Note to Pre-med Students

(a note to a pre-med student who asked a few questions...)

Career choice is like finding a spouse. You weigh all the options, think, consider and agonize...and then you pick based on what you feel. It is important to look at exactly WHY you want to be a doctor. Really. Why? 

The process of becoming a physician, and the process of maintaining one's sanity and love for patients while holding onto SELF once one is a physician... is very difficult, indeed. Many people do not make it. Or...they burn out and continue to work anyway, making life worse for themselves, their families and their patients. Med students, residents and physicians are famous for committing suicide or turning to drugs/alcohol because the demands of the training and the work are so intense.

Woo, started with a soap box.


I became a physician because it fit, for many reasons. The short answer is - I just couldn't help it, kinda like falling in love. I'm an idealist. My personality type is INFJ which I just discovered recently - and it's pretty accurate. I compulsively seek justice. I'm most happy working one-on-one, yet I also enjoy a team approach. The medical model of the interdisciplinary team (pharmacist, MA, RN, dental, social work, etc) working together for common good is perfect for me. I work at an FQHC; after residency, I have held two positions, both at FQHCs. It's what works best for me.


Why 'D.O.' instead of M.D? The fastest way I can explain what this is to patients - 'like an M.D. but with extra training, mostly in musculoskeletal medicine.' I gave informal massages and adjustments to friends and family starting young, and have been interested in the mind-body connection for as long. I also love anatomy. As a kid I watched surgeries and The Discovery Health Channel, and wanted to know what my doctor was thinking, and wanted to be able to do what my chiropractor did. I enjoy having another perspective to offer my patients; makes me feel like a superhero. : o ) D.O.s can specialize in any of the same fields as an MD while receiving more patient-centered communications and physical medicine training.


My book Prognosis: Poor explores my perspective on med school/residency. You should read the book knowing that I have narcolepsy, PTSD and major depressive disorder...but didn't know it at the time. I'm treated for all the above now, and life is much easier. If I had been treated for at least one of those problems, my route to becoming a physician would have been a bit less bumpy. I wish I would have been more proactive in self care, not just self analysis, before entering med school.


The take home message for this - you have to dig deep in yourself. Take the Myers-Briggs assessment, and look at the results with a grain of salt. What resonates? What in your life have you done to look impressive, versus what tasks/jobs/experiences have given you strength, character and contentment? This stuff may sound esoteric, but it isn't. It's quite concrete. You have to know who you are, what you want, and what is 'best' for you in order to get where you are going, with fulfillment and not just struggling to jump through all the hoops. All of this...while knowing that fulfillment is a moving target.

One of my favorite quotes: "One who has a 'why' can endure almost any 'how.'" This means...you have to have the type of meaning in your work that carries you and makes you feel worthwhile. At least, that's my personality type's requirements for career. Everyone has different needs.


Journalling, and asking friends/family perspectives can help a lot. Sometimes it's still not clear - and that is due to lack of experience. So get yourself some experience, by wandering around a hospital to see how it makes you feel, watching surgeries online, reading about pharmacology and anatomy...is this fun for you? If not, reconsider your goals.


If you want to 'help people,' - there are thousands of means to that end. Don't become a physician ONLY for that reason. You could be a social worker, foster parent, retail salesperson, soldier, etc. Wanting to help is not enough.


If you aren't a good test taker, you should seriously consider another field. Really. The path is chock full of testing, all the time, and it never ends. It is truly a life of learning. Right now, I'm an independently practicing physician, and I'm required to have 50 hours per year of Continuing Medical Education, and take tests at least every seven years to recertify. If this sounds more fun/exciting than terrifying, that's a good sign. If not, I honestly would recommend you reconsider. Some of my close friends with great minds and wonderful intentions were forced out late in the game because the Board exams were their kryptonite. They are finding meaning in other ways, and at the same time, I think their paths were especially difficult.


If you can handle being in charge when it counts, this is important. If you want more support related to the responsibility for big, decisions, consider another option. If you want to defer to someone else for final decision, become a nurse practitioner or physician's assistant; it's the same work but without residency and with backup for decisions. If you like the act of physically actually caring for people - interpreting orders to carry them out, summarizing patient information to be an advocate, administering medicines to actually MAKE IT HAPPEN - think about becoming an LPN or RN. If you want to be even more concretely involved with patients with activities of daily living like bathing, consider becoming a CNA. I can't do that. I like to assess, make a decision, and walk away. My visits with patients are 15 minutes, and in the hospital I saw patients for 5-45 minutes at a time, and then the nurses would actually do the work, watching it come to life.


There are all types of different fields appropriate for different people - radiology for folks who like to be alone but are perfectionists/minutia lovers, surgery for folks who are technically skilled, ICU medicine and palliative medicine for folks who like end-of-life care, OB for people who can tolerate being awakened at any hour as long as it involves a pregnant woman who needs help...and family medicine for people who kind of love it all, but mainly want to listen to people one-on-one and problem solve enormous problems into tiny, manageable steps.


If you can't tolerate authority, don't go into medicine. You have to deal with this for years, and then have to deal with insurance companies 'telling you what medicine you can practice.' You have to be able to understand this going in, and not be constantly upset about that.


What about if you don't like medicine at all? You like the physical part, helping people become more functional? Consider physical therapy or occupational therapy.


If you love all the actual medicine and science, but you don't really like radiology, don't like blood/gross stuff, and don't want to talk to the patients about their problems...consider pharmacy.


If you can't work well both independently and in a group setting - it won't be for you.
If you love it all but you feel more fulfilled helping animals than people and you truly are not in it for the money, consider becoming a veterinarian.


If you are going into it for financial security, think about a different path. Many other ways to achieve this. And many more lucrative fields than medicine. Many.


If at the end of all the soul searching and personality digging and answering all these questions, the only possible answer for you is to become a physician, that's when to take the journey.


: o )
Hope that helps.
Kind regards,
Dr. Southwick