A Letter To The Doctors Of Tomorrow: How To Find Fulfillment Now And In The Future

August marks the beginning of medical school for thousands of future physicians. And four years hence, summer will mark their transition to residency training. Depending on which specialty they choose, they will then work 80 hours a week as a resident, for as long as seven years, to complete their final transition from trainee to independent physician. It is a long, arduous path, and along the way people can get lost.

Readers of this column who are beginning on this path or are already en route—or have a family member or friend who is—often ask for my advice. In this blog post, I offer my perspectives. Of course, individual circumstances vary, so trying to write a letter to all must by necessity be general. But at the same time, these words and emotions are personal. They are based on my own experiences and observations as a healthcare leader, medical school professor and resident teacher.

Having talked with hundreds of medical students, residents and recently trained physicians, I’m concerned about the future of American medicine. At the start of the journey, every first-year student I meet is thrilled to begin medical school and is optimistic for the future. Yet the 2014 Survey of America’s Physicians suggests that more than half of all U.S. physicians are disappointed in medical practice, and reports that exactly half say they would advise their children to pursue a different profession.



Much of the unhappiness doctors experience today reflects the demands of daily practice and frustrations with increasingly burdensome paperwork and regulations. But some of it can be traced to the rigors and realities of medical education itself, and the lifelong impact it can have on trainees. Many complete the process having abandoned what motivated them to begin years before.

This week, I focus on the first step in the journey: medical school. In the next post, I offer my counsel to those in the midst and on the other side of the requisite decade of training.

Dear Class of 2020,

You’ve worked hard to earn the privilege of becoming a physician. I hope you took some time before starting medical school to enjoy yourself and embrace your passions, be they travel, music or art, or simply spending time with family and friends. Becoming a doctor is a long, bumpy and often lonely road. Resiliency is essential. My first and most important piece of advice is to be sure you retain these other parts of your life that you enjoy so much. If you don’t make the effort, it won’t happen.

Second, take time now to reflect on and celebrate your achievements. You’ve studied hard, scored well on your Medical College Admission Test and devoted time to community service and research. Your résumé was superb, and you interviewed well. Be proud of what you’ve achieved, and enthusiastic about the opportunities ahead.

Third, have confidence in yourself. As you strive to master the massive amount of material you will need to learn, you will at times feel overwhelmed and inadequate. That experience is universal. But don’t doubt yourself. You earned your place.

Early on in the process of applying to medical school, you feared you might be rejected everywhere, or at least from your top choice of schools. You’ve overcome that hurdle. Now you will face new anxieties going forward. Undoubtedly, you were one of the smartest students as an undergraduate. But your classmates are just as talented and motivated. They, too, want to demonstrate their expertise. As a result, on occasion you’ll struggle with the sensation that comes from falling short of your own expectations.

Resist the impulse to let the opinions of others erode your confidence. Over the next four years, you will be graded by many people, and some of the time they will undervalue your contributions and abilities. I warn you about this not to scare you, but rather to prepare you for when it happens.

I have seen the continual demands and pressures of medical education drain the energy and enthusiasm of many trainees and lead them to sacrifice the best parts of themselves. Don’t let it happen to you. You arrived in medical school wanting to embrace the art and science of healing, and provide compassionate care for your patients. Now you find your time consumed by the memorizing of biochemical pathways and tens of thousands of other facts. Despite words to the contrary from your dean, it can feel intensely competitive and overwhelming, particularly if your heart is set on certain residency positions. Medical school doesn’t have to be like this, but often it is.


The best way to avoid this is to refuse to let your human side disappear. In between studying hard, spend some time reading fiction, listening to music and exercising, or whatever completes you as a person. Treat these interludes not only as breaks from studying but also as nourishment for your soul. Begin a journal and write your thoughts on medicine, people and your emotions. Go back and read it whenever you begin to feel the human side of yourself receding. Unless you’re aware of and in touch with your feelings, they—like any part of the human body—will atrophy. The little time this takes will yield big rewards in the future.

Unfortunately, the dreaded United States Medical Licensing Examination will be as terrible as you fear. You will spend 10 to 12 hours a day for six to eight weeks studying—and then, after taking the test, worrying about your score.

