Becoming a Doctor

Thursday, May 8, 2014

As you can probably imagine, one of the things most consistently on my mind these days is medical school. In fact, my mind pretty much looks like this most days:

"Oh my God, I'm going to medical school. Are we going to be able to buy this house? I have 32 work days left at my job. Medical school is expensive. Like, really expensive. I should really finish those scholarship essays. Crap, who's going to proofread those things? I already hate them. God, I hate that the new house's attic is full of squirrels and the house is falling down. I hate people. Can I go home yet? Did I even accomplish anything today? Oh good, the cat barfed on the carpet. Again. What am I going to do when I have to be up studying until 2 am? Maybe I can figure out a way to not do that. Medical school... man, I wish there wasn't a dress code because I'd like to wear comfy pants to class. At least my work pants are pretty comfortable... even though they're too big. I hate shopping for pants. Why is my butt so big? It makes shopping for jeans impossible. I think I need to start a part of my budget strictly for tailoring clothes to my short-waisted-4'11" body that is shaped exactly so I can't buy button-down dress shirts with a giant gap in the middle. Why am I even thinking about this when I should be thinking about how to survive the next 4 years? Ugh, 4 years. I can't even get through the next 4 days. I need a nap..."

And on it goes. It's busy in there.

If you are a pre-med student or have been a pre-med student at some point, you are probably familiar with the next thing I'm going to talk about.  Everyone, and I mean everyone, seems to have an opinion about you going into the medical field. Your parents and family are (usually) over the moon with pride, your friends are stoked and kind of afraid they'll never see you again, your classmates might want to kill you because you got in and they didn't, your coworkers might be sad because you're leaving your job to go back to school, and your partner is probably ridiculously excited but also nervous because this is going to do strange things to your relationship. And then there's the doctors.

If I had a dime for every time a physician I worked with heard that I was going into medicine and then immediately said, "Don't do it," I could probably pay for medical school by now. (Okay, that's a slight exaggeration. Go with me, here.) Seriously, I have worked with dozens of physicians, and I think I can recall 3 who didn't immediately tell me to leave the profession, to run from the proverbial building as if it were aflame, and to never look back. This was always terribly disheartening to me, but never enough to make me reconsider my career choice. I always chalked it up to the fact that when most of these people became doctors, the medical landscape was different, to say the least. Insurance companies were less annoying and procedures were reimbursed at higher rates. The stereotype of people becoming physicians for the high pay were pretty true, and from what I understand, there was far less paperwork and far more actual doctoring occurring.

Now... not so much. I feel as though every other week, there's an article written about how miserable a career in medicine can be. In the most recent iteration of these articles, there's a statistic that 300 physicians commit suicide every year. Now, having not seen where they obtained said statistics or how said statistics were computed, I can't really comment on that number's validity, but regardless, the fact that someone's keeping track of the misery of physicians is telling enough. You should really read the article, but the jist is that being a physician, especially a primary care physician (that is, one who practices in internal medicine, family medicine, pediatrics, OB/GYN, or psychiatry versus a specialty) is really hard and isn't getting easier. The hours are getting longer, the pay is getting smaller, and the patient population is getting larger. You won't find a bigger proponent of the Affordable Care Act than me, but yes, it does mean that millions of Americans now need to see primary care physicians, and frankly, there are only so many of them! Lots of graduating medical students don't go into primary care because the pay is lower, and having $300,000 in debt is no joke when you graduate. Doctors have to see so many patients per day to actually make money that the office visits end up being 10 minutes long and anything more complicated than what can happen in those ten or fifteen minutes gets shoved off to the next visit or farmed out to a specialist. I'm not blaming doctors, they're doing the best they can with what they have; it certainly isn't doing anyone any favors though, doctor or patient.

So how do we fix it? Malcolm Gladwell seems to think he has the answer.

(Full disclosure, I don't love Malcolm Gladwell. I find him to be ather troubling. When his writing was accused of being oversimplified, he responded by saying that if the reader found the book to be oversimplified then that reader was not the audience. Great, so if the reader is astute enough to perhaps see that the logic doesn't follow or the claims may be erroneous, then they shouldn't read the book? Who does that leave? The people who will believe exactly what he's saying, regardless of its actual truth? How convenient.)

ANYWAY, he did this interview about how to fix the problems in healthcare, because apparently, everyone wants to put in their 0.02 and they're perfectly allowed to do so.  He talks a lot about ways to make healthcare more affordable, how to change the system from the bottom up (good luck with that one), and the differences between healthcare in the US and elsewhere (namely Canada). Then he said something interesting. Tell people what's it's like to really be a doctor. Really help those outside of the medical profession, that is, everyone who is a patient (or consumer of healthcare) only, to see what it is like to be a medical practitioner. He talks about the dual nature of being a physician, which is interesting, but he also talks about the many jobs besides "doctoring" that a physician must do. He says:

“I don’t understand, given the constraints physicians have in doing their job and the paperwork demanded of them, why people want to be physicians. I think we’ve made it very, very difficult for them to perform their job. I think that’s a shame. My principal concern is the amount of time and attention spent worrying about the business side. You don’t train someone for all of those years of medical school and residency, particularly people who want to help others optimize their physical and psychological health, and then have them run a claims-processing operation for insurance companies.”

No wonder 9 out of 10 physicians wouldn't recommend anyone else become a physician... it sounds insane.

