So I was asked "What do you think the problem is with the health care system?" in my medical school interview last week. I looked across the table at the 65+ year old gentleman who had just laughed at my desire to become the surgeon general of the united states and earlier noted that "Muslims" keep to them selves here, and I replied "you are." Not quit like that, but I expressed my notion that cynical old doctors (which he was clearly one of) are what continue to maintain the status quo in this country and only when the next generation take control of important positions will things actually change. I guess I won't be going there for medical school. I wonder if I still want to become a doctor? Do I? It feels like I'm jumping into pool of acid, with the direction that things are happening in the medical world. Can I make a difference? Will I come out with the same mindset as I went in? Will $200,000+ in loans change my views regarding public health and helping the under served? Are doctors a possible source for a solution, or is modern medicine and its reliance on high cost intervention and delaying death at any cost (if you can afford it) actually a problem in itself?
I don't know the answer but a potential solution will be to force admissions committees at medical schools to find a true way to assess the the goals and desires of those potentially attending their medical schools. And if they can find good people society should ensure that once finished with medicine these people will be allowed to follow their dreams, rather than being buried under the oppression of debt.
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7 comments:
Payam, first of all, good luck with your decision! Wouldn't it be wonderful (something I might propose in my paper for this course) if the government could subsidize medical school tuition for people who pursue an MD MPH? This way, those with the best of intentions wouldn't be forced to change their ideology because of the dollar bills in front of their medical degree, and in turn change the medical system for the better.
Strangely, I am thinking exactly the same things that you mentioned in your post. I think the real need is in changing the whole way admissions is done in the first place. Frankly, I don't think doctors need to be that smart--most of the stuff they do is pretty repetitive-so the only reason why doctors are so "brilliant" is because they make it so tough to get into medical school in the first place.
Payam,
That must have been frustrating. I know I would have been really upset if I had that conversation with the interviewer. I agree with you. When I tell people what I'd like to do, most laugh at me, and say that I'll "grow out of it" by the time I get out of medical school, and that I'll have my own practice in LA doing something like dermatology (that is to say, if I even get into med school). I'm sure we all get that.
But I don't think it has to be that way. I think there is something really wonderful about being a little idealistic and wanting to change the status quo. It's invigorating to come to classes like this and see that not everyone is LA is completely egocentric (I say this acknowledging that even WE the amazing public health graduate students are egocentric).
I think you can make a difference, and I think with some really intrinsic motivation you can totally come out of med school with a similar mindset. The world isn't getting any better, and all those MDG's are still waiting for you to tackle them. :)
payam, i had a similar experience w/ interviews too last year. i would give my whole spiel about public health when what they really wanted to know was how many papers i'd published in the biotech field (zero). i was wait-listed in a few places, didn't get in. i'm still trying b/c the way this world works, having an MD seems to open a lot more doors in global health. i already know i don't want to be a doctor, for reasons you listed and b/c public health is much more stimulating for me (plus dr. shahi's likening it to cheerleading stuck w/ me).
i have no idea why it's so difficult to get into medical school--i certainly haven't figured out how to do it yet--but i totally agree that they don't give the career goal of social responsibility nearly enough weight.
i think you're asking the right questions, and for that reason you'll be an asset to your classmates in med school.
Hey Payam, hope you don't mind this post but I thought I'd chime in...give you some hope?
Laurie Garret has an article in this month's Foreign Affairs and in her intro she talks about how 1 out of 5 current physicians is foreign trained and how a JAMA study says we might have a shortage of 200,000 doctors by 2020. Well, if that holds up, many of the old reich of worn-down, cynical doctors may have cleared the space for a new generation of doctors. That can be good, unless the people who take their spots qualify as more of the same.
I don't think the problem is with who they admit to medical school, necessarily. It's a flawed process, that's for sure, but I think the major problem lies in the process of medical training -- which can be draining and demoralizing for your everyday idealist and fresh fodder for the cynical, "too cool for school" types that I have come across in the last 6 months. The trend towards lesser competitive institutions (see: P/F grading) and more small-group, hands-on oriented teaching may cause a ripple that will show effects in 15 years, but work needs to be done in the area of residency training as well. Ultimately though, I think it really is up to each person whether or not they let the debt and the process get to them. The odds are against us, but with enough will power, you can come through w/o comprising your ideals.
I agree with the sedentary traveler. Dr. Cousineau came and talked to us in 509 about the US Health Care system and he said one of the major problems (from a public health point of view) is that doctors only receive about 2 hours of public health training, the rest is all about rewarding disease and prolonging life as you said. And Ivette, that would be awesome, but it would be even better if education was subsidized in all fields...France anyone?? :)
What crap when they ask you such questions in such a broad format. Nice response - way to hold your composition.
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