Entitlement

One thing most medical students have in common is that they will leave medical school with a considerable, if not daunting, amount of debt. Medical school tuition is an exceptional burden, ranging from around $10,000 per year for the cheapest public schools to over $46,000 per year for the most expensive private schools. The $10,000 price tag is not common though: the average debt for a medical student graduating from a public school is around $100,000, while the number rises to around $130,000 for private school graduates (the overall average according to the AMA is $130,571 in 2006, with 72% of graduates having at least $100,000 in loans and 86.6% carrying outsanding loans upon graduating). This, of course, does not include room and board expenses, transportation, books and supplies (e.g. $700 diagnostic sets, $100 stethoscopes, etc.), which brings the overall price tag to around $250,000 for four years. For some (myself included), this will be the first time that we will have to pay for our own education. Other students may still have to repay loans that financed their undergradute education. Some take a few years off before entering medical school in order to raise money for their education. A select few have the luck of being able to have their parents pay for their education, but unless they are extremely well-endowed, the cost of education is, at the very least, an uncomfortable thought that urges one to feel grateful.

People have lambasted and lamented the high cost of medical education for a variety of reasons, but for me, there is one problem that is much easier to see from the perspective of a medical student: the problem of entitlement.

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Simply put, the more students have to pay for their education, the more to which they will feel entitled. At a time when the standing of physicians is under attack from many sides and public opinion varies considerably, a culture of entitlement is that last thing we need to foster in the next generation of physicians. Entitlement serves no useful purpose: it makes us impatient, callous, lacking in perception and perspective, and unfit to do our jobs.

What do we feel entitled to? Some desires seem reasonable and natural: for the price we’re paying, we should expect to receive a top-notch medical education from experts in the field. We expect to have good resources that come with reasonable convenience: maybe not served to us on a silver spoon, but at least accessible without a gargantuan effort.

But there are also some expectations that are not as reasonable. We should not expect that our instructors are only there to teach us and have the time to attend to all of our needs. We should not feel entitled to common study spaces and get angry when someone else actually uses them (i.e. the amount of times I’ve heard people rant at a pile of books or a backpack…). We should not feel that we are all-important, or that our clubs, causes, and purposes exceed all others in priority. We should not expect to automatically receive respect and deference from house staff as medical students. We should not believe that, as medical students with great burdens on our backs, that it is acceptable for us to forget common courtesy. Or that our burdens exclude us from the duties of being a good person: to reach out to others, to be tolerant, to be patient and understanding.

The great weight of growing responsibility that comes with medical training has a variety of effects on people. The majority of medical students are humbled, to some degree, by the experience: we feel grateful to the people who have helped make our training possible, and we feel duty and responsibility to the people who need us. We complain little, or if we do, in private and with humor or a shrug of the shoulders. However, some students react in the opposite way: they see their medical training as a route to ascension, an expensive, difficult process that will make them something greater and stronger. Given the investment and the sacrifices they are making, it seems natural that everyone else should try and make the process as easy as possible for them: give me convenience, give me respect, give me a break. I am trying to do some good, I am holier than thou, I am the one with the quarter-million-dollar debt, and still you don’t respect me and my efforts?

To my fellow medical students, I ask of you: find some strength within you and be patient. Our path will not become any easier as time goes along.

This does not preclude you from being an advocate for change: it’s all about a change in attitude and approach. Instead of feeling entitled and making demands, step back, assess the situation, and think of solutions of mutual benefit and contribution. Be willing to meet the other party halfway.

Better to light one candle than to curse the darkness.

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