Photo-Illustration: Intelligencer; Photos Getty Images
Almost every medical student has a version of the same story. At some point, someone older than them — a professor, a physician, a family friend — has looked them in the eye and said something like, “If you can see yourself doing anything else, do that instead.”
For Sarah Alvi, 24, who lives in New York and has wanted to be a doctor since age 6, this moment happened before she even started medical school. In college, she decided to shadow some doctors to see what the job is really like. “Some physicians were so passionate about what they did,” she said. “But some of them were like … ‘This is horrible.’” She’s now a first-year medical student, excited to pursue a career in internal medicine. But that warning is still there in the back of her mind. “It does scare you a little bit to hear from a physician who went through all this training and still, at the end of that tunnel, is like, I hate this,” she said.
There are reasons to believe that being a doctor has never been more miserable than it is right now. Surveys point to high rates of burnout and depression among physicians across the U.S.; one 2018 data review found that physicians die by suicide at twice the rate of the general population. And although the latest figures show that doctor salaries have increased somewhat year over year, inflation and a marked decrease in Medicare reimbursement have resulted in an effective decline in compensation for many.
Add to that an increase in distrust in doctors and hospitals since the COVID pandemic and the looming doctor shortage starts to make sense. According to the Association of American Medical Colleges, the U.S. could be lacking some 86,000 physicians by 2036. The shortage is poised to cut across all types of medicine, but some specialties — including ophthalmology, vascular surgery, and family medicine — will likely see the greatest impact. The dearth of physicians is expected to hit rural areas harder than metro areas.
Dr. Amy Waer, dean of the College of Medicine at Texas A&M University, said multiple causes contribute to the projected physician shortage: not enough spots in medical school; not enough medical schools, period; not enough spots in graduate medical education, especially residency programs. And then there is the fact that, at the end of all that, physicians often find that practicing medicine is more harrowing than anticipated. The percentage of doctors looking to reduce their hours has doubled in the past decade, according to a recent American Medical Association survey. And a different AMA survey found that more than a third of doctors expressed interest in leaving their jobs entirely within the next two years.
And yet, “there is not a shortage of interest in the profession,” said Annelise Silva, a fourth-year medical student and president of the American Medical Student Association, which represents 30,000 med students. Enrollment in medical school has reached a new high, according to the AAMC, and there is data to suggest that it’s just as competitive — if not more so — to get into medical school today as it was 20 years ago.
The field’s popularity is baffling even to some med students. “It seems like there’s a post every week on r/medicine or r/medicalschool about how being a physician isn’t what it used to be,” a commenter complained on the premed sub-Reddit last year. “And yet we are seeing competition for med school increase each year.” So why do so many bright students keep applying?
Julia Watson, a 22-year-old medical student at Case Western Reserve University School of Medicine, has a theory: “Most first-years are pretty bright-eyed,” she said. “Generally speaking, I’m pretty optimistic, just because I’ve been locked in on this since I was a child.” At 5, she was enthralled by the drama and gore in TV shows like Untold Stories of the ER. “I have literally never ever considered anything else,” she said.
When Alvi shadowed physicians before attending medical school, one of them tried to convince her to choose a different path. She told Alvi she worked long hours and never saw her kids; she also delayed building a family — something that’s true for three-quarters of women physicians. “I was hoping she would say, ‘You know, it’s doable,’” Alvi said, “but she straight up was just like, ‘No — yeah, it’s hard. Don’t do it.’” Ultimately, Alvi decided to ignore the advice. She believes her passion will see her through. “Maybe, for her, if it wasn’t worth it — maybe she wasn’t as interested in the career,” she said.
That’s what Alexis, who’s 25 and in her third year of medical school at Carle Illinois College of Medicine, thinks, too. If you find meaning in what you do, maybe that’s enough. She’s currently doing an inpatient pediatric rotation, and the other day she was caring for a small boy, too little to call for help or ring the call button. “And you walk in and it’s just him in the room,” she said. It broke her heart. “It’s like, Well, if no one else is there for him, we’re there for him,” she said. “I will be whatever he needs.”
Watson, for her part, politely answered my questions about whether she and her friends were worried about the hardships ahead — burnout, for example — but mostly, she said they view those concerns as too distant to be relevant. “I just don’t think, personally, it’s worth my mental energy to be thinking about, like, Oh my gosh, in 40 years I’m going to be so burned-out,” Watson said.
