My Residency Dilemma (Should I Follow Conviction or Convention?)

This is going to be one of the most heartfelt articles on my site. For once, I’m gonna be selfish. I’m gonna write this for me, and not for you.

Maverick. Rebel. Dreamer. There are the things that people have called me when I told them about my plan for residency. I don’t think they meant them in a good way.

Right now, I have a choice to make. I’m at the crossroad. Should I take the well-worn road or the path less-traveled.

Why I Hated Medical School

Ever since the beginning of medical school, I knew I was different than my classmates. I majored in business. I took most of my requirements in a community college. I didn’t even wanna be a doctor when growing up.

And now, here I am. By God’s grace.

During my medical school interview, both interviewers said I would be a surgeon. I hope I didn’t come across as an asshole. Or someone with a God-complex. When I asked my close friend which medical field best suits my character, she also said surgery. (I’ve made her cry in the past.)

I’m not an asshole, I promise.

I’ve always thought I’ll be a family doctor. I’ve always wanted to know a bit about everything. I like kids. I like adults. So why not?

Well, there is a chance that I won’t be a family doctor (nor a surgeon).

And this is where I am right now.

I really didn’t enjoy rotation all that much. It wasn’t because of the medicine. I’m fine with that. I’m not in love with it, but I could tolerate it. What really turned me off is the broken, over-regulated, archaic, hierarchical medical system.


Paying for medical care is crazy expensive if you’re paying out of pocket. Medical expense is the primary cause of bankruptcies in the US. While the little guys have to pay the full amount of their medical bills … for some strange reason, insurance companies and the government only have to pay a fraction of the costs. So the rich makes out like bandit, while the poor gets the shaft in the rear.


Under this system, most of the time is spent documenting instead of treating of patients. You have to CYA – cover your ass … in case one of the many powers-that-be come after you: administrators, lawyers, insurance companies, government, etc. The huge amount of time documenting does not add value to patient care whatsoever. When I signed up to be a doctor, I did not sign up to become a paper-pusher.

When I was on inpatient rotations, I spent more time on paperwork than with patients. I honestly felt most of my third year was wasted on paperwork.

Archaic & Hierarchical

Under a hierarchy, those on top have power over those on the bottom. So attendings have power over residents. And residents have power over medical students. With power, comes ego, pride, and corruption.

Don’t get me wrong. As medical students, there are lots of nice people you’ll work under. But sometimes, you just can’t tell who is genuinely a good person. So to make sure you don’t fall on the wrong side of the people above you, you have to wear a mask to get ahead. Pretty much all medical students wear it.

It is a matter of survival. You need evaluations for every single rotation. (Why isn’t it enough if I just show up and do my work? Now I gotta try to be buddy-buddy with a person I just met and hardly know.) As you may already know, butt-kissers get higher grades. And because the path to your residency and to your future depends on grades, you gotta kiss butt. Yuck!

But sometimes, you’ll meet a resident, attending, or whatever hospital staff who wears two masks. These are people who are familiar with the “ascending up the ranks” game and have taken it to a whole new level.

Lemme explain about the two masks …

People act so fakely sweet to people on top of them in the totem pole. So medical students kiss up to residents. Residents kiss up to attendings. Attendings kiss up to administrators. Administrators kiss up to the executives. Executives kiss up to shareholders and to the public.

But then the very same people would terrorize those on the bottom. These are some of the ways residents acted toward medical students:

  • They would make you stay late for no reason at all — just because they can.
  • They would make you give up your seat when there are a million other unoccupied seats — just because they can.
  • They would ask you about the molecular weight of beta-HCG, not because it is relevant in any way — but just because they can.

They could not handle the power. And it got to their head. They are usually bitter, sociopathic, bored, or any combination of the three. Not everyone is a two-facer, but enough of them are. Once you meet one, your life will be hell.

And the thing is … once I’m outta medical school, it won’t be over. The cycle repeats. (You’ll still need evaluations as a resident.) The only difference is that I’ve advanced to the next level. But it is the same ol’ game.

