Decades ago, becoming a doctor felt like the obvious choice. People asked, “Why wouldn’t you?”

Today, the question has flipped: “Why would you ever do that?”

I’m a doctor. I graduated from UCLA, and I’m now an anesthesiology resident at Mount Sinai. I also help thousands of premeds get into medical school every year. And when I see doctors leaving medicine or premeds walking away before they even apply, I don’t think they’re weak or irrational.

I think they’re responding honestly to a system that asks for everything.

That’s why, for anyone considering becoming a doctor, it’s important to think about informed consent. For patients, informed consent is when they understand the risks, benefits, and alternatives before agreeing to a treatment.

A career in medicine deserves the same scrutiny.

The replaceable cog

One of the first risks people rarely talk about is how replaceable you can feel inside the larger medical machine.

I remember a night when the ICU was full, the PACU wouldn’t take the patient, and we proceeded with surgery anyway, hoping an ICU bed would magically open up. It didn’t. I ended up running a makeshift ICU alone in the operating room for hours. It was Friday night. My entire night disappeared.

That was the moment it hit me: I had no power. I was just one cog in a massive machine that didn’t care about my time, my exhaustion, or my life outside the hospital. Yes, I’m grateful every day for the opportunity to take care of real people with real families. I love that I have the ability. I literally use my hands and my brain to get sick patients through the scariest days of their lives. But this is the cost?

Death by a thousand paper cuts

Another risk is what I think of as death by a thousand paper cuts. Everyone in medicine has different incentives, even though we all like to believe we’re aligned around patient care. Nurses work on shifts and don’t gain anything by pushing faster. Techs, cleaning staff, surgeons, and anesthesiologists are all operating under different pressures.

I’m not blaming anyone. I’m just observing that the design of systems leads to their output. And this system is NOT designed in a cohesive way to respect all the hardworking providers serving our patients.

Even within anesthesia, when it’s close to a cutoff time for additional “moonlighting/overtime” pay, you can feel the subtle shift in behavior. No one is malicious, and no one is perfect, but the misalignment adds up. What it leads to is a complete lack of predictability. You stop expecting your day to end at a certain time. You stop making plans. Even if you genuinely love medicine, you’re forced to surrender control over your nights, weekends, and holidays indefinitely.

The emotional toll

Then there are the lows, and they are devastating. I once took care of a very young patient undergoing another liver transplant. Her disease had progressed so badly that breathing was already a struggle. I met her parents and her brother.

She had her hair in neat braids and was clearly terrified. Her brother talked about how, when she woke up, they would go to 7-Eleven, and she could get whatever flavor ICEE she wanted because she deserved it after everything she’d been through.

She didn’t survive the operation.

We did everything we could and still lost her. I still remember the nearly 100 blood products I personally spiked. I remember her getting shocked multiple times on that operating room table to restart her heart. I remember the blood stains all over our surgeons’ gowns, gloves, and masks as they performed CPR again and again and again.

That kind of loss doesn’t fade with time. It stays with you, quietly, in the background of your life. No amount of prestige or income erases those moments.

The sunk cost of medicine

Despite all this, many doctors don’t leave even when the costs outweigh the benefits. Why?

Most doctors never had another career. They went from college to med school to residency to fellowship. By their late 30s or early 40s, medicine is all they know. Leaving doesn’t feel like a career change. It feels like a failure.

You’ve invested over a decade. You’ve built your entire identity around this role. Walking away seems unthinkable.

There’s also the illusion that happiness is always just one milestone away. You’ll be happy when you get into medical school, then when residency ends, then when you become an attending, then when you make partner or land the right job.

But the finish line keeps moving.

The problems don’t disappear; they just change shape. If you can’t find ways to enjoy life during training, it’s unlikely that joy will suddenly appear later.

Purpose, autonomy, and mastery

Whether medicine is right for you depends on how it fits into your own values. There’s a framework Dan Pink describes in his book “Drive” that describes fulfilling work as a balance of purpose, autonomy, and mastery.

Medicine can offer incredible purpose, especially in moments when you return a child safely to their parents or help someone walk out of the hospital after being critically ill. It can also strip you of autonomy, forcing you to follow insurance algorithms, administrative rules, and schedules you don’t control.

Mastery, however, is where medicine truly shines. There are few experiences as powerful as applying science and skill to save a life in real time. Whether it’s managing trauma, supporting failing organs, or navigating a complex surgery, that sense of mastery is deeply compelling and often what keeps doctors going.

For me, becoming a doctor has been worth it, but only because I’m actively shaping a career that prioritizes purpose, autonomy, and mastery over money or prestige. Salary isn’t part of that equation. If making significantly less money means having control over my schedule, choosing my patients, and doing work that feels meaningful, that’s a trade I’m willing to make.

But that’s my answer, not a universal one. The real question is whether you can give informed consent to this career, fully aware of what it demands.

Michael Minh Le is a physician.