You hear it all the time from doctors — they would never choose medicine if they had it to do all over again. It’s practically a mantra, with the subtle implication that the current generation of doctors consists of mere technicians.
When I first started in practice, I found such comments both perplexing and annoying. I loved medicine and was excited to come to work every day. I considered those naysayers jaded has-beens, fusty old-timers pining away for the nonexistent “days of the giants.”
However, as the years have passed, the warts of medicine have grown more conspicuous to me. During some of the more stressful days — crushed by impossible time constraints and ever more onerous bureaucratic demands — I can’t deny that the thought of giving up clinical practice has crossed my mind. Life would be so much easier….
Yet, each year, a new wave of enthusiastic medical students floods our clinics and our wards. Part of me always wonders: Why do these students still choose to become doctors?
It certainly can’t be the money — Wall Street is the faster and more reliable route to wealth, as evidenced by the skyrocketing of applications to M.B.A. programs.
Applications to medical schools, surprisingly, have held steady over all, despite an exodus of top students to finance and banking. According to the American Association of Medical Colleges, about 40,000 students apply to medical school each year, with some 17,000 matriculating. (For comparison, there are about 45,000 students starting law school each year, and 100,000 starting business school.)
Incoming medical students, while steady in their numbers, have had a major shift in their demography. In 1970, medical students were nearly entirely white men. Now half are women, and a third are Asian, black or Hispanic.
I recently worked with a third-year student who’d just interviewed a patient with chest pain. The chest pain turned out to be nothing serious, just some acid reflux — a fairly ho-hum case in a medical clinic. But the student’s eyes were ablaze with fervor. “This was such an exciting case,” she said. “I had the chance to figure out whether or not the chest pain was life-threatening. And the patient was so happy when I reassured him that it wasn’t.”
The awe of discovering the human body. The honor of being trusted to give advice. The gratitude for helping someone through a difficult illness. These things never grow old.
But the frustrations of daily clinical life continue to mount. Administrative requirements increase exponentially, while the time allotted for the patient visit remains 15 to 20 minutes. The additional paperwork, electronic documentation, phone calls, insurance forms and quality assurance measures are all expected to be subsumed into the same workday.
I once tried to calculate how many thoughts a primary care doctor has to juggle on a given day. (My tabulations came to 550; you can read about it in
an article I wrote for The Lancet.) We keep pushing so many more balls into the air that there’s no doubt a few will fall. It’s this feeling of not being able to do as good a job as I’d like that makes me consider walking away from clinical medicine. I can’t countenance mediocrity, and I cringe whenever I feel that I can’t get it all done.
But then I cringe when I think about what it would mean for patients if doctors walked away from medicine because of the frustrations.
On top of that, I have to wonder about the alternatives if I gave up clinical medicine — pushing papers, sitting in endless PowerPoint meetings, crunching numbers — and realize that I am lucky and immensely privileged to be able to work directly with patients.
When I close the door to the exam room and it’s just the patient and me, with all the bureaucracy safely barricaded outside, the power of human connection becomes palpable. I can’t always make my patients feel better, but the opportunity to try cannot be underestimated.
If I’m having a really rotten day in clinic, all I need is one of these new medical students to pop in, even if they make a long day even longer. The fact that medicine is still compelling enough for 17,000 people each year to commit a decade or more of their life to training is inspirational.
And when my students and I have our inevitable “career talk,” I tell them that there is nothing else I’d rather do in my life than medicine. If I had it to do all over again, I’d end up right here in this office — telling them that there’s nothing else I’d rather be doing.
