Becoming a Doctor for the “Right Reasons” – Should That Really Matter?
NOTE: This is probably the most controversial article on the blog. I myself learned a lot from the discussion in the comments that followed, and I am willing to admit my current thoughts on this subject are quite different from when I initially wrote this. However, I think there is great educational value in keeping this article and the comments up. That being said, I would appreciate it if people read all the comments and my responses before making judgments about my perspective on the issue, as I think my initial article doesn’t explain my point of view all that well, and can lead to misinterpretations of my thoughts.
During elementary and high school, I felt as if numerous sources in society were encouraging the concept of “nobility” as the greatest thing in the world. Things like school and the media were constantly championing ideas like volunteerism, servant leadership, environmentalism, etc. to the point where it was suggested that being a “good, noble” person involved thinking and acting with those ideas in mind.
And while I myself was swept up by those ideas, especially during high school, I began noticing some problems when I entered university. I started realizing that issues aren’t as simple as we often make them to be. For instance, bring up a random high school discussion on the environment, and you often hear things like “yah, coal plants are bad! We should get rid of all of them and power our cities completely with solar energy” followed by nods of agreement. But then if you do a bit more research, you start to learn that solar panels are currently pretty expensive as well as take up a ridiculous amount of space, such that it may just not be feasible.
It seems that the more you know, and the more open you are to possibilities, the more complex the world becomes.
The concept of nobility is particularly prevalent with “premeds” and their interest in medicine. A lot of students seem taken by the idea that it’s good to be pursuing medicine for the “right reasons” – usually this refers to pursuing medicine for the sake of practicing medicine, often driven by the desire to heal others, improve lives, or an interest in a specific field of medicine. Conversely, these same students usually see it as sort of taboo to be pursuing medicine for the money or prestige.
Personally, while I am generally interested in people’s motivations for what they do, I don’t think it is right to judge a medical school applicant solely on their intentions. I think it’s wrong, and kind of illogical, to immediately associate noble intentions with good and not-so-noble intentions with bad, in terms of being a physician.
The Patient’s Perspective
If I am a sick or suffering patient, I want a doctor who can help me. I could care less if he is the most passionate physician – if he can’t help me, then I’m not better off. For me, and I think for most patients, the most important thing is that our physician is competent enough to help and treat us. I don’t see a physician to admire her dedication and love for her job – I see her because I need to be helped. In short, I’d much rather be a healthy, living human being saved by a physician driven by money and prestige than dead because my physician was incompetent but noble.
Of course, you could argue that a more passionate physician is likely to go above and beyond for your care, but when it comes down to it, I feel that a physician’s competency is way more important than their motivations.
It’s Still Like Any Other Job
When you get rid of all the smoke and dust, being a doctor is still a job. It sort of irritates me when I see students putting the idea of a physician on a pedestal and seeing it as some sort of magical career. It also annoys me when I hear about students in medical school calling themselves the “cream of the crop” from undergrad programs and stuff like that, as if being in medical school means that they are “better” than other people in aspects that matter more than anything else.
It makes no sense to view being a doctor differently from any other job. There’s no reason why I should be obligated to have certain ideals or values about money or prestige if I am a physician compared to any other job.
How many times have you taken up a summer job solely for the money? Does it make you a bad person if you chose to work for more money at a computer business instead of protecting and saving lives as a lifeguard at the local pool for less?
So why is it so bad even if someone pursues medicine only for the financial stability / success it could bring?
When it comes down to it, the only reason I would care about someone’s motivations is if it affects their performance. And I doubt you could find a strong enough correlation to show that physicians driven by money and prestige are significantly worse at their jobs than physicians with more “noble” motivations.
I mean, while I’m sure some people will contend that these not-so-noble intentions could create lazy physicians, it’s just as possible for these intentions to produce positive results. If a doctor wants to make a lot of money, they are going to work efficiently and try to see more patients (if you are one of those patients who hates sitting in waiting rooms for hours, you might like this). Or if they are seeking prestige, they are going to work harder, take on more difficult cases, spend more time doing groundbreaking research, etc.
