Too old for med school?

A friend of mine, almost ten years out of college, just told me she wants to go to med school and asked me what I think. And so much of me wants to tell her she's crazy, and tell her to look at this ridiculous life I've had for the past 7 years, either studying 80 hours a week or working 80 hours a week, for far less than no money-- as a resident, I'm pretty sure I haven't yet earned back my tuition money, even if I didn't have living expenses to take into account, and of course I have living expenses to take into account-- having far less than no fun doing it. I mean, whatever rewards I thought there were to a career in medicine-- and I don't mean just financial, at all-- do not make themselves clear as a student or in residency. No one should want to spend this much time in a hospital. Anyone who enjoys most of residency-- really, truly enjoys the moment-to-moment work of a resident, most of the time, not just the very occasional non-torturous moments-- has something seriously wrong with them.

And yet-- she's not crazy. Because-- unlike so much of what so many people I know do-- there is an endgame here. Not even 4 years of med school and 3 years of residency have convinced me (yet!) that being a doctor can't be a rewarding way to spend a career. There is human interaction. There is job security. There is financial stability. There are opportunities to think, and to read, and to be engaged in something important. Not in every setting, of course. And not right away, certainly. But there is an endgame, and I'm not yet convinced that the endgame has to be terrible. And I'm not yet convinced the endgame is incompatible with having a life you can enjoy and feel fulfilled by. And, as I look around at people I know and what they're doing, I'm not sure that medicine isn't unique that way. Because I don't know what else has stability, intellectual reward, and the chance to have some control over your time and your life. Tenured professor, probably. But getting a PhD and then tenure somewhere you want to live seems like as much of a slog as residency.

My friend, if I'm doing the math right, will be 34 when she can apply, after taking the appropriate post-bac classes. 35 when she starts med school, 39 when she finishes, likely 42 or 43 or 44 when she finishes residency, depending on what residency she chooses. Older if there's a fellowship too. I don't know what the job market looks like for 45-year-old brand-new doctors, and if that job market is different from the market for 35-year-old brand new doctors. Realistically, the debt is going to be around for a while after that. Realistically, my friend can't be doing it for the money, because the money isn't going to be visible until she's 50. Realistically, while being a doctor is hopefully compatible with having a life, I know that being a resident isn't.

I couldn't do this again. Having done it once, I couldn't do it again, at all. If someone wiped the slate clean, somehow my 4 years of medical school and 3 years of residency vanished and I had to experience it all again or I couldn't be a doctor, I could not do it again. But if I'd never done it, if I put myself in my friend's shoes, then maybe. I see the allure. I don't want to see the allure. I want to shake her and tell her she's crazy and it is not a smart plan to go to medical school when you're 35.

But I didn't shake her. Partly because the conversation was over the phone. But even if it were in person. I understand the impulse. I understand the allure. If I didn't, I guess I wouldn't still be a resident. There are people who've dropped out of the program. I don't know what they went through medical school for, and how they're able to justify the years and the work and the expense, but, I don't know. And then I look at most of the attendings, and they all seem kind of miserable, so I don't even know how I can still delude myself into thinking there's a light at the end of the tunnel, but I guess all the hope hasn't been wrung out of me yet.

Four patients today have asked me what I'm doing for the holidays. Four patients feel bad that I'm working. They shouldn't. They have it worse, because-- and I'm not sure they realize this yet-- they'll still be here too. And come Friday, I really don't think anyone's getting discharged over the short-staffed holiday weekend-- or, really, most of the week-- so, if you're here tomorrow, you may very well be here until 2012. Hope your beginning-of-the-year deductible isn't too high...