Is training into your 40s worth it?

[ChordaEpiphany]

I'm nearly done MS3 and surgery was my favorite clerkship by far. I spent the rest of this year off-and-on resenting my choice to attend medical school and considering non-clinical careers. I've performed well on all my rotations, but everything about clinical medicine just rubbed me the wrong way. I felt exhausted and demoralized nearly every day. Then I started on surgery. The OR just feels right, even in a case at midnight knowing I have to be back at the hospital at 5 am the next day. People in my life told me I was just a better person to be around while on surgery. I seem to mesh well with the specialty and have gotten multiple spontaneous offers from faculty to write letters despite claiming to be going into IM at the start of the rotation.

However, making this choice seems outright insane. I will be 34 upon graduating med school. I'm research/academia-focused, have an extensive publication history, and want an element of basic science in my career (likely co-PI on grants, but probably not my own lab), so that means 1-2 research years just to keep my biosketch from going completely stale. I've reached out to a few mentors/faculty, and the only advice I get is just harsh/stern, "If you need to ask for my input, then it's not for you." Are people really so sure of their choice that a single rotation at a single institution is all they need? I find the idea of being in "love" with a specialty naive. In a relationship, a few months of fiery romance does not predict a long and healthy marriage. At the end of the day, the "thrill" of operating is going to fade. What's left is the love of building a skill I'll never perfect, the day-to-day and case-to-case variability, and actual patient ownership compared to many other procedural specialties. I don't mind stress and long hours, but my partner certainly might, and time away from eventual children is an obvious downside.

I'm really just trying to see if I need a sanity check. I'm considering going down a 7-9 year all-encompassing training pathway starting in my mid-30s when I have the option of

1) Exiting to consulting/finance immediately after medical school
2) Exiting to pharma after a short residency or after much gentler specialty training (e.g., IM --> allergy/immuno or rheum)
3) Becoming an IM subspecialist with considerably less time/more forgiving hours
4) Pivoting to some other much easier specialty

None of those options seem appealing to me compared to being a surgeon, but I also met a lot of doe-eyed 20-somethings who "needed" to be a doctor in college who are now miserable today and just want their nights and weekends back. How many of you would still have chosen surgery if you started residency at 34?

---

Members don't see this ad.

 

[eteshoe]

Hey there as another MD/PhD who's going to be graduating around your age (~35) as well I definitely get the turmoil going on in your mind. The only thing being that I came out of surgery with the opposite thoughts lol (I got honors but what a miserable 6 wks that was). I'll be doing the more traditional IM sub specialist route -> co-PI w/ some pharma consulting + whatever the future holds.

I'll say this - we're already lunatics as it is doing our dual degrees so the last thing I'd suggest is picking a clinical specialty that you'd be miserable in. From your post hx I'd imagine you'd be competitive across various industries so I'd suggest pick surgery, do whatever floats your boat and if in 10-15 yrs you want to wind down your clinical time because being a surgeon-scientist is too much - you'd have plenty of things you can do at that point. The longer I've been on this path I've seen MD/PhD carve out so many variations for their careers that I didn't think were possible 9 yrs ago.

Now from a logistical standpoint, you may need to tailor your research interests if surgery is what you do since OR time will basically take over for a few years. Pick a strong academic program - take those 2 built in research years to craft/tailor your academic research niche. You want something that'll keep the pilot light burning (even if at a low level) since life will keep moving and you're choosing one of the tougher paths. Now as far as the SO and idea of family planning - from every mentor I've talked to there's no perfect time. Choosing something like a surgical career will come with restrictions and sacrifices. Best to plans and reasonable contingencies for the worst cases and hope for the best. That may limit where you train geographically if you need familial support and a location where your partner can work, etc, etc. But you got about 6 months to gameplay if that's what y'all will do (assuming you're applying this coming cycle and not having to delay) - and you'll def need buy in from them for this pivot you're considering.

