The Baltimore Sun recently published an article on health reform by fourth-year Johns Hopkins medical student Pooja Aggarwal, entitled "I probably won't be your family doctor."¹ At first, Ms. Aggarwal confesses her support for President Obama and his vision for increasing the number of physicians in primary care. But then, she says, reality hits her.

She observes the massive debt with which medical students graduate, and concedes that it is hard to ignore the specialty fields that offer the opportunity to earn more than twice the income of physicians in primary care. Then she considers the long hours associated with primary care, the red tape, and the high likelihood of experiencing low overall job satisfaction. She wonders whether the thought of "serving the needy" is really worth it. Judging by the title of her article, she is close to concluding that it is not.

To applaud her effort in grappling with the conventional morality, and to encourage her to make her career choice rationally, I posted the following response on the newspaper's website:

Good for you. Going into a field that you love—and that will love you back in terms of compensation and work-life balance—will help to make your life happy, fulfilling, and rewarding. There is nothing "noble" about slogging through your career, feeling unappreciated, and suffocating under unrepayable loans. It is the path of self-sacrifice, misery, and self-destruction.

Helping people is the natural product of practicing good medicine. It is the service for which you get paid. However you choose to go about it, remember that it is you who has made the investment in time, money, and energy to get where you are; therefore it is you who gets to set the terms of where you will work and for whom. Your career is for you to decide, not the politicians who wish to play central planner, and not the people who come to you with their hands outstretched.

Feel like giving some voluntary charity care when you have the opportunity or when you encounter a particularly deserving case? Go for it. Just don't fall for the promises made in the government's plan for health reform and paid for with your guilt, or else you will be taking orders (i.e. pushing paper and counting beans, as you put it) from Washington faster than you can say "so this is altruism."

To be clear, there is absolutely nothing wrong with going into family medicine—if that is the type of medicine that one wishes to practice. But to choose a particular field or specialty out of a sense of duty to others, or to defer to the ideals of some politician, would be tragic. Medical students should enter a particular field because they want to enter it, not because someone else wants or "needs" them to.

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¹ Aggarwal, P. "I probably won't be your family doctor" Baltimore Sun, July 19 2009

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