Reflecting on the First Year: Welcome, Former Premeds

While I was trudging through exam number sixteen of approximately eighteen (first year exams) a couple of days ago, thousands of individuals (premedical students, post-bacs, graduates, and those leaving their previous careers and pursuits) passed the point of no return as they committed themselves to a single medical school. Sometimes these decisions are quite complicated and stressful, sometimes there is no decision to make at all. It was definitely complicated and angst-ridden for me, though I am very happy how it turned out. As many former premeds are excitedly or apprehensively starting to look into housing and transportation options, others are anxiously beginning the long wait until classes begin to see if they will receive a Golden Ticket off the wait list. I’m not sure that many are as eagerly self-reflective as me, but I wonder how many are thinking to themselves: was all this work worth it? Will all the work and hardship to come be worth it?

I recently read a couple of insightful and thoughtful posts by Panda Bear, M.D. and Hybrid Vigor exploring these questions and the long and arduous medical school application process. In the fall, my successor at the Next Generation, Serene Chen, interviewed me and asked me to reflect on my early medical school experiences. Here, at the end of my first of what Panda Bear calls the “cool years,” I have found much in my experiences thus far that reinforce my motivations and make me happy to be on the road to becoming a physician. Here’s why:

My Thoughts

1. Medical school is actually kinda fun.

I’m not crazy. I swear. Granted, medical school is hard, and I’m spending the majority of my time in class or studying. However, some of the material I’ve learned is pretty interesting, and some of my physician- and researcher-instructors have very effectively illustrated the value of their lessons by incorporating engaging clinical correlations and the recounting of relevant, meaningful personal experiences. I’m very lucky in this respect: many of my instructors are quite serious and passionate about teaching, usually resulting in high quality instruction. On the other hand, some of my instructors have failed to engage the attention of my class and express the excitement and applicability of their fields to the practice of medicine.

But medical school isn’t just about classes. One thing I have enjoyed most about medical school so far is getting to know more about my classmates. There are a lot of cool, sincere people, and it’s refreshing to know that not all medical students were once cut-throat, backstabbing, eye-gouging, two-faced, résumé-padding premeds. Not that I have ever actively condoned such a characterization of premedical students, but one of my motivations for founding the Next Generation was my worry that a considerable amount of good people with good motivations would have their views of the medical profession jaded and discolored by the conduct and behavior of their cutthroat classmates. Nonetheless, there’s a certain camaraderie in medical school that one doesn’t find in college: we’re part of the same group, we have the same allegiances and the same general goals.

Another thing I’ve enjoyed: early clinical experiences. Some have been awkward, some have been incredible. I never would have expected to intubate a patient as a first year medical student, or get so much practice taking histories, performing physical exams, and presenting cases to attendings. I’ve noticed that my classmates who have actively sought extracurricular clinical experiences (e.g. free clinics, working in the various hospital services, etc.) seem to be the happiest and most content with their education, while those who haven’t seem to be the most discontent and the most likely to think of medical school as a depressing and tiring experience. My impression is that this is a reflection of the power of early clinical experiences in reinforcing initial motivations for entering medical school, but I’m sure there are other reasonable, alternate theories.

Lastly, one thing I find encouraging is that my upperclassmen have all individually expressed that their experiences have improved with time: they all thought second year was better than first year, third year was better than second year, and fourth was better than third. If that’s the case, I’m off to a pretty good start.

2. Though we shouldn’t give ground to forces that would erode our ability to effectively, eagerly, comfortably, and happily provide excellent medical care to patients, doctors will undoubtedly adapt and deal with changes.

Current doctors have a lot to complain about, as evidenced by the plethora of angry rants to be found on the medical blogosphere. There is much imperfection in the health care system, and a lot of unhelpful pressure and many impeding factors that make the practice of medicine so miserable and unsatisfying as to encourage many doctors to jump ship or scale down their clinical practice.

However, while doctors should resist these forces and strive for positive reform, there also remains the default option taken by most younger, incoming physicians: deal with it. While older, more experienced physicians may complain about the growing amount of paperwork, the difficulty of navigating electronic health records, and the shift from more personal, longitudinal care to shift-oriented, hospital-based care, many new physicians dive right in and take the status quo in stride. This is both encouraging for younger physicians and potentially discouraging for those who seek to improve health care: younger physicians are usually able to adapt to what seems to be an increasingly more challenging health care system, but at the same time, they might not have the historical context and institutional memory to recognize long-term trends that may severely paralyze or damage the practice of medicine.

One thing I wonder about is the value of advice and insight from former medical students or graduates who have since abandoned medicine because they found that it wasn’t what they thought it was made out to be. A good friend of mine had one such individual as her premedical advisor, and it often seemed that this individual tended toward trying to justify his decision to leave medicine rather than help her find out whether or not medicine is the right profession for her.

3. Medical school is insanely expensive, but if you think on your feet and aren’t a big spender, you’ll do just fine.

I feel like I’m hemorrhaging money. But at the same time, I suspect that I will likely specialize or at least work in an academic hospital with a decent (but not phenomenal) salary. I don’t need a beautiful mansion or an expensive car (at least, not right away!), and although I would like to honor my (pirate) ancestors, I really don’t need to buy a boat.

Anyways, there are medical disciplines that are in a rut at this point in time with respect to salaries, reimbursement, and paying for malpractice insurance. I don’t want to discourage people from selecting these fields; instead, these are areas that can use strong advocacy to illustrate why these fields are essential and need help. If you aren’t interested in swimming against the stream, then don’t pick these fields. If you do have the strength, resilience, and foresight, I (and many others) have great respect for you and will try to support you along the way.

4. Find out what makes you happy.

Medical school takes up a lot of time, but if you learn how to manage your time well, there is plenty of time for enjoyment. Although I’m performing well in my classes, I hardly ever study at night: I spend my nights playing video games, watching TV shows, writing on this blog and reading others, videochatting with my girlfriend and instant-messaging my friends, playing my guitar, practicing martial arts, and so on. I have time to go out with my classmates for dinner or ice cream. I have time to hang out with my friends outside of the medical school. I feel like I have more spare time now than I did in college, and I’m using that time to have fun, improve myself, and make myself happy.

I also really enjoy learning: I’m happy to be a life-long student, and I like glancing through medical journals, reading the news (medical and other), and spending time in the clinics and hospitals. I hope that all medical students would like at least some of these things; otherwise, they might be in the wrong place, or they might not have exposure and access to good opportunities and resources. If that’s the case, be proactive and seek out what you’re paying for: the best medical education you can possibly get.

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