Every doctor starts as a student. And the experiences students have in medical school help shape the kind of doctors they become.
But the reality is, many medical students are painfully unhappy. That’s the issue explored by Dr. Pauline W. Chen in her latest “Doctor and Patient” column.
Medical school was not easy for me. I knew that I wanted to become a doctor to help people, but I had given little thought to the process. I was poorly prepared for many things: the pressure to excel in ways that seemed so far from caring for people; rapidly mounting debts I signed off on every semester; a roller coaster existence from chronic lack of sleep; hazing from the more experienced students and residents; and the realities of patient suffering despite my best efforts.
Dr. Chen explores the fascinating research about medical student burnout and why it happens. Click here to read “Medical Student Burnout and the Challenge to Patient Care,” and then join Dr. Chen in the discussion by posting a comment below.
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Medical school has always been hard. Also, contrary to popular belief, life gets harder after med school, and even harder after residency and fellowship.
There are many other difficult professions as well.
But does it affect patient care? How are we doing?
We’re living longer and healthier than ever before. Studies show it is due to the increased quality of medical care as compared to about 50 years ago, NOT because we are living healthier lifestyles.
Can we do better? Yes. Can we make medical school easier? I’m not so sure. Med students and residents already work fewer hours than in years past.
— jackI was a special ed teacher (of profoundly handicapped students) for 8 years before starting med school. Every Sunday for a year after I started, I was checking the classified ads for the school system to see if any similar positions were still being advertised, knowing I could quit and go back to teaching any time. By my second year I was no longer miserable — perhaps this is a factor of having other jobs prior to med school.
— Pamela SmithMedical school isn’t for everyone. Your columns always focus on physicians in an unusual way. Yes, it is difficult, but it is very rewarding and most physicians enjoy what they do and want the best for their patients. If it was easy everyone would be a doctor. Would you want that?
— KMAs a first year medical student I can say with much confidence that it is horrible. Its not the material, its not the time requirements, as everyone who signed up for this expected to spend about ten hours a day with our faces in a book. It is, however, knowing that failure is only one slip up away. I would guess that 90% of students in medical school have no other marketable skills and know very little about anything other than biology or chemistry, and if they cant pass, they will have nothing to fall back on. I am almost 26 years old, I spent 5 years doing undergraduate work, I will be nearly 35 years old before I can ever see a patient as an attending physician, and I will be in debt over a quarter of a million dollars. As it stands now, we will almost certainly have some sort of universal health care that will no doubt bring physician salaries down, and just last year the government changed the way our student loans could be paid back letting interest gain while we are still in training. Couple that with a public that sees us as glorified car mechanics that they can sue when things go wrong, an aging population that wants “everything done” to keep them alive even if they have no idea who or what they even are, and a payment system that gives dermatologists more money and more time off than family doctors, the future looks less than bright. Oh and did I mention that every student in medical school wants to be either a dermatologist, plastic surgeon, or an orthopedic surgeon, thus creating the most competitive hostile environment. At my school people routinely misplace books in the library so others wont find them. In the end, I fail to see how half of the things I am learning will ever be of importance to the pratice of medicine, yet I will still be here, at the library till midnight tonight trying to cram them into my head. I should have been an accountant…
— StevenGreat article, Dr. Chen. Often when I read about how patients complain about their doctors being unempathic, I’ve wondered if they really knew what that doctor had to go through to get to be their doctor, maybe they would end up feeling sorry for him/her instead of angry. If it seems like doctors and patients come from two different worlds sometimes, the (mal)formative expereinces during med school might be one of the sources of that ideological rift.
I wasn’t surprised at all when the study came out which suggested that almost half of med students are facing burnout and maybe 1 in 10 were considering suicide. There’s nothing in academia which can prepare someone for the abuse and terror of medical school, especially during clinical rotations where 30 hour workdays are the norm (most people work 40 hours per week, just to put it in perspective). Getting hazed, screamed at, and publicly humiliated is commonplace, and medical students are made by their superiors to do essentially slave labor which has nothing to do with learning about medicine (”go fetch me my lunch!” “take these clothes to the dry cleaners!” “hold this retractor without moving, sitting down, or going to the bathroom for the next 4 hours, or else!” are all commands I remember having to follow). To add insult to injury, med students are actually paying the people who are abusing them for the privelege of recieving this treatment. During this time, they’re expected to master information that would be a challenge for a student to learn in 8 years in only 4 years. And just to make sure the student doesn’t have a shread of good humor left, they’re constantly reinforced of the existential terror of making a mistake, and possibly harming someone. After this systematic harrasment process is complete, it’s surprising medical students have any empathy for their patients, or even basic trust in humanity, at all. There has to be a better way to train physicians without humiliating them, for both them and the patients they will eventually treat.
