This Counterpoint is an open letter that was written in response to a recent Globe & Mail editorial (Think medical school is for you? You’re probably wrong) which took a pessimistic perspective on the pursuit of medicine as a career. This is the fourth in a series of replies, written by the BoringEM team.
Each part of this series features a reply from a person at a different level along in their medical career. The following is from an emergency medicine physician and residency program director at McMaster University. Join the conversation in the comments below or on twitter with #DearPreMed.
Dear Aspiring Medical Student:
I’ve spent the last few days thinking about how best to address Ms. Sinclair’s recent article in the Globe and Mail in a discussion with a premedical student. That contemplation has been consolidated into this letter of advice. I hope you find it useful.
First a bit about myself, I am an Emergency Physician at a busy academic Emergency Department in Ontario. While a medical student and resident, I was involved in student and resident leadership on the local, provincial and national levels. I’m heavily involved in both medical education and hospital administration and have worked with hundreds of learners (from medical students to residents) over the past 5 years I have been a staff physician.
I was none of the things Ms. Sinclair talks about in her article. My GPA in University was far from perfect (I think I got a C in first year Biology), my MCAT score was good but not perfect, and I was far more interested in being involved in everything than spending my life in a textbook (that has not really changed). I still don’t think I have read “Doing Right,” but I do have a copy of it somewhere on my bookshelf, which has as many (if not more) fiction books than medical textbooks.
Most medical schools and residency programs are not looking for a canned version of that clichéd answer – “I want to help people”, though we hope that is true. We are looking for, well, real people. Do you have to have good grades? Sure you do. But when I am sitting across from prospective candidates, I am looking for something else.
Medical school is not easy, but that is not because of many of the reasons Ms. Sinclair articulated. That’s why we are looking for people who have lives, play well with others, can carry on a conversation about what’s going on in the world, and are able to empathize with others. Many of our students have worked outside medicine, conducted research, and had another career before they arrive in medical school. Many have experienced failure and hardship in their lives.
Contrary to Ms. Sinclair’s supposition, Medical school is far from an easy answer… To give a bit of perspective, here are a few facts:
- Medical school debt often runs into the hundreds of thousands of dollars.
- In your first two years, you will try to cram a new language and skills into your brain before your senior years where you will suddenly be ‘part of the team’ (albeit under close supervision) and responsible for making decisions and caring for patients. With that new stress on your mind you will still be trying to learn everything you need to know to get ‘MD’ after your name. And it does not end there.
- Residency is your on the job training. You are both a health care provider and a trainee, trying to juggle your clinical work with learning the specific knowledge and skills of your chosen field.
- Sometimes the hours are long (although significantly improved over the past two decades). When it’s 4am and you are on your fourth bottle of diet coke, you’re not sure when you ate something other than chocolate, and you can’t remember when you last went to the bathroom you do begin to wonder: “What did I sign up for?”
Burnout is a real problem in medicine. Not because we don’t love what we do. And not simply because we experience conflict in the workplace. Sometimes there are disagreements in the hospital, but most of these are resolved by aligning interests with the question: “What is in the patient’s best interest?”
In my opinion, burnout comes from systems level issues. What hospitals and health care professionals around the world are facing: higher patient volumes, more complex patients, limited resources, and unreasonable expectations. Add to that working long hours (it’s 2am now), being on call or working when your friends are on holiday or sleeping, taking on the emotional load of those you care for, and having to make high-stakes, life-altering decisions with little to no information. Although most of us learn to deal with it – it is one of the hardest things in the world to tell someone their loved one has died, to watch someone die right in front of you despite your best efforts, to tell someone you made a mistake, to playing musical beds at 3am in an over-capacity Emergency Department so that there will be a bed for the next critical patient rolling in the door.
On the flip side, sometimes we win. Sometimes the system magically aligns to work for our patients. Sometimes, we can restore a pulseless patient’s circulation, quickly identify-and-escort a patient with early necrotizing fasciitis to the operating room and save their leg, or simply brighten the day of a petrified 4-year-old that needs stitches.
All of that being said, is it worth it?
Sure it is.
Most of the people I work with, from medical students to senior colleagues, love medicine. Sometimes, that love is the only thing that keeps you going.
Many of us take on other roles (many of them volunteer): teaching junior colleagues, sitting on committees to improve patient care, working on curriculum planning, or designing new care paths and medical directives. Why? We do it because it makes the system better. Why is that important? Because together, our teams of nurses, respiratory therapists, social workers, child life specialists, environmental aids, porters, doctors and innumerable others actually want to help people. Most of us do it, not for money, nor prestige, nor security, but because we actually really like what we do and we think it will help make the world a better place.
So to you, the aspiring medical student, I say: “Good for you!”
Medicine is a long road and it takes hard work. The work isn’t just in medical school and residency, it continues even when you finish your training. When you start your practice you will need to stay up-to-date in the ever-changing world of medicine.
However, there is nothing more satisfying then when you can help someone get better, or tell someone their loved one is going to be fine, or hand a popsicle to that child whose cut you just fixed… They may never know your name or remember you, but you will remember them.
Best of luck with your applications.
Alim Pardhan, MD, MBA, FRCPC
Royal College Emergency Medicine Program
Program Director (& Alumni), McMaster University
This part 4 of the #DearPreMed Series by BoringEM.
- Part 1 by Eve Purdy
- Part 2 by Teresa Chan
- Part 3 by Heather Murray
- Part 5 by Sarah Luckett-Gatopoulos