We read article after article about the complete dissatisfaction of physicians throughout the United States and how it affects patient care. Since it makes a good story to cover the woes of physicians, the general press seems to covers this topic as dogma. But it is not just the general news. Even Medscape, one of my favorite radiology news/blog sites, has multiple articles and surveys on this topic.
Many different reasons are espoused for the cause of physician burnout. But, I believe there is one major factor that is not addressed. It all has to do with our medical school system and how the system is not made for the student/trainee but rather to support the folks running the schools.
What is the cause for this situation?
Think about it. If you were to create a medical school, what would be first thing you would want the student to know? It’s very simple… The student should know which field in medicine they want to pursue. They should be exposed to a field that stokes their interests and makes them excited to learn and practice. Instead, what is the first thing that the typical medical school introduces to the student? Maybe it’s biochemistry. Maybe it’s histology. Or maybe, if your lucky, it’s a “introduction to clinical medicine” course. And, of course the “introduction to clinical medicine” course almost always emphasizes primary care. Even worse, the “introduction to clinical medicine” course does not expose the medical student to the day to day work of a typical physician. It may be a small group setting or an artificial patient situation. But, it is not the average day for the average physician. Medical schools are creating physicians, but the physicians they are creating are syphoned into certain specialties because they lack exposure to physicians practicing in the myriad fields of medicine from the very beginning.
I think about my story. When I started medical school, I wasn’t sure which specialty I should choose until I took an unrequited radiology elective during my 3rd year, right before the time that I was required to submit my application for the residency match system. I think back how much time, effort, and money I wasted pursuing different avenues when I could have focused on research, reading, and learning more upon my prospective specialty, radiology, during my first few years of medical school. And, I am one of the lucky ones. I actually found a field where I do not burn out. Why? It’s very simple… I enjoy coming to work because it is something that I want to do.
But let’s now think about other less fortunate “burnt out” physicians, who according to the media, may be a majority. What fields do they select and why? Maybe it was related to a chance encounter with a mentor. Maybe it was because they only had exposure to primary care specialties. Or maybe it was a random flip of a coin. I would argue that the exposure to different career opportunities in medical school is not enough and too late.
How would I solve the problem?
The solution to this problem of inadequate exposure to all specialties is so simple. All medical schools should stop with the nonsense of immersing students in the science of medicine or artificial clinical medicine on day #1. Instead, each student should be allowed to pick 4 specialties in which he/she may be interested. And for the first 2 months, they should be allowed to shadow a physician in one of these specialties for two weeks at a time in a real world practice situation, creating essentially an internship of sorts. What would this do? It would allow a majority of students to choose their field early and prevent them from wasting their time. It would create happier physicians because they would have chosen the right field. And, it would give a second chance to students who chose medical school for the wrong reasons a way out. These students could leave medical school early and choose a different career without the obligation of remaining in field of medicine because of a mountain of debt.
If the solution is so simple, why will it never be implemented?
Here lies the crux of the problem. No medical school will ever implement this very logical strategy for decreasing physician burnout. In fact, it is never even discussed. Why? Let’s think about the true motivation behind most schools. Of course, most schools have mission statements that propose to enhance the quality of physicians and their education. But really, what will happen if you create such a system as this? Medical schools are a big business. Implementing my program decreases the number of students in the medical school because you increase the dropout rate, thereby decreasing the tuition revenue for the school and decreasing the profit per student. Revenue is what truly greases the squeaky wheel of medical education. Furthermore, you will also be increasing the number of sub specialists when the government funds schools to emphasize primary care. Once again, the interests of the medical schools are truly not aligned with the interests of the medical students.
All of this discussion leads me to this final conclusion.
We all harp upon the topic of physician burnout. But we really have to take a hard look at the face of medical education. Are we truly examining the root causes? And are we really willing to face the problem head on? Like a good physician, maybe we shouldn’t just be treating the symptoms of the problem but we should be removing the cause. That will take a lot more than talk about burnout and will involve fundamental change in our system of medical education.