Is it possible to live a full life as a surgeon‏?

Neymar (not his real name) writes

Dear (Dr.) Skeptical Scalpel:

I'm writing this evening as a fourth year medical student wholly committed to pursuing a long and fulfilling life as a general surgeon. It's what I got into medicine for, and my love for the profession has only heightened in the arduous years of preparation and (nascent) training I've undergone thus far. I have had the fortune of living a very full life—travel, adventure, and a broad milieu of individuals have all shaped the form of the man I am now, and greatly influence the man—and surgeon—I hope to be in time.

Like many people in and outside of medicine, I reflect on what has been lost or what might have been lost along the path. At present, the balance sheet reflects a clear net gain. The opportunity cost, however, can be measured in the loss of time in wilderness, love and relationships and socializing that adds richness to my life. How do you advise young physicians pursuing such an ambitious and all encompassing professional course to maintain richness and fullness in their lives? How do you reconcile the personal forfeitures with the professional gains? And, most importantly, if one hopes to be a surgeon, are these questions worth considering or best left in the recesses of the mind?

Thanks for being a mentor to an entire generation of aspiring surgeons.

Thank you for writing and for the kind words.

The questions are definitely worth considering. I am not sure that my response will be applicable to your situation or anyone else's.

I chose surgery because it appealed to me more than any other specialty. Like most others of my era, I was young and had gone the traditional route—four years of college followed immediately by med school. I had experienced few adventures [in fact, none] and had not yet met my wife-to-be.

I never even considered what impact my choice would have on my personal life. The subject simply did not come up. I worked hard in medical school but had a great time. I think I had more fun in med school than I did in college.

My residency prepared me well for the rigors of a surgical career. I spent the first four years of my training taking call about half every other night and half every third night. As a chief resident, I was in call every night. Somehow I found the time to have a relationship and got married at the end of my third year.

My wife of 39 years is a saint. I have wonderful children and now grandchildren too.

I was fortunate in my career to have had the opportunity to supervise the training a number of surgeons who are helping people every day.

Although I'll never climb Everest, go an African safari, ski the Swiss Alps or do many other things that might be important to others, I've had an interesting and fulfilling life. Wilderness? Not so much. But love and relationships? I got 'em.

But it is different for the millennial generation. What I consider interesting and fulfilling might not be to you.

Surgery continues to evolve. I think it may be possible in the near future to have a career as a general surgeon and also have a manageable lifestyle. By the time you finish training, everyone will be in group or hospital-based practices. Or you could be an acute care surgeon with fixed hours.

You will have to decide what compromises to make such as deciding if leaving work at 5 pm is more important than staying late to operate on your patient who has a complication you created.

No one talks about this part—you will have to find partners you can trust with the lives of your patients. The roadside is littered with the corpses of group practices that didn't last because of productivity issues, attitudinal and/or philosophical differences among the surgeons.

For many surgeons, fulfillment is measured by the satisfaction of knowing you made a difference in someone's life.

Can you be a surgeon and have a rich and fulfilling life? You can, but it depends on how you define rich and fulfilling.

If you haven't read this post, you should.

A college student has second thoughts about med school

[The content of this email was edited for length and clarity.]

I'm a junior in college. I was on the path to medical school since sixth-grade. The problem is now I'm not so sure.

Lately, I've been going to sleep at night and waking up with an uneasy feeling in the pit of my stomach. For the first time since grade-school I'm having second thoughts on this career path. Before I studied abroad, I was hard-wired for medical school. But after experiencing so much life after studying abroad, I'm not handling the pre-stress of a medical school education that well anymore. I know there are realities, such as finishing at a relatively late age in life, the large amounts of accumulated debt, and the inability to set time aside for relationships (family, friends, significant other, etc). My alternate goal from here is to finish up my bachelor's in chemistry with a minor in computer science, then pursuing a master's in computer science.

So with this new plan in mind, I decided to call my parents. My mother took it exactly as I expected her to—delighted that I had found a new goal. "We're behind you all the way," said my father, "but remember that the choices you make now affect how happy you are in the future." Then he brought up the income issue and that I wouldn't want to have second thoughts later about sticking with medical school.

Leaving this path after seven or eight years of planning is a huge deal. Maybe this would be different if I were already in a committed relationship that could endure during medical school. But I'm not at the moment, and suddenly the idea starting a family in my 30s with ~300k debt looming over my head is almost unreasonable to me now. Not to mention the social distance I'd put between myself and my family and friends throughout the process of studying and clinical rotations.

I feel guilty. I feel like a disappointment. Not in my parent's eyes, but my own. I'm not sure whether I'll regret this decision or not, and I know that's not something you can answer for me either. I guess I'm just seeking some advice about all of this. What were your feelings before entering medical school? Do you think I'm insane for jumping ship?

Consider yourself lucky that your epiphany occurred now and not after you were in med school or even worse, in a residency. Your email says to me, no, shouts to me, that your heart isn't in it.

I went to med school because I relished the challenge. I had no doubts. I thought I wanted to be a psychiatrist and explore people’s minds. Obviously, that notion didn’t last. I opted for surgery because of the reward of seeing patients get better immediately.

Regarding income, I can't remember where I read it, but last year someone did the math. The loss of earning potential during med school and residency can’t be recouped. You will likely never be debt free if you owe $300K after med school. Don't forget, you will need to do 3 or 4 years of residency during which time you will earn $50-60K per year. The interest on your loans will pile up. I fully expect doctors' incomes to fall over the next few years too. Most of all, money is a terrible reason to choose a career. You should do what makes you happy. I know many MDs who have lots of money and are miserable.

My tuition at a private medical school was $1200 per year to start. Even in late 1960s dollars, my father paid for it with a check. I graduated with no debt.

And of course, medicine has changed dramatically over the years. I'm not sure that I would do it again if I had the chance.

By the way, I wouldn’t assume that being in a relationship before going to medical school would be a lasting solution either. The stress of med school and residency can be difficult for even the best of relationships.

I applaud your parents for supporting you. The second worst reason to choose a career after money is because you don't want to disappoint your parents.

I hope this helps. Good luck.