I'm not interested in surgery but my training will probably take 6-7 yrs post grad. Not ideal for starting in my mid-30s but I had a prior career, I enjoy the grind, and when it's all said and done I know I'm flexible enough to carve out a path that will bring me some "peace" even if that means more pivots down the line. Would it have been cool to start this journey at 20/21 when I finished college? Sure but life has a way of throwing you curveballs so you might as well learn to live with it. I also believe in interweaving some rewards on the journey. I travel, visit friends/family, eat, and enjoy life wherever I can fit it since delayed gratification can only go so far.

 

[operaman]

I started residency at 35 and did a fellowship so 6 years total for me. Would 110% do it again given the choice. My life is pretty awesome, love my job. Im not as OR heavy as some about 1.5-2 days OR per week. I just really enjoy the work, the variety (nice after a tough clinic day to know tomorrow I’m in the OR all day and have no clinic headaches).

You probably do need to do some more soul searching. You mention this surgeon/scientist career path, but then your number 1 alternative option is leaving med entirely for finance or consulting. I’m not sure how you would be co-PI on basic science projects while working for Bain or McKinsey.

If leaving all of medicine behind is an attractive option for you, maybe consider a more clinical track and a 5 year residency plus whatever fellowship you like? The research part limits your ultimate career options to major academic centers.

If you must have both the clinical and research to be happy, I’m curious if you know any surgeons with a career that mirrors what you want? I ask because it could be hard to find a position where you get enough protected time for research while not having your own lab and securing your own funding to cover your salary for those protected days. Seems like it would be hard to do that piggybacking off other investigators’ labs. Maybe this is more common than I realize. But worth exploring just in case what you’re picturing isn’t really possible

Overall I think it’s probably worth going for the career you enjoy the most since that ends up being so much of your time. Surgery really is a lot of fun. I’d definitely rather do what I’m doing than any other field of medicine.

 

[cpants]

A medical subspecialty is going to be 3 + 2 years, so really not that different in terms of length of training. Lifestyle and career longevity may be worse with general surgery. Might consider a surgical specialty like ENT, urology, or OB/GYN which could have advantages in terms of lifestyle and longevity. If your real goal is to go work in a lab or consult and not practice medicine, I would do a short residency just so you can get licensed and forget about surgical options.

 

[ChordaEpiphany]

You probably do need to do some more soul searching. You mention this surgeon/scientist career path, but then your number 1 alternative option is leaving med entirely for finance or consulting. I’m not sure how you would be co-PI on basic science projects while working for Bain or McKinsey.

Oh I'm not saying I'd continue being a scientist if I took that route or that it's my #1 path (far from it). I listed alternatives from least to most clinical work. I'm more just going through the thought process of, "how can I justify all this sacrifice when I have the option to train less, work less, and make more money?" I was always going to agonize over this decision. It feels selfish, impractical, privileged, and maybe even egotistical to pursue this pathway. Most people do whatever job will help them pay the bills. I have other options that will be easier on both me and my partner.

However, since posting this, I've done some soul searching and some non-surgical clinical work. I've realized I simply love the OR. Procedures won't scratch that itch. The OR is special and at times an outright magical place, and placing a hose up someone's butt isn't even in the same universe. The culture is infinitely better. I've struggled with the culture of medicine (vs. science or even business), and being around surgeons is the first time since coming to medical school that I've felt like the logic, flow, and thought process actually makes sense. When I think about who's told me to avoid surgery and who's told me to pursue it, those who've encouraged me have been people I want to emulate. My physician-scientist mentors run away from clinical responsibility and are bored by clinical medicine. My surgeon-scientist mentors still tell me the OR is the best place in the world.

If you must have both the clinical and research to be happy, I’m curious if you know any surgeons with a career that mirrors what you want? I ask because it could be hard to find a position where you get enough protected time for research while not having your own lab and securing your own funding to cover your salary for those protected days. Seems like it would be hard to do that piggybacking off other investigators’ labs. Maybe this is more common than I realize. But worth exploring just in case what you’re picturing isn’t really possible

I'm fortunate enough to have a few close mentors who are surgeon-scientists. The 80-20 track does not exist, but I've seen how it works in practice and I'd be perfectly happy with that. The surgeon scientist is 30-50% research with a heavy network of support (which they must be proactive to build during training and early career). They typically have a close PhD collaborator who is co-PI on most grants. They throw their position and reputation around to get funding, and in return PhDs lend their time and energy to making the collaboration work. When a surgeon scientist could actually understand the science, the PhDs bent over backwards to keep the relationship. Having a qualified surgeon-scientist on your grant goes a long way in an NIH study section.

