Only a generation ago, medical students thought about what specialty to choose simply in terms of what interested them most. All doctors made a comfortable income; money wasn’t a primary motivator. There was a sense that cardiac surgeons or neurosurgeons could make more than most other physicians, but in fairness their training was much harder and longer. Internal medicine was held up to us as the most prestigious and intellectually rigorous of the specialties, and was highly attractive to medical students who are a competitive lot at baseline.
For kids growing up in the 1960s and 70s, there was also a strong impetus toward doing work that benefited society. We remembered the civil rights era, the rise of feminism, and the start of the Peace Corps. The women who made up the first major wave of female physicians in the United States were determined to prove themselves as deserving of medical school admission as any of the men, by working as hard and achieving as much or more.
As a medical student in the 1980s, I considered a number of specialty options. Pulmonary internal medicine and critical care were my favorite rotations. On the other hand, anesthesiology involved critical decision-making in real time, and a great deal of pulmonary physiology—all those ventilators to manage. Besides, anesthesiologists work in the operating room. This can be a good or bad thing, depending on how much you like operating rooms and the company of surgeons. From my point of view it was fine.