In June, I suggested in this memo that healthcare costs might not be as high if insurance company executives didn't have multimillion-dollar compensation packages. Robert Whelan, a resident who finished his training at Wake Forest University in June, e-mailed me with his own perspective on the costs of healthcare and what's in it for young physicians. I'd like to share those thoughts with you.

"In medical school I spent easily 80 hours/wk in classes or studying. I completed a preliminary year in general surgery the year before the 80 hour/wk work rule took effect. Not one week had less than 120 hours of hospital responsibilities; most were between 125 and 135 hours. Our general surgery residency program boasted a 100 percent divorce rate among its residents before graduation. The three years of my anesthesiology residency has required approximately 80 hours a week of hospital and homework.

"As I graduate, I have approximately $170,000 in student debt from my medical school training alone. Before attending medical school, I worked full time and had nearly completed my MBA. That business background gives me a clear appreciation of what a different financial situation I'd be in now had I applied 80 to 90 hours a week over the last eight years to a career in health care administration.

"While I do not regret my choices, it will be increasingly difficult to expect talented individuals to make this sacrifice in the future, especially given the financial uncertainties that accompany life as a physician."

Many experts predict a shortage of physicians by 2020; judging by recruiting efforts, there's already one in primary care. So Dr. Whelan's fears may certainly prove true. Yet in 2004 we asked doctors—the people who know exactly what practicing in today's climate entails—whether they'd recommend the profession to their children. Six in 10 said Yes. The American people can only hope that fathers and mothers continue to hold medicine out as a worthy—and worthwhile—profession. And that their children listen to them.