It is the perennial question asked of medical students, “what do you want to go into?” Hitherto, it has been acceptable to shrug off such inquiries with a guileless ignorance of one’s own inclinations. For third year medical students, evasive, noncommittal answers are becoming increasingly less acceptable as we approach the end of third year; there is an expectation that we should have at least some idea, however vague, of what it is we wish to do with the rest of our lives.
We often preoccupy ourselves with a myriad of concerns regarding our perception of an increasingly oppressive workload, and the sacrifices we have had to make in our private life, in order to achieve some measure of success in our professional life. For all the legitimacy of these vague rumblings, there is a deeper truth which we collectively ignore.
Though we may only be medical students at the present time, we wield a tremendous amount of privilege. We have the privilege to attend medical school full time, to survive on borrowed money, which at the present, seems like an insurmountable debt. Yet, even the specialities which are considered to have the lowest compensation offer competitive pay and an unparalleled level of job security. Whereas the median annual wage of the American worker was estimated at $36,200, according to the Bureau of Labor Statistics citing the Medical Group Management Association’s Physician Compensation and Production Survey, the median wage of the primary care physician in 2014 was over $240,000. To put it into other, more tangible terms, it’s more than today’s average tuition for all four years of medical school combined.
The reality is, once we become physicians, we will be in an enviable economic situation, where we will enjoy a financial and occupational security that no other profession offers. We will be able not only to pay back such loans and their accrued interest, but to enjoy the fruits of our labor in a manner that only a small fraction of our patients will be able to achieve. When we finish our residencies, compared to our thirty-something counterparts, we will be among the top 1%. Compared to all age ranges, we will remain in the top 5% of income earners for the entirety of our working lives.
Perhaps then, this should give us some pause as we enter the next phase of our medical careers, and worry about what field of medicine to enter into, about what work-life balance such a career may offer, about how we will juggle motherhood and medicine. The fact that these are among our greatest worries is in and of itself, a tremendous privilege. For the uninsured patient who juggles multiple part-time positions because no employer will hire them full-time, for the underemployed patient who has to endure unfair labor practices such as just-in-time scheduling, for the patient who earns an unlivable minimum wage and cannot afford the exorbitant costs of childcare, for such patients, such choices simply do not exist.
And yet, when we encounter financially insecure patients with multiple, chronic medical problems, we ask ourselves, from our place of privilege, the obtuse rhetorical question, why did they allow their health to deteriorate? As we simultaneously adjudicate that they have only themselves to blame, we fail to recognize that poor health is not merely the consequence of poor decisions; often, it is simply a consequence of being poor. As physicians, from our place of privilege, we must be able to recognize the income inequality that is nascent to our society, and the socioeconomic barriers that inhibit our patients from receiving timely, high quality healthcare.
As physicians, we will enjoy the privilege of choosing where we practice and what population we will serve. Those who choose the endangered species that is private practice, will additionally experience the privilege of refusing to treat patients because they do not have insurance, or because they have public insurance.
There may be physicians who will deride such thinking as naive, noting that medicine is inherently a business. Indeed, this is the very subject that haunts many a third-year’s decision on what speciality of medicine to pursue, the one that achieves the greatest good or the one that achieves the greatest return on investment?