Now that I’m over 50, have enough grey hair, and have children in college, people occasionally ask me for career advice for their children. The question goes something like “My son/daughter thinks they might want to be a doctor. Would you be willing to talk to him/her about it?” I always am happy to have a conversation about medicine and have met some remarkable young men and women in the course of these conversations. Because it is again that time of the year, I thought I might post some of my thoughts. If you are already a doctor or have thoughts regarding the topic, feel free to add your two cents as well.

1) No matter what, we like our doctors smart. If you are even considering being a doctor you needed to start working on test skills in 8th grade because we pick our doctors based on test scores. This means that people who go to “good” school have an advantage as do people who come from wealthy families. If you struggle as a student we believe you will have trouble making it through the system. This is a real problem in rural America where the emphasis has not been on identifying smart students early and working to give them have more of an advantage. We are often not willing to take chances with marginal prospective doctors, no matter how well intentioned they are. We need more programs that help students from rural and underserved communities achieve because growing doctors from within is the best way to do it.

2) As a physician, you are guaranteed a very good living but not a great living. I realize that they tell people applying for medical school never to discuss money but I’m putting this out there. Me and my colleagues are paid at the top 5% of all earners in the richest country in the world. This allows you to live very comfortably but also puts you in an awkward position in that the majority of folks you care for will have a very different set of concerns and worries than you do. The other weird thing is that the way doctors are paid makes some doctors think they are rock stars when the money they make really reflects the weirdness of our payment system. This is problematic when the doctors feel like they are owed the money by society and the ground rules for paying change (which they do periodically). If you live up to every penny, it tends not to end well.

3) As a physician you will have to work hard, and not in the way you think. I compare myself to my chemical engineering friends. Both of us came out of school with a complex, technical knowledge base. The difference is that companies who hire engineers fully expect that after 10 years or less the knowledge will be outdated and the engineer will either move into management, attempt to stay current, or move into another field. As a physician you will need to keep up with medical literature at times when you are not seeing patients. This means a lot of after hours reading of medical journals when others are in bed, asleep. Although no one is making you, your patients and colleagues expect it.

4) You are always a doctor, even when you are off. Comes with the territory. Some of us like it, others don’t. This is more so in smaller towns where you will be recognized and asked to answer medical questions in the grocery but it happens to me in Mobile Alabama (often) and Marietta Georgia (rarely but there was one family get-together where my cousin cut a tendon with a knife…)

5) If you are nosey, it is a great job. When people are applying for medical school, I often hear “I like science” and “I want to help people” in various combinations. Liking science in the way it’s taught now isn’t a prerequisite to being a physician. Non-science majors often make the best physicians. The prospective physicians I know will do well are those who have been engaged in activities where they get to know the people that they help. Showing up on a Saturday with your fraternity to work on a Habitat project is not nearly as meaningful as volunteering for a hospice and getting to know the patient. Doctors are able to make people feel better just by being in the exam room. This can be a really cool thing. On the other hand, this is a job where people entrust you with their inner most secrets. If that doesn’t appeal to you, you’ll still get into medical school but it’ll be a long 40 years.

6) Just because you get into medical school, you can still blow it. If you are a jerk or greedy before you get in, turns out we can’t fix that in medical school. We put out some of the best doctors when all of the smart  jerks were going into dot-com jobs and we didn’t have to interview them in the first place. If you have an entrepreneurial spirit, medicine may not be for you. You have the ability to harm patients if you can’t put their interest before your own self-interest.

Other thoughts?