Deciding what you want

Making the decision to stay or leave medicine is difficult, here are some things to consider.

What is most important to you

When you are thinking about your future career, it is vitally important to recognize what you value in life. The decision of what career to follow, wether to continue with medicine or transition into another area, should focus on prioritizing whatever is most important to you.

In order to think about what you value in life, you need to know what drives you – what gets you out of bed in the morning. I think that following 6 things are most commonly considered among the most important aspects of a person's life and career.

  • Money
  • Free time or family
  • Flexibility
  • Impact on the world
  • Prestige of career
  • Measurable success
  • Learning something new
  • Day to day work

Which of these is the most important to you? Identifying which of these you value most can be an easy reality check that can help identify if a path is correct for you. For example, if you say the most important thing to you is ‘family and free time’ and are considering a career in surgery or finance, then I would challenge that you should consider another career - or you might not be answering the question honestly. There is nothing wrong with thinking that money, prestige, or free time are most important to you, and acknowledging this fact will allow you to more accurately answer the question of what career is truly right for you.

The rest of this document is a tool to guide your exploration based on what is important to you. 


Making money is an important consideration in every career and people value money differently. Money itself is a tool, which can be used to pursue hobbies, enjoy the finer things in life, or can be used as a measure of accomplishment or validation. This tool is only as useful as it helps you accomplish your goals. If those goals are something such as affording a modest lifestyle and paying for inexpensive hobbies, then you could achieve that with almost any career and money should not be your primary, or even secondary, goal.

If making the most amount of money is your primary goal then medicine is an inefficient method of achieving that goal. Please go explore the salary calculator tool to prove it to yourself if you have doubts. There are some careers that are a surefire (albeit not easy) way of making money. The two at the top of the list would be a career in finance, followed by a career in consulting. 

A career in medicine may have a high initial salary (after becoming an attending) but physician’s salary typically does not increase much over time. In comparison, careers in finance and consulting break away in early (during residency) and later (end of career) stages. Tech is typically similar to medicine, with a high initial but quickly plateauing salary. People who work at successful startups from an early stage certainly can make a huge amount of money, but these are generally uncommon exceptions to the rule. 

Free time and family

Time is one of the most precious commodities in the world. No amount of currency or goods can be exchanged for more time in a day. Since everything we do is an exchange of time (and effort) for something else (e.g., money), it is important that what you are gaining (e.g., money) is more valuable to you than what you are trading for it (e.g., time). When you spend time doing a job, you are trading time for whatever you gain from that career. It is very important to critically think about if you are happy with that exchange.

If having control over your free time and family are most important to you, then some specialties of medicine could be a good fit, but there are also other careers that would give you this ability. For most careers outside of medicine you can expect to have your weekends free, and for some careers you can safety expect a 40-50 hour work week.

It is also important to consider that the amount of free time will not be universally dispersed based on your career. A 50 year old attending oncologist and a 50 year old consultant may both have weekends free, but the oncologist forfeited his/her weekends during residency and fellowship while the consultant probably did not. If you are someone who is passionate about an activity that becomes more difficult to enjoy when you become older, such as mountain climbing, then this sacrifice of free time during your youth might be a bad deal.


Another factor that can be valuable to people is the benefit of flexibility. That could mean the flexibility to move cities easily, the flexibility to have control over where you live, or the flexibility to pursue different areas of interest.

Medicine is a very inflexible career path until you become an attending. During training, have little choice in the city where you live throughout medical school, residency, and fellowship. Additionally, some specialties can be limited on where it is affordable to practice. Interestingly, medicine is especially difficult when it come to living and working in major cities in the U.S. Here it is usually more difficult to get into medical schools, match into residency, and find high paying attending jobs. If living in a major metro area in the U.S. is important t you, then medicine can become a significant pain point.

In contrast, medicine is especially great at offering jobs in rural areas. There are some careers outside of medicine where you are able to live in a rural area, especially with COVID-19 making remote work more and more common, but there are several careers which are restricted to major metro areas in the U.S.

Impact on the world

Everyone has an impact on the world, no matter what your career is. Some people think it is important to leave a legacy in their wake, while some people are happy impacting their immediate friends and family. When you are thinking about what career you want to dedicate your life to it is important to consider if the careers will allow you to make the impact that you want to leave.

