As a premed or medical student, there are days when you ask yourself whether or not
it's all worth it. The sleepless nights, countless hours studying,
and missing special occasions to spend time with your one true bae, your organic
chemistry textbook, are enough to make anyone second guess their choice to pursue medicine.
Dr. Jubbal, MedSchoolInsiders.com.
If you’ve struggled to determine if becoming a doctor is right for you,
or if you’ve second guessed your choice along the way, you’re not alone. This video is for you.
The vast majority of premeds and medical students struggle with their decision,
suffer from imposter syndrome, and feel confused about the process of becoming a
doctor thanks to a lack of clear guidance. So many medical students I've worked with
over the years through Med School Insiders, as well as the colleagues I went to school with,
feel lost navigating life as a premed and medical student.
Dr. Amit Pandey, a young hospital medicine physician practicing in San Diego, California,
was a premed not too long ago who struggled through those same challenges. His new book,
The Premed Paradox: What You Need to Know about the Life of a Physician,
is his effort to empower premeds and help them through those struggles. It dives deep into
the life of a doctor, covering everything from the logistical steps of medical education and
training to the emotional experiences of medical practice. At its core, this book empowers premeds
with the knowledge they need to understand the complex life and career of a physician.
Dr. Pandey recounts a story in the book’s opening chapter that taught him an important lesson about
becoming a doctor. One day, in the beginning of his first year of residency, he needed to
perform a procedure called a paracentesis, which removes fluid from the abdomen of a patient to
relieve pain or diagnose infection. As he was arranging his procedure kit and getting ready to
inject a numbing medication called lidocaine, he encountered some unexpected turbulence. He recalls
“To my absolute shock, I immediately felt the glass tip of the vial penetrate both
gauze padding and sterile glove, cleanly slicing through my thumb,
which had applied the pressure. I placed the lidocaine bottle back on the kit and looked down,
horrified, as round drops of bright red blood began to emerge from the slit in
my pearly white glove. I looked over to the supervising doctor who was standing
behind me and barely managed to croak out these five words: ‘I think I cut myself.’”
This was a powerfully humbling experience for Dr. Pandey. He was able to bounce back
and complete the procedure smoothly after stabilizing his injury. But the experience
taught him a valuable lesson: No matter how prepared you think you are, there will always
be bumps and hurdles along the way. Medicine is a challenging but exciting career. Having
the humility to know that you can never know it all, while also pursuing as much knowledge as
possible to prepare yourself, will make premeds stronger when they join the medical profession.
Let’s now take a deep dive into what the decision to become a doctor entails,
and what every premed and medical student needs to know about the process. Plus, we’ll take an
inside look at the most important lessons Dr. Pandey learned from a decade of medical training.
First, let’s unpack the premed paradox, which Dr. Pandey describes as the following:
“How could so many intelligent and hardworking individuals dedicate their
lives to becoming a physician, perhaps the longest and most arduous professional path,
with such little information about what that commitment actually entails?”
More than 50,000 students apply to MD medical schools annually, and many more start out
as a premed at the beginning of college. But most have no idea what it’s actually like to
be in medical school, choose a specialty, work as a resident for 3 to 8 years, or choose your
type of medical practice. And it’s not their fault; these questions are near-impossible to
answer early on as a premed, and this real-life exposure is extraordinarily difficult to come by.
The level of commitment on relatively low information is a huge leap of faith.
Dr. Pandey notes that “there is a certain gravitational pull when it
comes to the medical profession that can keep one pushing forth for a decade or more despite
difficult odds…But for all premeds, this pull [should] not come at the cost of deliberate
self-reflection. Commitment to a career as a physician is a wonderful undertaking,
but one to be chosen carefully and for the right reasons.”
So, why do students want to choose a career in medicine when they have so little information?
Medical students typically have a desire to help people,
an intellectual interest in medicine, and some financial motivations.
But expectations of prestige and financial gain are not good reasons to pursue a career
in medicine, as the job is neither as lucrative nor as respected as it once
was. On the other hand, a genuine intellectual interest in medicine,
a desire to interact with diverse people on a daily basis, and a desire for lifelong learning
and innovation are reasons that will lead to long-term job satisfaction in medicine.
There are also alternative career paths in healthcare, such as becoming a dentist,
pharmacist, optometrist, nurse practitioner, physician’s assistant,
nurse, physical therapist, or clinical psychologist. These each have distinct
advantages and disadvantages compared to becoming a physician.
