The Illusion of Choice

Before starting as a premed, I always assumed that when a person went to medical school they had some relative autonomy to choosing a specialty. I wondered about all the physician burnout and why people would go into careers that were not fulfilling to them and find themselves burnt out and unhappy. Obviously, I knew that medical school and residency are intense and that could lead to some degree of burnout but this is a temporary hardship that most people will endure to be able to have a career in a field that holds one's passions. Now, in my second year of medical school, I've come to the realization that attending medical school does not guarantee a career in a desired field, perhaps not even a career as a doctor. Obviously this is not the only reason physicians could be experiencing depressed levels of satisfaction with their careers but I can't help but wonder if it isn't part of the problem. In medical school there is one single test that will determine what specialties are within a person's reach, USMLE Step One. As the importance of this test has become the dominate factor for residency programs in choosing their residents, students are placed in a situation where that one test can potentially close the doors to their desired field(s) and relegate them to an entirely different specialty that they never even considered. Further, there are no options to retake Step One if a student scores lower than they needed to score for their preferred field. To make matters worse, there are about 4K medical school graduates annually who do not match into any residency program. These individuals end up with more than 200K in debt and no job! These students can always reapply for residency the following year but their chance of matching in a second application cycle is cut in half. Each year students push themselves beyond their limits and lock themselves in libraries for weeks on end in order to get a competitive score. Test prep companies makers capitalize on students and make big money selling materials that teach to the test. Without fail, the national average score rises more as students pour their energy and money into learning the test. Score inflation pushes residency programs to increase their score requirements because, after all, they all want "the best" for their program. In turn, this cycles more pressure on the upcoming test takers to do better and push themselves even harder. For some the push is too much, it makes them sick and drives them over the edge. I recently spoke to a surgery resident who didn't match into orthopedics and is now in his first year of surgery residency. He's unhappy and feels like a failure for not being able to go into his preferred field. He didn't do terrible on step, well above average, but not good enough for the ever inflating score requirements. Now he is looking at a lifetime in a career that was never in his plan. All of this has me wondering what percent of students are actually applying for residencies in the field that they truly want rather than the field that will just get them a job? One would think that after spending four years getting the best grades in the most demanding undergraduate science courses, making a high score on the MCAT (medical school admission test), and making it through 4 grueling years of medical school one would have the ultimate say in their specialty. Unfortunately, now more than ever, this just is not the case. Going to medical school means that you will have an MD or DO after your name but it doesn't guarantee you'll be doing what you love or that you will ever work as a physician. This is a real worry for me. My family and I have sacrificed so much for me to be where I am now at age 34. I've lost so much time with my son in effort to follow this dream and, in doing so, show him that people really can do what they want if they set their mind to it, even those of us with disabilities. My career will be decidedly shorter than that of my colleagues and if I end up in a specialty that doesn't make me fly out of bed every morning to be with my patients, I'll be heartbroken.

One Woman Ship

Medical school is a lonely and isolating process. This is a truth that I want to get out because I thought things would be so different and this was a real blow for me. I knew that being a mom and in my 30s would mean that there would be some differences in my experience from most of my classmates but part of me thought that I'd make at least one or two good friends and finally feel like I was a valuable member of a group. Truth is, I don't think there is a time that I've ever felt so alone. I'm constantly studying in isolation and, even during mandatory group activities, my dramatically different upbringing and life experience leaves me feeling like the odd woman out. I'm a gen-Xer in a world of millennials. There are a few men in my class who are also in their 30s but I am the only woman. Otherwise, most of my classmates are in their early 20s. I really tried those first few weeks of school to make some connections but nothing stuck. I quickly became overwhelmed with the course load and the intensity of our accelerated curriculum, which left no time for making friends. To make the situation worse, my husband never received the transfer to Dallas so I have been single parenting our son the entire time. Trying to parent a special needs kid, maintain a household and do well in my courses has knocked me on my ass day in and day out. Everyday I feel less similar to my "peers". My ship is constantly in the eye of the storm and it really just plain sucks on most days. I've even caught myself feeling resentful toward my spouse for not being able to be here and for being so naive to what I have endured over this past year. Really the only relief from the intense isolation that I feel comes when I volunteer at the free clinic or interact with Parkland patients. In those moments, when I'm with the patients, I suddenly feel so connected. Perhaps I feel the familiar weight of their struggles and, in the words of one of my Parkland patients, I know "que son mi gente".

Fast Forward 3+ Years

How did this happen? My last post in this blog was in October of 2012 and now it is August 2016. I wish, so much, that I had documented the millions of baby steps that I have taken over these past few years. There were so many wonderfully small steps that I've come to treasure. When I started this journey I was uncomfortable with maintaining a focus on the immediate future. I had to unlearn that habit in order to find peace and enjoyment in the process. Interestingly, I am now terrified to think past a few months. Anyway here I am, a second year medical student. I'm currently taking Gastroenterology and Nutrition, my sixth internal medicine block. A lot has happened and I've learned so much that I want to document and share with others. I am going to make an effort to write short posts about various school and life related topics, just to get it out there. With time maybe I will be able to write longer entries but for now I'll stick to something that seems more achievable just to get in the habit and share the things that I feel could help others.