I received a wonderful inquisitive e-mail from a 1st year medical student.  He aspires to an academic internal medicine career and, as a non-traditional student with an MPH, has realistic goals.  He asks:

What scares me is the prospect of going into a relatively low-paying specialty in such a non-lucrative practice environment with such massive educational debt.  Are there any other challenges to going into internal medicine that are unique to the academic practice setting?

I must preface my response by saying that at this stage of my career I do not have any major financial issues.  However, when I entered academic medicine I did take a lower paying job than if I had gone into practice.  I did it for “flow“.

In retrospect, I could not be happier with my career choices.  From the 3rd year of medical school I loved teaching and learning internal medicine.  During my career I have dabbled in research and written many paper.  I have gravitated towards administrative positions but have always kept a clear rule that I will not take any job that removes me from ward attending.  When making rounds I find flow. From the Wikipedia entry:

According to Csíkszentmihályi, flow is completely focused motivation. It is a single-minded immersion and represents perhaps the ultimate in harnessing the emotions in the service of performing and learning. In flow the emotions are not just contained and channeled, but positive, energized, and aligned with the task at hand. To be caught in the ennui of depression or the agitation of anxiety is to be barred from flow. The hallmark of flow is a feeling of spontaneous joy, even rapture, while performing a task.

Colloquial terms for this or similar mental states include: to be on the ball, in the zone, in the groove, or keeping your head in the game.

During this career I have counseled many students.  I regularly tell them that “flow” trumps salary.  Daniel Pink’s recent book Drive tells us that after we make sufficient salary (and academicians make sufficient salary) we need more internal motivation.  We prefer to work in an environment that exists at sync with our values and our desires.

I hope to meet this student and have some long discussions about his career.  I hope he will find his flow and not focus too much on the money.  I wish we did not charge so much for medical school.  His e-mail reveals much about medical education, the economics of medicine, and the hidden curriculum.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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