So, someone you know wants to become a doctor?

Every now and then someone young approaches me for advice on choosing medicine as a profession. They are all extremely bright, capable and enthusiastic semi-adults, with strong desires to change the world and to “make a difference”.

With on average 6 000 applicants for 250 places at a medical training university, the odds are against all but the very best.

I was once like them, once upon a time, long, long ago …

I have wanted to be a doctor for as long as I can remember. At a very early stage in my life, as soon as I could walk and talk, I also wanted to be a Royal Marine. As an adult I got to be the closest equivalent to both I possibly could be. But the reality of being a fighting soldier was more in line with my expectations than those of being a doctor. Even while growing up I had a keen sense of what the military expected of me, and what it would do to me in return. For the realities of practising medicine I was, and probably still am, completely unprepared.

Part of the problem is that in the 30 years it has taken me to “arrive” as a specialist surgeon with my own practice, medicine has changed completely, and not for the better in my opinion. It is just not a “comfortable” profession anymore, because of the outside influences of managed healthcare, litigation, health economics and others. Helping people, and curing some of them, is still a big plus. It is the other “stuff” that goes with that that has become difficult. The level of frustration is getting so high it has become an inescapable part of the daily job description.

So, when young people approach me asking if they can job-shadow me for a while, I have to watch myself very closely in trying to give good, solid advice that will not put them off, but at the same time, not help steer them careering into a profession for which they may be both ill-suited and ill-prepared.

These are a few things I tell them, I hope with a sense of reality, tempered with awe of the incredible responsibility:

* Unless you really, really want to be a doctor, have no other alternative in mind, are willing to do as much as it takes to get into medical school, even if it means getting another degree first, don’t even think of it. The novelty of being “doctor” wears off a lot sooner than you may think.

* If you are bright enough to get into medical school, you are bright enough to do any other job or profession, and to be a success at it. With something tangible to show for that success. But if “success” is defined in your mind as financial wealth, choose another easier route! Or redefine “success” in your own mind, leaving out the fast cars and fancy houses.

* Medical school is going to drain your resources, and put you five years behind your peers in earning potential.

* Being a doctor will leave you physically, emotionally and mentally exhausted for long periods of your life.

* The establishment takes the brightest and most enthusiastic of a country’s youth, loads them with debt, and then pushes them into a workplace, which is invariably understaffed, ill-supervised, overworked and underpaid. For years at a time! Are you prepared to go through all that?

* Take a look at the doctors around you and how they practice medicine. In ten years’ time everything will have changed dramatically. No one can really say whether or not this will be for the better.

It’s not all bad:

* The highs in medicine can be very high, bordering on euphoria, at a challenging job well done.

* You will never be short of a job somewhere. It may not be the job you wanted, or where you want to be, but there will always be work for you.

* You can take your qualifications and experience with you almost anywhere you go.

* Other jobs may have diminished appeal after being a doctor, somehow lacking in relevance.

* You have a wide range of options within medicine itself, so careers can develop in different directions at different stages.

When I have had the opportunity to say all this, my young doctor wannabe may look quite thoughtful or even apprehensive. Many tell me that they never realised there was a dark side to being a doctor. I refer them to other sources, websites and blogs, and wish them all the best of luck.

How many have I seen come back to me as qualified doctors? I’m still waiting …

But I know of one who became a water-sanitation engineer. In terms of “saving lives” and “making a difference” he probably has the edge on all of us!