Well into medicine now, I find myself regretting the day I ever decided that medicine would be my career. Many of my colleagues feel the same way, but I can only speak for myself. The reason for this post is not to deter anyone from entering medicine, but to hopefully have some people deeply consider their motives and desires for entering this profession before committing themselves. I honestly believe that I just didn't have nearly enough information when I chose medicine. Or perhaps I did, but my ideals may have forced me to persevere. Years from when I decided, I can't explain how I never saw this earlier.
But it doesn't matter now. I've decided to leave the toxicity of this profession. I've decided to give up the ability to seriously help others, the respect, the income, and every other benefit medicine offers. I've decided to give it up and take my life back. My life is worth it.
Maybe these next few points will fall on deaf ears, but perhaps not. However, I feel an obligation to tell you, the younger generation not yet committed to this life, as no one did for me. Please ignore the fact that this is my first post under this handle. I was once active on these boards, and many know my real life alias of my regular handle. Those people, I'm sure, will find out eventually. But it isn't the time yet.
Hear me out.
Medical school starts out like a dream come true. The parties, the 100 odd friends you basically get given to you, the camaraderie, and the apparent lack of difficulty of the subject matter. It sucks you in and consumes you. I thought I had it made. But then come the professionalism talks (repeated, over and over). They drilled it into us that we are absolutely privileged to be a part of this profession. They tell you about how we are held to a higher standard, how we must conduct ourselves to the public. At first, it all seems fine. Why the hell would I care? I've obviously conducted myself pretty decently up until this point in life. I didn't really feel privileged, though. I worked my ass off to get here. Early mornings, late nights, ignoring friends, rinse and repeat. I earned my seat.
But then they start to drill it into us even more, and the message becomes very clear: We, as people, are not important. Our feelings, marriages, kids are not important. What is important is our patients, full stop. And they make you believe them by telling horror stories of medical students gone by who made the slightest of mistakes, and are now flipping burgers in the hospital cafeteria. They accomplished their mission: they put the fear of God into us, made us walk on eggshells, and made it so we always remember our "privilege" if ever we second guess ourselves, or think about having one too many drinks at the bar for fear of doing something stupid while drunk. God forbid we let loose on a Friday night. But still we persevered.
I would be lying if I said the first two years of medical school taught me nothing. It taught me to care about the community and be involved in it, even if at the expense of my own personal life. I enjoyed being a part of it, and being of benefit to those less fortunate. That feeling kept me going.
And then clerkship started. Clerkship was hell. Plain and simple. Think of the entirety of clerkship as an audition. You need to be "on", every single day. You need to say "thank you" when someone sh*ts all over you. And believe me, they will. If you work with any preceptors over the age of 40, they will have grown up in a time that promoted shame-based learning. And, like domestic abuse, the cycle of abuse in medicine also self-perpetuates. I still remember the first time I was humiliated by an attending. It was in an operating room on my surgery rotation, and I was 6 questions into a "pimping" session (http://jama.jamanetwork.com/article.aspx?articleid=2474430). I got the 6th wrong. The preceptor made sure I knew I was an idiot. In front of everyone: circulating nurse, scrub nurse, resident, anesthetist, and, worst of all, an AWAKE patient under spinal anesthetic (to this day, I will never forget that the reason you remove both the head of the pancreas and the duodenum in a whipple procedure is that they share an arterial supply). This is common, so don't be surprised by it. You will be shamed on a daily basis, unless you are the lucky 10% of students whose attending isn't an absolute psychopath. Prepare yourself for it.
It will teach you to be tough, or it will break you down. Students regularly take a year or two off in the middle for various reasons, but mostly mental health issues related to school.
You WILL be on call. 1 in 4 usually. 26 hours straight, still always "on". Auditioning. Always auditioning.
