Would you do it over again?

[UnicornDemon]

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If given the option to go back all the way to undergrad, would you choose again to pursue medical school? And, if so, would you re-select psychiatry as your specialty?

If no, what would you have done instead?

 

[OldPsychDoc]

Yes--and I would've done it sooner, instead of exsanguinating myself in a PhD program for 5 years*...

*though yes, in its defense, it did prevent me from having 6-figure debt, and it does put me in the top 1-5% of psychiatrists as far as actual understanding of neuroscience goes...but still not sure that outweighed the pain.

 

[Bartelby]

I'm a PGY-II so it's still hard for me to see what a working career will be like, but I think yes. I do fantasize sometimes about what life would have been like if I had gone the PhD tenure track route instead (much more day to day autonomy, better hours, working on a college campus instead of a hospital, but the stress of 'publish or perish' and winning grants). If I went into medicine again there is no doubt in my mind I would still choose psychiatry.

 

[DOC PENGUIN]

Yes--and I would've done it sooner, instead of exsanguinating myself in a PhD program for 5 years*...

*though yes, in its defense, it did prevent me from having 6-figure debt, and it does put me in the top 1-5% of psychiatrists as far as actual understanding of neuroscience goes...but still not sure that outweighed the pain.

i didn't know you were a MD/PhD. Do you still publish?

 

[F0nzie]

Definitely. Med school was rough but residency was an incredible experience. Work and life has been great so far.

 

[st2205]

I've always found this an odd question because I think it has a couple different ways that it can be asked. If I were to go back in time, having not had the experience (I'm an intern, by the way) and I was starting fresh then I'd absolutely do it again. If I had to go back, having already been through it in the hypothetical, then no, I would not do it twice. Though I feel like I made it through medical school with relatively less stress than imagined (and likely residency too), I would give strong consideration to a psych NP. Now I think from a professional perspective as well as confidence this would be significantly less than ideal, but looking ahead to finishing four years from now and comparing that to havin already been done 2-3 years ago, already making good money, and much less debt, it's hard not to see that as a significant plus personally and for my family. In the long run, however, we will see.

 

[animas]

If given the option to go back all the way to undergrad, would you choose again to pursue medical school? And, if so, would you re-select psychiatry as your specialty?

If no, what would you have done instead?

absolutely, emphatically, without a doubt, YES.

 

[hamstergang]

Yes.

 

[OldPsychDoc]

i didn't know you were a MD/PhD. Do you still publish?

Haven't since residency. Not doing any basic science anymore, but have a couple of things underway in the clinical education vein. Trying to beef up the "scholarly activity" piece of our program.

 

[notdeadyet]

Yes to med school. Yes to psychiatry.

The only change would be to start sooner. I'm not sure about this, though. By the time I will likely retire, I'll STILL have spent more of my adult life as a non-psychiatrist than as a psychiatrist. I'm finding that this sort of experience and persepective has helped me more with patients than I'd expected.

That said, I'd happily give back the year of waiting tables at Denny's...

 

[peppy]

Sometimes I do think that it would have been more efficient to just become a PA. The way that the medical profession is going, I think that becoming a physician is arguably not worth all the debt and hassle nowadays - especially now that med school enrollment has increased and getting a residency will probably no longer be as easy as it used to be. I do think that a well trained psychiatrist can provide better care than a PA, but I'm not sure that society really values that so much any more. I'm not sure that the difference is so great that it's worth the personal costs if something happens to de-rail your med school or residency experience (if you can't get a residency or get fired from residency, your career is basically ruined, and it is kind of ridiculous that that can happen after investing years into a career path when less-trained PAs can go from one job to the next very easily). I think right now we are in a phase where it's more important that a lot of people have "good enough" care than for some people to have the very best care. That environment favors the proliferation of PAs and the de-emphasis on physicians.

However, being a doc really hasn't been a bad experience. Most of med school was interesting and I had the chance to see things that most people will never see. Psychiatry residency has had its ups and downs, but overall not really that bad. The work itself is often interesting and personally rewarding.
Both med school and residency required personal sacrifices, but I am optimistic about my future on a personal level even though I am cynical about the overall outlook for physicians.

