The Biggest Problem I See In Medicine

I don't want this to be a rant about my personal troubles within the field of medicine. But, I'm going to try to lay out what I believe is objectively a concern of mine. One that I have personally been searching for a solution to for many years.

The medical field has a massive problem with leverage - or lack thereof - at every level of education and training. Let me break it down into individual levels to show you how.

🙇‍♂️ As A Pre-Med Student

You're applying to Medical Schools. The application process itself is incredibly expensive, but that's not considering the hidden costs:

1. The cost of extracurricular activities or volunteer work that you might not enjoy much, but is required to demonstrate commitment to the field.
2. The cost of the research you help with but are left unrecognized for. But, where you're afraid to speak up and ask because you're looking for a letter of recommendation. (small rant)
3. The cost of test preparation materials and classes, such as MCAT study guides and courses.

You're required to build on an ever-increasing band of excellence just to peak out the top hoping to get picked. If you decide that you're not willing to sacrifice yourself in the process, so be it, there are a thousand other applications with nearly the same qualifications.

The unspoken truth is that with the astronomical number of students applying, the relatively fixed number of spots, and the introduction of a "holistic review", getting into Medical School is now more similar to winning the lottery than applying for higher education.

👨‍🎓 As A Medical Student

Just when you think you're over the hump, you realize that the big hump was just covering up the others.

The reality of Medical School is that you're paying a ridiculous amount of money, for an education that doesn't really require the school. For example, at my Medical School, only about 20% of our class uses the lectures provided by the professors.

The remaining 80% never really touch them. We largely use Pathoma, Boards and Beyond, or even YouTube for our education.

So in essence, the hundreds of thousands of dollars that are paid aren't contributing to the majority of our education. This experience doesn't change during rotations. (disclaimer: not from personal experience, but from the experiences of my peers)

As a Medical Student on rotations, you commonly find yourself working far longer than what's required for your education. I feel like the system forgets that you as a student, are paying for this education. It instead will see you as a source of free labor. Which after all, you kind of are.

You can speak up about student health, and you can speak up about adequate precautions but none of it is a necessity for the institution. If you decide that this is too much for you to handle, it's only really costing you in the end. What real leverage do you have?

👨‍⚕️ As A Medical Resident

The reality is that residency is a lot more challenging than Medical School. Outside of the obvious elevation in job responsibilities, you now have to think about other responsibilities. Family, children, relationships, etc.

This hidden cost of residency is that whilst before residency, you have an opportunity to take time for yourself. Stepping into residency, you unwittingly forego that luxury.

You are notoriously underpaid and overworked, but the reality is you cannot really choose not to. If the same rules applied in a job you were working in, you could choose to take a leave, switch employers, or ask for more pay. Any number of things to make sure that you were being appropriately compensated/taken care of by the employer.

In residency, you cannot really choose to do any of that. You cannot switch hospitals. You cannot take leave without jeopardizing your entire career. You cannot really ask for a higher wage. You again find yourself with no leverage.

👍 The Summary

The reality of Medicine is that you as an individual do not really matter.
Imagine a job where you're a computer engineer. If you're great at the work you do, you will be sought after by companies to work for them. They will reach out to you to join them, and they will pay to have you come to interview. They recognize your value to them and are going to fight to keep it. Can you imagine that happening in Medicine?

You can be the best Medical Resident and you as an individual won't really be sought after. You're not going to be able to fight for higher wages, and you won't be able to ask for better benefits. The scales are just tipped against you.

💭 Final Thoughts

Unknowingly, this has turned into a harder truth to speak about than I had expected. Honestly, I started this post in a completely different direction, but I've been thinking about this idea for quite some time now and just wanted to share.

If you disagree with anything I've said, please feel free to correct me. I can only speak of my own experiences as an incoming M3 and the information that was relayed to me by my mentors.

I'm not a fan of making complaints without offering solutions. So in the next post, I'm going to talk about what I have been doing for the past 3 years to gain back some of the leverage that I have foregone during this process.

Stay tuned, and until then – Good luck. ✌️