We all grew up being told that one of the best careers was to be a doctor. Somewhere along the way this stopped being universally true, and a lot of people didn’t notice the change.
What is this article about?
I left medicine after graduating from medical school in the US — an idea that sounded crazy to many of my medical friends and colleagues and friends. I thought it was crazy that they didn’t consider it for themselves.
I want to share my perspective on a life decision that is rarely talked about. Many people in healthcare — medical students, residents, attending physicians — are unhappy with medicine but aren’t aware of all of the options available to them, or why they could be better than medicine.
Medicine is great for a lot of things that people look for in a career. You can make a huge impact in a patient’s life as a doctor. You have a prestigious job and get positive attention. You bring in a great salary. The list goes on and on.
The job also has serious negative aspects, which are rarely recognized and minimized when they are. You give up a lot of years to practice medicine— some would say the most valuable years we have. You sacrifice freedoms, both in the amount of time you spend working but also in the ability to choose where you live. Any given resident has complained about many additional negatives in the last week
There are several areas in which medicine cannot be beaten. If you value being able to operate then there is no better career option than being a surgeon. If you value being able to see your work make rapid and significant change in a person’s life then there are few options that rival taking care of patients.
I think that there are situations where medicine is the best career possible for a person:
1. If you value a (specific) prestigious career.
If you your main driver in life is to be able to go to a dinner party and tell people “I am a heart surgeon”, then medicine is the place for you. There are plenty of prestigious careers in the world, but few are as universally admired as a doctor. However, some people don’t gain much value from external validation like this — or at least not enough to justify all of the sacrifices (are you even going to be able to go to that dinner party?).
2. If your definition of impact is to change a single person’s life.
Impact from a career can have multiple definitions. One extreme would be to save an individuals life. The other extreme would be to create the alarm noise for iPhones. Which one has had a larger impact — majorly affecting 1 of the 7.7 billion people on Earth, or slightly annoying 1 billion people? If you think the former defines impact then a career in medicine is an effective way to make that change on the world. If you think the latter sounds more significant then medicine probably isn’t the most efficient way to accomplish that goal.
3. If you want to operate or deliver babies.
Some things in life are irreplaceable and there is only one way to accomplish them. There is no (legal) way to operate on a human other than to be a surgeon. And you’re much more likely to deliver a baby as an OBGYN than as a software engineer. If you think that there is a job in medicine is just the coolest thing in the world, then medicine is probably the right career for you. If you aren’t as romantically about medicine, or if you are but the negatives just aren’t worth it, then you should consider other careers!
Actually, if you want to be rich, medicine is a really inefficient way of accomplishing that goal. First off, let me be clear. Almost every practicing doctor in the U.S. is going to be in the top 10% of earners ($158,000 by the way). But there are other ways to be in the top 10% of earners in the U.S., like being a software engineer or working in marketing.
And what if you want to make $740,000 a year, to put you in the top 1% of earners? Some physicians can accomplish this, but it is a small percentage, they work very hard, and there are many more efficient ways to reach this milestone.
Huh? I thought doctors had one of the highest salaries of any job…
This is true on average, but when you consider the salary of a physician to another high-earning career it becomes clear that this idea has issues.
One problem stems from looking purely at the starting salary of different careers. A first year general surgery attending physician will earn ~$430,000 (on average, multiple sources) which is much higher than a first year consultant — at ~$170,000 on average. But consider when these salaries will be earned. The consultant will make ~$170,000 immediately after graduation, when the surgeon would be in residency.
This issue also arises because people often don’t consider the change in salary over time. Physician salaries rarely increase over the course of a career. In the best case scenario, the amount you earn is linearly related to the patients you can see. The more operations you do in a week the more $$$ you earn. But this is only feasible to a certain point. And if the compensation isn’t RVU based, then physicians typically earn a salary that only really increases with promotions in the department — and there can only be one chair.
Conversely, salaries for careers outside of medicine always continue to rise, and some of them can continue to increase into the millions of dollars per year. This is because in areas outside of medicine professionals figured out how to pull the lever to scale. [What is ‘scale’? They didn’t teach me that in biochem…] If a senior level investment banker makes 4 deals a year, and then the bank employs 8 junior bankers to execute those deals. What if that senior banker sells 7? Then the bank hires more junior bankers to handle the additional work. The senior banker is limited by the number of deals he can make — which isn’t limited by hours in the day — meaning the senior banker is not limited to linearly increasing their income. The same goes for tech, consulting, and other ‘business fields’.
What if your key driver isn’t maximizing money in the bank account? What if you are happy attending the dinner party and getting attention by the merits of your personality instead of your title at work? What if you value being able to go on vacation, spend time with your family, or find something new and exciting to do?
There are many situations where a career outside of medicine is much more attractive:
If you enjoy your free time during your 20s and 30s.
Residency takes up a huge part of life for physicians. Most can expect to only have one day off a week, and to work hard during the other 6. If you have a hobby that you love (especially one that you can’t do as easily when you age) then maybe sacrificing your weekends from the ages 29–32 isn’t worth it!
If you value learning something new.
In medicine, as you gain experience you become more specialized. This starts in residency, when physicians start focusing on a subset of the things they learned in medical school. For specialists, this continues with any additional specialization training, until you become an expert in the field. For primary care/generalists, you use a wide range of skills, but refer out anything that you don’t see frequently.
In careers outside of medicine, you have the ability to transition to a new field much more frequently and easily than in medicine. Not only can you switch between industries in a given field (e.g., transitioning from consulting in life science to consulting in aerospace), but you can also switch fields (e.g., switching from consulting in life science to product management for a tech company). This ensures that whenever you feel the need to take on a new challenge, or learn something new, you are able to.
If you need flexibility.
Medicine doesn’t allow for much flexibility in life. You have little choice over the location of medical school, residency, and fellowship. Attending jobs (especially academic ones) can be limited — especially in major metro areas. Conversely non-medical professions, especially now with remote work being a reality for so many, are able to move locations (and take vacations) quite easily.
There is a very long answer to that question, and there is no way to answer it completely. I tried to write down details to some of the careers which I get asked about most commonly on a website where I go into more detail — DoctorSwitch.org. I made DoctorSwitch in an attempt to help answer some of the most pressing questions that I personally had when I was thinking about leaving medicine.
DoctorSwitch is by no means a comprehensive list of careers available to physicians You could make a very successful career out of anything if you are good enough at it, and I firmly believe that the skills you gain in medicine are universally valuable. But there are a few options with more well-formed paths leading out of the forest of medicine. Consulting, investment banking, and equity research are all industries that value skills and experience that you gain as a medical student and doctor. Theses industries pay very well, offer a lot of benefits as a career, and avoid some of the negative aspects of medicine. Additionally, other fields of finance (e.g., venture capital, private equity), health start ups, pharmaceutical companies, medical device companies, and more would be interested in adding a doctor to their team.