This grueling experience is an important opportunity to take stock of yourself. Some people can accept the endless demands of the preparation, and even enjoy it. For most, though, it represents the dehumanizing side of healthcare. If you’re having difficulties staying focused, figure out what you need to do to maintain your balance, whether it’s taking an evening each week for dinner with friends or a half-day hike in the woods. Make sure you squeeze those activities into your study week, even if you need to push the exam itself back a week or more.

Most schools provide time between completing the exam and beginning clinical rotations. It is an opportunity to relax, sleep and travel. When you return to begin the next phase of your medical education, your energy will be restored to a higher level.

Being a medical student on the “wards” and learning to care for patients can be both fulfilling and frustrating. You will enjoy experiencing the doctor-patient relationship and its transforming magic. Suddenly, even if in minor ways, you will be contributing to your patients’ healing process. Cherish those moments, capturing them in your personal journal. After all, this is why you wanted to become a physician. It will be important to always remember the awe you experienced the first time you helped bring life into this world, your sense of fulfillment at the end of a well-performed surgery, and the powerful sadness you felt when one of the patients assigned to you died.

Of necessity, you will begin to develop objectivity about the patients for whom you are responsible. You need this to provide the best treatments for their medical problems. But please be careful to prevent this detachment from limiting your capacity for empathy. If you lose your passion, enthusiasm and joy for patients, medicine will become simply a job.

Certain clinical services will prove more challenging to you than others. In some, you’ll be treated well and, as a result, feel valued as a person. In others, you’ll find yourself at the bottom of a rigid hierarchy, and on occasion may feel slighted, particularly when you’re required to arrive at the hospital by 5:30 a.m. and have to stay until late at night. It can be frustrating when others with more authority than you fail to recognize your contributions. Unfortunately, this is the culture on some services, and usually there is little you can do to change that except continue to work hard. But if you feel abused in any way, don’t hesitate to speak up to those in academic leadership roles. Their job is to listen.

In your final year, you’ll need to select a specialty you want to practice. Along the way, you’ll have the chance to experience different ones. Make sure you understand what your life will be like at the end of your residency if you choose to practice that specialty, and also that you’re willing to invest the years needed to complete the training. My observation is that almost everyone has more than one right choice. Based on the students, residents and practicing physicians I know, your fulfillment as a practicing physician will depend more on who you are as a person than on the specific residency program or specialty you select.

Over the four years of medical school, you’ll grow in important and life-defining ways. By your graduation, you’ll be a doctor with the knowledge and technical skills required to begin the next phase, your residency training.

At points along your training, you’ll hear cynicism about the practice of medicine. And, as you make the necessary sacrifices to be a highly skilled physician, you may begin to feel like a victim. My final recommendation is don’t give into the temptation. Delayed gratification is intrinsic to becoming a doctor. There is no way around it. But it is worth it.

Medicine is the greatest profession that exists. When you are done training, you’ll have the ability to heal the minds, bodies and spirits of others. Few people in this world get to go home at night having accomplished so much good for so many in ways both small and large.

There is no right path for everyone, but along this life-defining journey, you’ll be well served taking the following six actions:

1. Congratulate yourself on how far you’ve come, and continue to do your best to be the most knowledgeable and technically skilled doctor you can be.
2. Hold onto who you are as a person. Be sure to keep a firm grip on the parts of yourself that you value the most. Embrace the elements of your life outside of medicine that bring you joy and fulfillment as a person.
3. Remember why you wanted to be a physician so badly. Nurture your capacity for empathy, a powerful force for healing others that also nourishes your own soul. Without that, you won’t be as excellent a healer as your patients need and expect you to be.
4. Beware of becoming single-minded. Never lose sight of why you chose medicine as your career and worked so hard to get here. Balancing all the competing interests inherent in a life in medical practice will prove difficult, but failing in the struggle to do so is why so many doctors end up unhappy. It can be done, but only if you make a conscious effort.
5. Pick a specialty that fits who you are and your personality. If you don’t enjoy your clinical rotation, you’re unlikely to find fulfillment in pursuing this path.
6. Savor the adventure ahead. If you have put into practice the first five recommendations, you’ll finish the journey with the skill to make the lives of people better. And you will have maintained the passion, optimism and spirit that you brought to medical school at the start. It won’t happen unless you decide to make it a priority. But if you do, you’ll never regret having made the effort.

Sincerely,

Robert Pearl

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