An excerpt from Essays and Echoes: Reflections from a Life in Medicine.
In the CBS series Blue Bloods, the 2014 episode “Most Wanted” finds Assistant District Attorney Erin Reagan considering leaving her government job to join a private law firm. The appeal is clear. The new job would pay much more, and her daughter is nearing college age. Erin is not choosing between good and greed. She is weighing work that feels meaningful against the very real need to pay for her family’s future.
Her father, New York City Police Commissioner Frank Reagan, offers the kind of advice TV fathers are supposed to give: “The brass ring in a career isn’t the number of zeros on your paycheck. It’s when you become indispensable, and you are.”
It’s a great line, but I’m not sure it’s good guidance for doctors.
Frank is right about one thing: Salary is a poor measure of your work’s value. A doctor can earn a high income yet still feel the job has become a series of empty, repetitive tasks. Another doctor might earn much less but spend their days teaching residents, caring for a community with few resources, conducting research, or being the person everyone turns to when a case gets complicated. Money shows what the market is willing to pay. It cannot tell you whether your work matters.
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In medicine, being indispensable can sound like the highest praise. You are the doctor everyone calls. You know the patients, the hospital, the backstory, and the unwritten rules. Nurses trust you. Colleagues seek your opinion. Patients wait months to see you. Your skills are not easily replaced. That can feel deeply rewarding. It can also become a trap.
The “indispensable” doctor is often the one who can never truly break free from the system’s demands. They are told they cannot take real vacations, cut back on clinic time, say no to another committee, or leave a harmful workplace because “we don’t know what we’d do without you.” The language of indispensability can flatteringly turn a doctor’s dedication into constant availability.
Medicine already struggles with that issue. In 2025, an American Medical Association (AMA) survey found that 41.9 percent of doctors had at least one symptom of burnout. Their research also showed that greater control over one’s work is linked to less burnout and better career plans. Building a career around always being the person who can never step away may be less like a “brass ring” and more like a warning sign.
A healthy medical system should value excellent doctors without relying on any one of them to be irreplaceable. If a practice falls apart because one doctor takes a two-week vacation, that does not prove how great the doctor is. It shows how fragile the system is.
Then there is the matter of money. Well-established doctors can easily tell younger colleagues not to chase income. It is much harder to hear that message when you are thirty-five, have spent more than ten years in training, have delayed saving for retirement and for buying a home, and are carrying a six-figure education loan.
According to the Association of American Medical Colleges (AAMC), the typical medical school graduate in the class of 2025 owed about $215,000 in student debt. The typical total four-year cost for the class of 2026 was about $298,000 at public schools and over $408,000 at private schools. Many new doctors will therefore start residency already owing close to or more than $300,000.
That doesn’t mean debt automatically determines what kind of doctor someone becomes. An AAMC review found that the nature of the specialty, how well it fit the person, role models, and work-life balance usually mattered more than debt or expected salary. But averages don’t make an individual loan bill go away. A doctor choosing between two good jobs can reasonably weigh a large salary gap heavily when interest, family needs, and lost years of saving are on the table.
The financial picture has also become more complex. Starting July 1, 2026, federal loans for new graduate and professional students were capped at $50,000 per year and $200,000 total, and Graduate PLUS loans are no longer available to most new graduate and professional students. Whatever one thinks of this policy, future medical students may need to plan how to pay for school even earlier and more carefully.
With that in mind, taking a higher-paying job is not proof that a young doctor has the wrong values. Money pays off debt. It supports children and private school. It helps aging parents. It builds retirement savings after years when interest could not work in your favor. It can pay for disability insurance, ease money-related stress, and sometimes allow a doctor to work four days instead of five. Above all, financial security can buy something medicine rarely discusses as a form of pay: the power to say no. No to unsafe workloads. No to contracts that strip away professional autonomy. No to staying in a job only because a loan payment is due.
That is why I would revise Frank Reagan’s advice. The “brass ring” is not the biggest paycheck. It is also not about becoming the one person no one can do without. The real prize is being skilled, trusted, and economically secure enough to make personal choices without being encumbered by financial necessity or institutional dependence.
For one doctor, that might mean taking an academic job with lower pay because teaching and research provide a sense of purpose that private practice cannot. For another, it might mean accepting a higher-paying role, aggressively paying down debt, and later using that financial freedom to switch jobs, cut back hours, volunteer, teach, or practice in ways that would not have been possible otherwise. A high salary and meaningful work can go together. A lower salary is not automatic proof of virtue.
Young physicians should ask a sharper question than “Where can I earn the most?” But they should also be careful with the question “Where am I most needed?” A better question might be: Where can I do work that counts, keep learning, retain enough control to practice good medicine, and build enough financial stability so my obligations do not trap me?
Erin Reagan could turn down the private law job because she truly believed she belonged in public service. That is admirable when it is a genuine choice. For doctors, having that kind of real choice may be the true “brass ring.” Become excellent. Become trusted. Become someone whose judgment makes a difference. But don’t aim to become so indispensable that everyone else can count on you except you.
Arthur Lazarus is a physician-author whose work spans narrative medicine, physician leadership, artificial intelligence, health care ethics, medical culture, and fiction. He has published more than 500 articles and essays across scientific journals, professional publications, and online platforms.
He is the author of numerous books on narrative medicine, AI in medicine, career development, and the changing moral landscape of health care, as well as fictional series including Rounds Never End, Sick and Systemic, and Real Medicine, Unreal Stories. His writing explores the forces reshaping modern medicine while preserving a central commitment to story, meaning, judgment, and the human relationship at the heart of care.
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