When it comes to choosing a specialty, medical educators rarely address the elephant in the room, which is lifestyle and compensation. Although we all know how important these factors are in our day-to-day lives as physicians, it’s a topic that is often skimmed over or flat out ignored when guiding medical students in choosing their specialties. Don’t get me wrong, doing what you enjoy and have an aptitude for is still the most important aspect of picking a specialty. No amount of money or a great lifestyle can make up for practicing in a specialty that you loathe day in and day out or simply struggle to do. There is also the fact that lifestyle and pay can sometimes vary dramatically, even within a single specialty, so that one may theoretically be able to find their ideal lifestyle and compensation in whatever specialty they choose, even if it is uncommon and rare. That being said, lifestyle and compensation cannot be fully ignored either, and it can ultimately have a real impact on the joy we get out of our chosen fields. Having pursued a career in primary care where pay and lifestyle are less than ideal, I learned this firsthand.
Before I begin, in defense of my specialty choice, primary care is an amazing field and I chose it for a number of reasons. I wanted to develop close bonds with patients and families who would remain with me for years in practice. I also liked the idea of being the jack-of-all-trades, getting to address a wide variety of health problems and being the point person for my patients when it came to managing their overall health. However, due to the poor lifestyle and pay, my reality of actually working in primary care was far from what I imagined in medical school. I found myself dealing with tightly packed schedules, getting just 10 or 15 minutes to review a chart, obtain a history, do an exam, answer questions, and document the visit. In between these visits, I was inundated with insurance denials, in-basket messages, forms, labs, phone calls, billing inquiries, and refill requests, which was all unpaid work. In reality, I had very little time to develop those bonds with my patients at their visits or to properly address the wide array of problems they came with. Instead, there were rushed visits with brief, if any, conversations, dissatisfied patients, referrals for issues I could have managed myself with enough time, and long hours working through my lunch or staying late charting. I worked very hard, but very little of that work seemed to be going toward my patients, improving my income, or practicing as I imagined. The very reasons I pursued primary care became almost irrelevant, and much of the joy left with it. I don’t say this to sound bitter but to highlight that an honest conversation about these tougher realities of my specialty in medical school might have allowed me to make a more informed decision and better yet, actually be prepared to manage these hurdles and challenges in a meaningful way.
This doesn’t just go for primary care either. All specialties have their own rewards and compromises when it comes to lifestyle and pay. Of course, some specialties fare better than others in these aspects. Just highlighting the amazing, exciting aspects of our specialties without discussing the practical downsides and hardships related to overall lifestyle and pay is a disservice to medical students. These conversations also rarely come up because medical students are often forced to seem overly excited, eager, and enthusiastic during clinical rotations if they want to get a good letter or chance to match. This makes it difficult for students to ask about pay, work-life balance, or any relevant downsides of the field.
Resources like the Doximity physician compensation report or Physician Side Gigs salary surveys can help highlight compensation issues, and I highly encourage students to consider these references. As for overall lifestyle both in and out of the office, medical educators should not be afraid to share common frustrations and issues in their field with medical students. Issues regarding their day-to-day practice, their work-life balance, or any problems with being able to work on their terms.
Going back to my primary care example. In a time when many medical schools are rolling out primary care tracks to encourage medical students into the field, I wonder if the discussion of what their day-to-day lifestyle and pay will look like is occurring as well. More importantly, I wonder if these students are taught ways to deal with these realities in a productive manner. Schools can teach these students business skills so they can more easily maintain or open their own practices, how to manage their loans efficiently so they can be reasonably paid off despite their lower pay, how to protect their own well-being and health in spite of demanding hours with increased administrative burdens, or how to negotiate contracts to be paid what they are worth and practice on their terms. If these discussions and preparations are not happening, then we are failing our medical students.
In the academic world of medical school, we protect medical students from the dark realities of modern healthcare. We show them how exciting each specialty is, but we don’t warn or prepare them for the hard realities such as poor pay or lifestyle nearly as often. Specialties like primary care where pay and lifestyle are lackluster can still be rewarding if we prepare students for these realities instead of shying away from them. The rewards haven’t totally gone away.
We still get to enjoy continuity of care where we often see the same patient or family over many years. We still get to be a jack-of-all-trades who sees a wide variety of problems as patients come to us first with their health concerns. We still get to focus on prevention and managing illnesses before they can appear or progress. However, lessons on how to manage school debt, run a practice, bill properly and get the most revenue for the work being done, deal with insurance, or negotiate fair contracts would go a long way to empower students to make the most of their chosen profession. More importantly, if this helps a few fresh grads retain their joy of practicing after all that training is done, then we can retain doctors in these fields and not lose them to burnout.
How did lifestyle and compensation shape your own specialty decision? Share in the comments.
Dr. Shadman Sinha is a general pediatrician practicing in New York. His passions are speaking out about healthcare reform and educating parents via his many social media accounts. He also loves rocking out on his guitar and playing with his band. He posts regularly on TikTok, Instagram and Youtube @docshaddymd. He is a 2025–2026 Doximity Op-Med Fellow.
Animation by Diana Connolly
