Medical School is rough. Fortunately there is a recent movement to make Medical Education more humane. The movement to bring humanity, ethics, and love back into the molding of our future physicians is crucial. Personally, I felt my medical school was on the forefront of this push. Perhaps it was because we had Jesuit Priests for Attendings and the institution’s motto of “We also treat the human spirit” was also filtered into the treatment of students. Whether it was something about myself or my medical school, I was fortunate to never experience the depression, competitive urges, burnout and isolation that is so prevalent during American medical school years.
But there is an underlying and hidden truth that is never spoken about, or at least wasn’t to me, in Medical School. As students we are warned how tough medical school is and furthermore how absolutely draining residency is. When we’re in the thick of either in even the most uplifting programs and schools, we are monitored for burnout, offered services to prevent it, and given support in ways students and residents of the 20th century never were. More frequently now, we are prepared for these harsh realities But what we’re not told, ever, is that even if and when we make it through medical school and residency/fellowship to attending physicians we may well find it’s still not greener on the other side. We may still first experience burnout when we’re supposed to be summitting our Everest Mountain of medical training. As many mountain climbers will tell you, often the way down from the peak is just as hard if not harder than the climb up.
After having spent a year in private practice, a year in Academia, and now venturing out on my own, I wonder what it is or why we aren’t more open about it? Perhaps it’s because many lifelong Academicians are indeed sheltered from much of the non-doctoring paperwork and data entry that private physicians are forced to do. That said, Academia is still full of challenges unique to itself. Getting grants, getting published, tenure, institutional and field specific sexism……to name a few. As Medical Students, it’s completely hit or miss if you’re exposed to a mentor or physician in private practice. You may get lucky in your 1st year Patient Centered Medicine group and get a group leader who is actually a private doc volunteering their time, but it’s unlikely. And even so, we docs are told to keep quiet about our struggles for fear of turning people away from the profession.
Maybe it’s just my personality. I don’t like surprises, and I have found over and over that if I am prepared for something ahead of time (whether it be emotional stress or physical) that I am far more able to cope with it when and if it happens. I don’t think however this is unique to me. As a physician, I have found my patients are far more able to handle hiccups or side effects if I appropriately forewarn them to anticipate them, normalize their feelings, counsel on what they do if those unpleasantries happen, and encourage them to call me if they’re concerned. Turns out, I get less calls in the middle of the night and my patients feel empowered, and less alone. I’ve also been a patient and I find the same is true.
It was the amazing mentors in Family Medicine at my medical school that made me jump from a path intent on Internal Medicine then Geriatrics to doing Family Medicine as my route to Geriatrics. Yet, I wish they had forewarned me that my potential salary and earnings as a Geriatrician would be lower in some places just because I was Family Med trained instead of Internal Med trained. I was also never informed of the heavy burden of Maintenance of Certification testing and modules that Family Medicine would make me do that are irrelevant to the Geriatric population. I wish some of the female mentors would have given me the heads up on the truth, that sexism in medicine, even fields like family medicine, is alive and well. Had they, perhaps I would not have felt so affronted and demoralized when I first experienced it as a new attending. I wish I had known how prevalent burnout is among attendings (of all fields) so that when I experienced it for the first time in what I thought would be my dream job, I wouldn’t have felt so alone. I wish I had known that those of us in time-based fields (Geriatrics) are actually punished for taking time for and with our patients.
To Medical Educators and those in Academia: Consider bringing in outside private docs as lecturers. Bring in diverse physicians who will speak truth and bring transparency. It will help Medical Students trust that the profession they are bleeding for is trying to be honest with them. To Medical Students: Know yourself early and seek help often. Reach out to anyone willing, and be prepared for the reality that, even if you make it through residency and med school without a hitch, you may find yourself still struggling to find meaning in your vocation in this American Healthcare System. But also know this: You are not alone, it’s normal and you will have legitimate cause if you feel that way. It’s not something wrong with you. In fact, you are probably a physician that cares if you’re negatively affected by the system. And most importantly, there is hope for a better future for medicine for both ourselves and our patients.