The Pre Med Process is Hurtful

I have practiced medicine since finishing residency in 1993. And I have seen a lot of change, for better and worse. Along the way I have made a lot of observation about the way we educate physicians. And I think that in some very real ways, our process is both effective and destructive. Here are some thoughts I had on the way we select students for medical school. This was published last year in Emergency Medicine News in my column, “Life in Emergistan.” The link to the original column is here.

https://journals.lww.com/em-news/fulltext/2023/08000/the_pre_med_process_hurts_future_eps.10.aspx

I know some pre-medicine students. They're hard-working and passionate. They struggle to overcome their academic weaknesses and to hone their strengths. They sift through the statistics, prep courses, Instagram and TikTok videos, and podcasts about who got into medical school and how they did it.

They take difficult classes designed to cull the herd. Their dreams are so big and their hopes so desperate that they sometimes feel completely wrecked when they do get a bad grade on a test or in a class. I remember the emotion. It's easy to succumb and want to give up.

These incredible people pass on vacations with their families to shadow, do mission work, volunteer, scribe, or engage in mundane work in research labs. They sacrifice years of their lives in the nearly endless attempt to prove themselves to future admissions committees.

Along the way they also face discouragement from many of the physicians they meet who advise them, “Go be a lawyer; that's where the money is!” Others tell them to become nurse practitioners or PAs. Even as they strive, other voices—the devils on their shoulders—tell them that the thing their hearts call them to do simply isn't worth the effort.

Sometimes one of the greatest hurdles these aspiring physicians face is being in classes with the intellectual superstars who inhabit every college. Those achievement machines are enough to run off many good but not perfect students. It's hard to imagine competing with that young woman who got a 4.0 in chemical engineering while she simultaneously designed a new device to fertilize rice in Southeast Asia and read to blind children. Everybody else feels a bit like a slacker by comparison.

We know we have an exploding shortage of physicians in America (and in other lands as well), and the system still seems designed to cause discouragement and exhaustion. Roadblocks are everywhere, even in the coursework. We know that we really don't use organic chemistry or calculus, but these are often the needle's eyes that future students have to thread, no matter how generally competent or kind they may be.

Not only is the process demeaning and demanding, it often forces students to delay normal “adulting.” The pursuit of medical school can make it hard to have good jobs and start saving for retirement. The demands on the pre-medicine student can make relationships perilous because their lives require a great deal of focus on self.

It's a natural outgrowth of the process. It certainly can be overcome successfully but not without focused effort. Fortunately, focused effort is sort of the phenotype of the pre-medicine student.

The journey to medicine can also cause a delay in romantic relationships and parenthood. Young people who want medical careers and children can find themselves caught in a hard place that forces them to make choices that in other less time-intensive careers might not be so difficult. We've made the system remarkably unfair to them.

It's no wonder that the process to medical school, coupled with the rigors of medical school and residency training, can leave physicians with physical exhaustion and emotional scars.

Oddly, after this epic journey into medicine, we look at the statistics on substance abuse, marital problems, depression, and even suicide in physicians, and ask, “How does this happen?”

We send physicians to wellness courses and therapy (squeezing it in between clinical shifts). We look for ways to make clinical care somehow more tolerable and humane. All the while their lives have been marinated in debt, seasoned with stressful life and death interactions, and garnished with the endless threats of failure and litigation.

We may be missing something important here. I believe in working on physician wellness and satisfaction, but I fear we poison our larval physicians from the beginning.

This job is awesome, but it is hard. It takes not only intelligence but the ability to sacrifice, take risks, and assume responsibility for the well-being of humans, which means it also takes a deep love of our fellow humans. But none of this even matters if our young physicians are broken and shooed away before we can even get them to the bedside.

I certainly want us to have intelligent physicians who can work hard and push through hard times. But I also want us to have well-adjusted physicians who haven't been beaten into submission, who haven't lost their joy, to do a job that will be arguably as hard, in different ways, as their educational process.

I'm not an academic, but we need to do better every step of the way for the future of medicine and the future wellness of physicians and their families. And that means not only caring for our practicing colleagues but for those starry-eyed pre-medicine students who want to follow in our footsteps.