 

[Trismegistus4]

Definitely not. I had a reputation on SDN a few years ago, while still in medical school, for droning on and on about how I went into medicine for the wrong reasons and how much I hated my life, so I won't rehash it all. Suffice it to say that I was never really interested in medicine for its own sake; I went into it basically to try to impress women. It didn't work, but by the time I came to terms with that fact, it was too late to back out. The fact that I was never really interested in medicine for its own sake was a big part of the reason I wound up in psychiatry. The only true dream I've ever had was to become a writer, so if I had to do it over, I'd try my hardest to make it as a writer.

 

[strangeglove]

Definitely not. I had a reputation on SDN a few years ago, while still in medical school, for droning on and on about how I went into medicine for the wrong reasons and how much I hated my life, so I won't rehash it all. Suffice it to say that I was never really interested in medicine for its own sake; I went into it basically to try to impress women. It didn't work, but by the time I came to terms with that fact, it was too late to back out. The fact that I was never really interested in medicine for its own sake was a big part of the reason I wound up in psychiatry. The only true dream I've ever had was to become a writer, so if I had to do it over, I'd try my hardest to make it as a writer.

Wow, dude. Please don't take this the wrong way, but have you considered psychoanalysis? If you're happy, then don't bother.

 

[NYCMS2]

Definitely not. I had a reputation on SDN a few years ago, while still in medical school, for droning on and on about how I went into medicine for the wrong reasons and how much I hated my life, so I won't rehash it all. Suffice it to say that I was never really interested in medicine for its own sake; I went into it basically to try to impress women. It didn't work, but by the time I came to terms with that fact, it was too late to back out. The fact that I was never really interested in medicine for its own sake was a big part of the reason I wound up in psychiatry. The only true dream I've ever had was to become a writer, so if I had to do it over, I'd try my hardest to make it as a writer.

Nothing stopping you from becoming a writer now, so instead of the pity party, seize the day, dude.

 

[UnicornDemon]

Definitely not. I had a reputation on SDN a few years ago, while still in medical school, for droning on and on about how I went into medicine for the wrong reasons and how much I hated my life, so I won't rehash it all. Suffice it to say that I was never really interested in medicine for its own sake; I went into it basically to try to impress women. It didn't work, but by the time I came to terms with that fact, it was too late to back out. The fact that I was never really interested in medicine for its own sake was a big part of the reason I wound up in psychiatry. The only true dream I've ever had was to become a writer, so if I had to do it over, I'd try my hardest to make it as a writer.

Well on a positive note, the fact that you "wound up in psychiatry" means you should have a good work-life balance and stable income, allowing you plenty of free time to work on your writing.

By the way, lots of people have dreams of becoming a writer. It's a good hobby to have but only the top 0.1% ever make it. You should consider yourself fortunate that you wound up where you did. You could just as easily have gotten a PhD in English only to end up in a high school teaching position wishing you had done something more practical (such as medicine).

 

[primadonna22274]

To the poster who said he might choose to be a PA instead, I offer the opposite experience. I chose to be a PA because I was afraid of being rejected from med school (analyze that!) The longer I worked as a PA, the more confidence I gained and the less satisfied I was with the dependent role. In my mid-30s my discomfort with remaining a PA for the rest of my career overcame my fear of failure and more debt and I went back to med school at 37.
Very early in my PA career I was interested in psychiatry but there were almost no jobs for PAs in my area--in Oregon PMHNPs owned that market. I went into FM instead and took advantage of PA lateral mobility and moved into the ED. I never did find my niche as a PA until I began teaching PAs--and then I found that I needed to learn what I didn't know and that ultimately pushed me back into med school.
While I enjoy aspects of both primary care and emergency medicine, I never really LOVED anything until I did a month of inpatient geriatric psychiatry. I really doubt this would have grabbed me in my 20s--I needed to grow up quite a bit, hurt a bit, learn a few more life lessons and be stretched to find that I could connect with people. I really am such a better doctor (almost doctor) at 39 than I ever would have been at 26. Maybe this is true for most of us.
One thing I fear about choosing psych is giving up medicine. I love medicine. One of my attendings told me "only BAD psychiatrists forget their medicine"...I appreciated that but really would like to hear from others whether their career as a psychiatrist satisfies them intellectually and professionally.

 

[futuredo32]

Personally, I wish I had gone to PA school instead of med school.

I'm only a pgy3, but I wish I would have done a fp/psych residency instead of psychiatry because I realized quite late that I want to do both, so I'm going to do a fp residency after psych and practice both part time. A combined residency would have saved a lot of time.

