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Information for people contemplating
a career in emergency medicine and
other medical specialties

By Kevin Pezzi, MD


Why is medicine such a demanding career?
The never-ending stress of being an ER doctor
The joys of being an ER doc

Q: Why is it so hard to become a doctor? Most people who start out to become doctors never make it. Why?

Thank you,

Smart female doctor
People want the brightest possible doctors

Answer by , MD: The ultimate reason why society makes it so difficult to become a doctor is because most members of society want the brightest possible people taking care of them. People are used to dealing with inept mechanics, builders, cooks, bureaucrats, salespeople, and weathermen, but not doctors—from whom perfection is usually demanded.

In regard to your question about the alarming attrition rate, there are many factors. Here are some of them:

It takes a lot of mettle to become a doctor. It is not just a matter of brainpower, although that is required, too. It takes almost superhuman dedication to endure the many years of training in college, medical school, and residency. Personally, I do not think it is worth it. I began my training with exuberant optimism and a singular focus, and that carried me well beyond the point at which individuals with more common sense realized that life doesn't have to be so hard. Yes, a medical career can be very rewarding, but remember that you will pay a high price for that reward. If nothing else, you'll spend a decade of your life cloistered away from your friends and family. Most likely, you will need to postpone marriage and childbirth—and if you do not postpone the latter, you're shortchanging your children.

Doctors have more than their share of stress,
but also many opportunities for joy. As a doctor,
you will probably have lower lows and higher
highs than most people experience as they toil
away at boring jobs. Practicing emergency
medicine is rarely boring, and often exciting.

BTW, the "doc" in this picture isn't me.

Even if you are not fazed by the daily hassles of being a doctor (long hours, numerous committee meetings, the constant need to study, the hassles of dealing with insurance companies, lawyers, bureaucrats, and dingbat hospital administrators), you will likely feel a never-ending sense of uneasiness about the fact that people's lives are in your hands. If a waitress makes a mistake, she will probably just perfunctorily say “sorry” and still get her 15% tip. If a judge makes a mistake, he is immune to the consequences and never needs to apologize. But if a doctor makes a mistake, people can die. That fact is unnerving, even for well-trained doctors. One of my prior bosses was a very knowledgeable and highly trained ER doc, but he confided that he became so worried hours before every shift that he was nauseous. I've been that way, too. In time, the pressure usually fades somewhat, but does not entirely go away. Being a doctor is an awesome responsibility. I suppose it is not so bad if you are in a low-octane specialty like dermatology or allergy/immunology, but if you are an ER doc you're going to feel the pressure—and the day you stop feeling it is the day you should get the heck out of the emergency room.

See a related topic: How ER doctors can combat burnout

UPDATE 2008: Medicine just became a much more desirable profession, thanks to the economic crash that devastated our economy in 2008. The profession of medicine offers one thing—job security—that is nice in good times but as precious as gold in bad times. I needn't remind you that things are bad now, and almost certain to get much worse (if you doubt that, read this). When times change, it is important to change with the times. I've used a lot of ink warning students in the past about the drawbacks of a medical career, and all of those reasons were quite valid. The cons are still there, but the list of pros just mushroomed in importance thanks to the inherent job security in most medical careers. Good luck trying to find another career that offers comparable job security.

UPDATE 2020 is markedly different thanks to the coronavirus that made work-at-home jobs much more enticing.

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