How hard should schools push med students?

With long hours, little sleep, inconsistent eating times, and drill sergeant-like teachers, medical school can be grueling. The theory is that the more challenging med school is, the more likely future doctors will be prepared for the tough realities of the job.

But is this sort of environment truly helping our future doctors or is it creating a toxic system that is setting our doctors up for a lifetime of poor lifestyle habits, anxiety, and depression?

To try and answer that question, we decided to investigate. What we found may surprise you.

Doctor shortage

A lot of people in the medical field feel this trial-by-fire approach is antiquated, possibly turning people off from a career in medicine altogether.

“Many talented young people have taken note of these negatives — and decided that medicine may not be the right field for them,” wrote Provost of St. George’s University Glen Jacobs on KevinMD. “The number of med school applicants has essentially been flat for the past four years.”

According to Jacobs, this is especially concerning because America is facing a doctor shortage. By 2030, the country is expected to have a 120,000 doctor deficit. A doctor shortage of this level would not only cause problems for our growing, aging population, but it’d also make getting medical care in rural areas extra challenging since fewer doctors move there after school.

This shortage is causing longer wait times, too. In a survey conducted in 2014, patients in Boston said they wait up to 66 days to see a family practice physician, and patients in Washington, D.C. wait 32 days to see cardiologists. If doctors continue to dwindle, so will American’s life expectancy, reported USA Today.

Burnout and PTSD

In a recent blog, we wrote about how doctors often face burnout or PTSD due to the high stress of their jobs. A factor that can lead to either of these two afflictions is intense demands put on medical professionals, often starting in med school. 

A survey conducted by the American Foundation for Suicide Prevention found:

• 28 percent of medical residents experienced a major depressive episode
• 23 percent of interns had suicidal thoughts
• Suicide for male doctors is 1.41 times higher than the general population
• Suicide for female doctors is 2.27 times higher than the general population

Sadly, these stats don’t get much better out of med school. Depression and PTSD are so commonplace in the medical field, there are medical professionals, such as Lissa Rankin, MD, who help other medical professionals deal with job-related stress.

Why med school is so toxic

There are several reasons why med school is an emotionally and physically taxing experience. 

One reason is due to med school’s inherent competitive nature. A whopping 86 percent of respondents in a Kaplan Test Prep survey said pre-med culture is too competitive. It’s very difficult to get into med school, with some schools only accepting 4 percent of applicants. Often times, the applicants accepted are extraordinarily competitive, and this behavior carries over into school.

There’s even a name for these students: gunners. These are students who are so ambitious, they’re willing to backstab, gloat, and bully. There’s no shortage of med school horror stories where gunners are to blame for a student’s misery.

That Kaplan survey also found that 19 percent of respondents said they were bullied or know someone who was bullied in pre-med. This number is modest compared to the Association of American Medical Colleges’ 2012 and 2013 graduation surveys that found 42 percent of respondents reported being mistreated in pre-med.

It’s not just student-student mistreatment, either. Teachers can be abusive, too. In an AMA Journal of Ethics article titled “To Bully and Be Bullied: Harassment and Mistreatment in Medical Education,” author Ajay Major surmises that teacher-student abuse stems from “the cycle of abuse”—meaning the teacher was once abused in med school and passes down that abuse to his or her students.

The good ones

Med school doesn’t have to be overwhelmingly difficult, and some institutions know that by treating students with respect, there will be better outcomes.

Take Yale School of Medicine, for example. Alumni Jenny Blair wrote in Yale Alumni Magazine , “Among would-be doctors, the Yale School of Medicine is famous for being mellow.” At Yale, she said students are treated like adults, are given freedom, and tests are optional. “The idea is,” she wrote, “to start students early on habits they’ll need throughout their medical careers—self-motivation, self-education, collaboration, scientific reasoning, curiosity.”

This system appears to be effective. Yale School of Medicine is ranked #13 (research) and #44 (primary care) in best medical schools in the country by U.S. News and World Report, and in early 2019, 85 of 88 Yale med students were matched with residency programs. So, patients who get doctors that graduated from Yale Med School will likely be in good hands.

Yale is not alone. When the University of Pittsburgh School of Medicine recognized that burnout and suicide are higher for students in med school versus the general population, they built a mental health program to assist students. The school’s mental health initiative for med students includes access to a psychiatrist, psychologist, and peer-counseling advocacy and resource program; mentorship; and observing faculty advisors outside of work to see how they “balance work and life choices.”

What can be done

So, if Yale and Pitt recognize that their students are humans who deserve respect and autonomy, does that mean the model could be used for other med schools? Absolutely. Though med school needs to be challenging in order to prepare doctors for the hard truths of their work, it doesn’t need to be that way at the cost of mental health and happiness.

Jacobs said at St. George’s, they’re implementing measures to help their students. “Our students work closely with learning strategists to navigate academic challenges and stay on schedule,” he wrote on KevinMD. “St. George’s also offers popular programs on time-management, effective note-taking, and mock residency interviews — essential skills students don’t typically learn in the classroom.”

If provosts and school leaders like Jacobs continue to acknowledge the challenges med students face, we’ll hopefully see more beneficial changes. This will not only help prevent burnout and suicide but also help correct our shortage of doctors—which we desperately need.