— GregIt is an interesting take on the woes of med students…but I think that the anxiety and self-inflicted pressure faced by med students are shared by the vast majority of other students pursuing tertiary degrees (Phd, JD etc). Because they’re so drive, be it by money, success, the need to prove oneself or ones parents, conquer the world, help others, each becomes an Atlas, shouldering a lot of expectations and pressure. Not that med students necessarily need the empathy, but it’s a universal self-induced affliction that is hardly just the domain of med students.
From Pauline Chen: I agree that a majority of other students also face such pressure (not to mention the many people who are working hard just to feed their families). But I find it worrisome that 11 percent of medical students have suicidal thoughts and that the pressures in general may eventually affect how medical students care for patients.
— ADPThough I am not a medical student I am a graduate student in a doctoral program. I know that being in a Ph.D. program is not the same as medical school, however, there are some similar pressures. I also have an autoimmune disorder. Before I got really sick it was hard for me to understand that sometimes you can’t just push through the pain, or the illness or the stress. I thought people were just being lazy, not working hard enough or something. One of the greatest gifts that my autoimmune disorder has given me is the understanding that sometimes people, even when they look okay, really can’t do everything and really ARE NOT okay. My guess is that it is hard for young M.D.s to be to understand because for them, if it is anything like my doctoral program, there is the expectation that hard work and pushing through the problems that arise is enough to succeed. I have been lucky in my choice of dissertation advisers and so this pressure has been relieved significantly. However, there are still faculty that feel that you can go home at night and deal with whatever you need to but you must come in the next day and be able to function. Failure to do this is a personal problem and sign of lack of seriousness about completing the program. If a person has this set of expectations for themselves, how could they expect anything different from their patients?
— AshleyYour comment “Students, just like doctors, need to take care of themselves in order to take care of their patients” raises another interesting topic that you should consider addressing. How prevalent is substance abuse among practicing doctors? What should a patient do if they suspect that their doctor may have such problem? If a doctor has recovered from a substance abuse problem, how should his/her patients respond when the doctor returns to practice? I would like to see this issue addressed some time.
— KarenIf there is only one thing I’ve learned from following this blog and Dr. Chen’s column, it’s that med students, residents…and to a large extent, doctors…are far too overwhelmed and demoralized to connect well with patients.
The more empathic one is, the more demoralizing it is to feel incapable of giving the right attention to patients. We don’t need the meanest and the toughest doctors to survive. We need the best qualified and still, the emotionally capable, to make it.
It’s got to be a good thing that this training is tough. Maybe a certain amount of “breaking them down, and then building them back up” (as in the Marines) is the right thing for the profession. But the system goes way over top. Glad that a lot of dedicated, compassionate people persist, but the existing system is bound to throw the baby out with the bath water.
— WesleyDr. Chen
Thank you for your article. It gives us an in depth understanding what doctors go through when they are in medical school and residence.
I want to thank you for your dedication and service towards the world population .
Richard
— RichardVery important topic. I can’t read the article right now.
— annaThere is no reason for medical students/residents to work insane hours. Yes, they are exploited, abused and unhappy and as such endanger the lives of their patients. It’s interesting that so many people spend their lives talking about children of abuse, a cycle of abuse, but nobody talks about abuse in the workplace. Is it possible that abused students become cynical and abusive doctors?
Jack, #1, there are many publications, this blog including on how we’re doing. I suggest you take your propaganda somewhere else. No, Jack, a CEO of an HMO doesn’t have to make 1.6 Billion a year. No, someone in charge of a hospital doesn’t have to make millions, etc. I can assure you that mothers don’t raise their children to be destroyed by someone’s greed. There is no reason to tolerate labor camps.
