John Talley and Orlantha Whitehair have known for years that they wanted to be doctors.
They want to spend their lives helping others. They especially want to help the disadvantaged. They are enthralled by all the discovery going on in medical science and the promise it holds for earlier diagnosis and treatment of disease.
They know about the negatives: long hours, interference from health care bureaucracies, the debt of up to $100,000 that they will have to pay back after they finish training.
Their greatest concern, however, is to not be so obsessed with their careers that they have no time for themselves and their families. They want, in other words, to have a life.
"I have a concern that my wife (Denise) and I aren't going to see each other very much" said Talley, 24, who will start medical school at the University of Arizona on July 28. "Although medicine is very important to me, my wife is more important than that, and I'm not going to sacrifice our marriage for medicine."
Whitehair, 24, who also will start medical school this month, has the same concern. Her Navajo culture is important to her, and she wants it to be important to her 3-year-old daughter, Taliah. That means not just time at home in Tucson, but visits with grandparents on the reservation in Northern Arizona.
"That's how my parents raised me, and that's very important to me," Whitehair said.
Talley and Whitehair symbolize a trend, according to the Association of American Medical Colleges. Applications to the nation's 126 medical schools dropped more than 10 percent from 37,402 in 1992 to 33,625 in 2002, according to the association. While that appears to be reversing, the association is still concerned and has begun a national survey to find out what's keeping young people out of medical school.
The association already has talked to groups of young people, some of whom wanted to go to medical school but changed their minds.
"They're saying they don't want to have to totally devote their lives to work," said Richard Sabalis, the group's associate vice president for student affairs. "I think this new generation values family life and they don't want to have to work 90 hours a week. I'm not going to say that's an unhealthy thing."
UA medical school officials also have seen about a 20 percent drop in applicants, from the 527 students whose applications were considered in 1995 to 429 this year, said Dr. Chris Leadem, senior associate dean of admissions and student affairs. This year's medical school graduates leaned heavily toward specialties such as dermatology and radiology, where doctors have more control over their hours, Leadem said.
Thirty-six percent of this year's graduates went into primary care fields - family practice, internal medicine, pediatrics and obstetrics-gynecology - in which physicians tend to give up more time to their practices, Leadem said.
Nancy Stiller, coordinator of the UA's pre-health professions advising center, said personal-time concerns have come up often during the four years she has counseled pre-med students.
"I think one of the challenges they are most concerned with is being able to balance their personal and professional lives," Stiller said. "They're concerned about managed care issues, patient loads, all the current issues in medicine. But my experience is those don't stop them from wanting to be physicians.
"If they undergo a change in career plans, it's because they are concerned they won't be able to have a family and be a competent physician at the same time."
Despite the drawbacks, Whitehair and Talley are determined to pursue their dreams.
Whitehair, who grew up in Page on the Arizona-Utah border, originally had dreams of becoming a pro softball player. Her direction changed during her sophomore year in high school when she injured her knee playing basketball. She had to be taken to Flagstaff, because there were no orthopedic surgeons, and no MRI scanners, in Page.
"Flagstaff is just ever so much more advanced," Whitehair said last week. While she has not decided on a specialty, she is sure she will practice medicine in a rural area, and be an advocate for better care for people who are underserved.
"One option would be to work in Page and deal with the rural health issues from there," she said. "If not there, then somewhere on the reservation."
Talley has wanted to be a doctor since he was a kid, growing up in Parker on the Arizona-California border. The son of a nurse, he spent summers during his UA undergraduate years observing his family's physician in Parker, volunteering in Tucson hospitals, and working a couple of summers as a "medic" at a boys' camp in upstate New York.
Talley also would like to work in an underserved area, in a field that puts him close to patients. He said he likes the hands-on aspect of surgery, "but I don't want to lose the interaction with patients, and I think you get more of that in family practice and some other specialties."
Doctors' working conditions and their quest for a better lifestyle are more of a concern given the shortages of physicians in Arizona and other states.
"I'm calling you on my cell phone on my way to a hospital to do an appendectomy at 5 o'clock, so I probably won't get home until after 7 o'clock. And I've been working since 6 this morning," Dr. Jeff Singer, a Phoenix general surgeon, said one afternoon last week.
Singer authored a study two years ago for the Goldwater Institute, which showed Arizona's physician work force was well below the national standard. "The recommendation is 195 doctors per 100,000 people, and we're well below that, around 182," Singer said. Rising malpractice premiums, longer hours, lower pay - "People are saying for these kinds of hours and this kind of compensation, I'm not getting enough quality of life. I'm not going to do this," Singer said.
But Talley and Whitehair will.
Talley said he has talked to doctors who have made it through medical school with their marriages intact.
"Their advice is: Communicate, make an effort to coordinate schedules, dedicate a specific amount of time each week to be together. So that's what we plan to do."
--Contact reporter Jane Erikson at 573-4118 or at firstname.lastname@example.org.