Welcome to a new chapter in your professional life! In some important ways, it is the first chapter. Everything leading up to this -- your college career, medical school and much else -- was no more than Prologue. For the first time, you will (correctly) be introduced as "Doctor." What can you expect next? Given the pace of change in healthcare, I won't even try to make predictions about anything beyond Chapter 1.
First, some bad news. For those of you who came to Medicine to "make a killing (financially)" I'm truly sorry. That era has mostly passed. (You should be comfortable enough, but there is certainly more money in Finance, commercial real estate or home improvement.) The same goes for "professional autonomy," if by that you mean the privilege to do pretty much what you want in practicing Medicine, or if you mean going it alone, or if you are referring to doing what you do without external scrutiny. That train has also left. Contemporary healthcare is team-oriented, quality- and value-driven, and consequently more closely regulated and scrutinized that any other profession or industry anywhere.
A little more bad news. I mentioned that you won't be able to make a killing. Of course, that is only partly true. A defining characteristic of the healing professions is the risk of inadvertently doing harm - including the ultimate harm of killing a patient. There is no way out of this. There are three doors from which to choose. First door: if the possibility of harming a patient doesn't concern you, then we have made a grave error in accepting you into our training program. I sincerely doubt, however, that this is the case. Behind the second door is another uncomfortable possibility - that we fail to provide you with any real responsibility during the next three years, relegating you to the role of "tourist" in our hospitals, with other physicians making all the decisions and thereby protecting you (and patients) from any risk at all. Unfortunately, that would leave you wholly unprepared to practice independently at the completion of your training.
It is my fervent hope that you arrive at door number three. Behind this is a scene in which you are an integral part of the care team, supervised but not to the point of exclusion from the process. Your mentors manage Risk, but do not seek to abolish it. This pathway leads to growth, but at the expense of some sleep. I refer not to the sleep lost from a night on-call, but rather to the experience of staring at the ceiling at 2:00 am, wondering whether you followed up on the electrolytes, or ordered the repeat chest film or remembered to tell the attending about that CT result. These moments of nocturnal anxiety are ubiquitous among real physicians, during training and, hopefully, for the rest of our lives. They are part and parcel of what it means to be a physician - one who accepts the awesome responsibility for the wellbeing of other persons.Why should you want to do this work? Why would any of us? And why would so many of us make the claim that we could never imagine doing anything else? Some of the answer comes from our patients and families, especially those who make clear statements of appreciation. And by the way, these tend to correlate very poorly with the brilliance of our diagnoses or our meticulous attention to clinical practice guidelines (not that these things aren't critical)! Mostly it is about the way you waited patiently to hear a wife ask all her questions, and then answered each in simple language, the way you sat down at the bedside, and in short the ways you communicated, with and without words, that you care. There are also the rewards that come from our colleagues. To be called "the physician's physician," to be held in high regard for your knowledge, skills and judgment, for your generosity of spirit and your professionalism - receiving expressions of this kind can make a day or much more.
Finally, however, what motivates and inspires us most must come from within. Caring for patients ultimately reminds us of our own mortality, and the fact that we have a finite number of days to make a mark in our world. How do we want to do that? How do we want to spend that precious time? Wise physicians will remind us that the practice of our profession should not be the only part of a life well lived. Attention to our loved ones and to ourselves is vitally important. But our professional lives comprise a great deal of our allotted time and the opportunity to use our minds and our hearts in an activity that beckons us toward ongoing efforts to master the craft, knowing that we can always improve and never find an end to learning or growth, and where our aim is the betterment of the situation of fellow human beings, this is unique to Medicine. Welcome and good luck.
