Medical

Academic Medicine? No way! (But are you so sure?)

The doctor business is win-win: doctor wins, patient wins. In sharp contrast, the legal profession is a win-lose dichotomy. That is one reason why we choose medicine. It is a huge difference in psychology that gets into our very bones. Becoming a doctor is a highly noble pursuit. Being a doctor is fun, exciting, worthwhile, productive and assuredly positive. Doctors create wealth in the world by increasing the ability of people to pursue their happiness. What in the physical realm could be more worthwhile than that?
But medicine can be an all-consuming life choice. Before embarking on it, ask yourself if you can tolerate sacrificing a large percentage of everything else you enjoy to do, and everyone you like to be with, for a long time. The job is great. No doubt about it. But don’t naively minimize the sacrifices. Is it worth the sacrifice? Don’t let anyone other than you decide that.

If you are on your road to becoming a doctor, here is some advice you probably have never heard: choosing what field in which you will practice within medicine is not the initial decision you should make. Rather, you first should choose between an academic career or a clinical career, and only after that should you pick the specialty field. Why? Because there is a much greater difference between an academic vs. non-academic life than there is between being a plastic surgeon and a primary care physician. Figure out the big forks before you decide on which side street to drive up.
To help understand this concept, let’s seemingly deviate from the road for a moment to examine your life. If you are like most in this field, you have throughout life had long term goals that appear in roughly four-year time horizons. You worke hard for four years in high school to get good grades to get you into your college of choice. You then work hard for four years in college to get you into medical school. You next work hard for four years in medical school to get the residency of your choice. You then work hard for 3-7 years so that you can become either a fellow or maybe skip to be an attending physician. You have always had long term goals pulling you forward, driving you each day, and most are goals four years out. After all this, you have become a long term goal driven person if for no other reason than your own neural rewiring from all this schooling.
So when you finally become an attending physician, perhaps an employee of a health system of some sort, what will be your long term goal then? You will be hardwired to have a long-term goal, and it may be that, for reasons you cannot even decipher, you are not going to be happy in your finally-achieved profession if you have no long term goals left to strive for.
I suspect that this final absence of goal is why many doctors are not happy in their profession. They’ve finally made it. But what’s next? They blame their discontent on the horrific system of health insurance, the administrative hassles, the government and bureaucratic intrusions, the legal liability, the declining payments, the longer hours for less reward, the loss of autonomy, or whatever it might be that most bothers them, all of which can and do contribute to professional disgruntlement. But few will ever recognize something deeper, and be able to attribute their dissatisfaction to something more internal: the absence of a long term goal in a long-term goal driven person. It is a empty space that most doctors don’t know is even there.
The space can be filled. Primary care doctors can recognize that they have long term goals with every well-known patient they follow for years, and allow those patients to fill their hole. Other doctors who have no long term patient relationships may need to look elsewhere within the profession: medical societies, building a practice, political involvement, changing perspectives of other doctors. But please look for that goal.
And this brings us back to road we were on, and that choice between a clinical life or an academic life. The academic doctor teaches and/or performs research (bench or clinical or translational) in addition to clinical work. Teaching and research provide long term goals always right there for you. And that can add to your feeling of being whole.
In addition, the lifestyle difference is substantial. A successful clinician—primary care or surgery or anesthesiology—generally knows he/she will be in clinic or surgery on any date you pick, even six months from now. In contrast, a successful academic doctor might have no set obligations on that date, or perhaps will be presenting his/her research in Prague or in Kyoto then. The hours are much more flexible in academia, travel as part of work is very common and can be extensive, the work is more diverse, and the collegiality is wonderful. Of course compared to clinical practice, there are downsides to an academic life: uncertainty about research funding availability, dealing with a university system that may not allow you to do things as you want to, dealing with JCAHO and ACGME perhaps, and of course generally lower pay. Academia generally yields less money, but more freedom. Which will help you pursue your happiness better?
Who thinks during medical school about the possibility of being an academic doctor? Very few. But you should think about it and try out some research and teaching if you can, remembering that performing your own research on your own ideas is much more fun than following the lab boss’s directions as a technician.
You can be academic in any specialty at all. Is there a rush to decide? No. You can decide during residency or even in early in fellowship. But if you can consider it early, you may see your path through your career a whole lot more clearly.
Deciding between a clinical career and an academic career is the most lifestyle-relevant decision you can make as a doctor. Give it fair consideration. Regardless of what your decision is, finding some form of long term goal when you become an attending may well help you maintain persistent happiness. Your happiness increases the wealth of the world. Your happiness decreases the overall level of poverty. You have the unalienable right to pursue your happiness as you see fit. Although there is no guarantee you will find all the happiness, it sure makes sense to run your best race in its pursuit.
I hope you have happy adventures and fill the bumps in your road to happiness with laughter.
John Hunt, MD is a pediatric pulmonologist, allergist & immunologist and the author of ASSUME THE PHYSICIAN – a novel that teaches through laughter. He is the cofounder of Trusted Angels Foundation, which works for the benefit of children in Liberia, West Africa.