I don’t read much anymore but recently I read a book called Half the Sky.  Lying safe in bed waiting for my boyfriend to come home I read about girls and women who are ritualistically raped as part of a marriage proposal. I read about clinics where women routinely seek two things: abortions and AIDS treatment. In the doctor’s tool kit are 1) a crude hook and 2) what can only be described as magic charms.  I don’t see patients like that. I spend my days doing what any other pair of scrubs would have done in my place. Am I really helping anyone? And if not is it because I am in debt?

The conclusion I came to is a difficult one.

The Leviathan that is our healthcare/medical education/insurance system is a complex maze with seemingly no solution. Stripping away the bullshit however with a simple thought experiment: If I didn’t exist do my patients receive care? Unfortunately for my own feelings of self-worth the answer is yes. Someone else would have taken my spot in med school and that would have had a trickle down effect until some poor schmuck on the bubble gets into medical school who otherwise would not have. Even if I do the minus one routine…every intern, resident, attending etc. Has been understaffed before.

Now let’s go the other route. Say I go to Africa and treat women who look just like me. Every single patient is someone I  helped. Or saved.

Now how does debt factor in? If you’ve read my earlier posts you know that I am guilty of using debt as an excuse to not even give small increments of my time to helping those outside of the normal hospital flow (middle class insured) and of course I am tempted to do the same here.

Benito always says that loans hold some our best and brightest back, preventing them from taking certain jobs and making the difference they otherwise would make. That’s the reason he started this blog. But looking closer, in this particular situation, I find the opposite is true.

If you have no debt you are essentially trading a comfortable existence for the opportunity to help people who would otherwise go without. You’re trading fancy cars, swanky vacations, trophy spouses and kudos from people society says matters.

However, if you have debt, the best you can do is hope by the time any future children are 18 you can pay for their undergrad and medical education and live vicariously through them. You will have the same station wagon, underwater mortgage and credit card debt as your neighbor whose job involves the words “analyst” and “cubicle” and the phrase “9-5.” He will look at you quizzically often unless he assumes you’re just very frugal.  Essentially you will be working for the loan companies ultimately repaying over twice what you borrowed while the stress prevents you from achieving the outer limit of your potential which is where of course doctors find the discoveries that take the whole world forward.

On that note let me say that I am in no way suggesting that the average doctor doesn’t help people. As we shed the shell of residency and develop as individual doctors we touch the lives of people and family where it matters most. There are even times when a lowly intern such as myself either with a kind word or a keen eye does something that “the next pair of scrubs” wouldn’t have done. I am making generalizations here. Plus Doctors don’t need my testimony. One has only to listen to the chorus of patients.

What I am saying though is that doctors with significant debt like me have less to lose financially by saying to hell with it all, finding a village, and working there for ten years or twenty years or a lifetime. Sallie Mae can’t reach you where there are no phones. The specter of loans back home might even get doctors who otherwise might quit to stay the course.

I refuse to come to a different conclusion despite the hard truth that I will not follow my own advice. I will not rationalize my decision or cite love of family, country or boyfriend. The truth is I am just not strong enough.