We Don’t Even Analyze Noble Intentions for Other Jobs
If I am business owner looking for someone to manage my store, I want someone who I think would do a good job and accumulate the most profit possible. I mean, would I really care if someone is genuinely passionate about managing the store?
Or if I am interested in hiring a student to mow my lawn for the summer, should I not hire him because he doesn’t absolutely love cutting grass?
Or if I am the general manager of a sports team, I wouldn’t care if the best player in the league is driven only by money and prestige, and is not genuinely passionate about playing the game. My goal is to build the most competitive team possible, and if that player helps me win, then I’m happy to sign him regardless of his motivations.
So why the double standard with a career in medicine?
I think it’s because of this obsession with nobility that we obtain through our youth. We become sort of idealistic, and think about people as “good” or “bad”, though I’m still trying to figure out why this is particularly prevalent with medical careers.
All in all, I don’t think it’s quite fair to be so quick to judge, and I think you are missing out on a lot if you are too busy forcing certain idealism on others instead of stepping back and thinking about why other people are viewing things differently from you.
Related Posts:
- Why GPA Should Matter and Learning the Way You Learn Best
- What’s up with premed altruism and nobility?
- Mastering the University of Toronto Medical School Essay – Part 4: How Your Premedical Studies have Prepared You for Medicine
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Comments
i love the businessman and athelete analogy!1 its so true, noone cares for they intentions, all they want is getting the job done well!
You raise some interesting points Josh. However, just like your original premise “it seems that the more you know, and the more open you are to possibilities, the more complex the world becomes.” – “being a doctor is just a job” is indeed a complicated issue.
You point out some good points, about competency, getting the job done, performance. However, there are patients who would rather have a caring doctor than a competent but rude one. It’s also dangerous to treat medicine like a business, because it’s hard to measure the true value of patient care. And medicine, although is technically a “job”, has many factors that make it more than just a job.
Long hours, dealing with death and disease, having someone trust you with their life, putting a patient’s well being and health before yours. The responsibility, privilege of caring for the sick, tolls and uncertainty definitely set it apart from most “jobs”
I’m sure you already know it, the career of a physician is somewhere in between. It’s not quite as idealistic as many people make it out to be and you can’t entirely apply business principles to it.
My perspective is that becoming a doctor for the right reasons do matter. Because if you have the right motivation, you will have the right attitude, and if you have the right attitude, you will sincerely serve and care for your patients.
Tim brings up interesting points.
U cannot measure the value of healthcare
but i still agree with Joshua, healthcare is a business
Illnesses that are more common, and have patients that are willing to pay a lot of money, always are the ones being researched one.
Havent you noticed that for rare diseases like “Xeroderma Pigmentosum (being allergic to sun) might never have a cure. Why? because very few people have them.
The public might say its because its only a few people that have it so why use all our resources on it
but what about the few people that die becaus eof it? a life is still a life
anyways i am sorry i’m going off topic
my point is healthcare, o being a docotr is a job. Without prospects or wealth, very few people can live on “passion” and “nobility” alone.
Thanks for bringing up this interesting topic, Joshua. This is something I always ponder too. I think this is not only for medicine but is also prevalent with other high-paying jobs which are naturally steroetyped by the public in the case of money. I often hear people say whoever study Commerce are driven by money, and are somewhat “mean”.
There is nothing wrong about money. I think no physician would not want to be finacially rewarded regardless what their motivations are. I think we need focus more on how you treat money after. Are you going to buy fancy cars in order to brag with your neighbours just because you are a doctor and earn lots of money? Or is it because you want people to praise you because you are intelligent and are qualified to be a doctor?
The key point I’m trying to say is as long as you don’t see yourself superior than others because of how much you earn or how high your social status is, you are okay to be motivated by money or pretige. Of course, passion and nobility will be a bonus if you have them.
“For example, it’s possible that someone who is only driven by the money and does not love their job as a physician might end up being unhappy in the long term.”