When it comes to doing hard work, that medical school definitely is, motivation is a very big factor. The only motivation for going to medical school discussed in the article is wanting to help people. That is a very noble goal and I am impressed by everyone who does it mainly for this reason. But I still wonder how many students are burned out because their only motivation has been the money and that suddenly an MBA or a law degree seems easier…
Other jobs are very hard and stressful as well, requiring the same degree of academic achievement, and by far not as well paid as doctors.
— HHAlthough it’s been 18 years, I can still see the look on my husband’s face when I came home from law school and announced I wanted to go out drinking and dancing. I don’t drink and he doesn’t dance. He looked at me as if space aliens had stolen my brain. Later that night, he asked if I wanted to go to a bar and hear a band. I asked him why? I didn’t like that kind of music and he’d have to do my drinking for me.
There are parallels between the med school burnout and the law school burnout. Each year in law school, I got sicker because the stress had weakened my immune system. Once I began practicing law, I watched another part of my body fall apart with each intense trial. I’ve been in practice now nearly 15 years. My body doesn’t fall apart with a trial, but I wonder how much my life has been shortened by the constant stress.
Helping others - medically or legally - shouldn’t cost us our lives. We need support groups. We need to be taught how to relax. We need to be taught it’s okay to cry. We need to work to overhaul a system that makes no sense. We can’t keep burning out and killing the most gifted among us.
— Deborah ThumanOne unique aspect of the difficulty of training medical students I believe is that the medical education system is designed such that 99% of students cannot get off the career path of becoming a physician.
In almost every other field, particularly the other professional schools of J.D. and M.B.A., many eventually realize that they are suited better for other forms of work, and do not end up practicing.
Given the culture and the match system in place for residency, as well as the ladened debt, it is near impossible for a medical student to choose not to practice, unless he/she can find a similar income field such as finance, etc. (a rare few) and is willing to bear the perceived embarassment and failure of leaving the “noble profession”. Thus, it is on the onus of medical teachers to figure out how to transform anyone into a competent physician, an arduous task indeed.
— DTI work with medical students, interns and residents everyday and I can see how they would suffer from burnout-being on call every 3-4 nights and being up for 24-36 hours. But that is just the temporary part.
— RNEveryday there are doctors and nurses suffering burnout. They have more and sicker patients to care for, with less. There is a demand from hospital administrators to increase productivity at less cost. While this is no different from the rest of the world with its different industries, we are talking about human lives that these people, including myself, take care off. We are doing it at a cost to our own emotional and physical health. As a night shifter, I know it is taking a toll on my health, but someone has to work those shifts. There are no easy answers, and this burnout will probably never end–but most of us love what we do, or we wouldn’t be doing it.
I went to graduate school twice, the first time for a Ph.D., and then, when I had completed that and done two postdocs, for a law degree, which I also completed.
I felt a failure getting my Ph.D., even though I was highly recruited and on scholarships the whole time. Why? Because I felt that I was an inadequate member of the tribe, someone who was insufficiently diligent (although I spent almost all my time in the lab), insufficiently intelligent (although I did well in all my classes), insufficient in living up to the standards of the great scientists who had gone before me, as well as of course my fellow classmates, who seemed to me to be so much better adjusted than I … although in fact they were (mostly) quite open about how unhappy they too were.
I felt much less a failure in law school, partly because I was older (35) and had a support group outside school (wife, child). But mostly because, having gone through the rites of initiation once before I saw them the second time around as exactly that: initiation, in the primal sense of tribal membership, what we scratch our heads at when aboriginal tribes do it in the amazon but which we happily recapitulate for any of the professional groups we have, lawyer, scientist, and doctor.
I had a conversation on that topic years ago with a friend who was a lawyer and a Ph.D. in sociology, who told me that there are normative behaviors for professional groups, and studied rites of initiation for those groups, ones that I’m sure sociologists treat intellectually exactly as they do the first hunt, the menstrual hut, or whatever other social aspects of “primatives” that we marvel at.
