Law of Increasing Returns: Advice I Wish I Had on My Medical Journey

By Milan B. Shah

The journey to become a physician is long and arduous, and often replete with misinformation that may negatively impact our well-being. The Law of Increasing Returns: Advice I Wish I Had on My Medical Journey is divided into three sections—focusing on your education, your finances, and your health. Dr. Shah summarizes years of learned information and shares his experience to encourage readers to consider facets of their lives that are important to them so that they may achieve an optimal work-life balance and avoid burnout.

• Language: English
• Publisher: Gatekeeper Press
• Release date: Feb 21, 2023
• ISBN: 9781662931758

Book preview

Introduction

Change is the only constant in life.

-Heraclitus

Most of us have heard of the law of diminishing returns. For those who may be unfamiliar, a quick Google search defines it as a principle stating that profits or benefits gained from something will represent a proportionally smaller gain as more money or energy is invested in it. With rising rates of burnout in the medical profession and the toll the COVID-19 pandemic has placed on our healthcare system, it is critical to look closer at our journey to becoming physicians. This journey not only encompasses the medical training pipeline itself, but also incorporates facets of our lives that are often as obvious as overlooked. These facets include wellness, nutrition, personal finance, and the importance of having a long-term focus while being mindful of short-term goals. The journey of healthcare providers will vary, obviously, but my goal is to provide a framework for anyone considering medicine as a career choice with lessons and advice I wish I had along the way.

The process is long, arduous, and often replete with misinformation.

I heard that two-year fellowships are better than one? Is that true?

Do I even need a fellowship? What is a fellowship?

I need to go to a more prestigious medical school because my residency chances will be higher, right?

In the end, it doesn’t matter, because P=MD, right?

These are just a small sample of questions I’ve answered for both pre-med and medical students over the years.

One thing necessary, if not already present, is the importance of cultivating a lifelong desire and passion for learning. I recently completed my oral board exam for urology, which required months of studying. After fourteen years of school and training after high school, the bar continues to remain high with board examinations after graduation to assess your competency. Don’t be frightened by that; just take one step at a time.

It saddens me when I hear younger physicians like myself discussing early retirement or departure from the career entirely due to increasing work demands, rising rates of burnout, and the ever-present threat of liability. A powerful skillset and talent are acquired at the end of the pipeline, yet many of us have encountered colleagues, classmates, friends, residents, fellows, family, or even ourselves, considering leaving the profession.

Blogs, friends, colleagues, and mentors often counsel us that achieving work-life balance is of paramount importance. Remember, however, that the ideology of balance is proverbial, and therefore, self-defined. Achieving your concept of an appropriate balance is all that matters. Society’s perception of your work-life balance does not matter. Because you are the one dedicating decades of your life to this journey, be mindful of choosing a field, specialty, or job solely based on money, status, or image. You may not be happy with the result.

One of the primary reasons I chose to create this book is because, while there are resources and advice on individual topics, including personal finance, entering a career in medicine, and preparing for board exams, to my knowledge, there is not a comprehensive overview of the medical career journey. My goal is to shed light on my journey through this process: the trials, tribulations, and successes. Although I recently received my certificate from the American Board of Urology, I can distinctly look back and remember the months I spent studying for the Medical College Admission Test (MCAT) in college. I hope to provide guidance for those who hope to embark, are currently pursuing, or are on the fence of whether to consider this profession.

The heavy personal finance discussion in this book is meant to provide healthcare professionals with the overview needed to create a financial pathway, enabling them to optimize their work-life balance both in the present and in the future. Our needs, desires, and responsibilities will change over time, and having a degree of financial stability may lessen the burden.

Another reason I chose to author this book is to empower clinicians and healthcare professionals to work diligently to craft their own proverbial work-life balance. Thoroughly thinking through and defining goals for wellness, fitness, nutrition, finance, job satisfaction and overall well-being is critical. The first quote of this book by Heraclitus is invaluable in terms of shaping our thinking. As you’ll see through the chapters, my goal is to help you think critically as you navigate these steps. The pathway of medical training is well-defined, but our personal growth in terms of maturity, priorities, nutrition, finance, and overall wellness, is not. The latter aspects may take shape and provide meaning at different points along the journey.

Your Education

Chapter 1: Pre-Med/College

Primarily, you must understand and clearly delineate your reasons for pursuing a career in medicine. While some colleges and universities have a major for pre-med, others do not. I completed my undergraduate studies at the University of Pennsylvania; a series of courses including biology, chemistry, physics, organic chemistry, biochemistry, English/writing, and math/statistics were recommended to satisfy the basic core requirements for most medical schools.

For those of you in high school, BA/MD and BS/MD programs exist that can enable you to obtain either a guaranteed or conditional guarantee of an acceptance to a partnering medical school. These programs can vary in length from an accelerated six years to the traditional eight years.

