Imagine: you are a prospective medical school candidate about to have an interview. The secretary ushers you into an office where an admissions committee member awaits you. After an exchange of formal greetings and a firm handshake, you feel more than ready to begin the interview. “Why do you want to be a physician?” your interviewer inquires. You have rehearsed the answer to this question many times in advance and readily respond, “I desire to help people.”

The interviewer, unimpressed, either moves on to the next question or begins to criticize your generalized response. Maybe if the interviewer is more sympathetic, he says, “I see, but are you really ready to deal with the challenges of becoming a physician?”

While many undergraduate students feel they are well-prepared academically for the rigors of medical school, many fail to take into account the long-term consequences of such a profession. Certainly, the bulk of the 41,200 medical school applicants each year aspire to help others with their medical skills [1]. However, due to highly selective admissions and a need to differentiate so many candidates, the student evaluations often must shift focus from the résumé and the transcript to the applicant’s non-academic strengths and personal motivations to pursue a career in medicine. Admissions committee members do not desire generalized answers from students, but rather a well-conceived display of dedication towards the calling. On the other hand, an applicant’s decision to enter the medical profession is often affected by issues such as financial stability, academic performance, ethics and morality, and personal health.

One of the greatest burdens of the educational process is the financial component. Many aspiring applicants view medicine as a hallmark of job stability. After all, physicians have one of the most secure jobs in the United States, considering that healthcare is a universal commodity. However, there is more than meets the eye, especially when taking into account tuition and student expenses. A quick check with the Association of American Medical Colleges (AAMC) reveals that of the 2003 medical school graduates, about 82% were in debt at an average of $109,500 per person, while a fifth of this past year’s graduating class incurred a debt over $150,000 [2].

Part of such high debt stems from increases in medical school tuition. According to the American Medical Student Association, the average medical school tuition increased from 33-40% from 1990 to 2000 [3]. Furthermore, a student’s state of residence may significantly affect his tuition costs. According to the AAMC, average in-state tuition at public medical schools during 2003-2004 was $13,447, while tuition for out-of-state students was around $30,642 [4]. This trend is also apparent at the University of Illinois College of Medicine (UICOM), where first-year Illinois residents pay about $18,000, and non-Illinois residents pay about $40,000 in tuition and student fees annually [5]. From these figures alone, it suffices to say that there are far more lucrative professions with a quicker return on one’s educational investment. Given that students must spend four years in medical school, one in internship and at least three years in residency with possible years of fellowship afterward, one must begin to seriously consider just how committed he is to the medicinal arts and sciences.

Another key concern is academics. Undergraduate curriculars, extra-curriculars, and special interest activities, while gearing the prospective applicant towards higher education, only go so far in preparing the student for an even larger workload and set of commitments. Considering the volume of work involved, medical school requires utmost competence and academic excellence for forty-four weeks a year. A compilation of anecdotes from medical school students and graduates of the Stanford University School of Medicine notes that reading all of the required texts during the first two years of medical school would require reading 25 hours a day, every day [6]. At UICOM, first-year medical students (M1s), begin the fall semester with the following courses: Essentials of Clinical Medicine I, Gross Anatomy/Embryology, Tissue Biology, Physiology I, Biochemistry, and Human Development; during the spring semester, the students take eight classes [7]. In the first six weeks of school, they take seven exams. Thus, the medical school curriculum places a tremendous burden on students that they probably have not experienced during their undergraduate education.

However, despite these factors, attrition rates for medical schools in the United States are still low, around 2.5% [8]. This may be attributed to the fact that medical schools continually guide their students and prefer that they graduate rather than drop out due to poor academic performance. In addition, high attrition rates in the 1920s were the driving force behind establishing the Medical Colleges Admissions Test (MCAT) in 1928 [9]. Keeping this in mind, the MCAT itself cannot predict one’s academic success in medical school. For those who need to relax their course load due to particularly difficult circumstances, UICOM offers a decompressed program that allows students to extend the first two years of basic sciences to three years. Medical schools strive to retain their investments in the applicants that they have selected; thus, making sure their students graduate from the school successfully is a reasonable, although sometimes demanding, expectation.

There is even more to medical school than academics. An undergraduate transcript fails to speak for the applicant on matters of personality, ethics, and morality. For instance, many clinical situations require a combination of medical expertise and interpersonal skills. Because health concerns exist for all humans, physicians find themselves treating a variety of people: the undereducated, the uninsured, and highly affluent and educated patients. Physicians may even sometimes treat their own peers in the profession. Consequently, ethical issues come up, such as whether physicians may or may not refuse treatment to patients based on patient status, income, and/or profession. For example, a growing number of physicians refuse to treat lawyers as a response to inflated malpractice insurance premiums and the malpractice litigation from which lawyers profit. Although many lawyers deal with other aspects of the law, they too may be blacklisted as some physicians attempt to make a political statement about injustices within the legal system.

Disastrous consequences other than legal fines may also ensue from a physician’s poor judgment, and typically it is the doctor’s livelihood and professional reputation that is at stake. For example, with this season’s unexpected flu shortage, one physician was accused of abusing his authority by administering expired flu vaccinations and claiming they were still viable [10]. Thus, sometimes ethical dilemmas do not involve specific scientific knowledge of the practice. Rather, human morality requires adherence to an acceptable and ethical standard of conduct when dealing with such issues.

The aforementioned issues may all contribute to emotional, physical, and mental strains placed on physicians. Such tensions can interfere with the physician’s interpersonal relationships and create enormous levels of stress. Many problems may be attributed to the number of extended work hours. Residents who are placed on call must be ready at moment’s notice to tend to the needs of their patients. Many of these positions entail twenty-four to thirty-six hour shifts at the hospital. The Accreditation Council for Graduate Medical Education (ACGME), which oversees graduate medical education for physicians in training, limits duty work to no more than eighty hours per week over a four-week period [11]. However, many residents routinely break this guideline in order to maintain continuity of treatment for their patients, risking the hospital’s accreditation by the ACGME [12]. Working on call regularly in this manner may severely hamper one’s overall physical, mental, and emotional wellness. According a Harvard study published in the New England Journal of Medicine, residents make 36% more serious errors when working on shifts twenty-four hours or longer compared to shorter shifts of about sixteen hours [13]. Such errors include prescribing overdoses of medication and making incorrect diagnoses.

A student must consider many factors before embarking on a long educational and professional career in medicine. The desire to help others may take on a more significant meaning after thinking about the toll the profession could take on one’s own finances, health, and other personal interests. Becoming a physician involves more than eventually gaining a stable job, and the process itself demands more than academic promise. Keeping all this in mind, students may come to develop a passion for medicine with even greater depth after deciding the profession truly is right for them.