I think you’re not giving this statement enough credit. Money and prestige wear off in time. I’ve encountered a great deal of doctors who, you could tell, had been in the profession for quite some time, and who were now lousy at it because they just didn’t care anymore. This would imply that “treating patients” had not been their original motivation for becoming doctors. I think that if you want to make money or have prestige, you should become something that doesn’t play with people’s lives on a daily basis, and I find it ridiculous that you’re comparing being a doctor to mowing a lawn.
I think that the stereotype that “being a doctor or a lawyer isn’t just like any other job”, because it isn’t. You can’t possibly compare most other jobs to it. I would include passing laws (as in being a part of the governement) under this umbrella, because these careers directly impact people’s lives, unlike say, a secretary or a plumber. Not to discredit any other profession, but there’s a definite difference.
And not to sound harsh, but I think that your mindset is what’s wrong with medicine – why in the US people get put out on the street if they don’t have the money to pay for a procedure, and why there’s corruption and greed in the system. If everyone who went into medicine genuinely wanted to help people, I think it would be much less of a “business”, and it would truly be much more beneficial to society and to the individuals being treated.
There are many professions where you’re given the same pay, if not more, but the reason doctors always had the prestige is because of the nobility. Saying that there’s need for nobility is discrediting the prestige, and you might as well be something else.
There are many morality calls one must make as a physician, and I would much prefer a doctor who cares about me as an individual, rather than one who just waits for his paycheck, especially in the specializations in medicine, with private practices.
Maybe you should consider another profession if this is how you feel?
Sorry, I didn’t re-read, I meant to say that I think the stereotype is there for a reason.
And also saying that there’s NO need for nobility is discrediting the prestige,…
I was revved up, what can I say.
Why do good intentions matter-
While I can agree with your point that technically being a physician is a job like any other they are some very huge differences. The first being the you are responsible for the care and well-being of people. And unfortunately many a time, competency will not be a factor in being able to help. While medicine has provided us cures for some of the worst illness, it still just a science. And there is a large percentage of the time where you will not be able to do anything for a patient besides make them comfortable and help ease their mind/pain. And also that of their loved ones. So while competency is needed, compassion and a sense of the greater good is equally needed.
Additionally the road to becoming a physician is long and hard. Probably one of the longest and most costly of any profession. In the US it takes 4years of Undergrad, 4 years of med school, and then 3-7 years in residency before you start making good money. And then you still have to pay back student loans. So we are talking about anywhere from 12-17 years before it is just worth the money. That’s a lot of time to put in just for money.
“We Don’t Even Analyze Noble Intentions for Other Jobs
If I am business owner looking for someone to manage my store, I want someone who I think would do a good job and accumulate the most profit possible. I mean, would I really care if someone is genuinely passionate about managing the store?
Or if I am interested in hiring a student to mow my lawn for the summer, should I not hire him because he doesn’t absolutely love cutting grass?
Or if I am the general manager of a sports team, I wouldn’t care if the best player in the league is driven only by money and prestige, and is not genuinely passionate about playing the game. My goal is to build the most competitive team possible, and if that player helps me win, then I’m happy to sign him regardless of his motivations.
”
What I think you are forgetting here is the human component to medicine. Docotors help save lives, not win games and not make a profit, save lives. This is why we evaluate their motives. Additionally, using your example about football, you sign the guy who cares only about money to help you win, but what happens when you start to lose? Will this player continue to work as hard, will this person be a great team player, will this person help you rebuild?
Another way to look at this is the job of parenting. Many are competent to conceive but does that mean they will make the best parent? No, because we judge parents on the ability to deliver love, emotional support, and provide the basic necessities. Basically we judge them on their ability to care for a life on multiple levels.
So as people put their lives in doctors hands, hence why we judge their motivation. We believe those who care more and are motivated by more than just salary, will tend to do better in the long term and when it really counts.
I agree with Joshua’s point.
A person motivated by ambition and money should not be immediately tagged as the wrong type of medical school student. Many students work hard in high school and university only because they wish to achieve something, or to show that they are better than others. These students worked hard and they earned their success. Sure, interest is as important. But being interested in something will make you take action, which is equivalent to taking action while motivated by other factors. Therefore the result is the same: action.