Incredible, right? Not necessarily. Though lined with benefits including select combined BA/MD or BS/MD programs not requiring the Medical College Admission Test (MCAT), it can be a lofty commitment to decide upon your career choice at the end of high school. Moreover, minimum GPA and/or MCAT requirements are often, though not always, required as part of the conditional acceptance. Not meeting these minimum requirements may void your conditional acceptance, forcing you to apply to other allopathic or osteopathic medical schools. To expand, if an accelerated combined program required you to have a GPA of 3.5 and an MCAT score of 510 (out of 528), for example, and if you were unable to meet either of these minimums, the medical school would rescind your conditional acceptance.

Does it matter where you go to college? Though not clearly black and white, if your end goal is to become a physician, then I do not believe it matters. However, if there is a chance you may be interested in pursuing other careers either after college or in the future, then I would argue that it does matter. Regardless of where you stand on this debate, the most important aspect of your education is what you make of it. The prestige of an institution doesn’t matter if you don’t take advantage of the resources available to you. Similarly, students who are at the top of their class in any institution may have an easier time during the medical school application cycle or applying to jobs at companies.

During your selection process of colleges, keep location in mind. Great academics and an inclusive learning environment are available at a plethora of colleges and universities. Location matters in the sense that your extracurricular and social situations will be formed by what is around you. Going to school in downtown Chicago will differ vastly from going to school in Geneseo, New York, for example, from a social perspective. I attended my first year of college at Boston University prior to transferring to Philadelphia. We used to joke that the Boston University football team has been undefeated since 1997 because that was when the sport disbanded at the university. Had I gone to school at the University of Michigan, my interest in college football may have been different from what it is now.

All joking aside, I did not transfer schools for the social scene. Transferring was a difficult decision to make, given the amount of effort the application cycle took, the scholarship I gave up, and the fact that I would have to start at another institution as a sophomore but with a freshman perspective. However, I knew that pursuing medicine was not guaranteed by any means and transferring to an institution with a strong business program would enable me to use the available resources in the event my life took a different pathway. Even though I was not in the business school, I knew I would have access to courses, and made sure to take full advantage of that opportunity. At the end of the day, even if unable to transfer for whatever reason, I knew that I would have optimized where I was. If you are currently at an institution where you feel like your goals are not being met, there is minimal value in being resentful. Evaluate your options and consider whether another institution may be a better fit. Transferring colleges is like the application process out of high school; it consists of essays, letters of recommendations, and interviews. Be mindful of transfer deadlines and any prerequisite college course credits required.

Use your time in college to expand upon your interests. If your long-term goal is to enter medical school, you will encounter classmates who have a science-based major and those with a completely unrelated field of study. In Boston, I initially majored in economics, and then switched to neuroscience in Philadelphia. Though my main courses were in the sciences, I took a diverse array of non-science courses, including Introduction to Jazz and Archeology.

As with most things, there are advantages and disadvantages to pursuing a science versus a non-science major. Having a strong science background from college may make the transition to understanding pathophysiology and pharmacology during the basic sciences years of medical school easier. On the contrary, if you are dedicating your life to science and medicine, you will have exposure as you progress on your journey. Pursuing a non-science major will open your mind to topics of study in a deliberate, organized manner, one in which you may not have such ease of access to in the future.

I thoroughly enjoyed my Introduction to Jazz course. Though I am not a connoisseur by any means, I developed a fascination and appreciation for that genre of music. I pay a little closer attention when I hear jazz streaming through lounges and coffee shops. Even though my knowledge peaked while studying for the final exam, I always think back and remember how grateful I am to have taken that course in college. Without it, I would pay no mind to it. It can be easy to overlook our non-career-related interests when we feel that any misalignment with our professional goals may hamper their progress. Similarly, there is a perception that we should spend vacations and college summers furthering desired career goals. That isn’t necessarily true.

College summers are an exciting time. Whether you use them for academic or non-academic purposes, use them to cultivate your interests or fill in gaps on topics you wish to learn more about. I knew that I was headed towards a career in medicine and used two of my summers to pursue internships at Washington University in St. Louis and RWTH Aachen University in Germany. Since I had transferred universities, taking advantage of study abroad would have proven difficult. The latter opportunity in Germany filled that desire beautifully. I remember thinking in college that I was fascinated with radiology, so I spent both of those summers strengthening that interest. I left those opportunities, however, with a realization that this was not the specialty I wanted to pursue. During weekends, I took trips to Berlin, Munich, and Heidelberg with my classmates. These early travel opportunities cultivated my desire for lifelong travel.

Your college may or may not have these opportunities readily available. A quick online search will lead to a plethora of available opportunities. Though it is enticing to spend the summer at your home institution, if you can, I highly recommend experiencing a new institution. You’ll be exposed to far more than a new setting. Innovative ideas will provide you with a fresh perspective and studying abroad magnifies that further.

Despite these academic pursuits, one of the most important things I did in college was developing great friendships. Classes eventually end, exams are cyclical, and even the years of college themselves seem to come and go—but strong friendships and their associated memories last. I remember the daily meals I had with one of my best friends after our last class ended. I remember going to our local all-night convenience store and ordering sandwiches at 3:00 a.m.