Sitting in a doctor's lounge today, listening to the realities of the practice of medicine in 2021, you can't help but wonder why anyone still does this job.  That said, it is quite obvious that bright, caring, and motivated people are still choosing to do this for a living.  A lot of that good fortune is due to the respect given to having doctors in the family in our immigrant communities, especially first-generation Asians.

The typical M.D. spends four years in college, four years in medical school, a year in internship, and two to five more years in residency.  Fellowships in specialties are another year or two, and that doesn't include possible years spent in research.  As a result, there are doctors still paying off educational loans well into their forties.  Part of that reality is because a lot of physicians don't make much money.

A family practitioner recently signed with our "big city" hospital group with a guarantee for $45K a year.  Some pediatricians are offered even less.  The cost of malpractice insurance is a benefit offered by the employing hospital corporation, making this more palatable, but any chance of getting ahead financially is laughable at that salary, even with production incentives, personal medical insurance coverage, and 401(k)s.

More money can be made if you choose to live outside large metropolitan areas.  But most physicians have a tough sell asking their wives and children to "live in the boonies," especially if they are of Indian, Pakistani, Korean, Chinese, or Japanese descent.  Cultural and social support in big cities is real, making it hard to think of working in relative isolation.  Intellectual stimulation is also greater when in large hospitals with active programs in things like cancer care.  Peer support has great value.  But it often comes with the reality of being paid less while the cost of living in these areas is high.

And while their fellow immigrant friends are striking it rich in fields like information technology, small business, and the stock market, M.D.s are making less each year.  This is uncomfortable socially, when they are expected to show largesse with the presumed wealth generated by being a doctor.  Most Americans would be shocked at the costs incurred in things like Indian weddings — paying for your future in-laws to fly to the United States and be put up in luxury hotels, fed, and entertained for weeks on your dime.   First-born Asians have the weight of their entire families on their shoulders.  They are the financial anchors.  Many have resultant anxiety disorders.

Given these trends in medicine and politics, we are fortunate to have them.  Entrepreneurial personalities with big financially rewarded dreams and a strong drive to succeed no matter the personal cost in time and potential risk are not suited for the future.  This may be the last decade in which first-generation immigrants still desire to put in the work to become doctors.  Medicine is still respected enough to attract the best and brightest in this community.  For now.