And yet, here I am, counting down the days that I can leave this office for the final time and walk through the doors of Rowan School of Osteopathic Medicine to start my training as a physician. (For the second time, but the first time at this institution.) Why is that? Is it for the money?

Haha, that's adorable:

Salary of Doctors

However, from the beginning of my crazy journey to medicine I've said that even if the powers that be wanted to pay me $40,000 a year to be a physician, I'd still do it. 9 year old Alison didn't say that she wanted to be a pediatrician because she wanted to be a millionaire. No, 9 year old Alison said she wanted to be a pediatrician because, at the time, the only thing she knew was that she wanted to take care of people and make them feel better. It has since grown into something much more nuanced and complex than that, which I will detail in a bit, but no, it's never been about the money.

Is it for the prestige? Nope.

It's certainly not for the ease of lifestyle (check out the average hours worked by various physicians), and I don't golf, so that's out. Is it because I can always get a job? Well.... even that's not so certain anymore! After 4 years of medical school education, it's off to residency to train for 3+ years in your desired specialty, but it's not just filling out applications and interviewing. No, there's a crazy, complex algorithm called "The Match" that literally matches up medical graduates with residency spots. If you have any friends in medicine, I'm sure you've heard about this, but the general idea is as follows.

You train for 2 years in the classroom, then you go on rotations through the various specialties and subspecialties of medicine. In the middle of your third year of school, your first year of rotations, you're supposed to decide your chosen career, often without having actually rotated through that specialty. Your fourth year, you complete "away" or "audition" rotations at hospitals where you might want to do your residency and then in the fall, you spend a lot of time and money applying for residency spots. And no, this isn't 2 or 3 programs, this is 20 or 30 (or more!), and each has a fee. Then, you spend more time and money traveling to interviews (a cost that is not reimbursed by anyone, despite this being a required portion of your medical training), and then you submit your rank list. The schools submit theirs. A magical computer program crunches a lot of numbers and in late-March, graduates from all over the country get envelopes that hold their fate. (This is, of course, just for the MD schools. If you're a DO student, you may take part in the MD match, but you also may have done the DO match, which is earlier, but it's the same principle.)

If you match, you're now contractually obligated to this program for the next "x" number of years until you graduate from residency. Many don't match to their first choice, and yes, there are a good chunk of people who do not match at all. These people either have to "scramble" into empty spots that may or may not be in the field the originally wanted, or they may be in less-than-desireable locales. If you don't match, you don't do a residency, and if you don't do a residency, you can't be an actual physician, so that $300,000 piece of paper with MD or DO on it is suddenly as worthless as toilet paper. The match is actually getting more and more difficult, too, because many residency spots are funded via Medicaid, and as Medicaid funding gets cut, so do training spots. This isn't doing anything to help the primary care physician shortage, and it's certainly not making the process of becoming a doctor any more appealing to those of us entering the field. Apparently, this system was designed by an economist, not anyone in the medical field, and it still wastes millions of dollars and hours and hours of time every year. I can't think of any other professions in which such a convoluted system is used to assign people to jobs that are necessary to advance their career.

So again, why am I doing this? Writing all this out makes me sound like an absolute lunatic. I might as well have called this post, "here's a hundred reasons why being a physician is the worst idea ever!" and left it at that. But here's the thing... there isn't anything else I'd rather do. It's hard to explain to people who don't "get it" but the closest I came was trying to tell my friend Pam about why I was making myself crazy to study for the MCAT and reapply to med school. I said that there was a doctor-shaped hole in my soul. Yes, that is what I literally said. Being a physician is as much a part of who I am as the fact that I am blonde or 4'11" or a total spaz who loves cats. It's just a fact of life; it's what I was put on this planet to accomplish. In my interview, I took a bit of a leap, got personal, and told the interviewers this:

I can't imagine what could possibly give my life more meaning than being a physician. This is what I'm meant to do. This is where my heart is.

And then there's always Grey's Anatomy, which, since the first season, has totally nosedived into contrived soap opera bullshit in my personal opinion, but Meredith Grey hits the nail on the head when she says:

"I can't think of a single reason why I should be a surgeon, but I can think of a thousand reasons why I should quit. They make it hard on purpose... there are lives in our hands. There comes a moment when it's more than just a game, and you either take that step forward or turn around and walk away. I could quit but here's the thing, I love the playing field."

So bring it on, medical school. Bring on the late nights, the early mornings, the overnights, and the 24 hour call. Bring on cramming our heads so full of information that we think our brains will burst, and then shove in a little more because these are lives we're dealing with. At the heart of this, we are people taking care of other people, and to me, there is nothing more noble than being able to truly change someone's life. This is why I can look at a post like this, the hundreds of articles that tell me why being a physician is horrible, the doctors who told me to pick something else, and say, "No. This is it. This is the point. I'll take it all."

I'm sure that at 3 am, when my pager goes off for what seems to be the 94th time that hour, when I'm bleary-eyed with exhaustion and can't remember the last time I ate, I'll want to shoot myself in the face simply so I can get some rest. I have to try and remember how I feel right now; I need to bottle this passion and this drive and pull it up from the bottom of my soul and remember that this is part of who I am, and there is no other option. There will be good days, there will be bad days, and there will be really bad days (my doctor friends, you know those days). I have a feeling though, it will all be worth it. I can't imagine doing anything else.

And that's why I'm becoming a doctor.

- A


  1. ::presses blog like button::

  2. I totally agree! Everyone has an opinion about the future of medicine, but sometimes we have to trust ourselves to make the right choice. Great post!


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