You’ve got to hand it to the Pakistanis, they learn real quick. With the number of doctors churned out by public and private institutions in Pakistan, everyone seems to know that becoming a doctor might well be your ticket to the class of the rich and the famous. Even though a doctor in Pakistan on an average earns in the middle class category it seems obvious to everyone that all that the doctor needs to do is to migrate to the US and voila that may well be the fast track to the peak of the earnings pyramid in one of the richest countries of the world.

Half a generation ago choices in Pakistan were limited and doctor, lawyer, accountant and architect were about it and if you were a female, teacher was the first and doctor was the last choice. The good and bad thing for the current generation is that there is now an array of career options. In the US it is said that at the undergraduate level over 70 % students change their major at least once in the first two years. Over twenty years ago in the book Future Shock, Alvin Toffler had written about the rate of change in America referring to how fast and changing everything was. Compared to then things are changing now at the speed of light. Additionally the current undergraduate population is part of the fast food generation and instant gratification is all they have come to know as the paradigm. So an internship with a doctor or architect and a measure of personal interest in a particular field may not be enough to clinch that career choice.

The last wave of Muslim immigration to North America in the 60s has been largely that of professionals. And there is something about Medicine that it tends to become familial. It is well recognized that South Asian parents, whether they are themselves doctors or not, feel duty bound to at least produce one child that blooms into a physician and if there is more, all the better.

Physicians do know that Medicine is not what it used to be even till the early 80s. Now there are DRGs (diagnosis related groups) and LOS (length of stay) and capitation, and long gone are the days that doctors could charge what they wished and were paid 100% of that little whim. What an aunt of mine said at the time of my graduation from Dow Medical College Karachi was correct though: a doctor can live respectably anywhere in the world. They still occupy the upper part of the earnings pyramid in the US and a six-figure income is standard. If you are looking for the higher six figures or a seven figure income you are strongly advised to jump ship and paddle the stock market or start a business.

Though a good chunk of one’s life is spent in acquiring medical education for a graduate from a medical or surgical residency may be anywhere from 29-32 years old, the advantage is that there is no need to climb the corporate ladder, once you graduate from a residency or fellowship, you have essentially arrived. Another significant edge that Medicine has over other professions is the fundamental manner in which the physician is able to affect a patient’s life. It is one of the few professions where, because one is affecting people in a major way, work can be a form of worship.

And if clinical medicine does not peak your interest, there is hospital management, research, pharmaceutical sales, the business of medicine and so on.

Knowing that such a large part of one’s life is spent in our professions, it is important for persons to choose what they feel is likely to give them the greatest professional satisfaction. And I still have sharp memories of the endless toil involved in getting to goal. An overarching interest can make the years zip by, coercion or the wrong reasons for studying Medicine, can mean a sort of slow poisoning. And then post-arrival, should one not enjoy it, it can be a process of living and dying on a daily basis.

From the perspective of the student the choice ought to hinge primarily on interest. From the perspective of parents, especially if both parents are physicians and the child gets accustomed to a particular lifestyle, it is incumbent on the parents to guide, and not coerce. “Money can’t buy me love…” goes an old song and though true, must be kept in perspective: radical lifestyle alteration can generate resentment and anger and these in turn can incinerate those idealistic notions of “I want to work in the depths of Africa and help suffering humanity”.

There are very few students and parents that are proactive and selfless enough to think of the needs of the Muslim community. North American Muslims need writers, TV journalists, lawyers and activists. And female Muslim scholars. On July 22, 2004 there was a front page article in the New York Times about the struggle of Muslim women in North America to just get a decent place to pray in the mosques across the land. It detailed the dearth of women on executive councils of mosques and the traditional model of the male elite making all the rules. While the article waxed on about the garages and hallways that women are made to pray in, the Islamic Center of Greater Toledo was mentioned as one of the few mosques in the country where men and women pray in the same hall, with a three-foot high partition between then, and equal space allocation to both.

Muslim women have lived almost a vicarious existence. There are many issues in current day life in which ijtehad or re-interpretation is sorely needed. And needless to say, the perspective of a female scholar will perforce have gender bias and that is definitely required. After 9/11 and especially with Islam now being under the microscope of the West, views about and from Muslim women acquire a certain critical need.

Professional satisfaction or its anticipation should be the primary criterion for selecting a profession. Money, especially when the career of your choice does not rake it in can easily be relegated to second spot. There is a lot to be said for itminaan, or inner peace, and in the Qur’an God takes full responsibility for the rizq or livelihood of all his creation (Al-Anam 151). The Muslim scholar can be analogized to the spiritual counterpart to the physician. The service that the Muslim scholar provides does not just affect another human being in a fundamental manner, it is a service to Allah and the reward for that in this world and the next is incalculable.

Luckiest are people that are interested in a profession that is lucrative as well, and I remember wanting to do Medicine since elementary school. “No you did not” remind my daughters quickly, and then I remember around age 9 or so I wanted to be a stewardess, for then PIA chose their stewardesses on the basis of looks, height and weight criteria and in my mind it was the epitome of glamour: beautiful women traveling the world. That very time prospective brides were being sought for my uncle, and someone suggested a young woman. I heard my grandfather say with unabashed contempt: “No not at all, she is an airhostess!” Cross off that choice honey, I told myself.

Even as parents deliberately and subconsciously push their children toward Medicine, I noted in the last convention of APPNA, Association of Pakistani Physicians of North America, held in June in Washington D.C. that a large number of the children of Pakistani-American physicians are not going into Medicine. The current favorite at least anecdotally appears to be international relations. Seeing ultra-busy life styles in their parents, especially their mothers doing an ace-juggling job can put off the most interested. One of them when asked by the father what he wished to do when he grew up said, “ Now tell me why would I want to wake up in the middle of the night and go to the hospital?”

And yet expectation and coercion continue in some families. The best is comedian Azhar Usman’s joke: a gentleman was going on and on about the need for Muslims in the media, law and politics in the US. Azhar asked him what careers his children had chosen. “They are all doctors mashaallah,” said he, flushed with pride and achievement.

(Mahjabeen Islam is a physician practicing in Toledo Ohio. Her email address is mahjabeenislam@hotmail.com)