So in family medicine residency, I gotta kiss butt, churn patients out, go home, and repeat the cycle for 3 years.

In general surgery residency, I gotta kiss butt, spend an ungodly amount of time at the hospital (at the expense of my health), go home, and repeat the cycle for 5 years.

I really think that there is only so much butt-kissing I can take. Give me my “C” and I’ll be on my way.

Which Road Do I Take?

So that is why I’m at the crossroad. What should I do?

Do I follow the herd? You know … get a conventional residency (the ones that last from 3 – 8 years and require a lot of butt-kissing). Afterwards, take my board certification exam and become board-certified. Next, work for a practice or for a hospital. Be a cog in the machine. And finally, wonder if this is all that life has to offer.

Or do I follow my heart?

I’ve told a few people about my plans. And in 9 out of 10 cases, the other person thought I was crazy. My sister loves to tell her friends about my plan. And of course, they all tell her I’m crazy. Well, if happiness means to be crazy … then I rather be crazy than be miserable.

So by now, I guess you’re dying to near about my crazy plan. Well, I will not disappoint you …

I plan to do a one-year internship. In the osteopathic community, this is known as a traditional rotating internship (TRI). In 30+ states, I could get a unrestricted medical license after a TRI. This means that I can practice any type of medicine I want in those states.

The state that I eventually want to move to grants medical licenses after a 1-year internship. Booyah!

Pros and Cons of My Crazy Plan

It sounds great! Forget about the extra 2+ years of residency. I won’t have to be unhappy for an extra 2+ years. And I get to practice medicine independently sooner. As a bonus, I won’t have to keep on retaking the certification exam every 7 – 10 years. That will save me a lot of time and a lot of money (thousands of dollars) every decade.

But it does come with its drawbacks:

I will never be board-certified. And if you are not board-certified, you will have a hard time getting hired … either in a private practice or in a hospital. You will have a hard time getting insurance to reimburse you. You will have a hard time getting malpractice insurance. And if you do find one, it will be more expensive.

Basically, I cannot be a part of the traditional medical system.

Anyways, I feel as if the drawbacks do not really pertain to me. My goal is to open my own practice. And since I will employ myself, I do not need to be board-certified. I only want cash-paying patients because I don’t want to deal with the hassle of filing for reimbursements. (To me, dealing with unending paperwork for my money is like being a circus animal jumping through hoops for food. It’s pitiful.) Therefore, I don’t need to be accepted by any insurance company. Even if I could work with insurance companies, I don’t wanna.

And as for malpractice insurance, if I do get sued in the beginning, there will be no assets to take. I’ll use all my profits to pay down my student loans for the first few years. And once I have enough money to lose, that means my practice is already successful — which means I didn’t even need a traditional residency.

Why Trading Time for Security Is for Suckers

Now a lot of people would say, “It’s only 2 years. Just suck it up and tough it out. Then you’ll have a fallback option in case things don’t work out.”

Once the GME director found out that I only applied to TRI’s, he wanted to meet with me as soon as possible, He wanted me to reconsider and apply to family medicine residencies too. Even when I told him about my goals of opening my own practice, he wanted me to do that after a family medicine residency, not after internship.

I don’t fault him one little bit. He was trying to help me out. And to most people, his advice makes a lot of sense: trade time and happiness for a bit of security. Lots of people do that.

Why do people pay so much money and spend so much time to go to school? For a bit of security.

Why do people trade 8 hours every weekday to do things they couldn’t care less about? For a bit of security.

Why do people give up their childhood dreams? For a bit of security.

First of all, trading time for security is the most costly mistake you can make. Two years is NOT a small amount of time. In 2 years, you can radically change the course of your future. In that time, the fat chick no one wants to touch with a 10-foot pole could look like Ms. America. A high school dropout could create a thriving business. An accountant could go to medical school.

Second, security is overrated. How much security does a person need? I really only need a roof over my head, food in my belly, and an internet connection. If I had those three things, I would be quite happy. You can get shelter and food in a homeless shelter. You can get internet connection in the public library or in the local franchise store (i.e. McDonald’s, Dunkin Donut).

