As I was visiting my beautiful undergraduate alma mater now 10 years after graduation, I had a flashback to spending hours of my time in the library sitting by the window jealously overlooking the carefree non-pre-med students, as I was busy cramming for my organic chemistry exam.‌ Now that I have completed medical school and I am exactly halfway done with residency, I can reflect on my experience and confess that a career in medicine is not exactly how I pictured it. Here are some truths that I wish someone had told me prior to starting my medical career.

Training is Long and Difficult

When I was an undergraduate studying for my MCAT I wanted nothing more than to get into a medical school. In my mind once that hurdle was achieved it would be smooth. Of course, getting into medical school is difficult. It is true that most people do not fail or drop out of their training programs, but there is a whole lot of self-sacrifice along the way. It is important to stress to anyone considering this career that medical school is four years of long hours of studying with the clinical years marred with long hours in the hospital in addition to this studying. I certainly was not thinking of residency when I was applying to medical school. In residency you are now older, and you still do not have complete autonomy of where you live or your schedule. Now you are working even longer hours. Fellowships are becoming more and more popular which means extra years of training, more time spent in a location possibly far from family and grueling work schedules. If you add up all that time in training, you can be spending around 10 years working 60-80 hours a week. I believe medical training should be long and should not be easy, but anyone going into a medical program needs to know that the journey only begins once one enters medical school.

Scores Matter

Medicine is both an art and a science, however, when it comes to influencing a career, standardized tests still have a major role, particularly USMLE step 1. Programs are starting to be more well-rounded and consider other aspects of candidates, but it would be a disservice not to mention that this test is likely the most important standardized test in a medical career and it follows physicians far, even to fellowship. Having said that, not doing well is not career ending and people bounce back, even from failure. Also, even though this test is important I would not sacrifice other invaluable learning opportunities particularly clinical experience to study for the test as the designated study time most medical schools provide and a thorough study plan is all you need.

Patients Aren't Always Grateful

I always wanted to be a doctor to "help people" and that has not changed, however, my expectations of patients' interactions have. As a physician you see people at their most vulnerable state and often you are not catching them at their best, which means that you may not receive the gratitude you think you deserve. Furthermore, medicine is now often reimbursed based on patient satisfaction, which is sometimes an unfair evaluation of physicians' work. Patient's desires sometimes clash with medical judgment, for example with opioid prescriptions or unnecessary testing. Managing patient's expectations and wishes while still being a good physician is something that takes time to master and is one of the most difficult parts of the job.

Loans are Real

Medical school loans are not the sexy part of medicine, but they are very real, and you will have to pay them back once you are done with training. Thus, when deciding on what medical school to attend, consider the price tag. Once the decision has been made, start saving early. Do not forget about your finances just because you are in medical school. I had friends in medical school that took out more loans to accommodate a lifestyle that they had when they were working, and their debt ballooned. Perhaps meet with a financial advisor and come up with a financial plan for medical school and residency. It is never too early to start saving and planning!

Don't underestimate the importance of a support network

Medical school and residency are challenging and having a support network is key for your sanity. This may mean choosing a program that is near family or friends or at least factoring that into your decision making. Also, it is very important to carve out time for yourself and your hobbies. I think making time for family, friends, and interests is the key to limiting burn out.

There is not Just One Path

One of the most wonderful things about a career in medicine is the many opportunities it opens for you. Most students and applicants are aware of the standard path. The standard path is undergraduate, medical school, residency, and then becoming an attending. Now there are many nontraditional paths, such as utilizing a second postgraduate degree, be it a degree in public health, science or in business. Beyond that, one can take time off during training and still have a meaningful career in medicine, even if it is not exactly what they originally expected. Even within one specialty, how doctors decide to allocate their time differs widely. Talking to many physicians about their careers and how they spend their time is a great way for young physicians to think about how they want their own career to look like.

Lifetime of Learning

The learning and the studying do not end with passing organic chemistry or even your Step 1 exam. Doctors need to continue to study throughout residency, fellowship, and their entire careers. Medicine is always changing and what is true today may be considered archaic in just a few years. Of course, some might find this tedious, but I think most that are attracted to medicine will find this to be a great attribute as being intellectually engaged makes a career in medicine to be extremely fulfilling.

Ten years after that organic chemistry exam, would I still choose medicine? Absolutely! Even though it is not exactly what I expected—my career is rewarding, challenging and exciting.

Maria Barsky graduated from Darmouth College in 2012 with a BA in Neuroscience. She spent a gap year as a research coordinator at the Massachusetts General Hospital before going on to earn her MD from UC Irvine in 2017. She is currently an internal medicine resident physician at UC San Diego.