Maybe more importantly, most people fail to become physician or surgeon scientists. Even for grads of top programs, funding is limited, and the path is long. If I failed and became a perennial middle author contributor doing 90% surgery, I'd still be happy. If I were doing 90% clinical medicine, I'm not sure I'd even stay in clinical medicine.

I started residency at 35 and did a fellowship so 6 years total for me. Would 110% do it again given the choice. My life is pretty awesome, love my job. Im not as OR heavy as some about 1.5-2 days OR per week. I just really enjoy the work, the variety (nice after a tough clinic day to know tomorrow I’m in the OR all day and have no clinic headaches).

I've seen a lot of your posts and never knew this. It's fantastic to hear it from someone who went through the process later in life. I've made an effort to talk to some older trainees and some faculty that started residency later. Not a single one has regretted it or told me to reconsider.

Right now all signs are pointing to surgery.

 

[LucidSplash]

Welcome to the dark side.

 

[HighwayVagabond]

I started gen surg residency at 33 and did a 2 year fellowship to follow. I had zero publications starting residency and did not do formal ‘academic time’, but did as much scholarly work as I could throughout my clinical training (mostly clinical outcomes research, no basic science). I am in my second year on faculty and applying for a K. I don’t think you ‘have’ to do dedicated academic time during residency to end up on the funded surgeon-scientist path. One of my co-residents also did not take academic time and has K and R funding. In fact we were commenting the other day that most of our co-residents took academic time and then did zero research after training, whereas she and I were the opposite, probably because we learned to balance the rigors of clinical practice with scholarly productivity during training and were able to transition that into practice. Anyway, my point in saying this is you have a background that makes it such that you could go straight through if you wanted, and at least save a couple years, and you could still achieve your ultimate goal. (We did train somewhere that had top notch research resources which was certainly helpful).

On another note, my senior co-fellow was same age as me when he graduated (41) and my current first year fellow is 42. It’s not as uncommon as you might think.

 

[operaman]

Oh I'm not saying I'd continue being a scientist if I took that route or that it's my #1 path (far from it). I listed alternatives from least to most clinical work. I'm more just going through the thought process of, "how can I justify all this sacrifice when I have the option to train less, work less, and make more money?" I was always going to agonize over this decision. It feels selfish, impractical, privileged, and maybe even egotistical to pursue this pathway. Most people do whatever job will help them pay the bills. I have other options that will be easier on both me and my partner.

However, since posting this, I've done some soul searching and some non-surgical clinical work. I've realized I simply love the OR. Procedures won't scratch that itch. The OR is special and at times an outright magical place, and placing a hose up someone's butt isn't even in the same universe. The culture is infinitely better. I've struggled with the culture of medicine (vs. science or even business), and being around surgeons is the first time since coming to medical school that I've felt like the logic, flow, and thought process actually makes sense. When I think about who's told me to avoid surgery and who's told me to pursue it, those who've encouraged me have been people I want to emulate. My physician-scientist mentors run away from clinical responsibility and are bored by clinical medicine. My surgeon-scientist mentors still tell me the OR is the best place in the world.

I'm fortunate enough to have a few close mentors who are surgeon-scientists. The 80-20 track does not exist, but I've seen how it works in practice and I'd be perfectly happy with that. The surgeon scientist is 30-50% research with a heavy network of support (which they must be proactive to build during training and early career). They typically have a close PhD collaborator who is co-PI on most grants. They throw their position and reputation around to get funding, and in return PhDs lend their time and energy to making the collaboration work. When a surgeon scientist could actually understand the science, the PhDs bent over backwards to keep the relationship. Having a qualified surgeon-scientist on your grant goes a long way in an NIH study section.

Maybe more importantly, most people fail to become physician or surgeon scientists. Even for grads of top programs, funding is limited, and the path is long. If I failed and became a perennial middle author contributor doing 90% surgery, I'd still be happy. If I were doing 90% clinical medicine, I'm not sure I'd even stay in clinical medicine.

