When I was in undergrad, I used to tell myself that everything would get better if I got accepted into medical school. I thought the sacrifices I was making to become a competitive medical school candidate were temporary. All the late nights spent in the library, the parties missed due to having to work overnight at the hospital, the money spent on applying and traveling to medical school interviews were just a means to an end. But now almost 5 years after I began the application process, I realize that was just the beginning of the sacrifices.
For those not familiar with the medical school process, the first two years of medical school are grueling. During these years, students learn anatomy, biochemistry, microbiology, physiology, pathology and pharmacology. After two years of pre-clinical courses all medical students must pass a national board exam. Not only does a student need to pass this 8-hour exam to advance in medical school, but how high they score is the biggest factor in determining how competitive they are in regards to residency. Any student who has hopes of pursing a competitive residency, like neurosurgery, dermatology or orthopedic surgery better do well on the exam, accepted candidates typically score on average in the 93rd percentile of all test takers. No pressure, right?
In the midst of studying for my first level boards last year, I came across a sign in Target (my favorite place to kill time) that said “It doesn’t get any better than this”. While it was intended to be a sweet sentiment, reading those words really sent me into a funk. You know how people always say you should live every day as if it is your last? Well I felt like my 2 pre-clinical years of medical school were wasted. Sure, I learned more in those 2 years than I did during my entire undergraduate career, but I felt like I had lost who I was as a person. Taking a hard look at my life, I had no idea what my purpose was. I knew I had to study hard to pass my boards to complete medical school and live out my dream of becoming a doctor, but spending each day studying for 14 hours each day seemed like a waste. To add insult to injury, going right from undergrad into medical school meant while I was locked in a library every weekend, I watched my college friends spend their new found freedom traveling the world or celebrating a work promotion.
To summarize my first two years of medical school in one word, I would say “frustrating”. Maybe I was looking at my world through rose-colored glasses when I started, but I felt foolish for not anticipating how difficult this process would be. I looked towards the incredible support network of medical students, residents and physicians I have found on social media, but I found that many of their articles focused on the good parts of medicine, the triumphs. I wish someone had sat me down and been brutally honest about the non-academic struggles of medical school. I knew learning the information presented in class would be like drinking from a fire hose, but nothing prepared me for the social and financial difficulties of choosing this career path. So, my hope is that someone reading this article uses this as a way of reevaluating their expectations prior to starting medical school. Becoming a physician is an incredible opportunity and a humbling experience, but this process demands sacrifice.
In my experience as a single, female who is part of Air Force HPSP who started medical school at the age of 22, these have been my biggest sacrifices in pursuing a career in medicine:
Finances: I can quite honestly say, I am in a worse financial situation now as a 3rd year medical student than I ever was while I was in college. While I was in college I could maintain between 20-40 hours per week at my job as a surgical care assistant. Being in medical school, I am not afforded that much free time per week and my schedule is so variable week-to-week that maintaining a part-time job is near impossible. I was fortunate enough to work about 8 hours a week in my medical school library, but the $70 earned barely covered the supplemental study materials and endless supply of coffee I needed to survive the first two years. Although I receive a stipend as an HPSP student, $2100 per month doesn’t stretch very far, especially depending on the cost of living of where I am rotating. In addition to not earning a salary, not being able to contribute to retirement or invest money into a home is a huge financial setback.
Medical school itself is an expensive endeavor! The median cost of medical school including textbooks, tests, and supplies ranges between about $208,000 and $278,500 for 4 years according to the Association of American Medical Colleges. Approximately 80% of medical students now graduate in debt, with more than 1/3 of these students owing over $200,000. It is estimated that with an average doctor’s salary, it would take between 25 and 30 years to be able to pay the loan off. This results in a subset of physicians working their entire career just to be able to pay off the debt that they accrued going to school.
Unfortunately this financial burden is causing many students to reconsider pursuing a career in primary care, which is contributing to the doctor shortage. After being saddled with $200,000 in debt, it is understandable that a student may be lured into a more lucrative specialty such as radiology or dermatology which have starting salaries often 3x more than that of a primary care physician.
Health: I have always taken my good health for granted, but it wasn’t until I got into medical school that I started realizing the effects of stress on my body. I have given myself acid reflux from the sheer amount of coffee I drink to get through each day. I began having chest pains and palpitations during my first year, likely due to a mix of stress and anxiety. I once had to go to urgent care once due to dehydration after not drinking enough water while preparing for a series of exams. I stopped going to the gym and started justifying eating whatever I wanted as a way of coping with stress. Fast forward two years and 10 lbs later, I was the most unhealthy I had ever been after I took my boards. Now almost a year after taking my boards I’m still working on shedding the extra pounds I picked up during my careless eating my first two years.
My mental health also took a beating my first two years of medical school. My sleep habits were terrible. I was so anxious I couldn’t fall asleep at night. I was so stressed from being behind in classes that I would stay up late to try to catch up which would result in even fewer hours slept. I was so tired I couldn’t focus in lecture. Several times a week I would call my mom and tell her how terrible I thought I was doing. I was convinced I was going to fail classes, fail my boards, drop out of medical school. I scolded myself for earning B’s in class, convinced if I had just stayed up a little later, or done a couple more flashcards I could’ve earned better grades.
