I still remember walking into the Student Health Center on Broadway with a raging headache and congestion to wait for an appointment to get antibiotics for my sinus infection. After signing in and getting put into an examination room, I laid down on the waxed paper and waited for the doctor to come in. I heard the door open and a voice that greeted me. As she situated herself, she asked me basic information to break past the initial awkwardness of meeting someone new. Questions ranged from, “How are you enjoying the city?” to “What did you do today?”, and I answered without hesitation, generally received with a “That’s great to hear” statement. The conversation between me and my doctor seemed natural and intuitive—nothing out of the ordinary. However, there was one statement I received that caught me off guard. As she began to look at my dossier, she asked what major I was. “Biochemistry,” I replied. The doctor responded, “So you’re probably pre-med?” I shook my head in acknowledgement, and she gave me a warning to “Get out while you still can.” During that moment, I did not think much about what she said, viewing her message as a cautionary tale about having to study hard and do well in both undergraduate and medical school. I have been told of the stressors of following the route to become a doctor: high grades, perfect MCAT scores, research, internships, shadowing, and volunteering were all aspects to becoming an MD. The process did not feel too different from what I had already done back in high school when applying to colleges, with the general exception of scope and specificity of each aspect. It just seemed to be the natural process to becoming an adult. I knew what I was getting myself into, or so I thought. Unsurprisingly, through experience, the process towards becoming a doctor is easier said than done. The tumultuous and sometimes absurdly high expectations of what it takes to be doctor seem unsurmountable. After taking full course loads, two part-time jobs, doing research, and having some sort of social life, I finally understood why I would be given such a warning. I began to question just how worthwhile it was to become a doctor. What do you mean I have to take a seven-hour exam? What do you mean I have to maintain a 3.75 GPA to be considered competitive at medical schools? While researching at Weill Cornell Medical College, I came across doctors and medical students recanting the same dialectic about the actual rewards of being a doctor. I still remember introducing myself to a doctor who interrogated me about why I liked medicine. Based on my response he said, “I always am curious to wonder why students choose to become doctors. It helps me to try and remember why I wanted to be one.” This questioning seemed to be not an isolated case. Even today, I heard my professor tell my class, “Being a doctor is a horrible job. Is it a needed job? Yes. But is it a good job? Not at all.” After several discussions, the gold gilded imprint with the letters MD on a white coat seemed to quickly tarnish. The stories I was told as a child about the prestige of becoming a doctor no longer seem to fall parallel to my own experiences and research into being part of medicine. From doctor burnout to a high percentage of doctors advising their children to not follow in their footsteps, I realized that being in love with the idea of becoming a doctor entailed a sacrifice of happiness. From the doctors, it was never really the four years of being in medical school that was the reason for regret; rather, it was the debt that ensued, the inevitable deaths of several patients, and, as one doctor told me, “the red tape of medical bureaucracy” that permeates the industry. Obamacare, medicare, and private insurance seemed be a forgotten in the journey to being a doctor. Student do not realize that even the healthcare industry is run as a business. Physicians are still under the mercy of profits, costs, and margins. The Hippocratic Oath seems to increasingly become a burden more so than a way of life. Wanting to help people at any means necessary seemed to be in discourse in any type of business and has lead to the tension between the physician and their own profession. Additionally, the pay seem to amount to much when there was no time to spend it or was used to pay off loans. Long nights with little breaks, as had been happening in high school to get to this point, continued. In the view of medical college admissions, maturity is an integral part to deciding who gets in and who does not. Maturity is an important criteria for admission into medical college. Would a gap year be enough to allow people to explore who they are and understand what the real world is without the help of a crutch? Would two or three years abroad exploring the world really amount to the readiness and expectation of devoting your life to medicine? Better yet, did the scores I have really matter when study-drugs become a common path to success? Cynicism aside, there are people who have enjoyed the journey to becoming a doctor; several times, this feeling sets in after retirement, when they can finally enjoy the fruits of their hard work and labor. These physicians would tell me about how being a doctor made them realize their potential—they felt success in being able to do the insurmountable, by helping everyone they can. There’s one caveat to these special cases though. There’s a generational gap that lies in the discontinuity between modern medicine and past medicine. Where penicillin was the cure-all, resistance is creating many major challenges with the introduction of antibiotic resistant bacteria lining the walls of hospitals, eating away the flesh of patients. More medical procedures are being added, and the list of medications that can be prescribed continues to grow. While more diseases are being cured, more information is needed to be learned within the same four-year timeframe. The ability to say “We just don’t know what is wrong” is no longer an option. Additionally, the information that has been obtained from basic and translational research is adding more to the curriculum of students not only in medical school but in undergraduate schools as well. The dearth of knowledge is exponentially increasing as more subjects become interwoven with one another. Business jargon and computer programming all seem to be potential requirements to understanding medicine in the modern context, and worries me how future generations will cope up with these increasing requirements in the medical world. Perhaps all these requirements were all signals telling me that I should move away from becoming a doctor and instead focus my interests in other things；for example, biotechnology is really taking off in Silicon Valley and that patent law is increasingly popular, and while a PhD or a master's degree is recommended to get a job in this market, some undergraduate degrees can be considered. However, I was still set on the idea of becoming Dr.Paustian. There seemed to be no reason why I or other pre-med students would seem to continue with their studies towards becoming a doctor of medicine even after hearing the cries from doctors to stop while we still can. Whether it is due to familial pressure, the need to help others, or the dream of becoming the next Atul Gawande, Peter Pronovost or Siddhartha Mukherjee, students constantly seem to take on the challenges of the pre-med track, even at the risk of regret. In ways that seemed to exemplify the human experience of pushing all limits to the max, it was all under the assumption that the ends justify the means. The line between success and failure seemed to not live on opposite sides in medicine, but rather in the same track. Although my premonitions seemed to be at the point of turning into actuality, I found myself walking straight ahead instead of going to a different path. After my appointment in freshmen year, I said goodbye to my doctor and thanked her for her time. I walked to the study pharmacy and waited for my prescription to be filled. In between my coughs and deep breaths, I pulled out my chemistry papers and began to review molality and colligative properties - “there was no time to waste” I thought to myself, planning out how many hours I will stay in the library that day. I was Dante entering the Inferno. This article was written by Shawn Paustian. Send an email to [email protected] to get in touch. Photo Credit: Dr. Farouk Flickr