As the United States health-care system braces for upheaval, young Americans continue to apply to medical school in droves. But academic administrators and others say that the parameters students assess in making their career choices-- to become practicing physicians, laboratory researchers, or both--will be among the changes wrought by reform.

Biomedical career decisions have never been easy. It's typical for a bright young student assessing the options to go through a period of self-examination, according to doctors and scientists interviewed for this article. Such introspection generally focuses on questions like: "Do I need to care for sick people in order to be professionally fulfilled, or would I be happier doing basic research, which ultimately could benefit millions of people?" "Will I be able to repay my medical school debts if I focus on patient- oriented research rather than a private practice?" "Do I really have the commitment to stick with...

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