Despite the assaults on medical dominance, becoming a doctor remains an at- tractive option that offers prestige, the emotional rewards of service, and high incomes. Although applications to medical school declined steadily from 1996 to 2003, they have climbed by 25% since then, perhaps because those who grew up during and after the recession have sought “safe” careers or because physician salaries have continued to grow faster than inflation. In this section, we look at how doctors in training learn both medical knowledge and medical values, and consider the con- sequences of this training for both doctors and patients.

The Structure of Medical Education

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Becoming a doctor is not easy. Prospective doctors first must earn a bachelor’s degree and then complete four years of training at a medical school. Before they can enter practice, however, and depending on their chosen specialty, they must

spend another three to eight years as residents, doctors who continue their train- ing while working in hospitals. (The term intern, referring to the first year of a residency, is no longer commonly used.) As a result, most physicians don’t enter practice until age 30.

For around 74% of students, going to medical school means going into debt. The median debt is $190,000, not including undergraduate debts. Debt levels have increased substantially over the last 25 years in response to substantial increases in tuition fees.

Becoming a doctor also carries tremendous time costs. Regulations first ad- opted after the 1989 death of a patient treated by exhausted residents now limit first-year residents to working “only” 16 hours per day; second-year residents can still work 24-hour shifts every three days. Even after graduation, doctors typically work long hours. These time pressures, coupled with the financial pressures of training, encourage novice doctors to defer marriage, children, and other personal pursuits and to choose specialties requiring less training over those they otherwise might prefer.

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