I write this during the final countdown to the beginning of my official entrance into the field of medicine—medical school. I stand poised and ready to set sail on a privileged journey, but before I do, it is only right for me to take time to reflect on the process that leads to this point, to share both my fears and excitement for all that lies in wait, and to posit a few ideas and predictions for the future of medical care in this great country. I share these thoughts in hope of helping to convey the perspectives of those of us who are not yet physicians entrenched in clinical practice, but who aspire to be and eagerly anticipate our position on the front lines.
As is often the case in any field or profession, those who have been immersed are often jaded and choose to dwell on the downsides and neglect the many upsides of this esteemed profession. Medicine is a backstage pass to life, and in order to keep it alive and well, it is important to maintain a consistent influx of youthful optimism, a spirit of camaraderie, and even an element of risk-taking bravado to question current norms in order to spark changes for the better. The naysayers may call us naïve, but I speak on behalf of the incoming class of first year medical students in declaring that we are poised but eager, confident but receptive, and respectful but brave enough to accept ownership of a central role in the health care system—its flaws, its miseries, and yes, its betterment.
The application process had been lengthy, arduous, and unduly expensive. In one sense, this is beneficial in that it selects for dedicated students who are process oriented and are prepared for immediate sacrifice in the name of a long-term goal. Medical education, while structured as a set, four-year process, is simply not so. Indeed, it is a lifelong journey that demands rigorous study, adaptation, practice and application. Those who desire to practice medicine should be prepared to devote time and energy to perpetual learning in an atmosphere that promotes shared sacrifice for the greater good. One the other hand, the travel expenses, time requirements, and application procedures required to put oneself in a position for acceptance into medical school are unrealistic for many. Those who lack the financial resources, those who are working multiple jobs to support a family, or those who lack the help to navigate the multi-step application are at an extreme disadvantage. Yet there are certainly many wishful candidates among such people, who would make tremendous physicians with assistance through the application process. In the future, travel expenses should be fully covered as they are for most formal job interviews. After all, this is not simply an interview for a job; it is an interview for a career and a major life decision.
Provided that interviews are likely (and should) be conducted in person at the medical school. I have become a converted proponent of the multiple mini-interview (MMI) strategy. As discussed in recent reports (http://www.nytimes.com/2011/07/11/health/policy/11docs.html?pagewanted=all), the MMI process involved approximately ten, 8-minute long discussions of an ethical dilemma or personal issues that arise daily throughout interactions between physicians and patients. These scenarios do not have right or wrong answers, but demand an understanding of multiple perspectives, racial and ethical undertones, and the role of the physician not only as a healer, but as a friend, a confidant, and an educator. Some of the situations are uncomfortable. Some of the topics are sensitive, and some of the interviewers are aggressive. But this is the reality of everyday clinical practice and those who perform most gracefully by radiating a sense of calm and comfort while simultaneously displaying compassion and conviction are likely to do the same in their careers as physicians.
Along my “pre-med” journey thus far, at each turn I have encountered roadblocks and obstacles that seem adamant in deterring my pursuit of a career in medicine. Not only are the prerequisite courses and application process itself designed to weed out all but the most committed, but physicians themselves seem to offer very few positives regarding the profession. There seems to be a persistent emphasis on the downsides—the thanklessness, the long hours, the dwindling compensation, the skyrocketing malpractice costs, etc—as clear-cut reasons to dissuade up and comers like myself from entering the profession. “It is not what it used to be,” they lament. “All of the paperwork, the angry patients, the bureaucracy. We have gone from an esteemed few to being disrespected and underappreciated. We are simply cogs in a wheel that is spinning out of control.” I have heard this, or some version of this from nearly every physician that I have encountered, worked with, and even interviewed with in the years leading up to this moment.
Yet we persist despite the rigor of the process that has passed and the unknowns of the lengthy journey ahead. We still believe in the nobleness of the calling. We revere the privilege of healing and seek the rewards both for our patients and ourselves. I speak of myself and the many other applicants who I met along the interview trail last year. I am pleased to report that the next generation of physicians is a dynamic, selfless, and fearless group of individuals. Call us naïve, but we stubbornly refuse to be disillusioned by those who have become jaded. A passion to do good, not only on behalf of individual patients, but on behalf of humanity in general, lies deep within our souls. Each of us brings loftier goals and visions shaped through a unique set of past experiences that collectively, we are committed to realize. An increasing share of us have taken a few exploratory years after college to work, to test the unknown, and to experience the world firsthand such that we are able to identify and ultimately rectify the many mishaps. We understand the negatives associated with the current state of health care both at home and abroad, but we view this as an opportunity to remedy the ills and enact change for the better.
The future of health care is strong. I would like welcome my fellow classmates as we embark upon a lifelong journey. It is a pleasure to meet you and I feel blessed to have you by my side.