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Every year you spend in med school and residency training you gain more and more insight into what it means to have a career as a physician. And the longer you’re out of school, the clearer perspective you gain on what would have helped you better prepare for your professional life when you were still a student or resident.

“I think it’s true that many doctors have things they wish they had known about the job coming out of med school,” said Thomas Strobel, MD, a pediatric gastroenterologist in Nashville, Tennessee.

We reached out to several physicians to hear what they wished they had known as med students and what they learned on the job. We’ve assembled some of their advice here for lessons you won’t necessarily get in school.

The ‘Real’ Education Starts After Graduation

After 4 years of med school, the idea that your physician training is only now about to start can be a daunting prospect. But it holds true for whatever path you choose.

“For people who want to be clinicians, the real ‘training’ begins after finishing medical school,” Strobel said. “I think many people realize this more near the end of medical school after they’ve already committed to a specialty.”

He added that as you narrow your career choices, it’s critical to consider the lifestyle you are willing to live when you pick your specialty.

“Recognize that most specialties will require real sacrifices for your time and energy and consider how much of that you are willing to make,” he said. “While the residency training is short-lived, really consider what life will look like after training and seek advice from others who have worked in the specialty for a few years.”

Martina Murphy, MD, senior associate dean of graduate medical education at the University of Florida College of Medicine, Gainesville, Florida, agreed that some of the most important lessons you’ll learn about being a physician are ahead of you.

“Medical education is excellent at teaching the science of medicine, but there are many aspects of the profession — business, leadership, communication, and work-life balance — that are often learned on the job,” she said. “Many physicians, including myself, find that navigating the nonclinical elements of medicine is just as important as mastering the clinical ones.”

The Only Constant Is Change

As much as scientists may value predictability, the world of medicine is nevertheless one of changing circumstances and unexpected developments. Sometimes you can see change coming over the horizon but not always. You will often have to approach things differently when moving to a new institution, adopting new diagnostic and treatment methods, responding to new guidelines, and so on.

“Medical school did not prepare me for how much the practice could change over time,” said Helmi Lutsep, MD, a neurologist and stroke specialist with Oregon Health & Science University, Portland, Oregon. “In neurology, for example, not many diagnoses were associated with a sense of urgency when I trained, since there were few acute treatments.”

Now, however, Lutsep said they have to respond urgently to treat strokes and other diseases.

“I’d advise medical students not to worry too much about what the specifics of a practice might look like, since they may change or may be addressed differently at different institutions,” she said.

And the best way to navigate a changing landscape is to be as adaptable as possible, Murphy said. “While I couldn’t have predicted my exact career path, staying open-minded to new opportunities allowed me to grow in ways I never anticipated,” she said. “Some of the most fulfilling aspects of my career, like my focus on GME [graduate medical education] leadership, workforce development, and healthcare communication, emerged because I was willing to adapt rather than rigidly follow a set plan.”

Medicine, she said, is a constantly evolving field, and “I’ve found that success comes from being flexible, embracing challenges, and recognizing opportunities as they arise.”

You’re Always On the Job

Not really, of course, but once you leave med school, you’ll never not be a doctor. On a plane, at a family reunion…the setting and the timing won’t always matter. That can be a great gift to those around you, but it’s a responsibility that you should brace for now.

“A challenge of the field that was not covered in medical school is that you are a physician 24/7, whether it is to others in the medical field, your family, or community,” Lutsep said. “You will be called upon for advice or help at unexpected times, such as on a flight during a medical emergency or on vacation. Knowing this would not have deterred me from the field but the demands took a little while to sink in.”

You Need to Focus on Finances

The jump in income many doctors experience when they move on from their residency or fellowship training can be both a welcome reward and a brand-new challenge to manage.

“Unless you have a background in finance, most doctors learn that they really need to seek opportunities to be more financially literate,” Strobel said. “I try to take every opportunity I can to go to a financial planning meeting for physicians whenever I see one advertised.”

He added that many doctors rely on close family members and friends who have more experience in financial planning and investing. But it’s even more important to learn some of those skills yourself — and sooner rather than later — so that you can start your career from a place of financial confidence and stability.

“Paying a professional to help you once your income rises isn’t a bad idea either,” Strobel said. “While being a doctor can be financially rewarding, the reward takes years to be realized and learning how to save money and be financially responsible early on can pay off in the future once you start independent practice.”

Comparing Yourself to Your Peers Is a Waste of Time

When you’re surrounded by brilliant, hard-working med students and residents, it can be hard not to let doubts about yourself creep in once in a while. You may want to think of this time as more communal than competitive, but that’s sometimes a tough assignment.

“We should avoid worrying about what other people know or care about,” Strobel said. “But that’s much easier said than done. The medical training is so demanding physically and mentally, that it’s really important to focus on the things that matter. I think that comparing yourself to others instead of focusing on things that will make you a better physician/family member/friend is generally a waste of energy.”

Along those lines, the more you can embrace collegiality and teamwork and model those traits to your colleagues, the more fulfilled you may be down the road.

“Success in medicine depends not just on clinical expertise but on how well we collaborate, delegate, and support those around us,” Murphy said. “If I had recognized the importance of leadership development and team dynamics earlier, I would have sought more formal training in these areas much sooner.”

The meaning of success also depends on how each person defines it, Murphy said.

“One of the biggest lessons I’ve learned is that success is deeply personal,” she said. “It’s not about checking off traditional milestones but about finding fulfillment in the work you do.”

Some physicians thrive in academic medicine, others in private practice, public health, policy, or industry. There’s no single right path, Murphy said, “and that’s something I wish I had understood earlier. It’s okay for your goals to change, and it’s okay if your version of success doesn’t look like someone else’s.”