The difference as far as I can see is that “primative” tribes do a better job of providing the support that makes those rites of passage positive experiences. Not to say that I graduate school was horrible, certainly not to say that I regret it, because I don’t, and in fact I’m a very happy patent attorney now. But I will admit that it took that second round to see the whole process for what it was and, even with that additional knowledge, a good plug of 5 years post law degree to get the final plug of knowledge … or, alternatively, the requisite loss of memory that adds nostalgia to events that, at the time, we never thought we’d look back fondly on.
— Andrew ScheinmanMy memories of medical school are similar!
I particularly like the idea that perhaps being more empathetic can make the experience more stressful.
Of course, this idea may be self serving. I have to say, though, that I am constantly complimented on my thorough evaluations and my “caring.” I have many patients who will only see me and tell me things that they do not share with their primary (I am a specialist.)
We should let these medical students know, it does get better.
— rini1Awww…. Poor babies. Maybe they know they are going to earn a half million dollars per year for the next 40 years! Maybe if medical schools took only students who wanted to be doctors in order to help people and not those who just want to earn lots of money, there would be less burnout. I have known both types and the former enjoy medical school and do well, but not always monetarily. The latter become egotistical millionaires who act as if the rest of us are only a little better than chimpanzees. I have 3 three relatives and 2 friends who are the latter, and 2 other friends who are the former.
— Carl R.Simple solution…
— Howard Green, MDChoose medical school applicants who have had more diverse educational backgrounds than the prototypical
pre med- biology/science/math students and nepotistic legacies who pack the classes now. This will achieve a more well rounded and less exhausted medical student body which may have the perspective and maturity to handle medical school and residency.
These findings can’t possible be a surprise. I’ve been reading articles about medical education for decades and they all say it’s torture. Was no one paying attention? I guess not.
— Lisa H.I was recently in a hospital in Brooklyn and not a single doctor or nurse was originally from the United States. I don’t have a problem with accents - I live in Brooklyn - but I wondered why we have to import so many of our medical professionals. I have a hard time believing that a nurse from the Philippines or a Doctor from India was necessarily that much smarter than similar American students. It seems that the barriers to entry and to exit in the medical professional are impossibly high. Perhaps there should be a 1-2 year school b/w undergrad and med school for those students that may not have made the first cut at med school but would after another year or so of study. And I really don’t understand the nursing shortage in this country. My friends that are nurses make a ton of dough compared a lot of professions. The job is hard but some of them have pretty flexible schedules and nice lives. I’d think it would be a profession more people would enter.
— john in brooklynI have to say that I (dare I say) loved med school, where I met amazing mentors / physicians who were both humanistic, skilled, and amazing at getting to know patients and their struggles. In fact, as I continue into my third year of residency, there have been ups and down but I have to say it’s been overwhelmingly positive, from taking care of chronic patients all the way to critically ill ones.
The most amazing thing is how much organizational culture makes a difference. It directly impacts quality of life for the med student and the resident / fellow / attending.
— TVPI am a doctor currently in the midst of my residency. I just wanted to comment on people being miserable in medical school or residency or in life. Medical school wasn’t easy; it’s not supposed to be, but I enjoyed almost all of it. Even the rotations that weren’t my favorite I tried to approach them thinking that each day I would learn something new and have fun. If you allow yourself to be overwhelmed and think that it’s all misery and suffering than it will be. I find that you have to enjoy every day and all the little moments it brings, otherwise you will be miserable at whatever you are doing. Medicine is hard, but fun. I can think of no better field. I enjoyed medical school and I am enjoying my residency.
— HunterThere aren’t many things in life as challenging and intellectually exciting than getting a medical education. By its nature the work is very hard and hence is not for the faint of heart.
The down sides particularly in these times for the tremendous effort required are the financial rewards are modest, takes decades to pay off educational debt, and the practice of medicine can easily become quite boring.
— MARK KLEIN, M.D.As a mother of a new medical student, this disturbs me greatly. How can we take some of the best and the brightest our country has to offer and abuse them in this way. Surely, there must be a better way to impart the knowledge needed to be good doctors. Hopefully those empowered to be able to make changes will see how destructive this situation is and change it. We may find it hard in the future to get the brightest students in the future to train as doctors - why be a masochist when there are so many alternatives who have skills needed for medicine (i.e quantitative, analytical and insanely motivated)? Then we all lose as a society.
— Lisa Heffernan