A Message From the President

What to Be or Not to Be, That's the Question

When I graduated from medical school nearly 40 years ago, career "planning" was virtually unheard of. Oh, I remember one of my classmates who did plan, from even before medical school, to become a cardiac surgeon; he never wavered and ended up doing just that. But for the rest of us, at least most of the rest of us, the careers we ended up in were less a matter of precise planning than of hopeful hunching. Few medical students in those days had access to formal career counseling. We formed our opinions about suitable careers from informal corridor conversations with our attendings, or from our distorted glimpses of what made up their professional lives, or from the stereotypic comments of residents or fellow students who were as poorly informed as we were. As for tailoring our career choices to some objective assessment of our innate talents, forget it.

But the stakes back then were much different from what they are now, and the risks of going with one's hunches rather than following a planned pathway were small. With the exception of the few who chose academic medicine or the military, medical students in my generation were faced with a pretty simple set of choices. One had to select a medical specialty from a list less than half as long as currently exists; one had to decide whether to do solo practice or join a group; and one had to pick where in the country one wanted to live. Have an MD degree was, quite literally, to have a ticket to certain prosperity in whatever specialty one picked, in whatever company one wanted to keep, and in whatever community one chose to settle.

To observe that a lot has changed since then would be to abuse understatement. Today's medical students face a virtual cacophony of choices, and the risks of making the "wrong" choice can be very costly indeed. Not only have scores of new medical subspecialties sprung into existence over the last few decades, a wide variety of new modes of practice are available to choose among. Although solo practice may have gone the way of the passenger pigeon, many other possibilities offer viable alternatives. Group practice, academic medicine, and the military remain realistic choices. But how about employment in a managed care organization, or in the burgeoning biotechnology field, or as a "hospitalist," or in a pharmaceutical company, or with an international relief agency? All are among the tantalizing possibilities clamoring for students' attention.

And, of course, geography has suddenly become a huge factor in planning a medical career. Some areas of the country now have ample supplies of all kinds of physicians, and many areas have more than enough of certain types of subspecialists. So it's not quite so easy any more to blithely choose to go wherever one's fancy lights.

And, finally, there is the matter of student debt. The vast majority of medical students are forced to take out educational loans along the way, with the average debt at graduation now exceeding $85,000. Choosing a specific career now also entails a choice about how to repay one's debt.

Confronted with so may options arrayed against a backdrop of competing pressures and restricted degrees of freedom, today's medical student needs smart, savvy career planning. And in the best of worlds, that planning would start, quite literally, from the first day of medical school. Most medical educators have long since recognized the need for such sophisticated career counseling, but few have had access to the resources needed to truly satisfy that need. Instead, reliance has generally been placed on the advice of well-meaning and experienced faculty and staff who, nonetheless, are often hampered by incomplete knowledge about the full range of options, and about the specific needs, aspirations, and talents of a given student.

Now comes MedCAREERS, the new career advising and planning program developed jointly by the AAMC and the AMA. MedCAREERS, which has just been released for use, offers a wide variety of tools to enhance the career planning process. It employs a four-phase career development model that has proven highly successful in other quarters of higher education. The phases are: self-assessment, career exploration, decision making, and implementation. The program is designed to be used either as a stand-alone, self-managed course or in combination with other career and specialty guidance programs already in use.

If the reaction from our schools so far is any indication, MedCAREERS promises to be a major advance. The first 17,000 student manuals sent out to institutions were snapped up immediately, and schools have already asked for 5,000 more. It will obviously take time and careful assessment before we can document the program's effectiveness, but I am convinced that this approach is moving us in the right direction. It's a different world out there for today's medical students-and MedCAREERS should strengthen their hand as they grapple with that world's strange and wondrous choices.

Jordan J. Cohen, M.D.
July 1999

Dr. Cohen was president of the Association of American Medical Colleges for 12 years (1994-2006).

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