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So you want to be a Doctor?
Andrew W. Seefeld, M.D.
Sitting at my desk, a year after having survived my internship and currently working as an Emergency Department (ED) Resident Physician, I was looking up labs and x-ray reports on a patient in room fifteen, a male that I had just examined with anemia and chronic headaches. I was approached by one of the ED secretaries, a young man in his twenties, who informed me that he had just taken the MCAT, an exam required to enter medical school, and was excited about the application and interview process.
“Are you glad you went to medical school and became a physician,“ he inquired with an enthusiastic grin.
What a question. I am thirty years old, I have been in school most of my life, and I make less money than my twin brother did right out of college. My brain is worth two hundred thousand dollars, yet my medical service, according to the government, is only worth forty thousand dollars a year (with an 80 hour work week). With the amount of debt incurred, no matter how I feel about medicine, I am compelled to stay the course so I can pay back my loans. That aside, I do remember the excitement of becoming a medical student, a future physician. Opening the letter and seeing that I had been accepted to medical school was exhilarating. In retrospect, I wish I had known more about the journey required to reach this destination.
And it’s been quite a journey. Your first two years of medical school involve learning about disease processes through lectures and textbooks. The second two years are spent applying this knowledge to real patient care. On the surface, this sounds like an ideal system. But at a deeper level, one must realize that it requires significant quality-of-life concessions in terms of personal time, commitments and activities. The never-ending evaluations, always wondering how you are doing and whether your superiors are satisfied with your work darken your dreams. The feeling that you have to stay longer, work harder and study more -so you can get the grades that may ultimately determine your ability to get the medical residency of your choice -constantly looms over your head. This pressure can take quite a toll on the human spirit.
Many medical students complain about being “emotionally abused“ by their superiors, constantly made to feel inadequate. This is not a productive type of learning environment. Even those students who are fortunate to find good teaching still endure considerable stress. The longer you are in the field, the thicker your skin must become to cope with the criticism, at times destructive rather than constructive. Demoralization and humiliation are two words that adequately describe many experiences during medical student training. I remember being referred to as “bookie,“ during a surgery rotation, a derogatory reference to my “job“ of keeping track of all the patients on the service in a “book“ carried in my pocket. I spent two months on that service and don’t even think my superiors knew my actual name. We tend to laugh it off, pretend that we’re having fun, but deep down, we feel less like humans and more like machines-training for a profession that requires as much humanity as medical knowledge and skill.
These aspects don’t improve much during internship. The only true differences: your white coat is two feet longer, you can write medical orders and you are called “Doctor.“ The condescension and denigration by superiors is still there. On an Intensive Care Unit (ICU) rotation, I watched a colleague get yelled at in front of the whole staff, simply because he didn’t get an accurate daily weight on one of the twelve patients he was seeing. Moreover, you still have very limited free time. And the time that you do have outside the hospital is usually spent catching up on sleep or staying up to date with current medical literature. I often joked about being a “homeless physician-in-training,“ living in the hospital and without an apartment. I could simply sneak from call room to call room each night, finding an empty bed for some sleep. If all the beds were taken, then the backseat of my Volkswagen Jetta would work fine, as it had many nights in the past during previous rotations. Yes, I actually slept in my car overnight! More importantly, my hospital provided free food to the interns, and I knew where all the showers were, hence, I had my own Motel, without the vibrating beds and late checkout privileges.
Healing patients and coupling medical science with patient care were the reasons I chose this career. Had I known what would be required to achieve this goal, I might have put a little extra thought into making my decision. I never imagined how radically the demands of medical education and training would alter my lifestyle. I was not prepared for the emotional impact of making mistakes and the strength required to cope with them. Unfortunately, nobody was there to tell me the realities of medical training, the hardships of medical school, and the mental as well as physical fatigue of residency training.
So the question resurfaces... am I glad I am a doctor? Looking at the energetic young man who had asked the question, full of excitement and desire to learn and obviously admiring my position as a current resident, I wanted him to appreciate the effort it took to get to this point: the pain I endured, the coping with mistakes, the sleepless nights, the alienation from family and friends. So, I told him to expose himself to the field, talk to current medical students, interns, residents and attendings, get an idea of what it is like, lifestyle outside the hospital included. This would at least allow for a truly informed decision, something I wish I had done. I told him with certainty not to base his decision on a desire for the status that the “M.D.,“ denotes. It’s not worth it, if your heart is not committed. Happiness in life is far more important than a doctorate in medicine. Lucky for me, I chose the right profession, despite my lack of knowledge of the realities of training. Not everyone is so fortunate. The cost is worth it to me; but will it be for everyone?
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