At the beginning of his career, this now-retired physician found that choosing a career in primary care held the same stigma that many trainees still face today. But with the blessing of an uncle whom he admired, Dr. Rawlings did choose primary care, and if he had it to do all over again, he wouldn’t change a thing.
By William Rawlings, M.D.
A recent piece in the New York Times
reminded me of how I chose my life’s course. It was a review of an article in Science
titled “Why You Won’t Be the Person You Expect to Be.” In surveying more than 19,000 people, the authors found “young people, middle-aged people, and older people all believed they had changed a lot in the past but would change relatively little in the future. People, it seems, regard the present as a watershed moment at which they have finally become the person they will be for the rest of their lives.”
How foolish we can be. If, in fact, we knew at any given time who we would become, or even better, who we were at the moment, we could make precise decisions about our future. Life would be less challenging, and such things as job dissatisfaction and marital discord nearly non-existent. Looking back on our careers, it is often easy to discern that we made the most important decisions of our lives based on what we thought we knew at the moment, realizing only later that the projections for our future were well intentioned, but quite misdirected. If not for the advice of a wise uncle, I would have made the same mistake.
I entered medical school all but certain that I would find my future on the cutting edge of medical science. I had done well academically and secured a coveted spot in an academic Internal Medicine residency program in the Northeast. I had little doubt that in a few years I’d find success and happiness in medical academia, or alternatively, a well-funded lifestyle in a prestigious private practice. I applied for and was accepted to the intuition’s nationally renowned cardiology fellowship program. My future success and happiness were assured. Or so I thought.
The letter of acceptance had demanded immediate acknowledgment of my commitment. Slots were limited and there was a long list of alternate candidates. But something—I didn’t know what—was just not right. I put the letter to one side. A week passed. After a particularly long night in the ICU, I was rousted out of a sound sleep in the residents’ lounge at 7 a.m. one morning by the chairman of cardiology himself, demanding my answer. This was a gift, he said, an honor to be chosen from the many applicants. Did I want it or not? Bleary-eyed, I begged him to give me until the following Monday, four days away.
Within hours I had booked a flight home, desperately seeking advice as to which fork of the road I should take.
I spent the weekend in my small rural hometown, talking to people I knew and who knew me. Most of the time I didn’t mention the momentous decision I had to make. I ran dozens of scenarios through my mind, fearful and at times ashamed of the thought of leaving the womb of academia and the big city. The university hospital I’d just left consistently produced renowned graduates—chairmen of departments and those destined to achieve medical breakthroughs. The unspoken mindset was that primary care was left for those who couldn’t otherwise make the cut, the losers, as it were, on the pyramid of career advancement. Like most people, I suppose I believed that a great deal of personal change had led me to where I was at that moment – feeling at home outside my rural town in an academic medical center in the big city – but I didn’t imagine I could be happy elsewhere because I didn’t imagine I’d change any more.
I spent a long afternoon with my uncle. A highly educated and erudite man, he himself had almost been seduced years before by the lure of the big city, but chose instead to return home to pursue a rewarding, but simpler, lifestyle. We rode about in his pickup, looking at the pine trees and the river swamp, periods of intense conversation interspersed with periods of silence. I don’t recall his precise words, except to say—as we viewed the remains of an old wooden bridge that once spanned the river—his advice about “burning bridges.” The essence of his conversation went something like this, “You’re a smart fellow, William, and you’ll be successful at whatever you choose to do—I have no doubt. Yet neither you nor I know what the future holds, what twists and turns your life will take, or the person you’ll become in a few years. You are afraid to leave the comfort of the referral medical center, afraid of professional isolation, of loss of your intellectual edge, of settling for a career that seems to represent something less than your full potential. Accept your cardiology fellowship if you will, but recall that in doing so, you’ll be narrowing your options, and burning bridges that can perhaps lead you to a fuller life beyond just your skills in medicine. If I were you, I’d come home and just try it for a while. See how things work out. I think you’ll be surprised.”
So I did. I turned down the fellowship offer, much to the chagrin of those who had been my mentors. All I’d needed was for someone to tell me it was okay. A year later I was in practice with a mixed medical group, learning and relearning the basics of primary care in a small town. Years passed, and to my half-surprise, I found that I was neither professionally isolated nor living in penury. I soon had a clinical appointment on a medical school faculty and turned out a number of academic articles in peer-reviewed journals over the following years.
Looking back, if I had the opportunity to restructure my life, I’d do it all the same way. Over the years, my patients have become my friends, and life—in its many facets—has been good. Now that I am near retirement, the best retrospective endorsement of my decision comes from those who were once peers in training, and who chose the “correct” path of sub-specialty training and/or academic life. One of them told me not long ago, “I thought you were pretty crazy, doing what you did, but now I wish I’d done the same thing. Guess you never know how life’s gonna turn out.” “Yeah,” I said, agreeing with him. “You never know.”
William Rawlings, M.D., M.S.H., F.A.C.P., lives in Sandersville, Georgia, where he is semi-retired from the practice of internal medicine. He is the author of five novels, with a non-fiction book on the crash of the cotton economy in Georgia in the 1920s forthcoming in early 2013. Dr. Rawlings attended Emory and Tulane Universities. He completed his post-graduate training at the Johns Hopkins Hospital.