A Harvard medical school student realized in his third year that he had lost his desire to become a doctor. Nevertheless, the student decided to complete his fourth year and obtain his MD degree. The student is now planning for a career in pharma or even comedy. Some individuals who read his online essay found the student’s decision-making comical in itself. Overall, their comments were evenly divided about the student’s virtues and next moves.

Before exploring readers’ reactions, we ought to know something about this student’s reasons for opting out of the medical profession. The student wrote: “Reflecting on the elements that brought me down, I felt sadness for my patients’ health, particularly when it seemed their condition could not be cured or treated effectively; disappointment over the influence of insurance coverage in determining which treatments patients received; frustration at the amount of documentation, which seemed to take precedence over time spent with patients; and discouraged by the overall environment where it seemed hospital personnel did not feel valued or happy to be there.”

Let’s not dwell on the merits of the student’s reasons but dive right into readers’ reactions to it, whether they shamed or commended him on his decision. I divided the comments into “selfish” and “noble.” Here is a sample:

Selfish

• How did this individual get into medical school not knowing his passions? Why did he apply when still intellectually and emotionally immature?
• As someone involved in teaching students and residents throughout my career, I know that an incredible amount of time and resources are devoted to educating doctors, and I find it very distressing when someone uses those resources and never provides care, especially when the provider shortage is so bad.
• Some other student could have really made something of the spot at Harvard medical, but now society is deprived of those benefits. This seems like a very narcissistic thing to do.
• You can be humorous with a bachelor’s degree.
• It is somewhat revealing that the [student] states he went into medicine to help others, and yet all the career choices he now describes are designed to help him.
• Now there’s comedy. Joining up with the pharmaceutical industry that puts sales above well-being. Trying to advertise the latest and greatest (and most expensive) alternatives to disease management and shying away from promoting healthy behaviors.
• You didn’t have the right stuff.

Noble

• With the pharmaceutical path, you may be able to help countless more people than you could have with the conventional MD route.
• Sounds like the smartest man in the room to me: Do what makes you happy! And avoid the EMR cash register and hamster wheel.
• If working with patients and practicing medicine is still a passion, consider using your skills and knowledge at a free clinic; if comedy is your passion, instead, enjoy yourself!
• Follow your heart, and the mind will be of great service to others.
• Everything he says is true. We went into medicine to help people and make the world a better place. But it seems that everything is more important than the patient.
• Good luck! It just proves that there is no other type of study/education that opens so many possibilities as medicine. Good for you!
• I hope he’s finding fulfillment outside the traditional med school to residency pathway, and I’m happy that he’s thoughtfully making the best choices for him.

The comments do not provide a consensus on whether it is selfish or noble to never practice medicine after medical school. One commentator – not the only one – was able to see the argument philosophically from both sides, saying, “Let’s not shame people into staying where they deeply do not wish to be or condemn them based on good faith decisions made when they didn’t fully understand what they were getting into.”

I think this reader made many good points, so I decided to quote him entirely: “The practical realities of clinical practice as a physician must be experienced to fully appreciate [them]. Pursuing and, if ultimately admitted, getting through medical school is something of a leap of faith for many. Sometimes it turns out to be a bad fit, a realization that may dawn after committing to a lot of debt. Of course, it rankles some given that accepting admission indirectly crowds someone else out (of this scarce resource) and doesn’t provide the expected societal return on investment of a practicing clinician. On the other hand, do any of us want a physician who chronically doesn’t want to be in that role? He may yet apply his education and degree profitably outside of clinical practice.”

Many years ago, I conducted a small study showing that over 90 percent of students who matriculated in two U.S. medical schools (Temple University and the University of Pennsylvania) graduated in four years. This percentage is in line with the Association of American Medical Colleges, which found that 4-year graduation rates ranged from 81.7 percent to 84.1 percent. Still, after six years, the average graduation rate was 96.0 percent.

However, a survey released by the health science and journal publisher Elsevier in October 2023 found that a quarter of medical students in the U.S. were considering quitting their studies due to the pressure facing today’s clinicians – issues not unlike those cited by the Harvard grad.

Reasons for dropping out of medical school can be diverse, but common ones include academic struggles, financial pressures, personal health or family issues, lack of interest, or, in this instance, a desire to pursue a different career path. It is important to note that the majority of dropout causes are non-academic.

After leaving medical school, former students may pursue a range of alternate career paths. Some may choose to continue their education in a related field, such as public health, biomedical sciences, or health care administration. Others may decide to enter the workforce directly, taking jobs in health care, education, or research. Some will pursue careers distant from medicine or unrelated to it.

Perhaps this student will follow in the footsteps of the Monty Python actor Graham Chapman (1941 to 1989), who turned down a career as a doctor to be a writer and comedian. I wish this student well, and I do not begrudge him for (almost) forcing me to go to Mexico for medical school. Well, I never would have had a shot at Harvard anyway.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. He is the author of Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.