Over the past few years, I’ve shared with readers some of my personal flaws — blind spots, microaggressions, and even lying. But my biggest secret is that I never wanted to be a doctor. I wanted medical knowledge, but not necessarily for the purpose of practicing medicine. I also knew that a medical degree would most likely provide financial security in any career I chose after medical school, whether or not it was directly related to medical practice.
To be sure, I was intrigued by medicine from an early age: the smells emanating from my pediatrician’s office, his assured ways, and his pronouncement that I was “anemic” all fascinated me. My personalized, confirmatory finger-prick test made me feel unique. There was also a cultural supposition that young boys of my religious faith (Jewish) would become professionals — doctors, lawyers, or accountants. I didn’t foresee law or accounting in my future.
The problem was, I lacked confidence in myself, and I felt awkward around my peers. I was overweight and I was always one of the youngest students in my class, a result of skipping second grade upon transitioning mid-school year from an inner-city elementary school to a suburban school. The new school suggested I drop back to second grade, but my third-grade teacher said she saw “potential” and persuaded my mother to keep me in third grade with kids a year older than me. Still, I doubted my own ability and lacked maturity, especially compared to the opposite sex. My childhood inadequacies became a permanent stain on my ego.
I entered junior high school in poor academic standing, in the lower third of the student body, based on the school district’s standardized testing in sixth grade. By the time I reached twelfth grade, I had worked my way up to “academically talented.” Yet, my standardized testing results were barely improved, achieving only average SAT scores. Although I graduated high school in the top 20% of my class, my overall record was undistinguished. I certainly was not the sharpest tool in the shed.
However, with unwavering determination to get into medical school, I applied to a combined 6-year baccalaureate-MD program. The interviewer, a physician, politely but firmly suggested that I modify my application and apply only to the baccalaureate program and revisit medical school after 4 years of college. It was another blow to my ego, but I never gave up on my dream of entering the medical profession. I persisted and was accepted into medical school even though it took me an extra year to get there (I struck out on my first try).
I suppose I learned at an early age to keep medicine at the forefront of my ambitions in order to compensate for my perceived deficiencies and to prove others wrong about me. I figured if I could win at the game — get accepted into medical school — whatever came afterward was immaterial and icing on the cake. In other words, the means became the end; once I had an MD degree, I would decide my next move. My outlook amounted to blind faith in the medical profession. “There has to be something I can sink my teeth into,” I thought.
Fortunately, medical school was able to hold my interest, especially psychiatry, which was a natural extension of my undergraduate major in psychology. But the reality is that although I found medical school intellectually rewarding, and I performed well enough to be selected for the Alpha Omega Alpha Honor Medical Society in my senior year, practicing medicine was not a good fit for me. I realize I had made that determination a priori; practicing now confirmed it. After 4 years of residency and 7 years of academic practice, I called it quits for a nonclinical career.
I am not alone in my career path. I also know that readers’ reactions will vary. Some will consider me a traitor to the profession — especially with an MBA degree and for working in managed care organizations — and others will criticize me for taking a slot away from students allegedly more dedicated to medicine than me. A minority of readers, however, will identify with me and see the value of training physicians for nonclinical careers. In fact, they will fault medical schools for not teaching business concepts, leading to the demise of medical practice.
The truth is, medical school applicants are very bright. They know how to answer essay questions and approach interview interrogations regardless of their ultimate persuasion. Physicians have learned early on how to game the system and even lie to get what they want. According to physician advisor and advocate Pamela Wible, MD, physicians have learned to make their mark, in part, by becoming “people pleasers who don’t want to stray from the narrative or risk being culled from the herd.”
I’m not advocating dishonesty, but if it means using medical school as a stepping stone to an alternative or non-traditional medical career, so be it. While I don’t practice any more, I’m just as passionate as the next person about fixing our broken healthcare system. And I’m just as concerned (perhaps more so) about the plight of patients in this dysfunctional system, which saw its average life expectancy drop for the second straight year and ranks dead last among high-income countries despite spending far more of our GDP on healthcare.
Of approximately 1 million active physicians in the U.S., less than 2% are fully administrative. Yet, the need for physicians to plug critical leadership gaps and assume positions in industry and government is greater than ever. These critical roles will remain unfulfilled unless students who have an inclination to enter the profession of medicine without necessarily aspiring to be clinicians are welcomed by medical school admission committees and are not judged harshly by their teachers and peers. They must be allowed to “stray from the narrative” without recrimination.
In my case, my third-grade teacher was right. She knew I had potential. It was up to me to figure out how best to channel my interest in medicine even if it meant being a “doctor” would lead me down a path less traveled.
Arthur Lazarus, MD, MBA, is a member of the Physician Leadership Journal editorial board and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia.