The Bubble of Medical Education

This past weekend I hosted a screening of The Vanishing Oath and was fortunate to meet the director, Ryan Flesher, MD. Face-to-face, he was upbeat and passionate about film and music and his current topic of physician burnout, which contrasts with his portrayal in the film. (His documentary tackles a tough topic, so it is no wonder he is less than cheerful in it.)  He was brimming with ideas on how to expose a side of the healthcare story nobody wanted to tell and which most of the public think they don’t want to hear. Dr. Flesher is observant and a good listener, too, which I imagine is essential to documentary-making, as well as doctoring.

The topic of physician disillusionment came up in the Q&A’s after the screenings and also in a conversation I had with Dr. Flesher. For years, doctors-to-be are in an idealistic bubble of medical education. I felt that not only could The Vanishing Oath educate the public regarding some of the interference in the doctor-patient relationship, but that it could also help medical trainees be more realistic about their career path. Dr. Flesher made the point that, in some ways, medical students and residents have to be idealistic. “They have to be.”

Do they have to be? This idea has been mulling around in my brain since then. It seems that the very thing that contributes to physician burnout is the very same thing that makes a well-meaning 17- or 18-year-old with little knowledge of the world decide to become a physician. Idealism or a sort of delusion must be a necessary factor in a doctor-in-training’s ability to endure – in the words of a friend – “the abuses of medical education.” Would anyone in her right mind sacrifice seven+ years of her youth taking endless tests (some 8 hours long), being demeaned at times by attendings, nurses, and some patients (yes, patients, too), and amassing around $200,000 in debt by the time she is just starting residency? A smart, cost-aware person would pass and might choose an easier path with work-life balance and financial success in another field, such as becoming a CRNA.  

However, I suspect that we, as a society, do not actually want the kind of doctors who are “doing the math.” We subconsciously expect our doctors to be selfless in every sense, foregoing relationships (check), social life (check), family life (delayed), money (check – in primary care). We don’t really want the kind of doctor who is thinking in dollars and cents for himself. We would have had a lot more self-serving physicians and an even bigger healthcare crisis if that were the case.  Shortly after I completed my residency, some non-medical business-minded relatives urged me to get my own practice and to buy an MRI machine. Why? So I could run a bunch of unnecessary scans and reap the profit? Needless to say, the dollar signs didn’t sway me from my morals.

Interestingly, I found that medical residents were among those who were the least moved by the description of The Vanishing Oath, which touches on why some doctors are leaving clinical practice. And now I understand. These are individuals about to graduate from residency. They are not only still in the bubble, but they are also moving towards the light at the end of a very long tunnel. Unfortunately, for some individuals, it is more like a mirage in the desert. As physician burnout occurs earlier and earlier in the current U.S. healthcare system, Dr. Flesher’s film could be a great starting point for discussion on how one might deal with it if it happens.

Perhaps, in some ways, it is best that doctors start out in a bubble of idealism, knowing very little about the business and reality of practicing medicine. The bubble has to stay intact in order to survive the process of medical education.

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P.S.

Dear American politicians,

Please be kind to your idealistic physicians who, without much business sense, decided to stick it out on a grueling path that just doesn’t add up in today’s economy. Be kind for they care for your children, your parents, and you. 

Thank you.

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