Writer-in-Training
University of Illinois at Chicago College of Medicine
I'm just a dude trying to find my way in the world through (public) health and advancing APIA status.
Whenever I hear the word “burnout,” I’m reminded of the ugly, oh-so-dark side of being a medical student, the side that hides in the shadows, away from the prestige and privilege that comes with the noble profession. Maybe it seems like I’m exaggerating; I mean, it’s just me jumping to conclusions when I associate the feelings of being overworked with the days where I can’t seem to find the bright side of anything, right?
In 2015, the Institute for Women’s Policy Research published an alarming statistic: on average, women made only 79 cents for every dollar earned by men. Even more alarming was the fact that when the study controlled for qualification or stratified by job title, the gender wage gap persisted. Unfortunately, medicine is not immune to the gender wage gap phenomenon. According to data from the US Census Bureau, women make up one-third of US physicians, but on average make only 69 cents for every dollar earned by their male colleagues. This results in over $56,000 in potential wages lost for women in medicine each year.
In today’s America, it is well documented that each year, more of our GDP is being devoted to healthcare spending, and a disproportionate amount of that healthcare spending is towards end-of-life care. According to a 2013 report from The Medicare NewsGroup, Medicare spending reached about $554 billion in 2011. This was 21 percent of the total spent on health care in the US that year. About 28 percent of that $554 billion — $170 billion — was spent on patients’ last six months of life.
My recent psychiatry clerkship inspired me to examine racial relations during third-year rotations. This reflection originated from a physician submitting a particularly disturbing evaluation of me. She wrote: “[The student does not] recognize and address personal limitations or behaviors that might affect their effectiveness as a physician … [The student is] defensive, rigid, intense and intrusive; unable to see nuances in human behavior that is necessary for analyses of the human psyche; lower emotional quotient than peers.” Her response left me with an open-jawed, stuporous gaze. I could not believe that she had made this kind of assessment after interacting with me in only two patient encounters for less than half a day!
“I could never be a primary care doctor,” my friend and fellow medical student says as she pops a french fry into her mouth. There are five or six of us sitting around a hospital cafeteria table, grabbing a quick lunch between our morning and afternoon lectures. “I mean, seeing fat people with diabetes and heart disease all day. It would just be so frustrating, because they did it to themselves, you know?”
I recently had the opportunity to shadow a local occupational medicine physician over spring break. I arrived at his office Monday morning expecting a brief day of clinic, maybe some conversation over lunch; maybe I get lucky and he pays for my sandwich. Within minutes of meeting him, though, the physician offered to host me for the entire week on a “mini-rotation.”
One of the major expenses that future doctors face is the cost of the United States Medical Licensing Exam (USMLE). This test is given in three parts, spread out across a student’s training, in total costing over $3,000. The most expensive item by far is the Step 2 Clinical Skills test, whose registration fee comes in at a whopping $1,275.
Too often medical students lose their motivation because of emotional exhaustion, depersonalization and a diminished sense of personal accomplishment. Medical students should no longer see their education as a challenge to overcome. They should see it as a game that can be won.
As medical students, we recognize that bias in medicine is doubly damaging: it burdens our peers and it harms our patients. In the opening narratives we see both of these at play: in Micaela’s self-doubt and frustration, and in the intern’s judgment of their older, Latina patient. Such clinician bias has been increasingly shown to contribute to widespread health inequities.
Like poker, medicine has certain rules — patterns of clinical symptoms and lab findings each correlating with a specific spectrum of prognoses that vary in likelihood, the differential diagnosis. Physicians are like seasoned card players, trained to maintain composure and incorporate numerous variables into logical, calculated decisions at what seems like a “dealer’s table” of outcomes. Sometimes, we hedge our bets that the patient will self-resolve, so we elect not to treat; other times, we act conservatively with a battery of tests and pre-emptive therapy.
Medical school is a notoriously challenging experience during which students undergo tremendous personal change and professional growth. Though the stressors that come along with this are varied and unique to each student’s context and experience, they may be categorized within a few common themes. Harvard psychiatrist Raymond Laurie has previously described the concept of “role strain” with respect to negotiating relationships with their families, friends, partners, peers, attending physicians and patients. Additionally, with regard to students’ concept of themselves, individuals who have high achievement may be challenged in new ways both intellectually and emotionally.
You knock on the door. “Come in.” When you enter the room, a gowned patient sits calmly atop the examination table. For the next 15 to 20 minutes, you spend your time in the small, cramped and surveillanced room with this individual to tease out the mystery of their chief complaint.
Medical Student Editor and in-Training Staff Member Emeritus
University of Florida Fixel Movement and Neurorestoration Institute
Nita Chen is a current movement disorders fellow at University of Florida Movement and Neurorestoration program. She is Class of 2017 medical student at Albany Medical College. To become cultural, she spent her early educational years in Taiwan and thoroughly enjoyed wonderful Taiwanese food and milk tea, thus ruining her appetite for the rest of her life in the United States. Aside from her neuroscience and cognitive science majors during her undergraduate career, she holed herself up in her room writing silly fictional stories, doodling, and playing the piano. Or she could be found spazzing out like a gigantic science nerd in various laboratories. Now she just holes up in her room to study most of the time.
