Physicians commit an immense amount of time, money and energy into their training. The typical physician attends 4 years of postgraduate school, followed by an apprenticeship of 3-8 years. The cost of the time alone is tremendous, but when factoring in tuition, lost wages, taxes, and interest; the break even point can be well into a physician’s 40’s or 50’s. Is it any wonder that physicians have a certain attitude of entitlement when it comes to wages; or panic, anxiety, and occupational dissatisfaction in an increasingly unstable medical economy? These concerns are perfectly reasonable from the perspective of psychology, but not economics.
Courses in economics or finance are not required of physicians and thus few understand the concept of sunk costs. When faced with a career decision today, past educational expenses are irrelevant. Framing effects and loss aversion are two important behavioral economics concepts that trick smart physicians into making stupid career decisions. For example, they may not choose to pursue a dream outside of medicine because all the work they put into becoming a physician would be “lost”. What sunk costs demonstrate is that time and energy are already lost, in any moment an individual should be mindful of their best choice.
The value of education is immense and arguably the greatest investment one can make in themselves. However, the 30 year liability of school loans is a very concrete anchor. This anchor may negatively bias physicians’ future career decisions, and it is unfortunate when an unhappy physician feels compelled to keep a higher paying job to recuperate sunk costs.
While interviewing medical schools I met a Neurologist dying from ALS (of course he specialized in neuromuscular disorders during his career). While gasping for air on his Passy-Muir valve, his advice to me was to choose a career and never complain about that choice. This sage’s paternalistic expression of agonal energy and choice not to be bitter, left an impression we can all learn from.
Undergraduate students need to understand the concept of sunk costs as well as the cognitive dissonance that burdensome student loan debt creates. If only to have increased awareness of the system and its pitfalls when loved ones become sick the value of a medical education is tremendous. A young physician is owed nothing by society, the risk they have taken in becoming a physician is entirely their own. From a temporal perspective, students need to structure the value of their education well beyond the fiscal liability of their student loans. They need to understand that the time and energy spent in achieving that education can never be recovered. Ultimately, happiness and career satisfaction is entirely within their personal control.