Fortunately after I finished my boards, my anxiety subsided, my sleep cycle became more regular (as much as can be expected as a medical student), and I am in a better spot mentally. But many medical students aren’t as fortunate. Mental health in medical school, residency and the medical field has become a hot topic in recent years. I saw an estimate that every year on average, we lose the equivalent of a medical school of doctors each year to suicide. Dr. Pamela Wible hit the nail on the head in her Ted Talk titled “Why Doctors Kill Themselves”. Dr. Wible has been a huge advocate for improving the mental health system for physicians and her work is truly inspiring. I implore you, if you are feeling overwhelmed in medical school, you are not alone! There are many resources out there for medical students.
A support network: As I mentioned in a previous post choosing an osteopathic school was very important to me. Unfortunately, growing up in Minnesota there were no DO programs in the state, and there are only two programs in the surrounding states (DMU and Midwestern). I knew whatever program I would choose, I would have to move away from home. In hindsight, I realize if I chose DMU I would only be a 4 hour drive away from home, but nevertheless I decided I wanted to move to the east coast and settled on a school in Pennsylvania.
Moving so far away has caused me to miss birthdays, engagement celebrations and weddings of my friends and family members. It’s been a struggle to maintain friendships, when I am only guaranteed 4 days off from my clinical rotations (Thanksgiving, Black Friday, Christmas Eve, and Christmas). I have been fortunate that I have been able to sneak back home for some long weekends since I started medical school, but when faced with a 15 hour drive or booking several connecting flights the trip itself is tedious. Fortunately I have some incredibly supportive family and understanding friends, that don’t hold it against me that I can only see them once a year or it takes me a week to respond to their text.
My school is unique in that it has several hospital affiliates. Many medical schools have a core affiliate hospital that all their students spend most of their 3rd and 4th years rotating at. My school has teaching agreements with more than 100 hospitals and clinics in 9 different states. While this was initially one of the things that lead me to decide on attending this school, moving to a new city knowing very few people has been a very isolating experience.
Once you leave the safe confines of college, you’ll realize that it is extremely difficult to meet new people in the adult world! I typically work one on one with my attending physicians, and spend my day interacting with my patients. Sparking a friendship with my boss or a patient is highly inappropriate, and I don’t get the opportunity to work with many other medical students from my school. Given the odd and unpredictable hours that medical students work it isn’t easy to find a club, sports league or volunteer group who’s schedule coincides with my own.
Aside from not knowing many people in the surrounding community, being an HPSP student I have several military commitments that require me to travel. In addition to my two elective rotations spent rotating at a hospital back home, I spent one month rotating at an Air Force base for my pediatric rotation. I also have two audition rotations scheduled at two separate bases in the next few months. Living on the road is hard enough, but doing it for several months in a row is mentally and physically exhausting. The excitement of exploring a new city is quickly wears off when you realize you don’t know anyone and can’t find your way around!
A family of my own – okay so this one is kind of theoretical as I am nowhere near settling down or starting a family of my own, but I do think it is important to realize the unique stressors that apply to women in medicine. Now before I get angry medical school dad’s yelling at me, I don’t think it is easy for any parent, male or female, to take care of a newborn during medical school or residency. Unlike men, however, women have the added pressure of very limited periods of time when they can become pregnant and give birth without delaying their career in medicine. Speaking with my male friends in medical school, I am utterly shocked that they have never considered how their career in medicine will affect their ability to have a family later down the road. My mom can vouch for me, I have been worried about my career limiting my ability to be a wife and mother since I was 16. I have even complete strangers question my ability to be a “good” wife or mother when I tell them about my decision to attend medical school.
Becoming a mother in medical school is challenging for several reasons. The process of becoming a doctor takes a substantial amount of time to complete (4 years of medical school + 3-7 years of residency depending on specialty). Even if a student were to continue from undergrad to medical school without taking a year off, the soonest one could be done with training would be at about 29 years of age. According to one article the number of students taking at least one year off between undergrad and medical school is now about 60%. If a student takes a gap year or wants to pursue a lengthier residency, training could last well into her mid-30’s. With the rate of being able to conceive dropping significantly after age 35, it is easy to see how many people don’t believe motherhood and medicine can coexist.
Even though I am unmarried and not planning on starting a family for several years, I have had many attendings and residents offer me unsolicited advice about family planning, some with good intentions, and other’s not realizing how inappropriate their comments may be. I had one attending tell me I’m at a disadvantage if I wanted to apply to a competitive specialty, because if he were a residency director he wouldn’t want to “waste a spot” on someone (cough *female* cough) who would need to take time off to start a family. I’ve had other residents tell me when are the best times to plan to have a child (between 2nd and 3rd year of medical school, at the end of your 4th year of medical school, the last year of a family medicine residency, etc.).
Although starting a family in medical school or residency seems like a logistical nightmare, I know several of my classmates who have very successfully done both! I don’t think having a child is ever an easy transition, but I do think it is possible to have both a family and a career in medicine. For any woman considering medical school who wants to start a family and not sacrifice their career, don’t fret! It is entirely possible! Look to resources like Anna in Med School or MomMD for some sage advice and inspiration!
So the real question is, is it worth it?
Well, unfortunately that is not a one size fits all answer. A career in medicine is for those who can’t imagine doing anything else. The truth is being a medical student demands you prioritize your life. Yes you will have to sacrifice, but finding a balance makes the process manageable. Use a trip to the gym as a study break. Take 5 minutes to call your mom. Stay active in church groups or volunteer programs. I think my biggest mistake is losing my perspective. As I mentioned before, I used to think getting into medical school was the big end goal, but it turns out that that was a very short sighted goal. Becoming a doctor is a marathon, slow and steady wins the race. I treated my first two years of medical school as a sprint and as a result I got burned out. Heed my advice and don’t lose sight of the things that bring you happiness! It’s a trying process, but the end goal is worth it.