There are many things medical school teaches exceptionally well. It’s a four-year fire hose flood of information. There are also many topics it barely touches. Looking back now as a mid-career physician, these are five things I wish I had understood before becoming a doctor.
1) Medical school debt will be substantial. And it will matter more than you think.
At age 22 or even 26, I did not fully grasp how long student loan debt would subtly dictate future choices. It is easy to overestimate how much you will make as an attending and underestimate how quickly lifestyle inflation creeps in. As tuition and housing costs skyrocketed over my four years in medical school, I finished with over $100,000 in student loan debt. I then chose the “defer loan repayment option” during residency, which seemed like a great idea at the time but resulted in an additional $100,000 in compounded interest over my five-year residency/fellowship period.
I operated under the “Emerald City attending” mindset of “everything will be unicorns and painted horses as an attending,” and “I will make so much money it won’t matter.” Sound familiar?
What I now see clearly is that physicians who pay down their loans early — including income-based repayment options during residency — give themselves far more freedom later. Many hospital systems — including the one where I landed my first post-training job — offer new doctors signing bonuses of several hundred thousand dollars in exchange for a five- to seven-year commitment. If you leave before your “time” is up, you must pay the full amount immediately. And before you even realize it, you are a white coat in golden handcuffs. A 21st century white-collar indentured servant.
Debt doesn’t just cost money — it costs optionality. Paying it off as soon as possible buys flexibility, autonomy, and most importantly, peace of mind. Discussing debt and money pitfalls transparently with other clinicians so they avoid similar traps isn’t tacky. It’s necessary.
2) It won’t be patient suffering or death that burns you out — it will be the system.
I went into medicine expecting the emotional weight of illness and human loss to be the hardest part. As it turns out, this is what medical school best prepares us for. And while those moments are heavy, they are also expected and meaningful. While any patient death is tragic, it also reinforces our purpose and the sacredness of what we do.
No, death did not deter me. What really wore me down over time was the American medical system itself: administrative burden, misaligned incentives, time pressure, extensive documentation requirements, prior authorizations galore, and the constant moral distress of knowing exactly what a patient needs, yet being unable to provide it because of endless insurance barriers.
Medical school prepares us to recognize and treat complex illnesses. Like you, I came out as a diagnosing and prescribing ninja. But it did not prepare me for what to do when our existing treatments become financially unattainable to those who need them most. Though I answered endless test questions on best treatment option(s) for serotonin syndrome and advanced lithium toxicity, neither of which I have ever encountered in real-life psychiatry, I never saw a single question on how to address insurance denials for “non-covered services” — a challenge I encounter daily. I’d prefer to treat lithium toxicity any day over “non-covered services” toxicity.
Lithium toxicity has a straightforward solution. “Non-covered services” and “not medically necessary” denials do not. Naming this struggle matters. Most type-A clinicians internalize burnout as a personal failure. But it’s just a human response to a dysfunctional structure.
3) If you are a woman, you do not need to wait until “after” training to start a family.
I waited until after medical school, residency, fellowship, and a few initial years of climbing the professional attending ladder before starting a family. It was the “responsible” thing to do. I deferred childbearing to my late 30s. Despite this, when I was 10 weeks pregnant with our first child at the “advanced maternal age” of 37, my boss warned my husband, “She just became assistant chief. She has a lot to do. Don’t get her pregnant!”
Despite the palpable professional pressure to postpone having a family, I watched several other female colleagues have children earlier in medical school and residency — and, from a financial standpoint, it makes sense. Taking parental leave when your income is lower, rather than stepping away from a higher-paying, higher-responsibility attending salary, is fiscally wise.
There is never a perfect time to have kids. Training is demanding, but so is life as an attending. I wish someone had said more explicitly that there is no moral or professional requirement to delay life milestones for medicine until it feels convenient. I was lucky enough to avoid infertility struggles, but I have met many female physicians who encountered this biological battle because they delayed having children for medicine. For many women, what starts as a temporary delay becomes a permanent trade. The body is an unforgiving timekeeper. And nothing in healthcare is worth sacrificing your personal life dreams.
4) You are far more prepared than you think you are.
I remember how nervous I was finishing fellowship as an addiction psychiatrist. In retrospect, the knowledge was there. The real adjustment wasn’t clinical incompetence — it was the sudden absence of constant reassurance. Residency and fellowship provide a built-in safety net of attendings who constantly validate decisions, refine plans, and share clinical decision-making and responsibility. Practicing independently requires trusting your training and replacing that familiar support structure with something new: trusted colleagues, consultation networks, and evidence-based resources. That transition can feel unsettling, but it is also empowering. You don’t stop learning — but you are not starting from zero.
5) Despite all the sacrifices, despite the arduous road to a long white coat, it’s all worth it.
This is something I wish I had understood not just intellectually, but emotionally. The very best moments in medicine are better than I ever imagined. The bad days are truly bad. But the meaningful moments — the ones that stay with you — are extraordinary. In addiction psychiatry, I walk alongside patients in recovery as they rebuild their lives from ground zero: returning to work, reuniting with family, regaining custody of children, avoiding death by overdose, having money for presents under the Christmas tree for the first time, and rediscovering health and purpose. Watching someone reclaim a life they once believed was irreparably broken is what it’s all about. Those moments don’t erase the hard parts — but they remind us of why this work matters. All the sacrifices that medicine demands of us — it makes them all worth it.
If I could go back and tell my younger self anything, it would be this: be thoughtful with your finances, be honest about the system, don’t postpone your life unnecessarily, trust your training — and hold space for the moments of human connection that make this profession unlike any other. If I had it to do over, would I choose medicine again? Absolutely. I would just do it differently.
What things do you wish you'd done differently throughout your medical career? Share below.
Dr. Lauren Grawert is an addiction psychiatrist in Arlington, Virginia. She enjoys walking, traveling, and spending time with her two young children. Dr. Grawert is a 2025–2026 Doximity Op-Med Fellow.
Image by Moor Studio / Getty Images
