(FORTUNE Magazine) – As I sit in my office at 8 P.M., nearing the end of a 12-hour shift, seeing snotty noses and sewing up lacerations, I reflect on your answer to a premed student's query about income...." So begins Rolf Naley, a doctor (who also has a master's in health-care administration) in Irving, Texas, about my comments in the Sept. 27 column. I was responding to someone calling him- or herself TO BE OR NOT TO BE who wanted to find "a good career" in medicine based solely on how much it was going to pay. Well, TBNB (and anybody else out there who is pondering--or perhaps romanticizing--a medical career), please keep reading. "If I could have foreseen the changes in the health-care field over the past 15 to 20 years," writes Dr. Naley, "I would not have gone near a medical school. As it is, I make a decent income for terrible hours." How terrible? He has spent one Christmas--count 'em, one--with his family in the past 25 years.

More than one medico pointed out the irony of this little discussion's having started in an issue of the magazine that featured "young dot.com punk multimillionaires with no special training whatsoever, who just happened to show up in the right place at the right time," as one correspondent put it ("The 40 Wealthiest Americans Under 40"). Well, there is that. You could file it under Life Is Unfair. But here is just how unfair it gets: The average debt of a graduating med student is $100,000. A surgeon--which is what our hapless TBNB halfheartedly hopes to become--must go on for at least five but perhaps nine (depending on subspecialty) more years of training, during which she earns the grand sum of $35,000 a year. This works out to about $2 an hour--and the loans aren't paid off yet. In fact, just for all this education, the average surgeon pays off loans of $230,000 over 30 years--kind of like a big mortgage, but with no interest deductions. Writes a pediatrician named Sam: "For many of us, the post-college path consists of anywhere from seven to 15 years of living in rented housing, driving crappy cars, and moonlighting to pay off our debts--all while watching our college friends go on to riches with their business and law degrees."

Med-school debt was no real biggie before so-called managed care (which, as any HMO member well knows, really means managed cost). But now, as one doctor writes, "salaries [for surgeons] are flat or decreasing, and this is presuming nothing goes wrong, e.g., sickness, injury, family tragedy, frivolous malpractice lawsuits...." So why the heck does anybody do it? The same doctor, who asked not to be named here, continues: "The rewards of being a physician go far beyond just income. It is the greatest job in the world, and it is an honor and a privilege. But I do think it is reasonable to at least inquire about income before embarking on a long and difficult journey. It is, after all, a profession and not a hobby or a pastime."

True. Writes a reader named Finbar: "We don't expect lawyers, accountants, consultants, managers, carpenters, or even religious ministers to be 'above' money." And, hey, I'm a little surprised that nobody pointed out one simple fact: Journalists aren't working for free either. But anyway. Adds Finbar: "I want a surgeon who is highly skilled and who has the self-respect to expect appropriate payment--not one who is disillusioned and unmotivated by having spent all those years in training and racked up all those debts, only to be paid less than a Web designer."

Joe Donnelly, a doctor who has researched this question with some care, agrees: "I hope to God the person who operates on me not only loves his work but gets paid for it too. The average new-hire internist gets paid about the same, on a per-hour basis, as a computer programmer with seven years' experience."

Which brings us back to the point I was trying, apparently with some ineptitude, to make: Meticulous readers will have noted that TBNB was trying to choose a good career based entirely on how much dough would likely be forthcoming. In that case, why be a doctor (or for that matter a veterinarian) at all? Why not try, say, Wall Street, where there is a very large bunch of cash floating around at all times, mistakes are never life or death, and you rarely miss Christmas? Those are questions that only TBNB can answer--but then, if I'd said so the first time, I wouldn't have gotten all this fascinating mail, would I?

Next time: more readers' comments on office romances, workplace violence, and what it will take for minority executives to be truly accepted in the corporate world.

Stay well.

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