they’ll suffer the same happy fate as my imaginary cardiologist above. Many of these older doctors had the blessing of practicing medicine during its golden age and still enjoy it enough to continue, even after traditional retirement age.
But if you’re going into medicine with the hopes of having extreme career longevity, I have some sobering news.
The fact is that medicine today isn’t the same as it used to be.
Even before Covid, up to 38% of physicians reported symptoms of burnout. Since Covid, doctors are more burnt out than ever. By 2021, burnout rates had risen to a whopping 63%.
Read more:
During this same time period, physicians lost more and more autonomy as the percentage of employed physicians rose from 62% to 74% from 2019 to 2022.
As a victim of physician burnout myself, I responded by shifting my practice intentionally to the part time model of locum tenens. I also expanded my life by growing a real estate investment business and aggressively moving towards financial independence.
In this way, I insulated myself against all the troubling trends seen in healthcare today. What kind of troubling trends? How about the increasing control over healthcare by insurance and pharmaceutical companies or the growth of private equity owned physicians? How about steady decreases in Medicare reimbursements?
Since I diversified my income streams, I now have the comfort that if healthcare continues on this path, I can exit the field entirely. I’ll miss patient care, but it’s incredibly freeing to have the knowledge that if worst comes to worst, I have options.
A recent survey by the AAMC showed that 20% of physicians were planning to leave their practice within the next two years, with a third of physicians planning to cut back on hours as well. This exodus is adding to the already grim physician shortage, which in many parts of the country is making it harder for the physicians being left behind.
While there will always be some physicians who happily practice until their 80s or 90s, I think this will become increasingly rare. That’s why I think going into medicine due to the promise of career longevity is just not a good reason anymore.
Conclusion
I hope you found this an entertaining read. The purpose of this article is to provoke dialogue and discussion, as I’m sure many practicing physicians will find many points of debate within this article.
But for pre-medical students who have yet to embark on a medical career, I think these points are well worth making. If you find your central motivation for becoming a physician is any single one of the reasons I list above, you might need to do some soul searching. If you’ve got a combination of three to five of these reasons that are pushing you into medicine, I think that’s a different story.
As you can tell if you read my commentary, there is still a lot of love about practicing medicine. However, there are strong headwinds to American healthcare that are important to acknowledge.
As always, make sure to leave your comments below, and please subscribe below for my free newsletter!
— The Darwinian Doctor
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Hey dude well written! I am a neurologist, but have no qualms with #8 🙂
As I read through your list I kept thinking to myself that I had a little but of many of these reasons for applying to med school. And the further I got down your list, the more I wondered what, in your opinion, would be a good reason for wanting to be a doctor.
My dad lost his job over and over when I was a kid, so I wanted something more stable than his career. I watched my share of ER. That was most of what I “knew” about medicine when I applied. Ego gets a bad rap. You have to have a healthy self-esteem in order to accomplish anything in life. You just have to counter-balance it with humility. I loved science in undergrad, and the idea of using science to help people really was a major motivation for applying the med school. (Yes, I am a neurologist. Haha!) And my grades were always awesome. And who doesn’t want to make their parents proud?
I can’t think of anything that motivated me to pursue a career in medicine that wasn’t reflected somewhere on your list.
Anyway, I got all the way to the end of your post, and in the conclusion you finally hit on the most important point, which is really just a caution about concentrated investment. Make sure that your reasons for wanting to be a doctor are appropriately diversified. I can agree with that.
You made it to the end! The article was conceptually just as you said — basically everyone will see some of the list as part of their motivation to go into medicine. That’s actually okay, though. As I mentioned in the end, concentrating on just one or two of the reasons to the exclusion of others is the danger. Thanks for your comment!
Number 8 speaks to me. I’m in Emergency, practicing for almost 10 years. I know exactly what to do when someone is sick and dying. I have a saying now that if I have to think about anything, it’s probably not good for you.
The negative patient interaction point is also true. Add the threat of violence and lack of support from administration and it’s hard for any amount of gratitude from satisfied patients to overcome.
Thanks for the insights!
That was a great article, full of insghts, presented with a superb style of writing.
I’m retired after 35 years of practice. I agree that if a prosective physician is forcused on one or two of your bad reasons to fulfill some inner need, if they summon the will to survive the process of becoming a doctor, they are going to become disappointed with their career vhoice.
However, appreciating those “bad reasons” without defining oneself by overemphasizing and being driven by one or two of them can make for a fulfillig progessional life. With a goal of balance, acknowledging but limiting the influence of those “bad reasons” (which are actually positive factors) can become positive attributes that contribute to experiencing medical practice as a rewarding endeavor.
Thanks so much for your thoughtful comment! I agree with your approach!
Wow, to some extent I went into medicine for all these reasons and I paid the price enduring a career I never loved, or even felt comfortable in. But I think you missed one more reason: fear. I was driven to medical school because I was afraid to explore less defined professions. Medicine seemed like a secure choice to an aimless college senior.
I’m about to retire, and medicine has provided me with a good life for which I am grateful, even though I kind of hated the job itself.
Great point! Fear is a bad reason to do anything, though it often is what motivates us (to our detriment). I think I experienced this to a large extent when I thought about the need for a stable, well paying job to help lift my family out of financial insecurity. Thanks for your comment!
It’s hard to make an informed decision about the medical profession before being in it. Even if you shadow a family physician awhile, what does that teach you about Psychiatry, Radiology or Dermatology? Even if it’s intriguing today, will it be after a decade of repetition? You have to make judgment calls that amount to educated guesses gambling with the health and lives of other people, and you will make thousands of these calls over a career as a physician – not all will go well, and you may have to live with that. The opportunity to make a difference sounds great, till you realize it can be a very negative difference at times.
One counter point; a great many people never find a vocational passion, a ‘calling’ that’s practical to pursue solely for noble reasons and matches up well with their abilities and opportunities (after all, how many astronauts can there be floating around in space?). While your list of bad reasons to choose medicine works well if each is considered as a sole reason, wrapping several together might be another story.
I appreciate you putting out this thoughtful piece.
Many thanks for this comment. You’ve captured the punchline of the piece — that individually, these are bad reasons. When taken as a conglomerate, they together form a pretty good rationale for going into the field of medicine. Because once someone enters practice and realizes the realities of medicine today, it’s inevitable that one or more of these reasons will ring hollow. But as long as there are other motivations and reasons to lend support, medicine can still be a rewarding and sustainable choice.
I like the bit about being smart and neurology. As an internal med resident, I worked mostly with young attendings not many years out of residency. The neurologists would usually do a cursory exam and then order an MRI before offering any treatment. One day, I was taught by one of the ancient physicians you mentioned. This gentleman (the real sense of the word) spent a good 30 minutes taking a thorough history, and another 30 minutes doing a meticulous neurological exam (including time for his painstaking explanation to me). He then sat down and came up with a list of differential diagnoses and their rationale. And before he offered any medical advice,,,,, he ordered an MRI.
Haha, so which method did you prefer?
#7 Love of science is an interesting point. I would agree that humanistic skills and soft skills become more important as an attending, but at least for myself I disagree that my current life would be better if it was a PhD. About 10 years ago Pacific Standard magazine wrote an excellent article called “The Real Science Gap” about how there are currently too many PHDs in the US and not enough university tenure track positions, which leads to unfortunate many PHds going from low paying post doc to post doc. Think about it like being in residency forever!
You’re right, that doesn’t sound very appealing. What do you think a better path might be for science lovers? Industry? I do think PhDs can be hired by private companies as well, so perhaps that is an option as well?