When I’m on my deathbed, I’m not gonna wish that I was more secure. Instead, I would have wished that I lived a little more dangerously. Because in the end, the timid mouse and the fearless lion both end up in the same place — in the cold dirt. The only difference is the life they lived. The mouse lives in the confines of its fears, while the lion roams freely through its bravery.

Those Who “Made It” Are Not Any Happier

You know … You would think that doctors would be the happiest people in the world. They beat out 90% of the best and brightest students to get into medical school. They then endured through academic hell (where about 10% drops out). Next, they got through residency. I don’t know the attrition rate for residency but let’s assume that’s 10%. Finally, they go on to have secure jobs and make decent money.

If you do some math, you’ll find that doctors are the top 8% of the college population. (10% of college students make it to medical school * 90% of medical students make it to residency * 90% of doctors make it through residency = top 8.1%.)

And yet, some of most miserable and meanest people are doctors. I think they’ve realized that everything in their life has been a lie. They grew up believing a lie — that you must rely on those in power would choose you, and then you would be happy.

Why else would they work so hard and jump through so many hoops? Wear a fake smile when they’re really crying on the inside? Pop some anti-depressants? And endure through the slog?

They wanna be chosen. And if they can outshine everyone else, they would be selected. Then they would be happy.

They beat out 92% of their peers to have the life they have. But they are not any happier.  

In the end, they found out that there is not pot of gold at the end of the rainbow. There is no pot of anything because the cycle never ends. It is like being the winner of an apple pie eating contest. And once you win, you get … more apple freakin’ pie.

  • People in college bust their butt to make it to medical school.
  • People in medical school bust their butt to make it to residency.
  • People in residency bust their butt to make it to a good, stable job.
  • People in a good, stable job bust their butt to pay off the school loans, the mortgage, and the consumer debt.

Where does happiness enter the equation? For some people … never.

On their deathbed, they would ask … is this it? Did I slave away for security? Because if so, it is not worth it. I should have pursued happiness and love. I should have pursued peace and God. I should have pursued freedom and adventure.

That is why even though completing a traditional family medicine residency is the safe thing to do, I will not do it. Trading 2 years of my precious life for security is not an even trade. Trading 2 years of happiness for security is not an even trade.

Tons of people do that already. College students. Graduate students. Professionals. They followed the system — traded years, sweat, and money for security. Look where it got them? Broke, unemployed, living at home with mom and dad. But they did get a fancy piece of paper and a whole pile of student loans.

If I do fail, I would not wish that I have taken the safe route. I would not wish I am working in a hospital. I would not wish I am working for someone else. Instead, I’ll pick myself up, learn my lesson, and start again. And I’ll continue my walk down the path less-traveled.

I will not live a life of regret.

For thoughts about medicine and its future, visit the About Alex section and look for “Musings (My Philosophy on Medicine).”


  1. These were powerful words. Beautifully written, at that. This post really spoke to my soul.

    I’m an incoming MD student from the Philippines. Coming from a third-world country, the issues and context may be different, but even here, many doctors become disillusioned and trapped in a cycle of poverty, perceived prestige and the utterly-dehumanizing hospital training.

    I, unlike most of my peers, refuse to compartmentalize medicine in this fashion. I plan on taking the road less taken myself, with a focus on global health, health inequity, public health and neglected diseases. The field may be less lucrative and established, but beneficial for a greater portion of society, nonetheless.

    More power to you and your journey! I hope someday doctors will no longer be needed except for complicated and non-modifiable conditions, as everyone is empowered to access healthcare and enlightened enough to maintain it.

    • Hey Jhonry,

      It seems like being a doctor sucks wherever you go. In the future, at least in the US, doctors will be less and less needed as mid-tier providers (nurses and physician assistants), technology, and outsourcing picks up the slack.

      Good luck on your journey. It takes a lot of courage to carve your own path.

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