Self-employed private physicians who charge a fee for each patient visit are the foundation of medical practice in the United States. Most physicians have a contract relationship with one or more hospitals in the community. They send their patients to this hospital, which usually charges patients according to the number of days they stay and the facilities (operating room, tests, medicines that they use). Some hospitals belong to a city, a state or, in the case of veteran’s hospitals, a federal government agency. Others are operated by religious orders (教会) or other non-profit groups.

Some medical doctors are on salary. Salaried physicians may work as hospital staff members, or residents, who are often still in training. They may teach in medical schools, be hired by corporations to care for their workers or work for the federal government’s Public Health Service.

Physicians are among the best paid professionals in the United States. In the 1980s, it was not uncommon for medical doctors to earn incomes of more than $ 100,000 a year. Specialists, particularly surgeons, might earn several times that amount. Physicians list many reasons why they deserve to be so well rewarded for their work. One reason is the long and expensive preparation required to become a physician in the United States. Most would-be physicians first attend college for four years, which can cost nearly $ 20,000 a year at one of the best private institutions. Prospective physicians then attend medical school for four years. Tuition alone can exceed $ 10,000 a year. By the time they have obtained their medical degrees, many young physicians are deeply in debt. They still face three to five years of residency (实习阶段) in a hospital, the first year as an apprentice physician. The hours are long and the pay is relatively low.

Setting up a medical practice is expensive, too. Sometimes several physicians will decide to establish a group practice, so they can share the expense of maintaining an office and buying equipment. These physicians also take care of each other’s patients in emergencies.

Physicians work long hours and must accept a great deal of responsibility. Many medical procedures, even quite routine ones, involve risk. It is understandable that physicians want to be well rewarded for making decisions which can mean the difference between life and death.

I walked into my adviser’s office, filled up with disappointment and confusion. The recent career workshop where I was given advice about following my dream didn’t work for me again.

To become a professor of biology had been my dream for 22 years. However, after about 4 years in a program, I decided I did not want to go after a career in research after all. I began to attend career workshops, hoping they would have the magical answers I needed, but without success.

Finally, I went to my adviser. After listening to my declaim, he calmly told me that instead of focusing on finding a dream job, I should think about what I was good at and what made me happy at least 80% of the time. He assured me there was seldom a perfect job and every job had its ugly bits. He also said it was important to find a job I was good at.

I was relieved to finally have helpful and practical advice. But I discovered that finding common ground between what I liked and what I was good at was not easy. I loved diving, but the physical demands were challenging. I was good at teaching, as evidenced by my friends before and favorable reviews when I was a teaching assistant, but I didn’t like repeating the same content every year. Through my teaching experience, however, I also learned that I loved telling stories about science. Maybe science communication would offer what I was looking for.

To test the waters, during my “spare time” I started a blog about the history of scientific discoveries. I found that I loved the freedom to choose what to write about. As for whether I was any good at it, the signs were promising. My writing got noticed, eventually by people at my institution, and I was given chances to write press releases and stories for the university’s news office. After 3 years of writing, I was offered a position as a science writer. It was nothing like my childhood dream. But I was happy—more than 80% of the time.