I would argue focus on the thing that interests you the most. Obviously lifestyle is a huge consideration as well regardless of your personal life, but there’s something to be said for actually enjoying your work too. For me, I love my work and found a great work life balance. As such, I have zero desire ever to retire. I’ll scale back in 20-25 years, but I truly enjoy and look forward to my work days. I also think I’m a happier person because I’m fulfilled in my professional life and I think that makes me a more pleasant person in other aspects of life.
Ok so now for the pearls about lifestyle and especially in surgery that nobody tells students by I shout from the rooftops whenever I can. Tuck some of this away for later, but I put it here just to give you some idea of how things shake out down the road:
1) your skills will determine your lifestyle. Applies in all fields, but especially in surgery. If you can do a case in 4 hours that takes another surgeon 8 hours, who has the better lifestyle? In my field, some faculty at my med school would have big cases that went til 8-10pm; those same cases in my residency would end around 2pm or earlier. Focus on developing your skills and your efficiency. The surgeon with lots of complications and take backs is coming in overnight and adding on cases all the time, canceling plans. The one who gets one emergent take back every 4-5 years has a very different life. Some docs see 25 patients a day and are writing notes until 6-8pm. Others see 40 and walk out at 4pm with all their notes done. If lifestyle is important to you, then getting the best training and becoming efficient should be high on your priority list. At times that may mean sacrificing a bigger “name” place in favor of training under better surgeons who are much faster. These are great questions to ask when it comes time to interview - case volumes, speed, efficiency - you can learn a lot.
2) lifestyle often hinges on other factors you can control IF (big if) you’re willing to make sacrifices. In the end, as a clinician you’re basically trading your time for money at a very favorable rate. I work 4 days a week, and adding another full day I could boost my comp 25%, but I’d rather a 3 day weekend every weekend. Medicine will take every second you’re willing to give it. Many docs grind it like mad when they’re young and single, then dial it back as they start families and have other obligations.
3) attending level lifestyle improvement often means changing jobs and/or locations, so make sure your life outside medicine is flexible. If you’re a young single neurosurgeon and grinding like some of ours, you can take in $2-4m+ per year. Those dudes take a ton of call and seemingly live in the hospital. But if you buy expensive cars and expensive homes and expensive toys, you’ll have a hard time switching and rebuilding later. If you live well but modestly and save aggressively, you’ll have all the freedom in the world. Once the family stuff starts happening, make lifestyle adjustments early since moving around gets tougher when kids and schools and whatnot enter the chat. You’ll have some lag time. If you live well within your means you can do whatever you want.
4) lifestyle is surgical fields also hinges on things partly under your control. For me as an ent, I make way more money in clinic than the OR, so that gives me lots of control. For surgeons who are primarily OR dependent, their lifestyle depends way more on OR availability and efficiency. Negotiating things like lots of reserved block time go a long way toward making things more predictable, or else you’re stuck adding things at odd hours and staying late or coming in on weekends to get cases done. The more in demand you are, the more leverage you have to get these things, hence why it’s almost impossible to renegotiate in your same job and often requires changing jobs or locations to somewhere you can get it.
5) beware the academic trap. There’s nobody more miserable than a mediocre academic. Lots of obligations and uncompensated time in academia. If you’ve got the academic interest and chops to be one of the fully funded surgeon scientists running a successful lab and operating, then go for it. But if you’re more of a clinician type and average academic, get out of academia after training. You’ll make more money and work fewer hours and probably be much happier. You may sacrifice resident coverage, but between Hospitalists admitting everything and mid levels that can round and assist in the OR, you can recreate most of the clinical benefits of academia without sacrificing your weekends to grant and manuscript writing.
In the end, even surgical fields offer a range of options in terms of lifestyle if you’ve made the choices that preserve your flexibility and allowed you to develop skill and efficiency. You can’t turn a neurosurgical practice into the lifestyle of a dermatology practice, but within your field you have a lot of flexibility to craft the life you want and to adjust your work life as your personal life evolves.
