Why I'd Still Choose Medicine-But Differently

The things about medicine that you don't learn in medical school...

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Why I'd Still Choose Medicine-But Differently

Me as a newly wed new doctor with high hopes and ambition to conquer the world

There are many things medical school teaches exceptionally well. It’s a four-year wide-open fire hydrant flood of information. There are also many topics it barely touches — even though they shape your life just as much or more as your clinical skills. As a mid-career physician now standing dead center on the see-saw profession of medicine, these are four things I wish I had understood before becoming a doctor.

First: medical school debt will be substantial. And it will matter more than you think.

I don’t think I fully grasped, at 22 or even 26, how long student loan debt could quietly dictate future choices. It is easy to overestimate how much you will make as an attending and underestimate how quickly lifestyle inflation creeps in.

I was lucky enough to start medical school with no undergraduate debt, and with a substantial scholarship to medical school. So I assumed I would finish with an MD behind my name debt free. But as tuition and housing costs skyrocketed over the next four years, I still finished with over one hundred thousand dollars in student loan debt. I then choose the “defer loan repayment option” during residency, which seemed like a great idea at the time, but resulted in an additional one hundred thousand dollars of compounded interest that accrued over my five-year residency/fellowship period.

I operated under the “Emerald City attending” mindset of “everything will be unicorns and painted horses as an attending,” and “I will make so much money it won’t matter.” Sound familiar? Once I finished training, I was just as shocked as my then newlywed husband to see the final number owed. “I thought you said you had less than one hundred thousand in debt?” he asked. “This number is more than double that.” This was not an intentional error of omission on my part. I was so laser focused on getting competitive grades in medical school and landing my top choice residency program, that I had simply lost track of the dollar signs adding up. It wasn’t a priority. It turned out to be a costly oversight (no pun intended).

What I now see clearly is that physicians who pay down their loans early — including income-based repayment options during residency — give themselves far more freedom later. I watched other colleagues like me who deferred aggressively, or took on additional debt they didn’t truly need, become effectively trapped in higher-paying but higher-burnout jobs for years longer than they wanted, simply because they couldn’t afford to leave.

More attuned to the increasingly common “new doctor grad high debt” scenarios, many hospital systems offer new docs large signing bonuses of several hundred thousand dollars in exchange for a five-to-seven-year commitment. And before you even realize it, you are a white coat in golden handcuffs. A twenty-first century white-collar indentured servant. Debt doesn’t just cost money — it costs optionality. Paying it off as soon as possible buys flexibility, autonomy, and most importantly, peace of mind. Discussing debt and money pitfalls transparently with other clinicians so they avoid similar traps isn’t tacky. It’s necessary.

Second: it won’t be patient suffering or death that burns you out — it will be the system.

This reality caught me off guard. I went into medicine expecting the emotional weight of illness and loss to be the hardest part. This is what medical school prepares us for best. And while those moments are heavy, they are also expected. And they are meaningful. While any patient death is tragic, it also reinforces our purpose, and the sacredness of what we do.

No, death did not deter me. What really wore me down over time was the American medical system itself: administrative burden, misaligned incentives, time pressure, extensive documentation requirements, prior authorizations galore, and the constant moral distress of knowing exactly what a patient needs but not being able to provide it due to endless insurance barriers.

Medical school prepares us fantastically for recognizing complex illness and knowing how to cure it. Like you, I came out a diagnosing and prescribing ninja. But it did not prepare me for what to do when our existing treatments become financially unattainable to those who need them most.

Though I answered endless test questions on best treatment option(s) for serotonin syndrome and advanced lithium toxicity, neither of which I have ever encountered in real life psychiatry, I never saw a single question on how to address insurance denials for “non-covered services”- a challenge I encounter daily. I’d prefer to treat lithium toxicity any day over “non-covered services” toxicity.

Lithium toxicity has a straightforward solution (dialysis). “Non-covered services” and “not medically necessary” denials do not. Naming this struggle matters. Most type A clinicians internalize burnout as a personal failure. But in reality, it’s just a human response to a dysfunctional structure.

Third: if you are a woman, you do not need to wait until “after” training to start a family.

I personally waited until after medical school, residency, fellowship, and a few initial years of climbing the professional attending ladder before starting a family. It was the “responsible” choice. I deferred childbearing to my late thirties. Despite this, when I was ten weeks pregnant with our first child at the “advanced maternal age” of 37, my boss warned my husband “She just became assistant chief. She has a lot to do. Don’t get her pregnant!”

But I watched several other female colleagues have children earlier during medical school and residency — and from a financial standpoint, it often made more sense. Taking parental leave when your income is lower, rather than stepping away from a higher-paying higher responsibility attending salary, makes more economic sense. More importantly, there is never a perfect time to have kids. Ever. Training is demanding, but so is life as an attending.

I wish someone had said more explicitly that there is no moral or professional requirement to delay life milestones until medicine feels convenient. Though I was lucky enough to avoid infertility struggles, I met many female physicians who encountered this biological battle because they delayed children for medicine. For many women, what starts as a temporary delay becomes a permanent trade. The female body is an unforgiving timekeeper. And nothing in healthcare is worth sacrificing your personal life dreams.

Fourth: you are far more prepared than you think you are.

I remember how nervous I felt finishing fellowship as an addiction psychiatrist. In retrospect, the knowledge level was there. The real adjustment wasn’t clinical incompetence — it was the sudden absence of constant reassurance. Residency and fellowship provide a built-in safety net of attendings who validate decisions, refine plans, and share clinical decision-making responsibility. Practicing independently requires trusting your training and replacing that familiar support structure with something new: trusted colleagues, consultation networks, and evidence-based resources. That transition can feel unsettling, but it is also empowering. You don’t stop learning — but you are not starting from zero.

And finally, there is something I wish I had understood not just intellectually, but emotionally: despite all the sacrifices, despite the arduous road to long white coat without training wheels, it’s all worth it. The very best moments in medicine are better than I ever imagined. The bad days are truly bad. But the meaningful moments — the ones that stay with you — are extraordinary.

In addiction psychiatry, I walk alongside patients in recovery as they rebuild their lives from ground zero: returning to work, reuniting with family, regaining custody of children, avoiding death by overdose, having money for presents under the Christmas tree for the first time, and rediscovering health and purpose. Watching someone reclaim a life they once believed was irreparably broken-that’s what it’s all about. Those moments don’t erase the hard parts — but they remind us of why this work matters. All the sacrifices that medicine demands of us-it makes them worth it.

If I could go back and tell my younger self anything, it would be this: be thoughtful with your finances, be honest about the system, don’t postpone your life unnecessarily, trust your training — and hold space for the moments of human connection that make this profession unlike any other. If I had it to do over, would I choose medicine again? Absolutely. I would just do it differently.

-Lauren Grawert

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