Author: Divyam Goel
The Spring of 2020 has been anything but ideal for the world as a whole. The COVID-19 outbreak has quickly become a massive safety issue and its effects are leaking into many of the very sectors that are fundamental to the wellbeing of our globalized society. These include the economy, higher education and critical supply chains. However, a small silver lining that many have already noticed is the widespread appreciation and recognition healthcare workers are receiving for their dedication and help. Nurses, paramedics, physician assistants, medical assistants, various types of doctors and the entire support system that assists and sustains healthcare administration are all highly valuable parts of our society and are all being acknowledged as such. As the topic is fresh and current, I thought it would be opportune to discuss one particular cog in this healthcare machine- the physician. Specifically, I wish to address the arduous path to becoming a physician and an often-overlooked facet of it, pre-medical student burnout.
Medical education is exceedingly difficult and substantially long. What begins with an undergraduate Bachelor’s usually ends with a multiple year fellowship, with a three-year residency and the actual medical school itself in between. As an eighteen-year-old entering college, you’re looking at a 13-14-year commitment. Additionally, there is a wide variety of variability in medical education. Of course, you have the initial choice between a DO (Doctor of Osteopathic Medicine) and MD (Doctor of Medicine), followed by various specialties like oncology, internal medicine, pediatrics etc. Structurally, there are a myriad of options available to the MD candidate to diversify their education. These may be dual degree programs (including, but not limited to, MD-PhD, MD-MS and even MD-JD), gap years, and the fairly new three-year MD. Throughout all this, it is well expected that some stress/anxiety will be experienced. However, over 50% of medical students experience ‘burnout’ which is defined as emotional exhaustion associated with work-related stress, feelings of detachment toward patients, and a low sense of personal accomplishment (L. Dyrbye, MD, MHPE, Mayo Clinic Department of Medicine, 2008). Dyrbye also co-authored a 2016 study that determined medical students experience alcohol abuse at a rate of 32%, almost double the national average for educated students. Alcohol is one of the many possible strategies medical students use to cope with burnout, and medical schools have been working to assist students on how to maintain their mental health. Yet, a very overlooked part of medical student burnout doesn’t even happen in medical school itself. In fact, it starts in the aforementioned undergraduate portion of the student’s life.
Undergrad hopefuls for medical school, or pre-meds, often experience burnout similar to their older counterparts yet there is very little out there looking at this problem and trying to alleviate it (A. Goshua, kevinmd.com, 2018). In terms of studies we do have, there are a few strongly indicative ones: 88% of pre-meds worry about earning the needed GPA for their choice schools; Fang et. Al in Acad Psychiatry, 2012, write “premedical students had greater depression severity and emotional exhaustion than non-premedical students” and, in another study, conclude that “Premedical students were more likely to meet screening criteria suggestive of the presence of major depressive disorder and to exhibit more severe depression than nonpremedical students”.
Regardless, I wish to round out my thoughts with something more anecdotal. As a student at a large public university I have met countless pre-meds on various stages of their undergraduate journey and the one unifying factor for all of us is, undoubtedly, the uneasiness, agitation and anxiety we all feel in regards to our success on this path; an ounce of legitimate confidence could be seen as ‘cockiness’. Perhaps the most toxic part about the world of premedical education may very well be the innate sense of competition. As thousands of students are fighting for a few hundred spots per school, a sense of comradery that we all start out with, as well as compassion for our fellow peers, is slowly replaced with apprehension and an ‘every man for himself’ attitude. Conversations about one another turn to comparisons of ‘who is doing what, how strong their GPA is and what they will get on the MCAT’.
Practicing physicians themselves are already having a difficult time staying emotionally healthy. Yet, a competitive culture that is founded upon the principle of ‘weeding out the undeserving and insufficient’ breeds this scarred confidence from a very early age. While residencies and medical schools themselves are slowly shifting and improving, undergraduate education for premedical students needs to receive appropriate attention as well.