 

[primadonna22274]

Personally, I wish I had gone to PA school instead of med school.

I'm only a pgy3, but I wish I would have done a fp/psych residency instead of psychiatry because I realized quite late that I want to do both, so I'm going to do a fp residency after psych and practice both part time. A combined residency would have saved a lot of time.

I appreciate hearing this. I am particularly interested in IM/psych. I have one more week of OB and if I never had to deal with a birthing vagina ever again I would be a very happy woman!

 

[countryboy75]

I am happy where I am. The only thing that I would change would be where I did my Undergad. I chose a costly private school that in the end did nothing to help me get into medical school. I would have chosen a cheaper state school.

I am now a PGY-IV and happy where I am. And I am happy where my future is headed.

The financial aspect of medicine has changed a lot in the past 10 years and will change even more in the next 10 years. Be aware of that when chosing your undergad and graduate training.

Also, I recommend having a hobby of some sort, you will be burnt out very quickly if all you do for 12 years is biology...chemistry....o-chem...medschool...residency

 

[Dharma]

Personally, I wish I had gone to PA school instead of med school.

I'm only a pgy3, but I wish I would have done a fp/psych residency instead of psychiatry because I realized quite late that I want to do both, so I'm going to do a fp residency after psych and practice both part time. A combined residency would have saved a lot of time.

Sorry for the possible derailing here, but I've heard from a number of residents and attendings that for the most part the combined residencies are not worth it being that ultimately one will work in only one of the two fields anyway. Not sure how much truth there is in that, but that's what I've heard so far. How realistic is it to practice in both fields? I can see how the training in one will help with the other and help one grow as physician (maybe?), but is it necessary? Just curious.

 

[michaelrack]

I love medicine. One of my attendings told me "only BAD psychiatrists forget their medicine"...

I have lost most of my medicine and I am board-certified (pending completion of a quality improvement project required for recertifcation) in IM.

 

[michaelrack]

Sorry for the possible derailing here, but I've heard from a number of residents and attendings that for the most part the combined residencies are not worth it being that ultimately one will work in only one of the two fields anyway. Not sure how much truth there is in that, but that's what I've heard so far. How realistic is it to practice in both fields? I can see how the training in one will help with the other and help one grow as physician (maybe?), but is it necessary? Just curious.

IM/psych combo practice is only practical in academics. It is a little more possible to do neuro/psych in private practice (although still not easy)

 

[DOC PENGUIN]

Definitely not. I had a reputation on SDN a few years ago, while still in medical school, for droning on and on about how I went into medicine for the wrong reasons and how much I hated my life, so I won't rehash it all. Suffice it to say that I was never really interested in medicine for its own sake; I went into it basically to try to impress women. It didn't work, but by the time I came to terms with that fact, it was too late to back out. The fact that I was never really interested in medicine for its own sake was a big part of the reason I wound up in psychiatry. The only true dream I've ever had was to become a writer, so if I had to do it over, I'd try my hardest to make it as a writer.

Well, There have been great Physicians who are also remembered for their literature. Oliver Wendell Holmes Sr was known for his excellent poetry (Old Ironsides and Autocrat at the Breakfast table) as well as his witty anatomy lectures at Harvard. William Carlos Williams was excelled in his Pediatrics practice and his poetry. He would have been more famous if not for TS Eliot rocking the world with Prufrock. Anton Chekov contributed to the great Russians and Sir Arthur Conan Doyle created Sherlock Holmes. If you need somebody modern, Samuel Shem wrote a definitive satire on his Internship. And he was a psychiatrist.
Maybe you can make your mark.

 

[sunlioness]

Probably not on both counts. Now whether that's coming from genuine dissatisfaction with the profession vs. burnout, I don't know. I think it would be nice if I could have my loans paid off (because my debt limits my options to do things that pay less) and fix the things that are burning me out (largely the fact that our access is crap and I feel like I'm not helping my patients anyway a lot of the time because they don't have access to a lot of the interventions I'm recommending due to financial issues) and then see if I actually fundamentally like what I do. I would like to think that I do, but at the moment I just really don't know.

