When I finished medical school in 1989, I was one of the student speakers at our graduation. I gave a speech that many still remember, though not so much for any sage advice as for the prop I used. My goal at the time was to never lose sight of the wonder and joy of medicine. Because I had chosen to go into pediatrics, I equated the way a young child sees the world — full of mystery and wonder and unbridled joy — with our initiation into medicine. As newly minted doctors, we were still full of curiosity about all things medical, and I urged us not to forget that.
To illustrate the point, I used some common soap bubbles, the kind that you blow out through a hand-held plastic ring. I then produced a small container of bubbles and proceeded to blow a few into the crowd. I said that the scientist in each of us could calculate the surface tension of the bubble, and the laminar flow of the ventilation system in the room, to explain how the bubble could float and move. And that’s important to know. But I stressed that we should also never forget the sheer beauty of the bubble and should always remember the joy we felt when we played with bubbles as children. This would serve us well in our careers, I thought, so that we would never forget the miraculous wonder that is the human body and the human spirit. I wanted to remind my colleagues to remember to take joy in our work and our patients.
As I look back on that speech, it wasn’t necessarily “bad” advice, just incomplete. And now, 31 years later, I’ve been thinking about what I might say to the graduating class of today, knowing what I know now after practicing medicine for almost three decades.
To the graduating class of 2020:
Congratulations! You’ve finished four hard years of medical school, and are now looking forward to embarking on a career in medicine. After three decades of practice, I’ve learned a lot, but the most important thing is this: find what you love about medicine and do everything in your power to do exactly that.
Think hard about what you want from medicine, and when you figure it out, go after it with laser focus. That first part is harder than it seems. There’s a lot to love about this career, and your passion may not be limited to just one aspect. But figure out what gets you excited, what brings you joy, fulfillment, a sense of accomplishment. In any endeavor that we love, there is an essence that imbues one with vitality. Find out what that is in medicine and do that for the rest of your life. To be clear, I’m not only talking about the academic discipline: nephrology or pathology, surgery or primary care. I mean really think about what gets you out of bed in the morning. Maybe it is the mysteries of the kidney or the brain. Maybe it’s something more basic, like being the “family” doctor to generations of patients. Whatever it is, be bold, be creative, and don’t let tradition or others’ expectations sway you into taking the “traditional” route or doing something you don’t want to do.
This may seem like odd advice. “Thirty years of practice, and that’s all this guy has to offer? Isn’t that what everyone does: finish residency and take the best offer out there?” Yes, but it’s critically important to not just take a job, but to do it in a way that fulfills the promise of this graduation day. It’s very simple but trust me, I’ve seen a lot of physicians burn out. Most doctors my age tell their children not to go into medicine, and they regret many of their own choices. But that’s what they are: choices. Think now and in the coming years about how you want to live your life and how you want to practice your career every day. It may not be the job you take that causes burnout; often, it’s how you practice.
Many docs I know go from residency to a job, then realize that after 20 years with a mortgage, two car payments, and three kids in college that they are stuck in a job more than a career, captive to a lifestyle that just crept up on them. Why? For many, it’s because they spend less time doing what they love (helping patients, for example) and more time on tasks they despise (charting in an EMR). Don’t be that doctor. Find what you love to do, then go do that — and try to minimize the rest. Hire a scribe to chart for you, for example, or get a dictation system that charts while you talk. The point is, don’t just complain about the stuff you hate, figure out how to reduce those stressors, and practice medicine the way you want to practice it.
There is plenty to gripe about in medicine. Insurance companies are almost all malevolent, and they increasingly control more of what we can and can’t do for our patients. We all have to deal with them. … Or do we? Some doctors open practices that completely forego insurance coverage and depend solely on patient payment. Yes, I understand that’s few and far between, but the point is: they did it. And you can, too, if you really want to. And if you can’t change it, then stop griping about it. Realize you can only change so much and move on. Don’t waste time and energy simply complaining about something you can’t change. If you desire to make a real change to the system, then work on that. Policy work, public health administration, professional organization work, or an active role in government are roles to consider.
Some of you may have tremendous debt, and your choices may be limited by that financial burden. But there are ways to minimize the debt early in your career by working in an underserved area or for the NIH. After a few years, you could be free to do whatever you want.
For still others, it’s not about money, it about a more precious commodity: time. Less time doing menial tasks, more time with patients, or more family/personal time. You can do that, too. You might have to readjust your expectations regarding income and lifestyle, but it can be done. I’ve seen it.
Over the next few years, you have the ability to choose the path you want to take. Take time to think about the kind of doctor you want to be, then go out and devote your energy to becoming that physician. Don’t wake up in 30 years feeling trapped and burned out in a career that you once felt so passionately about. Choose your own path. It takes resolve and courage and commitment, but it’s worth it. And if you achieve the goal of becoming the physician you envision yourself being today, as you graduate from medical school, then that’s the true measure of success.
A practicing pediatrician for over 26 years, Dr. Ruben J. Rucoba currently serves as Director of Medical Services for PediaTrust, a large pediatric "supergroup" in the Chicago area. He also established his own thriving medical writing and editing business in 2010. He has no conflicts of interest to declare. Dr. Rucoba was a 2019–2020 Doximity Op-Med Fellow and is a 2020–2021 Doximity Op-Med Fellow.