For example, dentistry requires 4 years of undergrad and 4 years of dental school but
can have a shorter training. Dental residency is optional. If chosen,
it ranges from 1 year for general dentistry to 3 years for specialties like orthodontics. This is
considerably shorter than the minimum of 3 years for medical residencies,
up to possibly 8 years in certain surgical or medical subspecialties.
The cost of dental school is typically slightly higher than medical school on
average. Dentists also generally go into private practice more frequently than physicians. To
learn more about what it takes to become a dentist and whether or not it’s for you,
check out our So You Want to Be a Dentist episode linked in the description.
Meanwhile, nurse practitioners and physician’s assistants work alongside physicians,
typically under their supervision. Their training is shorter and less expensive, and consequently,
their earning potential is lower. That said, they have more flexibility and can
change between specialties easily throughout their career, whereas physicians cannot.
Premeds should consider these comparisons, as becoming a physician isn’t the only possible
path within the healthcare profession. Many students want to become a doctor
because they love science and want to help people, which are things that can
be achieved through other career paths as well. Being aware of the alternatives will
help you make an informed decision when choosing the path that’s best for you.
The next challenge anyone who wants to become a physician
faces is navigating the journey of actually becoming a doctor.
Getting into medical school is no small feat. The med school application process is long
and challenging, and only approximately 40% of applicants are accepted annually. Fortunately,
this is the aspect of becoming a doctor that has the most resources available for students.
The Med School Insiders blog has many guides outlining each aspect of the application process,
including a month-by-month timeline that outlines everything you should be working
on each month during the application cycle. If you’re a premed, this resource is invaluable.
Find it in the description. Medical School
Getting into medical school can feel like the end of the race when it’s actually only the beginning.
Dr. Pandey describes the early years of medical school, stating:
“Years one and two are primarily classroom learning, a bit like undergrad ‘on steroids.’
This time is spent learning the bread-and-butter medical knowledge needed for clinical practice.”
You might “dissect the chambers of the heart in anatomy lab, learn the
pathophysiology that drives neurologic disorders like Parkinson’s disease,
or grasp the microbiologic causes of historical diseases like the Plague.”
Moments like this can be exhilarating, as you finally gain the knowledge that
you set out to learn. But these early years are often described as drinking
through a firehose. Students have to learn so much information at such a rapid volume
and pace that traditional study methods do not suffice. It’s at this time that students
must adopt active study techniques, healthy habits, and defined routines.
The latter half of medical school is when students finally get the chance to practically apply what
they've learned during clinical rotations. But this time is a whirlwind as you jump from one
rotation to the next in rapid succession. While it involves difficult work hours coupled with
intense studying, it is exciting as this is your chance to test out the various specialty choices
you could potentially pursue. Specialty Choices
The next hurdle medical students face is choosing a specialty and career path.
Although clinical rotations help students better understand their likes, dislikes, and interests,
the required clerkships only cover the core medical paths, which include family medicine,
internal medicine, OB/GYN, pediatrics, neurology, surgery, and psychiatry.
There are many other paths and subspecialties a medical student can pursue.
For example, a graduating medical student might match into internal medicine residency. From
there, the internal medicine resident can become a primary care physician who
sees patients in a clinic, or a hospitalist who sees patients admitted to the hospital.
They can also choose to pursue additional training,
called a fellowship, in many fields such as cardiology, gastroenterology, or pulmonology,
to name a few. If they choose a fellowship in cardiology, they can go even further to
do subspecialty training in something like electrophysiology or advanced heart failure.
This whole pathway can take more than 10 years after undergrad to complete.
Residency After choosing their
specialty, medical students move on to residency,
the real core of medical training and the time when the student really grows into a doctor.
Some residencies are more inpatient heavy, while others are more outpatient focused. Inpatient
refers to taking care of patients admitted to the hospital for acute medical issues,
while outpatient is caring for patients in a clinic setting,
such as a primary care doctor or specialist doing a scheduled visit.
Getting a comprehensive picture of what it’s actually like to be in residency is
critical for anyone deciding whether or not they want to become a doctor. Reaching out
to those who are going through or have been through residency, watching videos like The
Day in the Life series on the Kevin Jubbal M.D. channel, and reading personal accounts
from practicing physicians like Dr. Pandey can help students understand what they are
committing to. This knowledge is crucial as a premed making career decisions early on.
Career Practice Eventually,
after finishing their training, physicians must choose their preferred career practice setting.
Academic practice involves supervising and teaching medical students and residents,
as well as performing academic research.