What would I do instead? I don't know. That's really kind of the million dollar question. Because if I knew the answer to that, maybe I'd go do it. Sometimes I think it might be satisfying to leave clinical practice and work on a policy level trying to fix all the problems on a systemic level that lead to physician burnout at the clinical level. I don't know who does this though, or what the training involved would be, or if it would provide enough income not to also see patients as well.

Winning the lottery would help, but I don't play and I haven't seen how to get around that. 😉

 

[OldPsychDoc]

Well, There have been great Physicians who are also remembered for their literature. Oliver Wendell Holmes Sr was known for his excellent poetry (Old Ironsides and Autocrat at the Breakfast table) as well as his witty anatomy lectures at Harvard. William Carlos Williams was excelled in his Pediatrics practice and his poetry. He would have been more famous if not for TS Eliot rocking the world with Prufrock. Anton Chekov contributed to the great Russians and Sir Arthur Conan Doyle created Sherlock Holmes. If you need somebody modern, Samuel Shem wrote a definitive satire on his Internship. And he was a psychiatrist.
Maybe you can make your mark.

Correction: Conan Doyle created Watson, who created Holmes. 😀

 

[vistaril]

Haven't since residency. Not doing any basic science anymore, but have a couple of things underway in the clinical education vein. Trying to beef up the "scholarly activity" piece of our program.

one thing to consider, though, is that people pick certain programs for certain reasons. A lot of residents don't have much interest in research and would frown upon what they consider just more requirements that are a hassle. I understand that there are acgme requirements for some things and such, but the reality is that anytime one requirement is added(or strengthened or whatever you want to call it), there are only two possible outcomes:

1) other requirements/activities/teaching/mandatory project is done away with, and then it becomes a question of is the new activity/requirement more worthwhile than the old?
2) nothing is done away with, and then the final result is *more* requirements. And does anyone really believe, with all the requirements many programs have already(many due to acgme requirements), that this is a good thing?

 

[Rena]

I'm disappointed with psychiatry and I don't feel that I'm the real doctor. I almost hate therapy. Sadly enough, I'm too old to go to IM and do another 3 years of fellowship (6years - just impossible).

 

[nancysinatra]

Nothing stopping you from becoming a writer now, so instead of the pity party, seize the day, dude.

There is a whole heck of a lot stopping him from becoming a writer. It's called the publishing industry, which doesn't just publish anything. It's called talent in most cases. It's called low pay.

 

[nancysinatra]

Wow, dude. Please don't take this the wrong way, but have you considered psychoanalysis? If you're happy, then don't bother.

I think he's just admitting and realizing things a lot of people are afraid to say. Half if not 95% of my med school class was probably there to impress their parents. And they lacked the self-awareness to realize this. Doctors are among some of the least self aware creatures in the universe. Only in a medical school can you claim to be going into interventional radiology because you "are really inspired by science" and "really want to help people," and watch as people lap it up. Everywhere else this is known as being a phony.

 

[PistolPete]

I thought about this for a few days, and you know, OP, I'm not sure.

I'm only about 50% sure I'd do medical school again. But then again, I'm not sure what else I'd do. Thought about finance but the job security just isn't there, plus all the traveling that would be required, plus I wouldn't really want to live in NYC. Law? Lawyer are a dime a dozen, if you're not from a top 10 school you can say bye-bye to a nice 200k salary. Engineering? Was never good enough in calculus and physics.

I'm only about 50% sure I'd do psychiatry again. Some days I don't feel like I make much of a difference. Maybe if I find a fellowship I really am good at and like, I'll feel better about my decision. But I can't say I get up in the morning overjoyed.

That's the honest truth.

 

[NYCMS2]

There is a whole heck of a lot stopping him from becoming a writer. It's called the publishing industry, which doesn't just publish anything. It's called talent in most cases. It's called low pay.

I didn't say I thought it was a smart move, or a good idea, and certainly did not imply it is a path paved with riches, just that there is nothing stopping him from doing it now. Furthermore, plenty of doctors have the writing bug and fulfill that need with articles, books, or blogs.

The world doesn't owe him (or me, or you, or anyone else) a high paying profession with high job satisfaction.

 

[strangeglove]

I think he's just admitting and realizing things a lot of people are afraid to say. Half if not 95% of my med school class was probably there to impress their parents. And they lacked the self-awareness to realize this. Doctors are among some of the least self aware creatures in the universe. Only in a medical school can you claim to be going into interventional radiology because you "are really inspired by science" and "really want to help people," and watch as people lap it up. Everywhere else this is known as being a phony.

