Why Don't Medical Students Want to Practice Medicine?

Introduction

Welcome to the inaugural 8 O’Clock No Show newsletter! In this issue, we’ll look at decreasing medical student interest in clinical careers as well as the benefits of doing a bad job!

Why Are Medical Students Fleeing Medicine?

When starting a newsletter, you often find yourself explaining to friends and family why you've embarked on this journey. My pitch included the fact that I would write for like-minded physicians, a group largely invisible to the general public. These doctors, in my experience, often wish to trade a portion of their clinical practice for opportunities similar to those of their high-achieving, non-medical peers. At least half of my colleagues, as I've observed, harbor this desire. So, when a news article reported that over half of medical students do not plan to practice clinical medicine, I saw it as a sign to start writing.

Today, I'll provide an unmasked look at how medical students choose their specialties. Understanding this process is crucial to grasp why many wish to escape clinical medicine.

Motives for Pursuing Medicine

Many will find relief in knowing that there are still people who fully dedicate themselves to becoming doctors. This attitude is most common at the start of medical school. Here, we find individuals who have worked hard for medical school acceptance, intending to use their education for clinical work, with few exceptions.

These young medical students eagerly anticipate joining a profession revered like no other. For the most privileged members of an entering class, respect and admiration are the main extrinsic motivators for their career choice. They have chosen medicine over more comfortable and lucrative opportunities afforded by their affluent family backgrounds. Children of physicians who practiced in more profitable times, make up a large portion of those who arguably have easier options than medicine. These students, somewhat immune to the financial doom and gloom surrounding modern medicine, represent the purest of medical students.

To paraphrase an old saying, medicine is the dream of the non-upper class. These students share the same desire for respect as their wealthier peers but also aim to climb the economic ladder. They enter medical school influenced by outdated estimates of physicians' earning potential, soon to learn how much times have changed.

Awakening From Premed Dreams

On the first day of medical school, idealism and limited exposure dominate. Some students have dreamed of becoming pediatricians since childhood. Others, passionate idealists, aim to improve primary care in underserved areas. You'll meet students determined to emulate a parent or mentor, and those drawn to the excitement of emergency rooms. And it wouldn’t be medical school without the future surgeons.

As medical school progresses, the cohort of aspiring surgeons grows. Students feel pressured to choose their lifelong specialty much earlier than outsiders might expect. Friends start discussing survey results about average salaries and burnout rates in various specialties. They ponder their future lifestyles, contemplating the demands of overnight emergencies or sixty-hour workweeks, especially once they have families. These considerations form the basis of a specialty's "lifestyle."

Within the first two years, medical students narrow down their specialty choices based on interest, income, lifestyle, and prestige. At this stage, many students at MD-granting schools in the United States either decide to work hard for a high income or find a specialty with a more humane balance between money and lifestyle. It seems at one point that half the class wants to become surgeons or dermatologists.

Reality Bites

The first reality check hits with licensing exams. Students strive for the highest possible scores on these exams. Once they receive their results, many whose self image was anchored in competitive and lucrative specialties like dermatology suddenly change their minds. Their peers politely pretend to believe it’s simply a coincidence they choose specialities less demanding of stellar board scores.

Upon entering the clinical portion of medical school, other students realize the specialty that checked all of the boxes isn't right for them. They might dislike the people in that field or its demanding schedule. I've repeatedly heard students express that surgery is more boring and repetitive than they expected, or that they can't stay awake in the radiology reading room.

The spring of the final year in medical school brings the harshest form of disillusionment: Match Day. This is when students find out which residency program, and by extension, which specialty, they will be joining. Despite careful crafting of their applications to avoid disappointment, many still face it on this day. The least severe form is matching with their chosen specialty but in an undesired program, often due to location. The most devastating outcome, however, is not matching into any specialty. This unfortunate reality affects 5-10% of US medical students, and most of them will not secure a position in the specialty they initially sought.

In a future issue, we will delve into how physicians cope with this widespread disappointment and explore why the younger generation might be opting to avoid it entirely.

Please let me know how this matches up with your experience. Start a conversation on social media, links below.

Quality of Life Corner

The typical medical student matriculates with a streak of perfectionism, but medical training often forces us to temper this trait. We learn to maintain high performance by strategically cutting corners out of sheer necessity.

When it came to actually publishing this first newsletter, however, the perfectionism crept back in and my plans were delayed by months. Only a small portion of the time I spent “working on the newsletter” was more productive than just sitting down and writing something.

My reminder for today is to just start whatever it is you want to do. Accept the possibility you might do a bad job. There are people who spent decades planning to do something they never did. Are they better off having never done it or should they have just taken that first step?