For those outside the medical field, there is often the idea that all doctors are similar. That they come into medicine with similar motivations and similar interests. This couldn’t be further from the truth. Those who decide to become physicians are as varied as in any other field. However, a view from the inside can help you understand the motivations, and pressures, that your physician is practicing under.
Before we embark on this topic, I think that there is one distinction that I need to make. The medical field is different than most other fields because it involves an interaction between an expert, the physician, and your health. That makes medicine unique. If a physician does their job right, your health improves. For almost all physicians practicing today, that is their goal. With that in mind, let’s move forward.
The Process of Becoming a Physician
Becoming a physician is a long process. By the time a person gets their MD or DO they have typically spent 20 years in school (12 from 1st through high school, 4 years of undergraduate, and 4 years of medical school). They aren’t finished there, though. Medical school is followed by residency training in their chosen specialty, a minimum of 3 years. This may be followed by a fellowship to further subspecialize. By the time all is said and done, a physician will spend 23+ years of schooling/training before they are able to practice independently.
The length of training often means that those deciding to become physicians have postponed major life events. For those that go straight through (like me), it may also mean that you reach a level of adulthood without having the responsibilities of being an adult. The transition can be jarring. Stating this is not meant to be an attempt at sympathy. Physicians go from training to top income earners in a matter of years. Instead, it is meant to help explain why physicians may act in certain ways. Most of us spent our 20’s in school, not on the job, and not forming a household. This brings me to one of the weirdest aspects of becoming a physician: The Match.
Once you finish medical school, you apply to specialty-specific training programs (known as residency programs). A student will interview at as many as 20 (or more) different programs and then rank them from most preferred to least. The programs also rank those that they interviewed from most preferred to least. All of this enters a computer database and on one specific day each year, students learn where they match. What this means is that until the second half of their 4th year of school, students aren’t sure if they are going to be able to pursue their preferred specialty and absolutely have no idea where they will be going. On match day you find out where you will be spending the next 3+ years. If you don’t like it? Too bad. Who would decide to enter this process willingly? I would argue that almost no one truly understands what they are getting into, but those that decide to become physicians often fall into broad categories.
Who Decides to Become a Doctor?
It has always been fascinating to me the wide variety of reasons that people decided to go into medicine. That may be due to my own personality. I know how I think about things but at times struggle to understand why others think the way they do. That being said, I do know that you can group those that decide to become physicians into broad groups.
Family Legacy/Expectation
One group of physicians decide to enter medicine because of outside expectations placed upon them. This group tends to be highly motivated because of those expectations and as a result, will often be high achieving. The expectations from family, however, can sometimes weigh on these individuals. This can manifest as frustration with the field as a whole or as burnout. The challenge that this group finds is that once you enter medical school, the monetary burden is so high that you can feel trapped. Even if you hate it after the first year, you are already $50,000 in debt. What hope do you have for repaying that outside of pushing through?
This idea of being trapped in medicine is real and it’s not limited to this first group. It is why I argue that all medical schools should offer debt forgiveness after the first year. If the goal of medical school is to produce high-quality physicians, why would you force people that don’t want to be there to stay? This “grace period” would be better for both students and patients, but I doubt it will gain traction. Medical schools have big budgets that depend on tuition and the federal government has no incentive to offer such a program.
Altruism/Helping People
There is a group of physicians who decided to become doctors out of a desire to help people Some of this group is motivated independently and others have had experiences in their own lives that pushed them in this direction. This could take the form of personal health problems or those of family or close friends. The medical field would have you believe that this is the largest group that goes into medicine. If you did a survey, I would suspect that most would say this was their motivation. It is the idea that you are going to be helping people that keeps students going through the long hours of training and pile of debt that most endure.
The problem is that I think that this group is highly prone to burnout once they complete training. The medical field in the US is more like a fortune 500 company than most would like to admit. The profit motive drives most hospital systems as they compete amongst themselves to build newer, more state-of-the-art hospitals. Systems compete in cities to drive patient traffic, while physicians working in those systems are pushed by metrics to see more people resulting in less time spent with each patient. Unfortunately, the system is biased against independent practice outside of highly affluent areas.
Personal Interest
The final group that I’ll highlight is those that enter the field out of personal interest. This is the group that I fall into and is also, in my opinion, the group least at risk for burnout. This group finds the medical field to be fascinating. If they are like me, they could not imagine working in another field. Personal motivation to practice may seem misaligned with patient interests. However, I would argue that excelling in medicine is predicated on taking good care of your patients. It is a risk that this group could have interest without skill, but this group should be weeded out in medical school and residency training programs.
Why This Matters
I write this post as an attempt to help people understand those of us that went into medicine. We have experienced a unique set of circumstances that include delayed progression to adulthood and taking on large quantities of debt at an early age. The system also involves archaic systems like “The Match” where students have very little control over their futures. I don’t point this out for sympathy. The only people in the process who deserve your sympathy are those that decide to leave but are still saddled with $50k+ of student debt. The rest of us made a choice to proceed with the process.
This choice is a combination of understanding the process and a desire to provide good care. In the end, most physicians enter medicine desire to help their patients live healthy lives. Over time, the healthcare system can make physicians jaded and burned out. In the future, I will try to highlight how these systems issues can pervert the physician/patient relationship. Until then, I hope that those reading this have a better understanding of their physician.