On Medicine

WHAT'S HAPPENED to medicine?

It’s a question that plagues physicians, residents, nurses, students—pretty much anyone who has had to close a complicated 15-minute office visit without really resolving anything, or fought tooth and nail for approval for an essential medication, or been named in a lawsuit. Anyone who has begun chipping away at a quarter million dollars of educational debt while simultaneously starting a family. Anyone who has had to navigate the hulking, monolithic bureaucracy that is the American health care system.

The time for existential ruminating is behind us. It’s time to stop asking, “Have we lost our way?” and acknowledge that, yes, we have definitely lost our way. An MD is no longer the ticket to prestige, prosperity and professional fulfillment that it once was. At this point, the much more difficult question we must tackle is, “Why would anyone in their right mind want to do this for a living?”

The oft-cited annual survey that

asks how many physicians would do

it all over again consistently spits

out a percentage a little over one-

half—the statistical equivalent of a

shrug and a "meh."

Let’s review the sobering facts:

Becoming a doctor is not just difficult, it’s expensive. Including undergraduate debt, a prospective student can expect to graduate medical school owing an average of $180,000, and often much more. Even if you secure a residency position (not a guarantee by any means—there were 53,642 applicants for 26,836 spots in 2016), you won’t be making anything near a physician’s salary for several more years. Plus, nowadays “physician’s salary” means something very different from what it did a decade or two ago—just ask a primary care colleague.

Morale is at an all-time low, both in training and in practice. Abuse is common during medical school and residency, when trainees are most vulnerable and insecure in their knowledge and skills. The annual AAMC Graduation Questionnaire, an exit survey for medical school graduates, includes a section for students to report how often they have been subjected to various forms of mistreatment, such as public humiliation and physical harm, during their education. That the AAMC feels the need to ask these questions is an embarrassment for the profession. Why students should pay for the privilege of being abused remains a mystery, and strategies to combat the toxic culture of medical academia are either nonexistent or ineffective. After training is finished, things don’t get much better. Physician burnout has almost become a field of study in its own right. The oft-cited annual survey that asks how many physicians would do it all over again if they had the choice consistently spits out a percentage a little over one-half—the statistical equivalent of a shrug and a “meh.”

If you need any more evidence that doctors are hurting, look no further than the shocking frequency with which we hurt ourselves. We lose up to 400 physicians per year to suicide; as Dr. Louise Andrew points out, that’s the equivalent of an entire medical school. With each life lost our profession is robbed of an invaluable fund of expertise, skill and humanity. What other graduate degree is accompanied by higher rates of depression and a two-fold increased risk of suicide?

Again, I ask: Who would want to do this for a living? What intelligent, ambitious young person would clamor for the future described above?

It may come as a surprise that the prospect of becoming a doctor is no less popular now than it has ever been. But it’s dangerous to assume it will always be that way. It may not be long before college grads wise up and steer clear of medicine. We could be facing a future in which the profession no longer attracts the best and the brightest.

We should look to law schools as a cautionary tale. Faced with a crippled job market during the Great Recession, people applied in droves, only to find that the market had not rebounded by the time they graduated. The sudden abundance of jobless JDs dampened some of the enthusiasm about law school’s return on investment. Subsequently, applications plummeted, and another interesting thing happened. While analyzing their annual data, the Law School Admissions Council (the law equivalent of the AAMC) stratified the percentage drop in applicants by LSAT score and found that the most precipitous drop was among high scorers; that is, fewer people applying to law school were scoring in the coveted 165+ range. The schools were attracting a new, less-qualified class of applicant. It should be noted that the same has not been observed for medical school; in fact, mean MCAT scores of applicants continue creeping up each year. But that’s not to say that it couldn’t happen, or that it won’t.

Let’s not let it get to that point. We need smart, idealistic, motivated people in medicine. If the perception that being a doctor is not all it’s cracked up to be takes hold, the damage could be considerable. There’s not a lot we can do in the near term about the cost of medical education, or the inconveniences and inefficiencies of a dysfunctional health care system. What we can do is look out for each other. Be kind. Work to uphold common decency in the office, clinic and hospital. No one really knows what being a doctor will look like a decade from now. But small efforts now will reap rewards down the road and preserve some of the allure of medicine for the incoming generation.

recent posts