Why This Med Student Is Sticking With Primary Care

For as long as I can remember, I've had a vague wish to be a doctor. In college, at Johns Hopkins, I was pre-med. But I graduated in the roaring '80s. I went to New York, joined an investment bank, worked hard--and made good money.

Then I began volunteering at an AIDS ward at New York Hospital. I would leave on those nights frustrated and angry that a decade after the virus was discovered it was still killing people. My dreams of becoming a doctor returned. And in 1991, I entered medical school at Emory University in Atlanta with what, in 20/20 hindsight, was a great deal of naivete.

I had this romantic image of hanging out a shingle and fighting disease. Primary care was my first choice--either family practice or obstetrics and gynecology. I wanted to establish relationships with patients. To me, that's where the challenge of medicine lies.

I haven't changed my mind about that, but there are obstacles I didn't foresee. First, primary care isn't the best choice financially: I'll be $80,000 in debt at graduation. Though no doctor truly suffers for money, that's a heavy burden to bear for the lowest-paid physician. Those among my colleagues who choose cardiology can expect $400,000 salaries in a few years.

There are also times when I feel a little self-conscious about my choice. The word among students is that if you've got any brains, "tertiary" medicine--which involves complex diagnostic procedures and comprehensive care--is where it's at. Instructors often refer to the best students as "future surgeons" and belittle the family-practice specialty. These attitudes trickle down. I've heard my peers say the reason so many women choose pediatrics is that "they want to be mommies." And students who take a family practice residency may be maligned by colleagues who say the choice is a sign of subpar academic credentials.

I'll probably struggle with the issues of prestige and income for a while. But I also know that doing what is personally satisfying is a good part of what makes life meaningful. To me, the meaning is in primary care.