The Healer’s Quandary

So I’m on the road again. Just popped through Telluride where the skiing and the views are spectacular, sheer cliffs, 14,000-foot peaks and pure expanses of sparkling snow, like another planet. Then drove and drove through the frigid core of the Rockies (2 below at mid-day).

The main reason for the trip is interviews. I’ve applied to medical school, and this is my last one–unless some school I haven’t heard from surprises me with an invitation very late in the application cycle.

As the days roll nail-bitingly by, I find myself poring over the motivations for my decision to go the med route. I originally set out on this path for two main reasons: 1) the inspiring journey of becoming a healer, meeting and helping people and becoming a pillar of the community; and 2) the abject rottenness of the job market for recent Ph.Ds.

But it’s strange the hidden stories some people have. I remember a nurse I met long ago during a check-up, very energetic and unusually bright, who related that she had once attended law school–purely for “ha-ha’s”, as she put it. She ended up leaving and of course wound up in a radically different career.

With no acceptances, only this interview left, and my 30’s ticking away, I find myself wondering if in a few years I will tell people, with a practiced nonchalance, the same thing about my graduate school experience and about applying for med school: that I did it for “ha-ha’s”.

I have come to see is that medicine is a house of cards in this country. Docs are often miserable, up to their eyeballs in expenses, administrative hassles, and debt, and students and residents are even worse off. In about a year since setting out to pursue medicine, I have already seen first-hand a series of hideous outcomes due to medical mistakes, while a recent article in Time, about the epidemic of depression and suicide among medical students, also threw my grand imagery of re-tooling for a medical career a serious curve.

Then add in debt. For example, this particular school I’m interviewing costs >$50,000 a year, which puts it slightly ahead of the curve, but only slightly. With living expenses and loan interest near 7%, one can easily come out $300,000 in debt.

This extreme level of indebtedness seems to have the ultimate effect (goal?) of pulling the medical profession into a kind of financial servitude, though it afflicts the scions of the well-to-do as much as the underprivileged: read about Ben Bernanke’s son, who recently graduated med with $270,000 in debt. According to AAMC, the average indebtedness of the class of 2014 was $180,000–a number that may well be higher in reality, considering the source, and in any case is almost guaranteed to increase.

Yet here is the amazing thing: this seems to be no deterrent. A huge, indeed record number of people are applying to medical schools, filled with a starry-eyed conviction that if they just get in, their lives will be immeasurably more fulfilled. I can’t tell whether such people are magnificently idealistic, unbelievably tough, or lamentably drinking too much hero-doctor Kool-Aid past its pull-by date.

Another possibility is desperation, as more and more avenues of advancement for smart and highly educated young people seem to be cut off. Ladders are being thrown away, and oligarchy becomes the order of the day. The United States now ranks among the least economically mobile advanced nations, and though incomes for doctors have declined and continue to do so, medicine remains one of the very few areas where, if you are smart and (extremely) hard-working, you can be fairly assured of a top-1% salary.

As a result of this flood of applicants, admissions and interviews have never been more competitive, even for low-tier schools. Tiny slips or deficiencies can doom you.

A friend of mine, to whom I voiced these concerns–particularly about ending up over $1/3 million in debt after school–simply shook his head and said, “if the money concerns you, then you don’t really want to be a doctor”. But I think this is over-simplistic. It’s true that part of becoming a professional is to go through struggle and suffering to prove yourself. But any object of enthusiasm can be reduced to an object of ambivalence if the obstacles and sacrifices get too crippling.

As I ponder these prospects I find myself wondering: could medical school be a bubble? So far, it appears not. Despite a huge shortfall of physicians, admissions have been kept low, and the record tide of applicants shows no sign of slackening. Yet I cannot help thinking that at some point, unless things change dramatically, more and more people will begin to realize that a medical career is not the prosperous happily-ever-after that it once was, and is still widely thought to be.

Then I look at the alternatives, which with my educational background and no industry connections, pretty much means postdoc: make barely more money than a grad student stipend, have zero job security, crank out boring papers.

So for all my concerns, when I ask myself what I will do if I don’t get in to any med schools this time around, the answer comes back: apply all over again next June.

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