In community practice, most of your time will be spent on clinical work,
as there’s less teaching and research involved.
Private practice is essentially a physician running their own business,
providing medical care to a private set of patients.
Learn more about each of these career paths in our
video Academic vs Community vs Private Practice, linked in the description.
Data published in 2020 reports that “49% of physicians worked
in practices completely owned by physicians, down from 54% in 2018.”
Currently about half of physicians are in private practice, but this number
decreases in metropolitan areas where larger medical groups dominate more of the market.
In The Premed Paradox, Dr. Pandey explains that understanding the
different career paths you can take in medicine early on can help aspiring
physicians prepare for what awaits them during their career in healthcare.
Lastly, there are some aspects of a doctor’s journey that are rarely taught and sometimes
considered taboo to speak about. Finances
It is no secret that medical school is very expensive. The average medical
student graduates with over $250k of total student debt. But that notion
may be somewhat abstract when you are early on in your education or career.
Dr. Pandey describes an example of two college friends graduating together,
one off to medical school and the other taking a job as an engineer in the tech industry. The
engineer starts to earn immediately upon landing a job after graduation. The med student is slowed
by two important factors: Debt due to expensive medical education and Opportunity cost—the cost of
time spent not earning money in medical school and then earning a relatively low salary in residency.
Medical students, residents, and new attending physicians must exercise considerable patience
and delay gratification. They must wait for financial success, which will come years down
the line after debt is paid off and the lower resident salary rises to the attending physician
level. They must be okay with reaching financial milestones later than their peers in other fields.
On the other hand, being a physician provides a “high financial floor,” as Dr. Pandey calls it,
or in other words, a very solid guaranteed salary once training
is complete. It also provides a high degree of job security. In general,
healthcare workers remain in demand and are less likely to be laid off than
workers in other industries. These are strong financial benefits of a career as a doctor.
Understanding these factors, how to manage debt, and prioritizing financial education is critical
for anyone interested in a career in medicine. We break down why so many physicians struggle
with managing money in a previous video, Why Are Doctors So Broke?, linked in the description.
Burnout Burnout is another
important topic critical to understanding the healthcare profession. It leads to mental and
physical exhaustion, detachment from work, and decreased effectiveness.
Medicine is undoubtedly an awesome career, with great psychological benefits, such as saving
lives, caring for others in times of need, continuous learning, and opportunities for
innovation. But the career also carries inherent challenges which make it high-risk for burnout,
including long work hours, many bureaucratic tasks, and facing life and death on a daily basis.
A survey by the American Medical Association showed that 42% of all physicians self-reported
some form of burnout. Critical care reported the highest rate of burnout at 48%,
while plastic surgery had the lowest at 23%. While burnout is common in medicine,
it can be combated through awareness and taking specific steps, such as maintaining
manageable physician work hours and patient loads, improving physician
workflow for documentation and computer use, encouraging education and professional growth,
and making mental health services available to all medical professionals.
Work in any healthcare profession is certainly not easy but can be extremely rewarding. That said,
it is important to be aware of trends and common pitfalls. As Dr. Pandey states,
only by acknowledging burnout can we seek to avoid and combat it. Aspiring physicians
must understand these nuanced factors before choosing this complex career.
At its core the purpose of The Premed Paradox is to provide a real-life,
honest account of what life in medicine is truly like. It is meant to empower the next generation
of physicians with knowledge, so they are ready for what lies ahead. Ultimately, the road will
be challenging for anyone, but there will be tremendous highs along with the tough lows.
A career as a physician is complex and is a tremendous commitment. The author
Barry Schwartz said “Learning to choose is hard. Learning to choose well is harder. And
learning to choose well in a world of unlimited possibilities is harder still, perhaps too hard.”
With The Premed Paradox, you won’t be choosing alone. This book will
help you deeply understand the physician experience, prepare for your own journey,
and empower you to embark on your medical career with clarity and confidence.
The Premed Paradox: What You Need to Know about the Life of a Physician is a new book for premeds
and medical students that I’ve had the pleasure of previewing myself. It’s an invaluable resource
for anyone on the path to becoming a doctor or anyone considering a career in a medical field.
It’s the book I wish I had as a premed.
If you are interested in reading The Premed Paradox, visit thepremedparadox.com or click
the link down in the description. Dr. Pandey and I also shared a discussion about the book
and our own personal experiences in medical school on the Kevin Jubbal, M.D. channel.
Much love, my friends, and I’ll see you all in that next one.