You are still fighting for a career at this point. You do everything you can for a good comment on your "MSPR", basically a report card that CaRMS programs read when you are trying to apply for residency. Even one unfavourable comment can sink your battleship. Doesn't matter if you are applying for surgery and the bad comment is in peds. It will sink you. And even when you are a superstar, and do 80% of the attending's work for them, they may still write a generic one liner: "keen student, shows up on time". Might as well have just asked you to come in so they can slap you on the face directly. So prepared to work hard and look "keen", even if you absolutely hate "well child" visits in outpatient pediatric clinics. Prepared to get sh*t on, and to respond with "Thank you, sir. Please sir, may I have another?". Any other response can cut your career short. And the MD without a residency is useless, unless your entire goal was to get "Dr" on your credit card (which I am aware, now, that you can just request that even if you DO flip burgers).
So you've shouldered your way to the end, decided on a specialty (in what is not nearly enough time, as you have to arrange electives basically before you have exposure to most specialties), and sucked enough D to get some decent reference letters. Hopefully, at least. You don't get to see them.Then comes CaRMS time. Spending ridiculous amounts of time and money preparing personal letters, trying to convince every program in the country why you think theirs is the best, and why they should pick you. And then the waiting game, and you still might go unmatched, and be left without a job. Hopefully an unmatched student can come give you the personal experience of the agony of that experience, and enlighten you in that regard.
And then residency comes along. I won't repeat everything I said about clerkship. But a summary: it's clerkship on crack. More work, more hours (80+/week), more responsibility, more getting shit on. The one upside is you now give zero f*cks about what people think about you. You got your career, unless you are in the 80% of specialties where jobs are now scarce after residency, so you have to be well liked. HAH. It never ends. The nurses also don't treat you like absolute sh*t anymore. You now outrank them. Tangential side note: never believe the nurse's charting resp rate. They literally never count it, and always report it as 18 or 20. Because it's so hard to watch a guy's chest move for 20 seconds and multiply by 3. Oh well.
Finally, you are a royal college physician. Now you have to go interview for jobs, 13 years from when you graduated high school. If you picked ortho, or any of the other surgical specialties, be prepared to locum, or work somewhere you don't want to work. The old guys won't retire, and there's no OR time for the fresh new grads whose hands don't shake like a reluctant bride at the altar. And be prepared to deal with the endless politics of medicine. Everyone has a chip on their shoulder. Everyone. You still work a ton of hours, and still get treated like sh*t. Only this time, it's the patients that walk all over you. Dr Google always knows more than you, according to them. Every patient has a nurse friend that thinks you should manage their disease in a certain way. Good for them.
And don't you even think of trying to convince them that they are wrong. Come off as offensive in any way, and you will get a complaint to your respective college: our "self regulatory" body. They literally only exist to "protect the public" from us deadly doctors. Our motives must be so sinister. If ever you think a patient is batsh*t, bring a chaperone to the encounter so you can prove your side of things. And document, document, document.
It all wears on you after a while. It wore the shit out of me, and continues to. There is a reason physicians have a suicide rate almost double** the general population. Our addiction rates are 20-25% compared to the 15-20% of the general population. Eating disorders, depression, anxiety, etc... You could argue this is because of the personalities that enter medicine are predisposed to mental health issues. Maybe. But medicine takes a tangible toll, and is solely responsible for at least some of the cases. This is not to mention the divorces, and being absent from the lives of your children. Your spouses and kids deserve you too, they deserve you more than your patients. Don't forget that they sacrifice in order for you to do this job. Interestingly, surgeons have the lowest addiction rates in medicine, but the highest divorce rates. Pick your poison.
If you know you can withstand all this, then all the power to you. People need us. We genuinely do good. We help people, and I would by lying if I said that I didn't get an enormous amount of satisfaction from this fact.
But if you think that this road may cause you more trouble than it's worth, than I urge you to consider deeply your decision to pursue this career. For many, it is more trouble than it's worth. It was, for me. I just wish I realized it earlier, before I paid the high price in my personal and family life. No longer, though.
After all this time, I have decided to walk away, to cut my losses and turn to something else. I've had a good run, but all good things come to an end. Again, I don't mean to purposely discourage people from medicine. I just want you to know the TRUTH so you can make an informed decision for yourself. The same informed decision we always say our patients should make. Why should we be any different, any less?
Regardless, good luck in your future endeavours. If you choose medicine, I hope that it gives you what you need each and every day. If you don't, no one will give you fault.
Consider dentistry, though.