Having worked with physicians over the last 20 years, I have come to recognize a familiar pattern. It is a pattern of trauma which begins in medical school, sometimes earlier. Unlike other high stress professions that acknowledge the risks, physician stress is mostly ignored. When it’s not, the physician is pathologized, made to feel as if they are the problem. The pathologizing starts early. Desperate to get into med school, then desperate to graduate, desperate to match into residency, desperate to specialize, get into a fellowship, a group practice. And so, what I call the desperation cycle begins.
Medical students are thrown into the rigors of study in much the same way military personnel are thrown into the boot camp experience. Most are told that medical school will be HARD. More than hard. To quote one instructor, “Med school will break many of you sitting here. You are not as bright as you think you are. In fact most of you are average, or less than average.” These students who have been the “brainiacs” in previous educational environments find themselves challenged and critiqued, told they are not up to snuff and better crank it up. Dealing with the impossible pressures totally re-frames their sense of self. The system of breaking down physician confidence has begun.
The AVERAGE cost of medical training is 170k. Most students graduate owing far more. The financial commitment, delicately balanced on a fragile foundation of low self-esteem, becomes a constant destabilizing and threatening reality.
Once you manage to get through medical school with all its test taking, hazing and competition, you move on to the Residency experience. Attempting to “match.” “Attempting” because there aren’t enough residency positions to go around. In fact, there are 11,000 fewer residency positions than there are applicants. The competition is fierce and desperate. It is tragic that many contemplate suicide at this juncture, before they even qualify to practice medicine independently.
For those who do match and find themselves in the pressure cooker called, residency, they arrive exhausted, financially insolvent and with an eroded sense of self. This is where pimping, humiliation, training/mentoring and physical abuse happens. Interns are pitted against each other, required to work up to 36 hours, ignoring their basic needs. It is not uncommon to hear of residents falling asleep in the parking lot of the hospital in which they work, or at the wheel while driving home. Full blown psychotic breaks, seizures and medical errors often sabotage careers for even the most promising in their field. By the time residents complete their training, they are often too depleted to even entertain the idea of Fellowship beyond residency. Entering the workplace already entrenched in the Desperation Cycle, physicians prepare to….PRACTICE MEDICINE?