Whenever I describe my career path to people, they seem a little perplexed. “Journalism to psychiatry?” they say. “How’d that happen?” I admit, it isn’t a common path. Young people have always left journalism, of course. Many get tired of eking out a living as a freelancer and seek something more stable. Some find that they don’t like the grind of constantly producing copy. And then there are those who are talented and thriving but nevertheless seek greener pastures. In my brief time in journalism, I saw two very talented twentysomething colleagues leave for law school and another depart for graduate school and then become a successful fiction writer.
But leaving journalism to enter a scientific field such as medicine is unusual. In fact, if you’d told me in college that several years later I would walk away from a budding career in journalism, I would have been surprised. Like most aspiring journalists, I had always been interested in politics and policy, and I wanted to be in the thick of it. Like many before me, I wrote for my college newspaper and parlayed my clips into internships and finally a post-college job. The job was at Slate. I was very fortunate.
But there was something amiss. I liked my job in many ways, but I was getting tired of covering daily politics. It was the summer of 2001, and I was writing a news-summary column for Slate called “The Week/The Spin.” As this assignment compelled me to write about what was on the front pages, I found myself writing every day about the Chandra Levy-Gary Condit affair, one of those gossipy stories that people in Washington, D.C., occupy themselves with in slow news seasons. I found it draining.
Of course, burnout from the steady stream of dish from inside the Beltway didn’t require that I leave my profession. I could have carved out a new beat for myself. But there was something else going on. I had always been fascinated with folks who have trouble making it in society—with the people who mutter to themselves on the street; with the plucky outcasts in the photos of Diane Arbus; with the neurotic, obsessive narrators of Philip Roth novels; and with everyday people who struggle with grief and anger and trauma and loss.
I also had some personal connections to mental illness and its treatment. My paternal grandmother had been permanently institutionalized with schizophrenia when my father was 7 years old. Although I didn’t know her well, the knowledge that an unfathomable insanity had robbed my father of his mother had a strong effect on me. Moreover, my own experiences in psychotherapy had a profound effect on the way I viewed the world. It allowed me to be more open to new opportunities and to people and provided me with tools that helped me continue to grow, long after the treatment ended. Over time, it made me more flexible and optimistic.
It also made me want to practice the treatment myself. I was 26 years old, and I had been working in journalism for several years. I wasn’t sure I wanted to make a career out of mental health care, but I figured that I would regret it if I didn’t at least explore the option. I started by dipping my toe in the water—I became a weekly volunteer at both a suicide hotline and a homeless shelter. About six months later, I took the plunge. I quit my job at Slate and took a full-time position as a floor worker at the shelter where I had been volunteering. I didn’t have any formal qualifications, but I didn’t really need any: The position paid $10 an hour and didn’t require a college degree.
This position was everything you might expect. I dealt with the mundane—homeless people bickering over plastic folding chairs—to the profound—people withdrawing from heroin on a mattress in a corner, or lying stiff and cold on a bunk bed after morning wake-up, having overdosed the previous night. (You can read a five-day diary I wrote for Slate while working this job.) Of course, the job was tough and caused rapid burnout. After about a year, I managed to secure a position as a case manager at a community mental health clinic. I now had regular working hours and a caseload of patients to follow up with. But I had no formal training in mental health, was making just $12 an hour, and with only a bachelor’s degree in political science, I had hit my career ceiling as a mental-health practitioner.
Ah, the degree. As a job requirement, this was new ground for me. In the world of journalism, degrees are emphasized about as much as clear, jargon-free prose is in medical records. When I was an editorial intern at a magazine in college, recent j-school grads would send in résumés looking to be hired. They thought their degree gave them a leg up, but many editors are disdainful of this academic professionalization of what, to them, is a trade. In journalism, you’re only as good as your clips. In the field of health care, the degree means nearly everything. Degrees determine “scope of practice”—who is allowed to perform which treatments—and who’s the boss of whom in a hospital ward or a clinic.