Some say that the desire for money will wear off over time, that really depends. Especially with the current economy, would you rather have a boring but stable job or none at all?
I also believe that “caring” is not merely a personality, but more of an action (yes, action again). Shakespeare once said, “All the world’s a stage, And all the men and women merely players.” If you act as a caring person on the outside (even if you don’t have a caring personality), sooner or later you will become one.
Lastly, I’m really glad that Joshua posted this article. I’m currently considering medical school as an option but I’m not quite if I’m genuinely interested in medicine or not. This article gave me a different outlook on the qualities of a medical student. So Jushua, thank you for that.
Hey Joshua,
Thanks for blogging, it’s an interesting read!
Here’s a thought:
“So why is it so bad even if someone pursues medicine only for the financial stability / success it could bring?”
I’m a 3rd year nursing student and currently volunteer twice a week in a hospital in the pre-op/anesthesia department… a few days ago there was a need for a translator in the ICU and I happened to be able to help out… long story short, I helped the doctor communicate with one of his patients that he’d no longer have use of his legs and would require breathing assistance in order to live. The doctor also wanted to discuss the patient’s beliefs about what kind of quality of life he’d have and which direction he’d be more inclined to… basically to continue living like that or to die. While this had very little to do with me, or my feelings, I have to say that it hit me hard emotionally, spiritually, and even physically. One of the many thoughts I had bouncing in my head was, “I’m not sure if this would be any easier to deal with in the future if I made twice, or even three times the money.” This is why I have to challenge your statement. It’s not “bad” to persue a professsion in medicine for the money and prestige, but foolish. There is no amount of money in the world that can rid you of that awful feeling in your stomach once you’ve gone home for the night, leaving a patient stranded in such an unfathomable position. In fact, for some doctors, I’m sure that if it was possible, they’d give away every last cent they have just to ease the suffering they see. As for prestige, it quickly escapes out the door once you’ve been humbled in such hopeless situations. In fact, all that glory rightfully belongs to the patient… because in some strange way, their hardships make you thankful for your blessings, and makes you appreciate being alive and well much more than you could ever imagine.
I wish you best of luck as you start med school and hope you persevere when you run into similar situations. All the best. 
I disagree with you. Although it’s true that we should judge people based on job competency, it IS true that “nobler” people make better doctors.
I shadowed a few doctors this last summer for a few weeks, and I found that people who truly care for their patients end up with the higher social status/more money, etc. There is a strong correlation b/w what you TRULY love to do and how well you do it. Remember during high school when you wanted good grades in every single class? Is it just coincidence that the classes you truly enjoyed (for me it was chemistry, physics, and calculus) you did better in and the ones you didn’t like as much you did worse in?
Hi Josh,
I read the comments and your clarifications and the entire thing makes more sense to me now. I think you make an additional good point in your comments that using “nobility” alone to base a cut-off line would be inappropriate.
However I have some beef for this point… you say that “we don’t even consider the noble intentions for other professions” and you use the examples of a lawn-cutter and an athlete. As someone already pointed out, lawn mowing obviously cannot be adequately compared with medicine, and as for athletes, some cases I thought of:
- skilled but dispassionate athletes who are lazy at practices or are less willing to play as a team
- athletes who do not perform well after signing a long-term contract
- athletes who mysteriously perform much better during the last year of their contract (and then are disappointments after a big free-agent signing)
- (as Jai mentioned, an athlete who signs to help you win, but does not play as well when the team starts losing, is a poor team player, is unwilling to help team rebuild)
I find that in the above cases that these motivations would be very important because they are intricately linked with (future?) performance. Say player A has a history of the above “non-noble”/selfish qualities, and player B is a consistent hard-working player who has taken a discount in his contract. In this case, I believe that even if the skill and performance of player A has been higher than player B, player B may end up the “better” player.
So re-applying to the medical profession, I would think of it as a more “noble” doctor with less skill / lower “performance”(as measured at graduation?) may still end up a “better” doctor [perhaps in the future?], for possible reasons such as hard-work translating into more willing to stay up-to-date and practice self-improvement as medicine is highly evolving, as opposed to a “less noble” doctor.
