5 May 2011


One day later, our medical school organized a dinner to celebrate the establishment of an honor society. Alumni with distinctions at professional examinations were invited. It was a wonderful evening where we met old friends and graduates from different years.

During the meeting, we could not help noticing a clear trend. While the popular specialties of the older generation were general surgery and medicine, graduates turned to the “ROAD of success” at the turn of the century. ROAD stands for four attractive specialties: Radiology, Ophthalmology, Anesthesia and Dermatology.

The advantage of getting on ROAD is obvious. The on-call duties are less demanding, most fellows get promoted soon after they have completed training, and the private market is blooming. When I asked friends practicing in those specialties, most claimed quality of life was the major reason behind their choice.

This I can understand. What intrigues me, however, is why the preference changed. Top graduates in the past were also free to choose the easier path, but they didn’t. Is it just a generation thing, as most people in the older generation love to say, or are there deeper reasons?

While the generation change is obvious, I am reluctant to take this as the sole explanation. If you ask 100 medical school applicants at the entrance interview, 100 of them will tell you they do not mind hard work and are not doing medicine for money, and I believe them. If they state otherwise, I would not hesitate to reject their application. No, this is not about moral judgment. This is about intelligence. If you want a big pay check and leisurely work, medicine is a dumb choice. So, if these enthusiastic youngsters suddenly consider the thing they despised important by the time they graduate, our education has been killing their dream.

To satisfy my curiosity, I reversed the question and asked senior clinicians why they chose general surgery and medicine. This time, the most common response was the satisfaction of managing a broad range of medical conditions.

This would make sense. ROAD was less well developed 2 to 3 decades ago and provided less job satisfaction then. Over the years, these newer specialties have advanced a lot. On the other hand, you like it or not, practitioners in general surgery and medicine are also focusing on a much narrower field nowadays. If the job satisfaction and breadth of practice do not differ much, it is not surprising that other factors come into play in career decisions.

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