Blog Post Focus
This blog post will discuss golden handcuffs as relating to a medical student. Golden handcuffs are those things that tie us to a certain life or situation because it is expected to be a greater payoff than other options. Medicine can be a very rewarding field, but it can also feel like one is trapped practicing medicine due to a mix of debt and delayed income and a skill set that does not translate.
Background—The Golden Handcuffs of Medical Education
Golden Handcuffs refer to financial incentives to keep course. For the medical student, golden handcuffs refer to the expected high income and benefits of an attending physician. These benefits and high income as a physician only can be attained by someone who completes their medical education. So, one is chained to medical education in order to attain a high income with good benefits.
Personal Experience
I really enjoyed the pre-clinical years of medical education. However, I did not care for the clinical years. In fact, as each rotation went by and I did not experience any specialty particularly favorably I got worried. I got worried that despite all my preparation for medical school and all that I did that had assured me that being a physician was a good fit for me was wrong. I worried that I would in fact not enjoy being a physician and that all this time and effort and money were wasted.
More Aware of the Costs of Medical Education
This fear made me even more painfully aware of the sunk costs of my education. I could have started a job right after undergraduate education. Instead of earning money, I was getting deeper and deeper into debt each year of medicine. Plus, these skills were not transferrable.
Non-transferrable Skills
Without a degree in medicine I could not practice medicine, but medical school did not make me an attractive employee for any other job for any other reason. Even upon completion of medical school with a medical degree few options really existed and none that seemed financially reasonable. Later on as attending physicians our very specialized skill set, while important and potentially life-altering, can really only be used in medicine. Some fields in medicine overlap certain patients, but have limited mobility within the health profession.
A Legacy of Debt
Medical school is very expensive and require most matriculants to take on high debt to get through medical school. These expenses and debts are commonly reported to be okay because the endgame of high income will overcome the debts. Those who have gone through it already get numb to the challenges of those going through the system and expect others to need to suffer as they did. Those outside of medicine who do not understand the struggle see the delayed payoff as reasonable.
My Golden Handcuffs
By the time I finished my clinical years I really was worried that I would not be happy as a physician as few experiences were anything like I had hoped them to be. At this point I had enough debt that it seemed unreasonable to try to pay it off doing something else. It felt like I had to finish medical school – and then residency – to become an attending simply to pay for the decision to go to medical school.
Luckily, I eventually found a specialty I enjoy. Not everyone is so fortunate.
Others Start to Think of Golden Handcuffs Too
Many medical students expressed the same thoughts during medical school. They felt at some point in their medical education that whether they would be happy or not they had to continue as a physician – the debts precluded any other option. Some matched into specialties that were not their first choice.
Worse, some did not match. Working in a career that was not your first choice can be difficult. Not matching is a nightmare—not just golden handcuffs, but golden handcuffs with a longer chain necessitating another year without payments, of building debt, and of trying again next year without a guaranteed job to pay off ever-increasing debts.
Being a physician can be a great thing. However, when it feels like it is the only option, then it can lose its luster. If one is not practicing their desired specialty, it can be unpleasant. Spending all the time and effort and money and then not even becoming a physician is a real shame.
Concluding Thoughts—The Current System Generally Requires Debt and Delayed Earnings
Golden handcuffs in medical school refer to taking on debt to attend medical school and requiring then to become an attending physician to realistically pay off that debt. It is the idea that the great opportunity to become a physician—a position relatively well-respected and with a relatively high income–is also a burden.
If you liked this post and want to see another perspective, checkout the following post by The Darwinian Doctor about Golden Handcuffs.