The Path

Pardon my absence. Unfortunately I am not blogging from China because due to powers out of my control I was not allowed to go. Instead I've been at home wallowing in boredom and lethargy. At least I saw the movies Star Trek and Up - great movies by the way.

With so much time on my hands, I might as well elaborate on "the path" to medicine. It is one of delayed gratification almost to the point of torture and insanity. Even reaching the light at the end of the tunnel is no guarantee of a break from all the money, hours, blood, tears, and sweat that went into the journey.

Here are my prospective thoughts on the path - perhaps I'll return and let you all know how things turn out in the end (at least 7 years from now).
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The Beginning
I would argue that this path starts sometime at the end of high school or the start of undergrad. To embark on this path one must be certain and focused on it. One must be determined and have a sense of where he/she is going in life before they can pursue it. No one goes into medical school half-assed or without some sense of why he/she is there. Once the determination is set, various things must be done to verify that it is not all a mistake.

Such things include hospital volunteering, biomedical research, core biology and other physical science classes, and doctor shadowing. It is rarely easy to devote enough time to all of these and still maintain the requisite grades for medical school, much less a calm sense of self. And then there is the MCAT, a foreboding test that is a standard equalizer in a sense amongst all applicants.

The Application
The application process is a long and arduous one. Unless you know you're an amazing applicant, most applicants will apply to at least 12-15 medical schools. There is first the AMCAS primary application that is sent out to all medical schools you apply to. Then the medical schools that want to consider you will send you their secondary application, often filled with many essay questions and other details to fill out.

Then, when the medical school is satisfied with your grades, MCAT score(s), extracurricular activities and achievements, as well as your answers to their essays, they might invite you for an interview. The interview is both a good sign and a daunting undertaking. Based on how well you connect with your interviewer(s), how you answer and ask questions, and what impression you give, you'll either be accepted, wait-listed, or rejected.

Medical School
Now you're in medical school. After the first year you can say goodbye to being debt-free (if you ever were in undergrad), goodbye to traveling over the summer, goodbye to sleep, goodbye to hanging out - goodbye to practically everything except classes and studying. I feel that only the most well-balanced and most efficient time-managers among us can survive beyond becoming consumed by medical school.

The first two years consist of grueling coursework and studying, all in preparation for the USMLE Step 1 (US Medical Licensing Exam) taken at the end of the second year of medical school. The last two years consist of rotations in the various medical departments to get a flavor and experience of what the different specialties in medicine are like. The fourth-years must then apply and interview with hospitals to obtain a spot in a residency program in a process called "the match." All over the US on a specific day at a specific time in March, fourth-year medical students all receive their residency placements. I hear it's a day filled with much crying - whether it's crying for joy or disappointment.

Residency
Now you're done with medical school. You are a doctor now but must first gain the experience to make yourself an effective and capable doctor. And so for at least the next 3 years you are an intern (the first year) and resident (the remaining years). Your meager salary of $40,000 to $50,000 and 80 work hours a week is like a slap in the face for all the work you've done in medical school to get here. If you worked the 40 hours a week of a normal person, you would only earn $20,000 to $25,000 a year. And always looming over your head is the $150,000 debt (on average) that you had to borrow to afford medical school - let's not even mention the interest on that.

After residency you may opt for further specialized training in a fellowship. You tell yourself that you'll be able to relax and sleep after residency, that you'll have time to take a vacation every now and then to travel, and to make "real" money. You realize the follies of such thoughts.

Attending
Now you're an attending physician, done with your medical training and top of the food chain now, as it were. Your hours are more relaxed (generally) and you are at the top of the pecking order. Yet, you're often still on call, and you can't really get away for a vacation because there are always patients, and of course the patients come first. Is there ever time for yourself?

There are overhead costs that you hadn't anticipated before, especially if you plan on opening your own private practice. Such costs can include: office rent, heat, water, electricity, lab tests, paper, nurses' salaries, receptionist salary, malpractice insurance, supplies, internet, etc. All this might cost upwards of $100,000 (I don't know the true figure). And oh yeah, you still have a good chunk of that borrowed $150,000 that you still have to repay (plus interest). You have to fight insurance companies for every cent just to fill your bottom line.

What is this? A business? This is not what you signed up for when you started medical school. When did medicine become a business? Why are there limits on how and what you can do for a patient to ensure the best care? And of course, the threat of a lawsuit by a particularly disgruntled patient looms over your head.
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The path is a curious one - a noble and honorable path at its core. But why then does it contain such "suffering?" Is this how the best doctors are made? You have sacrificed sleep, friends, family, vacation, traveling, current fortune, all for the promise of doing something better later . . . much later. You have taken on a tremendous amount of debt, long hours with comparatively horrendous pay, battle the broken system tooth and nail for not only your patients, but also yourself.

It's curious that once you embark on this path people outside the field assume you have it made. Sacrifices? Well at least you have money. No life outside the clinic/hospital? Well at least you have money. Traveling? Well you have the money to do it (too bad you're now old and patients will hate you for taking time off while they're sick). What is up with this fixation on money? What use is money if you can't use a lot of it for things you want to do? When a good chunk of it goes to repaying debts? The most valuable thing for physicians is not money but time, and there's simply precious little time for the physician him/herself.

The most difficult thing on this path is balance: the ability to not lose yourself along the way. It's too easy to let medical school, residency, and being a physician control your life that you miss the things most people cherish in life - hearing your baby's first words, seeing your baby's first steps, attending your kid's games, attending their graduation, traveling, a nice night out.

My greatest fear is that medicine will consume me whole, and that I'll lose myself and all the little things I enjoy in life in the process. And no, I have no answers. But I pray that I find them along the way.