“It’s so unfair that you have to pay for your flights for residency interviews!” George, my fiancé, was indignant. “In addition to hotels, applications, and everything else!” I looked over, surprised at his outburst. It was justice, not stinginess that lit the fire in his eyes.
“Dear, we pay for everything when it comes to medical education.” I said. It made sense to me—that’s the way medical training worked after all. Debt, debt, debt, and years later, a paying job.
“But why? It doesn’t seem right that corporations pay for potential employees’ travel fare and hotel on their interview days and universities arrange for PhD candidates to come and see their programs, but medical schools and residency programs won’t. The way I see it, that’s unprofessional.”
Unprofessional? Medicine is all about professionalism. And tradition.
“That’s just the way things are,” I told George.
From what I can see, medicine leans heavily on prestige and people to entice candidates to its programs. It can’t afford (and perhaps doesn’t need) perks to do the job for them. But George has a point. In a world where money is valued so highly, the medical field remains a privileged one. Why is that so? The answer is complicated.
My first year of medical school concluded less than a week ago. I think back to the $70,000+ spent on my one-quarter-MD and part of me cringes a bit. It is a well-known (and well-accepted) struggle that enormous loans are often necessary to make it through the four years of medical school. Yet, even with the MD in our hands, at least one year of internship and, more likely than not, another two to five years of residency is needed to practice. Often, physicians-in-training will continue on to do a fellowship and subspecialize in their field, which can take another one to three years. And the cost of applying to residency? It is not unheard of for medical students to take out additional loans during their fourth year for the sole purpose of “residency and relocation.”
Beyond the monetary expenses of medical education, there is often an underlying complaint of lost time in medical school, something that is a mix of lost sleep and lost opportunities for making money, exploring the world, and even, of developing relationships. Somehow, it seems that there is the notion that medical education has a way of sucking the marrow out of life. The best years, prime years often in one’s 20s, are spent studying in libraries or wrapped up in cases in the hospital.
Still, a large part of me is idealistic. I see the pursuit of medicine as inherently sacrificial. Student doctors spend their time buckled down in books or the wards, learning how to bring others into health and wellness. I admit to oftentimes believing that it should be so—that in this field of caring and healing, our focus should always be on the other, the sick patient, and not on ourselves and our own sacrifice and debt.
I told this to my friend Arnav and he laughed at me. “You know, it would be way easier to get into medical school if being a doctor wasn’t a high-paying job.”
I thought about it and after a while, I nodded. I guess it’s true.
“Plus, there are no poor doctors; only doctors in debt.”
Hmm. True again. Indeed, it seemed an oxymoron to imagine a starving doctor. The idealist in me heaved a sigh. Arnav, as always, was deeply practical about his decision to go into medicine.
Like Arnav, many of my classmates have reasoned away the burden of their loans. Being a doctor is a secure and respectable job. Their debt pushes them to pursue fields that reimburse well. As one of my medical school friends shared with me, no one wants to stay in debt forever. The less time needed to pay it all off, the better.
Nevertheless, I believe that most of my classmates would agree that in the end, all those numbers fading away from our bank accounts will be forgotten. Already, the payments to AMCAS for applying to medical school are long-gone, lost amidst the moving process of dissecting a human body, the willingness of busy physicians to be my mentors, the privilege of being so trusted by another in clinic. Many years from now, I believe that my exorbitant tuition will be long-gone too, forgotten amidst the incredible experiences I have had, the colleagues I have met, the patients I have walked with on their journeys. These opportunities are indeed worth so much more than the entry fee that is medical school.
My first year blew by. The end was jerky—I performed badly on the final exam for neurology. Yet, even in feeling unable to remember any information, I told myself this: medicine is not about numbers. Medicine is about listening, caring, healing— things that are so human and valuable.
And so, neither will I judge myself by numbers.
Featured image:
Student Loan by Simon Cunningham
2 replies on “The Value of Medicine, Amidst all That Debt”
Long-gone? I don’t know what you did with them, but my payments to AMCAS, secondaries, and the like, certainly are not “lost.” We all come from different socioeconomic circumstances and for some of us, the memory, and dollar balance, of spending that amount of money (an estimated $2,198 for application fees alone for JHU undergrads) is not so easily brushed aside.
I am a second year medical student and while I understand your good intent, I find your message flawed.
I am tired of hearing that to be successful at medicine, you must embrace the coming years of apparent self-flagellation and sacrifice with nary a peep of complaint. I am tired of hearing that if you think about yourself, and the stressors you face along this career path (financial and otherwise) then this is bad, and you are bad. Some toss this notion around as if you can’t contemplate your own needs without that meaning that you’re taking time away from thinking about your patients and their suffering — which apparently, you’re supposed to be doing every single moment of the day.
This attitude bothers me because it’s unrealistic. Doctors are people and they have needs too. Moreover, it smacks of elitism. Med students and those who choose to pursue medicine are not monks. We are not saints. And we are certainly not above the desire to have a happy, balanced life like every other human-being on the planet. But every time an article like this is written it suggests that is what you must be in order to be a “good doctor.” In reality, I think this attitude is the exact recipe for a bad doctor; it contributes to unrealistic expectations, physician burnout, depression, and myriad other issues which in the end will come back to inhibit our delivery of quality patient care like the most insidious of negative feedback loops.
Caring about oneself, one’s future, one’s time with family, and yes, even one’s financial situation is not mutually exclusive with being a kind, caring, and capable physician. I am happy you are unconcerned by your student debt and your sacrifices but let’s not dish out back-handed compliments those that aren’t by declaring them practical-minded as opposed to idealistic, and “judging by numbers,” rather than “hearing, listening, caring.”
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As a side note, I am curious as to where your quoted material came from. No source is given, and I was confused during my first read-through as this made it seem as though the anecdote with “George” was your own, and that you were a fourth year, not a first.
Hi (Julia? Julian? Juliana?),
First of all, I want to thank you for your honesty and the passion with which you’ve shared your perspective.
To clarify first, I wrote this blogpost earlier this year as I was finishing up my first year of medical school. I too am a current second year and recently got married over the summer. At that time, my now-husband, George, and I had been discussing with a friend (with a PhD) the “injustice” of the residency application process. As you mentioned in your comment, the costs of medical school and applications are very real and burdensome for a student with little to no income. For me, it is now something that not only I, but also my husband need to shoulder. Thus, even as a first year, the cost of applying to residency was something I was thinking and talking about– apologies for any confusion!
Now, on to the meat of your comment. I appreciated how you spoke of the doctor as a person– a person with flaws, passions, shortcomings, desires. Yes, I see how my words dismiss the tiring reality of medicine (with burnout and depression as two key issues in the medical field). However, I want to challenge you on how you define the “bad doctor.” I think we are both coming from a place where we understand that success as a physician goes beyond knowledge and skill and that to properly care for our patients, we need to encourage each other to learn to love and care for ourselves. My admittedly idealistic views on the physician are, as I stated, mine– and neither will I be a bad doctor if I do burnout. I will be a doctor always trying my best, even as I struggle. Like you said, to be realistic and practical and at the same time idealistic– I do not think that these necessarily clash.
For my friend who is indeed a very practical person, I am grateful for him, whose comment propelled this article. I believe he will be as good of a doctor, if not better, than I, for he has been able to properly balance his expectations of the field as well as his hopes and dreams.