The personal cost of medical training. Why it’s worth it for this doctor.


I was at an orientation luncheon prior to my first week of medical school when my new classmate turned to me and asked, “So why did you decide to go back to school?”

“Back” to school? In the eyes of this then-23-year-old future doctor, I must have appeared older than I was supposed to be. She was right. I was a little bit older, but I had never viewed myself as such until that moment. I had taken all of the pre-requisite courses for medical school during my so-called traditional college years at the age of 18 to 22 as part of my science degrees. I just didn’t consider a career in medicine until my financial situation had pushed me to leave a PhD program, opt out with a master’s instead, and enjoy a brief stint as a medical microbiologist before settling my debts and trading my lab coat for a coat of a slightly whiter (and shorter) variety.

My decision to pursue medicine wasn’t easy. My personal monetary price tag was close to half a million dollars in forfeited income during training in addition to a shiny new set of student loans. Though I was not hit as hard as many of my classmates, it is fairly common for medical students to owe over $200,000 or more after 4 years of medical school, and I can’t imagine the immeasurable sacrifice those with families make.

The time cost for typical radiology training breaks down to 10 years after college (in 4 different cities in my case) including medical school, intern year, residency, and fellowship. While you can attempt to minimize your moves for the sake of family and stability, your fate, for the most part, is often governed by a computerized matching algorithm, and your options become more narrowed in the more competitive medical specialties. Despite this investment, there may not even be a job waiting, especially if you are partial to a specific city or practice style, and physicians are often forced to enter into non-compete agreements meaning that if your job doesn’t work out, your contract may not allow to practice within a certain radius right away.

As I scroll through my various social media contacts, I see a catalog of friends from the cities I’ve lived in. Most have growing families. Many are physicians with successful practices. A fair amount are too busy to write me back. My news feed is a memory parade of goodbyes, smiles, new starts, triumphs, and tribulations complete with the weddings of ex-girlfriends who couldn’t tolerate the time or distance apart, funerals that I was too busy to attend, and graduations that I just couldn’t make time for. It does seem reasonable to question why one might opt for this lifestyle in retrospect. A typical reader may assume that doctors are all wealthy and that this should be compensation enough, but not only is the wealth myth inaccurate, but what is ten years of your physically healthiest years really worth?

It is the experience of practicing medicine that makes it worth it to me, not the money. Returning to the question of my former classmate, many years later, I went to medical school because I didn’t want to be like so many people I’ve met in life who have a laundry list of complaints about their jobs while submitting to an external locus of control that governs their inability to advance and improve. I went to medical school to merge my interest in academic science with the realm of clinical research. I went to medical school to push myself to an intellectual pedestal that allowed me to compete with the most intelligent in a curriculum that integrates the pantheon of anatomy, physiology, pathology, and human behavior. I went to medical school because I saw it as a summons to transform my life while affecting the lives of others on a more personal level. I went to medical school because the ambition of my own 23-year-old self had been incompletely realized.

If anyone has a right to feel frustrated about changes and regulation to the profession, it should be me, but I am not going to complain. I have been treated like a second class citizen in a series of jobs in the past including being more than one CEO’s pawn, and I can now say that my voice matters. It matters to the physicians I work with. It matters to the other medical professionals I have the privilege to share the hospital with. It matters to the patients who trust me with their health.

Don’t get me wrong — there are a lot of problems with the system, but as doctors, we need to make sure that we matter to administrators and politicians as well. Among the hundreds of standardized questions given to me in 10 years time, not a single one required a meaningful understanding of healthcare economics. This leaves us behind the management personnel we so often wind up working for instead of working with, and when we show up to the negotiation table, we fight with each other over a few slices of a pie that has already been largely spoken for by other stakeholders.

We have the right to complain, but our complaints should come with solutions that address the system as a whole. We should look at leadership positions within health systems as opportunities to matter, not annoying wastes of our time. We should push our educational system to reform and conform to the modern age, recognizing that we can’t truly treat the whole patient if we are never told how, when, and why they are charged for our services. We should recognize that time spent on non-clinical duties may be necessary to lay the ground for an environment of successful practice in the future so that we can help the next patient. If we are not at the table, we are on the table.

In reflection, the personal cost of medical training was worth the constant personal and professional hurdles. To our loved ones who support us through this path, we couldn’t do it without you, and we’re sorry if it feels like our “second spouse” (our career) occupies so much of our time. Only with your understanding is our vocation possible, and it is that understanding and support that reminds us that we are as human as the patients we treat.

Cory Michael is a radiologist.

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