There have recently been a lot of discussions on social media about whether pursuing a career in medicine is still worthwhile. It started with a TikTok post where an undergrad shared his dream of going to medical school. A commenter who said he/she was a doctor discouraged the student from pursuing medicine, saying that it would ruin his life.

Undeterred, the aspiring medical student said that he acknowledged the commenter’s experience, but he still wanted to be a doctor. To which the commenter replied that medicine was a trap, and you’d only know it once you were there.

Is there any truth to this pessimistic outlook? Is a career in medicine an opportunity to serve but also a source of disillusionment?

Each doctor’s experience is unique, and there are many specialties and subspecialties in medicine with variable workloads and expectations. However, it is possible to look at the trends in medicine over the years. As a Gen X doctor, I lived through the shift from the altruistic ideal of medicine as a healing vocation to one that acknowledges work-life balance and the importance of earning a decent living. When we entered medical school, we were told that the primary objective of a physician is to heal and that the professional fee is incidental to the service being provided.

I enrolled at the University of the Philippines (UP) College of Medicine in 1996 after finishing BS Biology at UP Diliman. The curriculum at that time expected first-year students to see some patients in addition to managing a brutal academic workload. Anatomy class involved groups of six students dissecting a cadaver. One of our classmates on our first day walked into the acrid odor of the dissection room, looked at what we were about to do, turned around, left, and never came back.

Aside from lectures, we were expected to complete multiple research projects while juggling clinical duties. Starting the third year, we went on 24-hour duties every three days with hardly any rest in between and certainly no time off after each duty.

During one particularly hectic duty day in the Philippine General Hospital emergency room (PGH ER), I did a quick survey of my classmates who were there during a lull in the early morning hours. I asked whether they would reconsider their decision to go to medical school, knowing what we were going through. Almost everyone said they would not have gone to medical school, including me. However, all of us in the ER that day completed our training and went on to become full-fledged doctors.

I currently teach in the same school, and I can tell you that the amount of wellness breaks and mental health support built into the curriculum would have been unimaginable during my time. There are no more 24-hour duties, just 12 hours at most, and it isn’t every three days either.

A lot of the “scut work” we did as medical students, such as drawing blood, monitoring vital signs, and searching for medical supplies, has been relegated to other people. There are now hospitalists in PGH, doctors who are hired by the hospital to take care of patients when the students and trainees are over a set number of patients. During our time, there were no such caps. You just kept admitting patients as they came.

After medical school, a year of clinical internship is required prior to sitting for the medical boards. Internship is built into the UP College of Medicine program, and so, unlike other medical schools, we graduate our medical students after internship. While a medical graduate who passes the medical licensure boards can already practice as a general practitioner, many doctors pursue specialty training, known as residency.

Pursuing residency is desirable from a financial standpoint, as it can increase one’s future income, but it is an additional two to five years of training, depending on the specialty. Since residents take care of patients (for clinical specialties) or do other medical work (radiology residents read films, pathology residents read slides, etc.), they are paid a salary by the hospital. These salaries are variable, but in general are higher for government hospitals than for private hospitals because the workloads in public hospitals tend to be heavier.

Residents in PGH are paid a living wage, better than salaries in many private hospitals, and it is a huge increase compared with past years. I did a residency in the US, and they do pay better wages, although the cost of living is also higher, and matching in a US program is an expensive and difficult journey on its own.

After residency, many doctors choose to start their practice as specialists. Some go on further to subspeciality training, also known as fellowship, which can take one to three more years. Fellowship in the Philippines also pays a salary, but paradoxically, it might be lower than residency wages, especially in public hospitals.

I also did my fellowship in the US, and the fellowship salaries are higher than residency wages, which makes more sense since the work is more specialized. Fellowship can substantially increase potential income beyond that of residency and increase one’s chances of getting into a tertiary hospital if a particular subspecialty is in demand.

I like to think of compensation not just in terms of money but also in terms of how many hours I choose to work, which is very important for younger doctors nowadays. Fellowship opens the door to more efficient work hours while getting better compensation.

The bottom line is that career paths for medicine are many and varied, and there is no “one size fits all.” The salary and work hours are variable, and if one has advanced training or fulfills a particular niche, such as primary care in concierge or travel medicine, it can enable one to significantly influence salary grade and the hours of work one chooses to do.

Most doctors find their way and are able to come to terms with their choices. Some of my classmates have left medicine entirely, but their medical training still benefits their work in some way, especially those who join the pharmaceutical industry or proceed to academic research. If one feels trapped or burnt out from a medical career, one can always pursue other things afterwards.

Medical school is still hard and requires a certain level of intelligence, but the hours nowadays are much more humane. There is more awareness of mental health issues.

Nevertheless, there will be times, especially when things are tough, that a medical trainee will question his or her career path and wonder whether another career might be better. For myself, those moments have become fewer and farther between once I settled into my practice, because the difference good medical care makes in the lives of patients becomes more tangible over time.

I do not know the circumstances of the commenter, but if he or she is still early in medical practice, my advice would be to give it time and think back to what attracted you to medicine in the first place. For me and many of my colleagues who remain in practice, getting up in the morning is easy because medicine can be both spiritually fulfilling and materially rewarding.