If making an impact on the world is what drives you, then the next question is what defines impact? Does making an impact on the world mean changing a few people’s life drastically? If so, then medicine would be a very applicable career.

Does making an impact on the world mean making a small change in millions of lives? If so, you could affect that level of impact through working in tech on a widely adopted application, or consulting for a company that reaches large amounts of people. Another alternative would be working in a startup that has an ambitious and wide-reaching mission. You could also work in medical research, where discoveries might cause change to many people across the world.

If making an impact to you is important, and you think the best type of impact is one that dramatically changes the lives of a handful of people, then a career as a physician is a good way to accomplish that. If you define the best type of impact differently, or you don’t place much value in having an impact on the world, then a career as a physician loses a lot of the inherent value.

Prestige of career

Having pride in what you spend your life doing can be very important. Often, having pride in your career is directly associated with the prestige of the job. Some people derive a huge amount of value in being able to say “I am a surgeon” at a dinner party when someone asks what you do for a living. Some people would be equally happy describing themselves as a plumber or a small business owner, and wouldn't get much of reward from having a classically prestigious job.

I know many people (disproportionately surgeons, but also people in other medical specialties and also in people who work in tech) who seem to value career prestige over all other factors. If this describes you, then being a physician in certainly a good way to achieve societal prestige. Other careers can afford a healthy amount of prestige, and if you either do not value job prestige very highly - or would derive just as much value out of a career in a field with less universal (but still significant) prestige - then you should consider alternative careers to see if there is a better balance for you.

Measurable success

Some people need to be recognized for doing good work, and thrive in an environment where they can see their own progress. Others need to constantly be working toward that next level or the next promotion, only to summit that peak and start looking at the next one. If you are one of these people then medicine is a fantastic field for you, at least before becoming an attending. After becoming an attending there are less structures tiers, and a more nebulous progression pathway, which could be an unwelcome change. Careers outside of medicine typically have less structured progressions - meaning you are not guarenteed to move up a level per year like you are in residency.

Learning something new

All jobs require some level of learning on a daily basis, and the difference is what that learning looks like. Some people spend much of their career gaining a very deep knowledge of a specific field. Others learn about a large number of different areas, but aren't able to learn as deeply in each one.

These two types of people would have very different situations where they would be the best person to tackle a problem. If someone wanted a complicated surgery or cancer treatment, then they surely would want someone with knowledge a mile deep - with no regard for how much that person knows in any other field. Conversely, if to hire a CEO of a multinational corporation, a company would want someone with a really wide base of knowledge - with little regard for the depth, since that will be delegated to others. The ideal here would be knowing just enough to comprehend problems and identify an expert in the field to tackle that problem.

Understanding which of these types of learning (and if learning in general) excites you can give you insight into a career that would be ideal for you. If you want to be closer to a mile wide and an inch deep then working to become a CEO of a company might be a good fit. If you want to be in the middle of the two extremes, then general medicine (IM, PCP, ect) might be a good fit but so could consulting or banking. If you want to be the ‘mile deep expert’, then medicine would be a fantastic way to accomplish that, but so would equity research.

Day to day work

It is important to consider the day to day work that people do in different careers, and best to think of it in two buckets. 

  1. What is the coolest or most fun feature of this job?
  2. What is the most common or most tedious aspect of this job?

To consider which jobs have daily work which you would enjoy the most, you need to figure out if any careers have a factor that is truly irreplaceable to you. If one of your favorite things in the world is suturing, then you don't have many options to do this outside of surgery. If you love delivering a baby and seeing the look on a parent’s face, then a career as an OBGYN is the best place to do that. If you like brainstorming and finding a solution to a fairly unique problem with a team, then consulting is a fantastic way to achieve that.

Then you need to consider the most common, or most tedious, task that someone in that job has. Surgeons spend a large amount of time with administrative work and managing patients. OBGYNs spend a lot of time at the hospital waiting for babies to decide to come (often in the middle of the night). Consultants need to create many PowerPoint slides and deal with client’s last minute requests.

If you can find a job where the aspects of bucket (1) greatly outweigh bucket (2), then that is likely a career which you would really enjoy. If you think the aspects of (1) are not that great, or the aspects of (2) are really bad, then the balance might not be right, and you should consider looking at other careers.

One vital aspect is to consider not only what your job will require immediately when you start, but also what you will be doing 5 and 10 years down the road. A career is a lifelong journey, and you should plan for the long haul!