Good evening. How many of you have heard the expression, "The doctor hung out his shingle?"

Nobody? Well, no surprise.

It's a pleasure to speak to a group like this, high-school students from around the country interested in medicine. And you have the opportunity to meet speakers from all realms of the medical profession. My job tonight, as a practitioner here in town, is to tell you my story. I hope you find hearing it useful, but your stories, however they may develop, will be different than mine.

Hanging out a shingle once meant opening a medical practice. Picture a doctor setting up a solo practice in their home and telling the world they have arrived by hanging a shingle with their name on it from a post in their lawn. You've probably never heard this expression before because nobody goes into solo practice anymore, certainly not in their house.

Times do change in unpredictable ways. In 1981, I took over the practice of a retiring dermatologist. As we met in his home office, a converted garage, he sat across his desk and said, "You young people like to spend money on unnecessary things, like secretaries." I smiled to myself and looked at him the way you are looking at me, which is how the next generation will someday look at you.

If you had told me 30 years ago that a doctor would need not just a telephone but a whole telecommunications system with voicemail, a network of computers, and an army of clerks to enter data, check insurance eligibility online, scan insurance cards and privacy disclaimers, and access electronic medical records, I would have thought you had landed from another planet.

Voicemail, computers, e-mail, online, not to mention PPOs, OSHA and HIPAA regulations, ICD-9 codes, and concierge practices – in which you pay a doctor extra for the honor of having your phone calls returned – nobody could have foreseen any of these novelties, and no one can predict what developments there will be 30 years from now. The only sure thing is that changes will happen, and in whatever profession you enter you will deal with them because you have to.

But there is one constant. Although technology advances and systems change, people don’t.

Six years ago, I spoke to students at this forum and told them how I became a dermatologist. In college, I majored in math, lost interest, didn’t know what else to do, and followed a friend’s advice that medicine might be a good choice. In medical school, I chose pediatrics because the internists at my alma mater were intimidating, and the pediatricians were nice.

Out of residency, I took a job at a university-connected hospital, where my boss told me I needed "a gimmick" to stay in academics and proposed dermatology, which I had never encountered or thought of in school.

I spent time with a dermatologist and pretended to be one myself until my hospital lost its university affiliation. Since there were no opportunities for pediatric practice in the town I was living, my wife, our three small children, and I moved up this way, where I retrained in dermatology.

Not a very well-considered decision, was it?

The students I was addressing were miffed. They were expecting a more linear, perhaps inspirational, narrative, along the lines of: I always wanted to cure skin disease and help humanity. But that's not how it was, and if you ask your parents and other adults how they got where they are, you will find that’s not generally how it is.

But the punch line is that it turns out I do want to save humanity, at least one patient at a time, I do want to heal the sick and comfort the afflicted. But, at your age and for some time after, I didn’t know it yet. At 17, what can you know about your life? You haven’t lived it. But you will.

With opportunity, family support, hard work, and good luck, I was eventually able to figure out what I wanted to do and to spend the rest of my professional life doing it. May you have similar fortune in the field you pursue.

If you do join the medical profession, you will adapt to changes no one can anticipate. But however diseases evolve and therapies advance, people will continue to worry, to get sick, and to die. They will need your help to navigate their journey. That won’t change, whether you tell the world you’ve arrived by launching a website or by hanging a shingle on your front lawn.

Thank you for listening. I wish all of you success, contentment, and the very best of luck

Remarks to the Medical Youth Forum