I. The Decision to Pursue a Career in Medicine

One of the most important decisions that a person will ever make is the choice of a career. This choice will determine to a large extent the lifestyle and satisfaction that a person will experience.  It will have many other influences.  A great many young people enter college expecting to become medical doctors but with little real knowledge of what is involved in the practice of medicine. They know that physicians have much better than average incomes, that medicine has been a highly respected profession, and that an opportunity exists for service to their fellow man. The role of a physician is unique among the professions. A physician will usually be present when a person is born and when they die, plus during many times of crisis in between. But many students have little real understanding of the "trade-offs" that are made when choosing medicine as a career goal, particularly concerning the pressures and demands made by the profession and its patients on physicians on a daily (and nightly) basis.

Premedical students should be aware that the competition for admission to U.S. medical school is very intense. The number of applicants for recent years is usually posted on the American Association of Medical Colleges website.

AAMC recently interviewd 171 medical school faculty members, residents, and students about the behaviors most likely to result in success in medical school and residency. See: http://www.aamc.org/data/aib/aibissues/aibvol1_no4.pdf

According to the survey the following ten qualities are key:
1. Taking an active role in helping to shape their own learning and knowledge acquisition
2. Self-management and coping skills
3. Effort to foster a team environment
4. Interpersonal skills and professionalism
5. Empathetic and listening skills when interacting with patients and their families
6. Technical knowledge and skill
7. Extra effort and motivation
8. Ethical judgment and integrity
9. Mentoring skills
10. Demonstrating an ability to maing calm under pressure

What can the entering freshman in premedicine expect during the next dozen years or so after entering college? During the four undergraduate years, rigorous courses will be taken with very intelligent motivated students.  There will be uncertainty and anxiety as the student prepares to take the Medical College Admission Test and decides where to apply for admission to medical school.

When a student is accepted to enter medical school, she/he can expect even more difficult academic and psychological demands.  The M.D. degree requires four years of study in an allopathic medical school. The first two years, called the preclinical years, are usually spent primarily in a classroom setting studying the basic medical sciences. The typical first year usually concentrates on the healthy human body with classes in histology, cell biology, anatomy, biochemistry, physiology, etc. The second year often emphasizes human disease with courses in pathology, microbiology, pharmacology, etc. At the end of the second year students take Part I of the U. S. Medical Licensing Exam (USMLE). Most medical schools require passing scores on this test before beginning the required "clinical clerkships" in internal medicine, surgery, pediatrics, psychiatry, obstetrics/gynecology, etc. during the third year. The fourth year is a continuation of clinical training, usually with opportunity for ‘elective’ monthly rotations so that students may gain experience in an area they are considering as a specialty. The third and fourth years are spent working with patients in a clinical setting under the supervision of interns, residents, and faculty. 

There is considerable stress on most medical students. The greatest stress is probably due to the workload. Most medical students agree that the amount of material required to be assimilated goes up by a factor of two or more compared to their workload as undergraduates during the first two years of preclinical study. During the clinical years pressure generated by constantly working with people who are sick and often dying is emotionally very difficult for many. Seeing death first-hand makes most students much more aware of their own mortality, sometimes leading to emotional pressures.

There is pressure and uncertainty as medical students compete for a 'slot' in residency programs, and there are the physical and psychological demands made by very long hours of hard work. The American Medical Association website has a useful link on “Medical School and Residency.”  These demands do not cease upon completion of residency training as those who are familiar with the long hours required for the successful practice of medicine can testify after residency, some begin practice and some continue in fellowships for sub-specialty training. Such stresses are often difficult for the spouse of a medical student. Many are unable or unwilling to accept the fact that the demands of the profession must often take precedence over the social needs of the family for a person in medicine. It takes an exceptional spouse to adjust to this fact and not make demands on his or her mate that will ultimately cause them problems professionally. Many physicians share holiday and "night call" duties in a 'group practice.'

The work itself is sometimes unpleasant and can be highly stressful (as anyone who has been involved with trauma cases will agree). Some of the things that must be done to patients who are often seriously ill or injured will be unpleasant. In some of the primary care areas the work may, at times, be routine, often unstimulating intellectually, and sometimes boring. Many of the situations encountered in medicine are not like those seen on television programs.

It is true that a physician will have the expectation of a much better than average income after completion of the many years of training and the economic hardships that often result from these long years. If the primary motivation for entering the medical profession is to make a great deal of money, perhaps certain areas of business or other careers should be considered instead.

Many knowledgeable observers believe that the "golden years" of medicine may very well have been during the 1960's and 1970's. The prestige of the physician is being eroded. Many patients now view their physician as an ‘over-paid’ professional who has little personal interest in their well-being. One factor contributing to this attitude is the increased specialization in medicine, which rarely results in the formation of long-time associations and friendships that were the rule a generation or two ago when most people went to their general practitioner for essentially all their health care needs. Rising expectations of the patient are another reason for increasing lack of trust and even hostility toward the physician. This is a major factor in the increase in the number of malpractice suits. The years since World War II have seen tremendous advances in the science of medicine and in the availability of highly effective new drugs and treatments. Many patients now expect their physician to be a “miracle –worker” and, if there is a bad outcome, even through no fault of the physician, the tendency on the part of many patients and families is to sue their doctor for malpractice.

During the past years the cost of medical care has increased at a rate much above the inflation rate, making "cost containment" a primary concern of legislators and many government officials, as well as private health insurance companies. Health care reform is an issue that generates many headlines intermittently. Governmental programs such as Medicare and Medicaid and private insurance programs have had the effect of setting fees for physicians. Managed health care is a method that has been proposed to help in keeping down cost and many companies have signed agreements with Health Maintenance Organizations (HMO's), Preferred Provider Organizations (PPO's) and an "alphabet soup" of other organizations that is changing the way in which physicians are reimbursed from the traditional fee-for-service to some type of prepaid medical care. Note: this AAMC web link.  

These comments should not be interpreted as a recommendation to our best students that they should no longer aspire to careers in medicine. It is an honorable profession that will continue to reward those who have the talent and dedication to practice it competently and compassionately. But premedical students must be aware of some of the trends that appear to be shaping the future of medicine. A number of programs will be held during the year that are designed to inform our students about such changes. Many of these programs are sponsored by Alpha Epsilon Delta (AED), the premedical honor society, and they typically consist of a speaker who may be a physician or surgeon, a medical educator, or a medical student who will candidly describe his/her profession and discuss its future. Such programs are supplemented by the UGA Premedical Forum. Membership in AED is not a requirement for participation, and, in fact, everyone with an interest is welcomed and urged to come and take part. All premedical students, including freshmen, are invited to all AED functions, and those of the affiliated UGA Premed Club.

Students who have doubts about whether or not they should continue in premedicine should keep their options open. Medicine is not for everyone and there are few successful physicians who have not questioned at times whether or not the rewards are worth the long years of training and the hard work required. Nevertheless, most physicians cannot imagine themselves in any other profession and they would make the same choice again

 (Please send all questions and comments to resa@uga.edu, Memorial Hall, Athens, GA 30602)