Some students, on the other hand, are very much thinking about it but say they’re going into medicine with clear eyes. To Waer, the biggest difference she sees between her generation of med students and the current one is that today’s students have a keener regard for their mental health. “The current medical students we have, they appreciate the need for work-life balance … and they care about their own well-being,” she said. Daanish Mahmood, a third-year med student, often has this conversation with his neurologist dad. “Our generation coming up is realizing you don’t have to, for lack of a better word, kill yourself,” he said. “You can do this in moderation.”
Mahmood wants to be an orthopedic surgeon, which last year was identified as the top-paying specialty in medicine with average annual earnings of $558,000.
“I want medicine to make me enough money to be able to do everything else I want to do in life,” Mahmood said. Eventually, he hopes to set his own hours. “Maybe as I get older … once I’m in my 40s or something … maybe take, like, three-day or four-day weekends,” he said. “Or maybe once a month I just take a whole week off.” But orthopedic surgery is typically grueling. Full-time orthopedic surgeons work an average of 53 hours a week, and one older study found that “highly successful” orthopedic surgeons (like department chairs) work up to 110 hours per week. A majority of those surgeons also reported spending fewer than ten waking hours with their loved ones each week. In addition, half of early-career physicians in the specialty change jobs within their first five years largely owing to burnout. While part-time work in the specialty is possible, those who engage in it are often in their 70s.
Last year, Dr. Daniel E. Choi, an orthopedic surgeon, gave an interview to the American Medical Association’s editorial arm, encouraging more young physicians to consider private practice, which has allowed him to set his own schedule. “I hear about doctors and other health professionals complaining of burnout, and I think, I’m not burned-out at all,” Choi said.
But fewer physicians today are in private practice. “The generation ahead of me, and even my generation, you could become a physician and you could hang a shingle anywhere you wanted and be in private practice,” said Waer, who attended medical school in the late 1980s. “Those days are almost gone.” In the early 2010s, 60 percent of physicians were working in a private practice, but in the 2020s that figure has dropped to 47 percent, according to the AMA, largely because of rising costs. When adjusted for inflation, payment rates from Medicare declined 29 percent between 2001 and 2024. That means more physicians are now employed by hospitals, and not all of them are happy about it. In New York City in January, more than 1,000 doctors at four public hospitals threatened to strike over low pay and lack of benefits.
Frances Mei Hardin is an attending physician, and the expectations she had as a medical student have not matched her reality as an ENT surgeon in rural Tennessee. “The false promise in medicine is that if you’re a really bright young person who is not afraid of hard work, you can go and provide a great service to the community and the world, and it will be rewarding,” she said. This has not been her experience.
She became increasingly disillusioned with medicine during her rotation and her residency, mostly due to the poor treatment she received, and observed, from more senior physicians. She has seen surgeons scream, slam doors, and throw sharp objects in the operating room. She cares about her patients, but that doesn’t erase those awful memories. “In terms of if those patient interactions are worth it to me, all of the trauma and abuse of the past decade — it’s not even close,” said Hardin, who is 33. When her contract is up later this spring, she plans to leave medicine.
There are some indications that more students may be seeing the writing on the wall and planning accordingly. A 2023 survey of more than 2,000 medical and nursing students found that nearly 60 percent do not plan on practicing clinical medicine after graduation. One redditor, who goes by the username Leaving_Medicine, has even started a Discord for medical students interested in pursuing nonclinical career paths, especially in consulting.
To many of the students I spoke to, this idea sounded faintly ridiculous. “I don’t think most first-year medical students are starting out being like, After four years of doing medical knowledge, I’m going to then go into medical consulting,” Watson said. “We’ve worked so hard to get to this point.”
Her medical education was indeed hard work, Hardin said. But there was also a certain ease to having a one-track mind. There were plenty of reasons she was motivated to grind through medical school, most notably family pressure and the allure of a prestigious career. But sometimes it felt as if she were just following the path set before her. “That conveyor belt is truly quite freeing and easy in some ways,” she said. “You just know what your next step will be for, like, 15 years.”
She said that nothing could have persuaded her to consider another career path along the way. Of course, someone tried. When she was 20, an older medical student gave her a version of that ubiquitous advice: “If you can see yourself doing anything else, don’t become a surgeon.” Hardin said she could see herself doing plenty of other things with her life: She did some modeling while in med school and was fascinated by astrophysics. “I did see a lot of other real career paths for me,” she said.
But at the time, she took the student’s advice as a challenge and forged ahead anyway: “I viewed it as Okay, watch me do it.”
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