Monday, May 18, 2015

The Do-it-Again Equation

Cutter’s excellent post and the comments to follow really got me thinking. What factors go into our thoughts about whether we would do it again (become a doctor)? Can this change?

This is just my way of thinking about the question (one way of potentially many), but I think the simplified, general equation may look like this:

Outcome - Sacrifice    =    DiA

If DiA = positive, you would do it again. If negative, you would not.

And where Sacrifice = time, money, family relationships, moves, etc , thus far

Outcome = present level of satisfaction with career, may include work-life balance (or work*life product), income, career-related meaning, work-related aggravation

And time, because I do think time is a factor because time attenuates sacrifice/hardship. For instance, if you asked me whether I wanted to have another child while I was sleep-deprived and breastfeeding my newborn Q2 hours during those awesome early weeks of being a new mother, occasionally crying in the shower if I was fortunate to have a shower, my answer may not have been a resounding Absolutely! Not that I didn’t think my child was a magical gift, but wow. My pregnancy/labor/post-partum period were not easy. Fast forward a couple of years and that hardship didn’t seem quite as insurmountable relative to the outcome.  That was kind of a terrible analogy (along with math, not my forte), but I think in general, distance makes the heart grow fonder and the memories fuzzier.  Alternatively, maybe the Sacrifice was way too much and no time in the world would make that value small enough.

For me, my Sacrifice to become a doctor was relatively small and feels smaller with time. I met my husband during medical school. I was really fortunate to finish training with minimal debt, and besides being very tired and on-call during multiple holidays (Thanksgiving dinner with my co-residents in the physicians’ dining room; watching fireworks on July 4 through the 8th floor hospital windows), it wasn’t so bad. My Outcome, on the other hand, has increased over time. I now have more control over my schedule (compared to being junior staff right out of residency), higher income, more clinical knowledge, have engaged in new areas that keep me excited (teaching, research, mentorship, leadership) and after working with all different members of the healthcare team, value the role of physician as leader more than ever. Don't get me wrong- there are parts of my job that are the mental equivalents of how I imagine a root-canal would feel, but on the whole, my career is rewarding beyond what I could have imagined right after my pre-duty hours residency. My DiA started out positive from the start and only has grown more positive with time.

It goes without saying that this equation and its variables are individual, and there could be a fatal flaw that I have not considered in forming this equation. But, it’s not an easy path to take, no matter how you compute it.


  1. I like this formula and it makes sense to me. I would do it again in a half second, and this equation helps explain ti for me: my job is rewarding -- I'm in a small subfield, that even as a senior fellow, I'm respected as a relative authority, and considered a huge asset to my department; I get to do only the types of patient care I enjoy, balanced out by a research career that's been productive and successful and I feel like part of a functional multidisciplinary team populated by people whose company I enjoy and whose expertise I respect. In exchange, I've had to move twice, but both times to cities were we have friends, and most recently to a city that I've fallen in love with. The medical school debt is low, as I went to a subsidized medical school. Call was time-consuming, but mostly finished before we had our daughter and was mostly enjoyable, as I was in a big program with many residents, so never lonely at night.

  2. Don't forget to include the present discounted value of future benefits. Very few people would ever start medical school without that in the equation. If being a more established doctor is better than where you are right now, you might still choose to do it again even if you wouldn't if things stayed as they are right now forever.

  3. No. I think my sacrifice outweighs everything else. Of course, I am still a resident, but I have a special needs child. I would have never done this had I known he would be the special kid he is. He deserves better than this from me. My husband is brilliant and non medical and I think every day about what if I could have been a novelist and SAHM and raised our kids and let my husband be the breadwinner. He would have done a great job, and we would have been fine. For all but 6 months of our 9 year marriage, I have been in school or training. This is insanity. I would not do it again. Time matters. They all deserve more from me. Don't get me wrong- you are getting honesty from me here. If you saw me in my hospital, I would strike you as nothing but thrilled to be there and happy. Because I love my specialty and what I do - it's true! But I wouldn't do it again.

  4. This is a great perspective and I appreciate your experience and positive input. Cutters post was the most depressing thing I have read on this blog.

  5. I agree with ^, it was a drag to read Cutter's post and from all the MiM who regret or wouldn't repeat their choice to go into medicine. But given the high level of dissatisfaction and burnout in medicine in general, it would be less than honest if this blog didn't have a place for those voices to speak and share their experience. I'm hopeful my math will come out on the positiv end once my training is finished but I'm grateful to know that this blog exists as a place where we can share our authentic experiences.


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