I've seen a lot of your posts and never knew this. It's fantastic to hear it from someone who went through the process later in life. I've made an effort to talk to some older trainees and some faculty that started residency later. Not a single one has regretted it or told me to reconsider.

Right now all signs are pointing to surgery.

Yeah sounds like we’re going to be seeing you around the ORs! Welcome to the crazy!

Truth is the path isn’t as long as it seems. If I’m honest, my day to day hasn’t changed a whole lot from MS3 to now. I have a lot more autonomy and control of my schedule now, but I get up every morning and round on any inpatients, then go to clinic or OR, see patients, document, see consults, then go home. Add other assorted mandatory and optional meetings and other activities. There’s a lag before getting paid really well, but not so much lag in getting to do what you want to do. If you love the OR, you’ll spend a ton of time there as a resident and then before you know it you’re the attending.

Sounds like the research thing may be way more feasible than I realized! The other nice thing is that you’re so valuable as a surgeon you can always transition easily to a heavier clinical load if you tire of the research side of things. But having 1-2 days a week of protected time might give a nice balance. The rest depends on the cases you do - I usually need 2.5-3 days of clinic to fill an OR day; people who do longer cases like my H&N cancer partners do 3-4 OR days per 1 clinic day. So you’d have some mix of 2 days research, then at least 1 clinic day and 1-2d OR.

Not a bad setup! OR definitely is fun. I’m typing this from an OR right now actually - definitely makes for great days. I’m still amazed they allow me to come in and do this stuff.

 

[vm26]

I'm nearly done MS3 and surgery was my favorite clerkship by far. I spent the rest of this year off-and-on resenting my choice to attend medical school and considering non-clinical careers. I've performed well on all my rotations, but everything about clinical medicine just rubbed me the wrong way. I felt exhausted and demoralized nearly every day. Then I started on surgery. The OR just feels right, even in a case at midnight knowing I have to be back at the hospital at 5 am the next day. People in my life told me I was just a better person to be around while on surgery. I seem to mesh well with the specialty and have gotten multiple spontaneous offers from faculty to write letters despite claiming to be going into IM at the start of the rotation.

However, making this choice seems outright insane. I will be 34 upon graduating med school. I'm research/academia-focused, have an extensive publication history, and want an element of basic science in my career (likely co-PI on grants, but probably not my own lab), so that means 1-2 research years just to keep my biosketch from going completely stale. I've reached out to a few mentors/faculty, and the only advice I get is just harsh/stern, "If you need to ask for my input, then it's not for you." Are people really so sure of their choice that a single rotation at a single institution is all they need? I find the idea of being in "love" with a specialty naive. In a relationship, a few months of fiery romance does not predict a long and healthy marriage. At the end of the day, the "thrill" of operating is going to fade. What's left is the love of building a skill I'll never perfect, the day-to-day and case-to-case variability, and actual patient ownership compared to many other procedural specialties. I don't mind stress and long hours, but my partner certainly might, and time away from eventual children is an obvious downside.

I'm really just trying to see if I need a sanity check. I'm considering going down a 7-9 year all-encompassing training pathway starting in my mid-30s when I have the option of

1) Exiting to consulting/finance immediately after medical school
2) Exiting to pharma after a short residency or after much gentler specialty training (e.g., IM --> allergy/immuno or rheum)
3) Becoming an IM subspecialist with considerably less time/more forgiving hours
4) Pivoting to some other much easier specialty

None of those options seem appealing to me compared to being a surgeon, but I also met a lot of doe-eyed 20-somethings who "needed" to be a doctor in college who are now miserable today and just want their nights and weekends back. How many of you would still have chosen surgery if you started residency at 34?

I completed rad residency at 39. Completed fellowship at 40, ended up doing a 2nd fellowship (due to bad job market) which I completed at age 42...Was interested in ortho when I started med school (former PT) but decided on rads in part due to the fact that I can work into my late 60's/early 70's if needed-my current group has a 74 y/o who's 50%. Unsure how common this is for surgeons but longevity should be considered.