Right. Self-awareness, honesty and psychological-mindlessness are all great characteristics of a good analysand. Probably a lot of doctors could benefit from analysis, just like a lot of lawyers and financiers. You don't have to be "sick" to get something out of this. Quite the contrary. You just have to have unconscious conflict, which a lot of successful professionals have in spades, along with money to spend.

I will say that one thing that helped me to know whether medicine and psychiatry were right for me was taking a couple of years off and working between undergrad and med school. By the time I hit med school, I was looking forward to being back in school, instead of dreading yet another 4 years of the same old thing. It also helped to have some time to enjoy life, relationships, and freedom. I also had a chance to contemplate other career paths. I would do it again, although I'm sure glad my training is over.

 

[notdeadyet]

I will say that one thing that helped me to know whether medicine and psychiatry were right for me was taking a couple of years off and working between undergrad and med school. By the time I hit med school, I was looking forward to being back in school, instead of dreading yet another 4 years of the same old thing. It also helped to have some time to enjoy life, relationships, and freedom. I also had a chance to contemplate other career paths.

Ditto this. Your average 24 year old doesn't have a good grip if who they are or where they want to end up in life. Heading immediately into medical school after undergrad saddles them with so much debt that some find themselves unable to make the decision to leave and then continue on in a field they aren't passionate about and deliver poor care while romanticizing other fields they never really had the chance to explore.

The circadian rhythms don't bounce back like they did in younger years, but other than that, taking a few years out between undergrad and the decision to go to medical school is a good thing.

 

[sunlioness]

I had a few years in between and I'm still not sure I'd do it again. I worked as kind of a junior archivist in a library and a historical society. The jobs themselves were rather mindless, but I liked what my bosses did. Remember having doubts at the time and thinking maybe I should get an MLS instead of an MD. Talked to my boss about it and she told me I was crazy. So I became a psychiatrist. I guess I still can't say I made the wrong call. I know so many unemployed librarians. And I have a meeting with my boss tomorrow to talk about my burnout issues. I've already backed off from doing 4 new evals daily to doing 2 and that's made a tremendous difference. Not just in terms of doing fewer of them, but I'm using the time that opened up to getting some of my follow ups back in. I should have addressed it a long time ago, so I think I'm still going to be feeling tired and cranky for a little while. But having some hope back is good. And some humility. I can't single handedly solve the problem of too few psychiatrists . . . well, unless I leave and solve it systemically, which I still think might not be a bad gig. But for now, cutting myself some more slack and asking for what I need will have to do.

 

[Lokhtar]

I'm only a third year, but ABSOLUTELY so far. I love it. I think partly because I worked in another industry for the better part of a decade, and only then decided to do a post back and medicine. So I've been out in the world and know what I really want. My first career (nothing to do with medicine) taught me a lot about what I want. If I had gone straight through, I think it's very possible that I'd be having doubts - I'm always surprised when I see people in early/mid twenties around...there is no way I would have been happy in medicine back then. I just would have been too unsure and would have been dreaming of greener pastures elsewhere.

 

[MacDonaldTriad]

The only thing I would hate more than the shortage of psychiatrists would be having too many of them. Whenever I feel a little burned out and over worked, I try and reflect on the job market for our services. We should all hope things don’t change too much. We could stand to have some increase in supply, but since we can’t have it both ways, let’s not hope for too many more.

Oh, and yes, in a heart beat.

 

[hamstergang]

she told me I was crazy. So I became a psychiatrist.

That's how it typically goes, I guess...

 

[gibits]

I went to med school to become a psychiatrist. I know I wanted to be one since I was in middle school. If had one regret it would be taking off for 3 after undergrad to dick around.

 

[PhinyGage]

Second year resident at a workhorse program.....

To be honest, residency sucks. I see way more patients than I could ever process and get to experience all of the mishaps that are apart of this country's/state's poorly designed mental health care system. But I could always be doing something else like internal medicine (oh god), or even worse, some other field with poor job security in an uncertain economy

Now....looking down the road at my (many) Attending's lives... Most of their schedules are freaking awesome! And the employment opportunities available for psychiatry grads are second to very few other specialties.