So a new point I’d like to hear your thoughts on is the effect of time. Perhaps “noble” motivations may be useful to predict not the test scores at graduation, but on-going and future performance?
Also, your counterexample of a top athlete not passionate about their game may be very difficult to find, because it takes a lot of dedication, perseverance, hard work to get to the top. Can there be a comparison with medicine here? Does the medical school process naturally weed out most who lack the motivations other than money/prestige? Are we leaving “selfish” albeit skilled and competent doctors behind? Are “selfish” albeit skilled and competent athletes left behind??
Actually, are these athletes (selfish+skilled) the best of the best i.e. to stay in major league?
Then, do doctors have to be best of the best?
(which seems like a point you are trying to convey)
(i.e. can society afford only licensing the best of the best doctors?)
One more thing: you use as a counterexample: “If a doctor wants to make a lot of money, they are going to work efficiently and try to see more patients”
Perhaps because of the stereotype and negative connotations of non-nobility, but a doctor working more efficiently for money sounds like a doctor who will miss symptoms or not provide enough consideration (an efficient doctor is better, all other factors equal, but it seems there would be a correlation between a “noble” doctor taking his time and sacrificing efficiency/profit for perhaps even “better” performance)
Sorry, one last point to bring up (responding to your comments): Is it actually fair for us to expect this “more than just a job” concept from physicians? If so, why?
- health, quality of life, as you mentioned
Are there not other occupations you could also apply this to?
- law, politics
- but by stretching, you could also include: law enforcement, business (making decisions affecting jobs, health and safety, long-term environmental effects), engineering
- I believe the reason for the stereotype of required nobility is because medicine most directly affects health and quality of life, whereas the other professions appear to be more indirect. I would say that the closeness of the effect on quality of life appears to be proportional to the amount of required “nobility” as perceived by the public.
- You ask is it fair for medical practitioners to be subjected to such scrutiny (compared to other occupations)?
- I only have more questions: how much closer is a surgeon, doctor, pharmacist, paramedic to health/life than a lawyer or judge sending someone to jail or even capital punishment? How about a politician making decisions regarding health care, education, or even war?
Then what about business executives who might neglect the health and safety of employees?
And engineers developing and deploying technologies that could drastically affect health and life?
- Most of the occupations I suggested are actually designated by society as “professional” professions, which are society’s most trusted members
- We trust professionals with our well-being and lives.
– We trust them to not to make mistakes
– But also for them to be ethical and moral
- We also trust professions differently
- Doctors are probably the “most trusted” profession, so the demand for the most “noble” makes sense (but is it reasonable? fair?)
- How much trust does a doctor earn by their skill/”performance”?
- What about a surgeon (precision/get the job done)?
- How much trust does a judge earn by their skill/performance?
- What about a judge working only for the money and prestige?
- Now that I think about it, there are many different lawyers out there… I guess I’m thinking more of prosecutors for public welfare? Do we trust them to deliver justice?
- Can we trust a police officer to be fair if he is working for prestige and power?
- Politicians??? Can they be trusted????? Shouldn’t they be “noble”???
- Possible anomaly: for the amount of trust society puts in engineers, “nobility” is almost a non-factor to become a professional engineer, save for the requirement of a “good character” reference and passing of an exam with an ethics component for a P. Eng.
– Is it the perception of the amount of trust into a profession ? People put their trust in engineers in modern everyday life, but usually not consciously, so is that why “nobility” is not demanded?
I’ve run out of time… Josh, your writing, topics, and comments definitely get me thinking!
Arthur
I’m a premed student and this post (and all the comments) were very though provoking, so thank you Josh for taking the time.
MedHopeful @ Premed101
WOW
this post is exactly what i am thinking!
its true society frowns upon those who pursue medicine because of the money
i agree money shouldnt be everything but it is a good way of motivating others. Everyone wants a career that stabilizes them finacially too.
if doctors werent rich (or well off), if they earned just enough to get by, we would not have the same amount of people being as pasionate as they are for medicine.
THANKS JOSHUA for discussing this topic!