The medical profession—and doctors love to think of themselves as professionals, never as tradesmen—emphasizes the importance not just of degrees, but of hierarchy. In journalism, a certain combination of talent, hard work, and luck can land you a very good job at a very young age. In a way, that had been my story—I had been hired for a full-time staff job at Slate immediately after leaving college, which was an enviable “get” for a young, ambitious writer. But in health care, no amount of talent and hustle will let you leapfrog the organizational chart. A crack surgical intern is still just an intern, and until he completes his five (or six or seven) years of residency, he will never wield much influence in his field, no matter how precocious he may be.
So, as a social worker at a community mental health clinic, I had a decision to make. I knew that I liked working with the mentally ill. I enjoyed their stories, I felt privileged by the intimacy they granted me, I could sit with their pain, and I felt I had the ability at least to begin to make things better. But, on a clinical level, I needed some real training. I had gotten as far as I was going to get with on-the-job experience, clinical intuition, and my own reading. And on a practical level, I needed some qualifications to put on my résumé.
My choices were a master’s degree in social work, a master’s- or doctoral-level psychology degree, or an M.D. The master’s-level choices didn’t really tempt me. Those degrees were useful for private-practice therapists, but I would be excluded from certain research and administrative career paths. As a former journalist unaccustomed to such hierarchical restrictions, I chafed at this. I didn’t want my degree to limit what I could do with my career.
A psychology Ph.D. or Psy.D. had its appeal, but ultimately I chose the long and winding path—the M.D. I was influenced by many things. For one, my therapist in college had been a psychiatrist, and I held him in high esteem. I also liked the practical bent of medical training. Given the choice between spending five to seven years in a narrowly focused doctoral program, burdened with an esoteric thesis, or spending a similar amount of time learning about treatments for all forms of bodily illness, I preferred the latter. But mostly I knew that much of what interested me about the field of mental health was the interplay between the psyche and the body, between the “science” of psychopharmacology and the “art” of psychotherapy, between the mind and the brain. At the end of the day, psychiatry is the discipline that truly allows one to straddle these multiple ways of looking at a person’s mental suffering.
After several years in social work, I was nearing 30. As an undergraduate, I hadn’t completed any of the science courses needed to apply to medical school. Completing them on a part-time basis at the local university would take several years at best. So I had to do a “post-baccalaureate” pre-med program, essentially going back to college full-time for a year. I then had to apply to med school, which would take another year, assuming I got in on my first attempt. Then four years of med school, followed by four years of residency. I would be close to 40, and more than $200,000 in debt, when I finally started to practice on my own.
I chose to do my post-baccalaureate year at Bennington College in Vermont, a tiny (its undergrad population is around 700), rural school, with an even tinier post-baccalaureate program (five or six students a year) and a good track record of getting its graduates into medical school. The small class size appealed to me, as I didn’t want to spend my “post-bac” year getting lost in a sea of ambitious pre-meds clawing to stay ahead of the grading curve.
But studying at a residential liberal arts college at my age—I was at least five years older than my post-bac classmates and 10 years older than the undergraduates—was an odd experience, to say the least. I lived off-campus, but there wasn’t much going on in little Bennington, and Boston and New York City were both more than three hours away. The first weekend of the fall semester I went to campus to socialize. I found myself in a 10-by-10 cinderblock dorm room sipping wine from a red plastic cup amid a dozen or so undergrads. Suddenly there was a knock on the door. The music stopped, someone said, “Security! Hide your wine, hide your wine!” and people began to stash the alcohol in the closet and the cups under the beds. These Bennington students were a hip and well-dressed bunch, but they were still underage. This theme of being older than my peers (and occasionally older than my mentors) followed me throughout my medical and psychiatric training. It was a bit unsettling at first, but in the long run it is a useful exercise in humility to recognize that just because someone is younger than you doesn’t mean he doesn’t have more experience and knowledge, that he doesn’t have something to teach you.