I love Psychiatry for all of the right reasons. I will be making a very decent living by actually helping patients and their families deal with something our society has put on the back burner for far too long.

In general, many folks in other fields (both medical and non-medical) are very unhappy about their choices, and money does not always seem to be a protective factor. Even as a resident making 50K and working in what is clearly a botched system, I am not one of them.

 

[Sophie]

Definitely! I enjoyed med school and am really liking residency so far. I took 4 years off between undergrad and med school because I didn't know what I wanted to do, then did all of the premed courses in a one year postbac. If I had to do it over I would skip those 4 years, just take the classes spread out in undergrad, and not have agonized over my future so much. But I would definitely go to med school and choose psych.

 

[Trismegistus4]

Wow, dude. Please don't take this the wrong way, but have you considered psychoanalysis? If you're happy, then don't bother.

No offense taken. I actually visited a psychiatrist my 4th year of med school, and he told me psychoanalysis was indicated in my case, but I didn't follow through, largely because of the time investment. I knew spare time in residency was scarce enough; I wanted to be able to have a life rather than spending every non-waking moment when I wasn't at work on an analyst's couch. As far as happiness goes, I feel a bit like the protagonist in "The Necklace" by Guy De Maupassant, a short story we had to read in 8th grade. I remember she describes herself as "content" at the end. That's how I feel. Content, but it's a contentedness reached only by going through a long travail it turns out I never had to go through in the first place.

Also, I think while it would be mildly interesting to undergo psychoanalysis (if only because it would be nice to have someone to unload on,) I'm skeptical it actually creates a lasting beneficial effect.

By the way, lots of people have dreams of becoming a writer. It's a good hobby to have but only the top 0.1% ever make it. You should consider yourself fortunate that you wound up where you did. You could just as easily have gotten a PhD in English only to end up in a high school teaching position wishing you had done something more practical (such as medicine).

You sound like my father when I was 16 and told him I had finally discovered my life's dream and wanted to be a writer. ("Are you crazy? There are thousands of people who want to be writers! Everybody's trying to get a book published! The only way you can get anything published is if you know someone in the publishing industry!") I've always viewed his extreme discouragement as the primary reason I never actually tried to do it.

 

[GreenGeek]

I've always viewed his extreme discouragement as the primary reason I never actually tried to do it.

You haven't missed the deadline yet. =)

 

[Barfalamule]

One reason I chose psychiatry was so I would have time to write on the side. I have always wanted to be a writer, but the reality is "Don't quit your day job." A phrase uttered a thousand times by a thousand poor writers. I have met writers that have published dozens of books and live in poverty. You have the opportunity to write in comfort. Use it! Spend some of that hard-earned cash on Clarion or some other workshop. Most people who don't write are just afraid they'll fail. But the only one that matters is you. Think about what you want to accomplish by the end of your life. Think about where you are now. The clock is ticking.

 

[PrideNeverDie]

To the poster who said he might choose to be a PA instead, I offer the opposite experience. I chose to be a PA because I was afraid of being rejected from med school (analyze that!) The longer I worked as a PA, the more confidence I gained and the less satisfied I was with the dependent role. In my mid-30s my discomfort with remaining a PA for the rest of my career overcame my fear of failure and more debt and I went back to med school at 37.
Very early in my PA career I was interested in psychiatry but there were almost no jobs for PAs in my area--in Oregon PMHNPs owned that market. I went into FM instead and took advantage of PA lateral mobility and moved into the ED. I never did find my niche as a PA until I began teaching PAs--and then I found that I needed to learn what I didn't know and that ultimately pushed me back into med school.
While I enjoy aspects of both primary care and emergency medicine, I never really LOVED anything until I did a month of inpatient geriatric psychiatry. I really doubt this would have grabbed me in my 20s--I needed to grow up quite a bit, hurt a bit, learn a few more life lessons and be stretched to find that I could connect with people. I really am such a better doctor (almost doctor) at 39 than I ever would have been at 26. Maybe this is true for most of us.
One thing I fear about choosing psych is giving up medicine. I love medicine. One of my attendings told me "only BAD psychiatrists forget their medicine"...I appreciated that but really would like to hear from others whether their career as a psychiatrist satisfies them intellectually and professionally.

this is the reason i'd pick med school again over being a psych NP

psych NPs have everything but the income and guaranteed leadership role

once they get autonomy, all bets are off