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.