From the outside, it looks like I have it made. I have a letter of admission to a top tier medical school and enough scholarship money that I will graduate with much less than average debt. And now, after taking three years off between undergrad and medical school, I’m facing the reality of what I got myself into. I’m admittedly pretty cynical about the state of healthcare in this country and I’m honestly not sure what to do about it. I’m sure this post is going to make me sound self-absorbed and myopic, but it is still something I’d like to share and document.
1.) I’m afraid that the training will suck the life out of me
Yes, this sounds selfish but to be honest, medical education seems a bit like a modified version of the hunger games. It is long, tedious and seemingly a bit inhumane. I just don’t understand how it is acceptable for sleep-deprived, green doctors to be making life changing decisions for other people. Yes, residents’ lives are “better” now that they capped the hours at 80, but 80 is still a lot. I’m afraid I’m going to have to make sacrifices of my own health and happiness to make it work, seemingly ironic demands out of our healers.
2.) I’m concerned about the current state of healthcare and what it will look like in the future.
For better or for worse, I’ve spent time outside of school and working full time in healthcare. I’ve seen what the destination looks like, and it is not what most first-year medical students envision when they thing about their careers. Physicians are thrown into the conflicting interests of administration, insurance companies, pharmaceutical companies and patients while facing an impossible amount of tedious documentation. I can’t forget what I’ve seen or what I know.
3.) I’m concerned I can’t ethically practice as a physician
This one needs to be explained. I’m not questioning my own ethics but the ethics of the system I am going to be immersed in. First, most quality metrics and standards of care have been derived from population studies to develop blanket guidelines for everyone. There are two problems with this: 1) what is statistically “best” for a population as a whole is not necessarily what is best for an individual- there are people that fall on either end of a bell shaped curve. 2) The research these guidelines are based off are overwhelmingly funded by the pharmaceutical industry, creating some questionable conflicts of interest.
These factors essentially takes the nuances and clinical decision making out of doctoring and results in questionable care.
4.) I’m concerned I can’t feel ethically sound with the way I am paid.
lnsurance companies are convoluted and confusing by design since their business model is figuring out how not to pay claims. So I have to tell patients- this is the service I offer but I can’t tell you how much it will actually cost you, you’ll find that out after it is done.
4.) I’m concerned I won’t be able to actually help people.
There are niches in medicine that very directly help people, however, the farther you move away from surgical fields, the blurrier this line becomes. Since I have every intent of being a cognitive physician (IM, neuro, endo, or PMR), people usually won’t walk away immediately “fixed”
5.) I’m afraid of being a pawn in the system.
I don’t want to be caught in between the vested interests of corporate medicine, the government, the patient, and the pharmaceutical industry.
6.) I’m concerned about the level of negativity in the current physician workforce
I spend significant time reading physician blogs. Although there is a range of attitudes and tone, the general perspective is quite negative. This ranges from sharing frustrations to outright ranting about the state of healthcare and blatantly warning others to run far away.
“I will not be so dramatic as to shout, “Abandon all hope ye who enter.”
Medicine has changed in twenty years. The Machine has won.
I will not opine for the “good old days”, but twenty years ago it was still mostly about the patients.
The patient has been squeezed to the edges of the equation at best.
I can not in good conscience tell another human being to dedicate a decade of their lives to enter the medical profession.
I am saddened by my statement.
Physicians are dispirited and have been demonized. I expect things to deteriorate.
I eagerly await someone to show me signs that this is not the inevitable future. I am open to positive possibilities (other than Direct Patient Care model that I am certain the centrally planned health care system of the near future will seek to eliminate). I would love to be wrong, but I am reasonably certain that I am not.
The power of positive thinking, while admirable, has very finite limits. It is not a force that can affect reality.”
However, despite these factors (and partially because of these factors), I am still going to give this a whirl. The truth is, things have to change, they have to get better. The current system is not working for docs and it is not working for patients. But instead of being passive players in the game, we need to be invested in change and rethinking the current paradigms of healthcare delivery.
Medical school starts in one month where these macro-concerns will compete with the short-term concerns about passing exams and absorbing a fire hose of information. I hope I will still be able to see the forest for the trees and be aware and invested in these ideas over the course of my training and career.
In Pursuit 