After a year of chemistry, physics, calculus, and biology, I spent a summer studying for the MCAT, drove back to Seattle, and was accepted at the University of Washington School of Medicine. For me, medical school was largely what I expected—intense and grueling, yet eye-opening and formative. I spent semesters watching hundreds of PowerPoint slides a day, cramming my head full of facts; then weeks on surgery rotations, watching trauma victims get stitched back together, or in pediatric clinics, doing routine well-baby checks; and, ultimately, years absorbing the intricacies of knowing which attending physicians to please or how this type of patient expressed his illness differently from that one. It was exhausting. Although I’m glad I did it, I don’t think I could do it again.
Being a “nontraditional” student—the moniker applied to older med students who have had another career—could be construed as a burden. It’s harder to take a high-stakes multiple-choice science exam every week if you’ve spent your academic life primarily as a writer in the liberal arts, and it’s also harder to do overnight call in your 30s than it is in your 20s.
But being nontraditional gave me a crucial perspective. It is common, for instance, for first-year med students to grumble about how cursed their life is for having to spend so many hours studying, or for third-year students on their clinical clerkships to bemoan their peon status in the chain of command. These students are typically 25 years old and have either never held a job or served for one year as a research assistant after graduating college.
I, on the other hand, had recently left a position where I spent a sizable portion of my time doing paperwork for doctors because my time was not considered as valuable as theirs, where I made $25,000 a year without much hope of earning more, and where I almost never had the opportunity to be formally supervised or to improve my skills. I knew, in other words, that working your ass off in medical school is qualitatively different from working your ass off in a dead-end job. I also knew that being at the bottom of the physician hierarchy is not the same as being at the bottom of the health care hierarchy. The second lieutenant doesn’t spend much time bitching about orders if he was once an enlisted man; he’s just happy he’s an officer.
I’m now about to enter my final year of psychiatric residency at Mount Sinai Hospital in New York City. One thing I can say about the training of psychiatrists is that it is highly inefficient. I estimate that 80 percent of what I learned in pre-med classes and medical school I never use, and never will use, in the practice of psychiatry. But the 20 percent that is useful is crucial. First, because it allows me to think about my patients’ problems in a medical and biological, not just in a psychological, way. And just as important, because it allows me to prescribe medicine safely and effectively. Psychotropic medication may not be appropriate for many patients, but for others it is a vital part of the healing process, and sometimes it can be lifesaving.
My career change has become part of my life story. Like many parts of a life story, it’s something one can grow weary of—or, at least, weary of rehashing at cocktail parties. But it is something I’m awfully proud of. I had many advantages over other career changers. I didn’t have a family to support. I had the ability to borrow money with a decent chance of paying it back. I was young and had energy. Even so, it was a huge sacrifice.
Before you make a similar sacrifice, I would advise a few things. First, know exactly what you’re getting into. For example, don’t go to law school with the vague notion that “it will sharpen my analytical abilities” or “maybe I’ll get involved in politics.” Go because you want to be a lawyer, because representing clients is in your blood, because you dig argument and discovery. Go because you’ve worked in a firm and seen what lawyers do on a daily basis. Once you have a true sense of what the job requires, you can assess whether you have the stomach for its less-elevated aspects. People may gravitate to law school because they like the idea of justice, but to be a successful lawyer, you need to be comfortable with conflict.
Second, do something you not only enjoy doing and have an interest in, but that you think you may have some talent for, by dint of innate ability or life experience. A lot of folks like being around kids, but a successful teacher is likely to have a proven ability to both inspire them and channel their chaotic impulses in productive ways. He knows he has the personality to both motivate students and enforce class discipline—a delicate balancing act that many find impossible. And he has the drive to seek out training that will enhance his ability to improve kids’ lives.
At the start of my career transition, I was interested in the workings of the mind and the brain, but I also knew, from my experiences in life and as a social worker, that I could tolerate and effectively work with the sadness, anxiety, and anger that patients bring into the clinic with them day after day. I also knew I had the drive to complete a long course of medical training, because I truly believed that I could best serve my patients by considering their problems from both psychological and biological perspectives and by offering them both psychotherapy and medication. To be able to use those skills to help patients is something that I find very rewarding, and that has made the past 10 years of my life well worth it.