I’ve spent quite a few nights in the hospital more awake than I’d like to be, under more stress than is healthy, and wondering what careers would’ve better accomplished the immediate goals of being more asleep and less hopped up on catecholamines. I am confident that most of us have had such thoughts at one low point or another.
The hardships and sacrifices in medicine are many: an arduous and expensive training pipeline, long hours, high stress, competing demands on time, a variably satisfied patient base, convoluted and painfully difficult payor navigation, and the persistent threat of burnout. All of it contributes to an environment that, at times, seems hostile to our profession. We weigh these costs with the benefits: generous compensation, social standing, job security, and perhaps even academic or intellectual interest (to name but a few). We spend a significant portion of our professional lives trying to find the “best answer” for our patients.
Is it possible that, when viewed through the retropectoscope, there was a “better” career choice for ourselves?
Such is the question at hand in today’s exploration of the interesting but pedantic. If there is a cleaner path to financial independence and professional satisfaction, we might discover it by comparing compensation to the work associated with it. To do this, I will examine five professions using the following criteria: income, benefits, education costs, hours, and longevity. Now, before you start yelling at me that this method is wildly contrived and speculative, I’ll concede your point while, in the same breath, muttering that so is medicine.
To establish a baseline, we can first look at a career physician. How high are the barriers to entry—education costs and training? What is the median and peak compensation for your given speciality? What additional benefits are offered (such as retirement, insurance, and those outlined in your annual statement of personal compensation)? How much must one toil in it regularly to pay off debt, build financial security, and maintain a desired standard of living? How long can one keep the pace of practice?
Every shred of medicine is different, as is the setting. Understanding the tangible and intangible costs of your chosen career is useful in evolving your practice, considering alternatives, and counseling those interested in pursuing the same path.
The Road You Could’ve Taken
Physicians are generally competent, enterprising, and persistent. These traits (virtues?) abound in many disparate professions and occupations, and as such, they represent fields that physicians could have (should have?) more strongly considered. Put bluntly: here are five careers that are probably better than yours.
Engineer
Like “medicine,” engineering is a broad term encapsulating an incredibly diverse range of fields. Ultimately, it is the scientific practice of problem-solving. Humans design and build, and we will always need engineers to do so.
The education and training are not easy. Professional competency is achievable within several years of completing undergrad. Compensation and benefits are competitive, and they far exceed the national average ($69,846 in 2024, per our friends at the Social Security Administration). The relatively compact education timeline (four-year degree plus several more to be eligible to sit for the professional exam) means that savings can start earlier. Depending on the type of engineering and the project at hand, hours can be demanding. The job market is competitive, and the work can be tedious and difficult, which also means rewarding.
Pilot
The barriers to entry in aviation have changed dramatically over the last decade. As demand for pilots has increased, experience requirements have decreased. Where once the selection for a commercial pilot position was extensive and highly competitive, airlines are now recruiting in a manner that, while still quite competitive, makes the old guard jealous.
Pay and benefits can be quite generous, depending on the company and seniority, with unions having established favorable terms. Seniority affects income greatly: a pilot fresh out of training may have a salary more similar to a resident or fellow, while a seasoned wide-body pilot at a legacy airline will enjoy a salary and benefits that rival many procedural specialties in medicine. Once trained and experienced, many pilots admit to a bit of boredom at altitude, though the view from their office is celestially better than that from an exam room. Flying is no panacea, though: time spent away from home and family takes a toll. But it's a career that can be practiced to the point of Social Security eligibility and which offers the benefit of world exploration.
Attorney
After just three years of law school and several more as an associate, a universe of legalese awaits those with the intestinal fortitude to argue for a living. The education is expensive, the training is long and selective, and the hours worked are grueling (more so than a resident? In some cases, absolutely). In the best-case scenario, lawyers advocate for and help achieve a more just society. But losing cases also happens. Difficult clients also exist.
Reimbursement can be high, though there is a bimodal salary curve that allows for one law school graduate to make $60,000 in their first year and another to earn four times that amount. Also, productivity depends on available work, which is not always guaranteed.
Sommelier
The benefits of this profession are self-evident: a lovely work environment, constant learning, and a skillset that you could continue honing until Bacchus himself tells you to quit. Only the best of the best find themselves in the highly acclaimed establishments. But those who do get to that point represent an elite cadre of fascinating humans.
If given the choice between spending years studying biochemistry and molecular genomics in a dusty library or tasting the difference between Old World and New World, I would happily choose the latter. Certification is rigorous, and compensation is a fraction of that found in other jobs on this list (reported incomes peak around $125,000 per year for the most sought-after sohms). But life isn’t all about money. Sometimes it's about wine, too.
Park Ranger
The National Park Service needs good folks to tend to our greatest treasures. The training is intense, the work is physical, and there is the added drawback of having to deal with pesky tourists. But it's also intimately outdoors, which is the best place. The pay is not sterling, but the rewards can be spectacular. A government pension is available to those who qualify, even if compensation isn’t on par with most professional groups. This job wouldn’t be the worst on most days.
More information here:
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Setting Expectations for the Moderate-Income Physician
My Spouse Is Quitting Medicine
The Bottom Line
In truth (and if I am being fair about this comparison), there is a sixth category of comparison: fulfillment. While a person can reasonably work toward several careers, satisfaction in them is dependent on personality and interest. And if I am being really honest, I would admit that it's in part because of the darkest moments of my job that the work is so satisfying. The grass always seems greener on the other side. We have good days and bad days in every profession and occupation. I am fortunate that I get to work alongside incredible physicians, nurses, and staff with a shared goal of helping the vulnerable. I am fulfilled in medicine, I imagine more so than I would be in any alternate universe (aside from perhaps being the in-house Sohm for Bern’s Steak House).
Going through the exercise of “what if” is a reminder that there are benefits and drawbacks everywhere. If possible, learn from the good and discard the inefficient. Incorporate the best attributes of your (day)dream job into your own career.
If you love aviation, the FAA needs aeromedical examiners and flight surgeons. Do you enjoy semantics and opinions? Maybe you missed the boat on law school, but it's not too late to consider adolescent medicine. Have a penchant for novel interventions or devices? Many physicians have gotten their engineering fix through device creation, systems engineering, and software development. Perhaps you aren’t a park ranger, but that doesn’t mean you can’t take up wilderness medicine. While viticulture and medicine don’t mix, the latter does afford opportunities to enjoy the former.
Find what you value best in other fields and draw those qualities into your work. Having done it successfully, share that skill with the younger generations. And maybe you’ll find, in the end, that the career you should have pursued is the one in which you’re already working.
What other career would you have liked to pursue? Would it have been as financially lucrative? Do you think another profession would have made you happier?