To these bright and nervous young people, with large debts from medical school loans, worrying about finances as they ponder buying a home or raising a family, weighing an offer in hand from a top private practice, what can I say to get them to cast their vote for the laboratory, notwithstanding 10% paylines, an uncertain future, and profit and loss statements from the chair of medicine that will be marked with red ink?
How do I fill help fill in the blank of Carville’s famous remark to help them sort out their thinking?
“It’s the _________, stupid?”
I will suggest three words from my own experience to help crystallize their thinking about research: challenge, opportunity, and excitement. Of these, I would rate challenge the highest. Although every undertaking in medicine is a great challenge, I think that the creation of important new knowledge—the kind that will transform thinking and have an impact on practice—comes with the biggest rewards and the biggest risks. The ascent to the top of research is steep and arduous and, as often as not, winds up with the person falling off the cliff, stuck in the mud, or lost in a rowboat without a paddle.
On the other hand, trying to find new knowledge also comes with wonderful rewards. Although some of these rewards are very public, like the Lasker and Nobel Prizes, most are personal and private. I do not holler, “Eureka!” I hear it in my head. Unfortunately, reviewers, editors, and study sections all too often could not recognize a eureka moment if it smacked them in the face. What do these so-called experts know, anyway?
Opportunity in science is also very bright and a reason to choose research. Opportunity, however, is a terra incognita filled with swamps, quicksand, high mountains, driving storms, and harsh wind. So, too, was the American West. Exploring new lands is never easy, but it is exciting trying to be a pioneer. It gives a jolt to the soul and makes every day truly new and invigorating.
Challenge, opportunity, and excitement. Each is a fine way to fill in Carville’s blank. It’s not nice to call anyone stupid, but it does get attention.
I will end with the words of another famous politician, Horace Greeley, who said, “Go West, young man.” Would Greeley have been remembered for saying, “Stay East, young man”? (We live in different times because the medical profession now is filled with men and women. While “Go West, young man or woman,” is not as euphonious as the original, it is more correct today.)
