Tuesday, February 24, 2009

The Student

In the not too distant past, I had the good fortune of having a really great student with me for an "Office Ob/Gyn" elective. When I say "really great student," I mean exactly that. She arrived early and stayed late. She was professional and comforting to the patients. She asked appropriate questions and wrote really great notes. She had a good knowledge base, and she did it all with a smile and no 'tude. Truly, an awesome student. Unfortunately for her, we spent more time in the hospital doing surgery and deliveries than we did in the office. (I think that Whooville is having a serious baby boom. They just. keep. coming.) I do think that I was able to give her a taste of what being an Ob/Gyn is like, at least as far as being a solo practitioner, any way. She is trying to decide between Ob and a couple of other more "lifestyle friendly" specialties.

During the rotation, I really tried to let her form her own opinions about the life that she saw me living. I found myself, several times having to refrain from trying to talk her out of being an Ob/Gyn. A student that any Ob residency would be lucky to have, and I kept wanting to, I don't know, *protect* her or something. Maybe it was her sweet, un-cynical self, not yet marred by years of being beaten down by the establishment. Maybe it was because I wanted her to have a chance at a less stressful life, before it was too late to look back. Or maybe I was just trying to warn her not to make the same mistake that I made when I chose my first job out of residency (an essentially solo practice). I would like to think that it was the latter, because I truly love what I do, I just don't want to do it so, um, *often.*

I want to be able to feel confident in inspiring the best students to follow in my footsteps in a field that desperately needs good physicians. I worry that my first instinct is to tell my students to run, run, run, because I know that I wouldn't have. Even if the attending told me to run, I would have made the same choice. So at the end of the rotation, after we went over her evaluation, she asked for a letter of recommendation (which I will gladly write). When I asked whether she wanted one geared toward an Ob residency, or one for more general purposes, she chose the "more general" category. She's still making up her mind. Perhaps my feelings were telegraphed more than I had realized. I do feel hopeful, though, to know that the such bright rising stars in the future of medicine exist out there. So, to all you bright med students and would-be med students...don't let the disillusioned attendings get you down, y'all. We need you more than you know.


  1. Seems to me most of my colleagues would tell their kids not to be doctors. That makes me so sad. I'm a third-generation doc, and I kind of doubt that my kid will be the fourth, and that's OK - but I would never discourage anyone from going into medicine. My specialty's not a perfect fit for me, and when I see students (which is rare these days) I talk with them about finding that fit.

    I guess I'm just optimistic or idealistic enough to think that the misery-making parts of medical training and practice can be changed, and that the rewards are worth it.

  2. I loved my surgery rotations. Still, when I asked one of my residents (who was awesome) whether he was happy he'd chosen surgery, he said, "I wake up every day and wish I'd gone into radiology. I can assure you that no radiologist wakes up every day wishing he'd become a surgeon."

    It really did mean something to me and I will be taking his advice (the not-surgery part). I think if your student decides to go into Ob anyway, you can take comfort in the fact that she is doing so with her eyes wide open.

  3. I echo the part of this post that wishes I could do what I love - take care of kids - but less often. Seems that the longer I'm in medicine - a couple of decades - the more complex it gets. In Peds as in other primary care specialties there is a big push to create medical "homes". That's a really tall order for a small pediatric practice to be more available. I agree better and more consistent care can take place that way - but at some point, there's a limit to what one human can provide another in medicine. I wish your student the best of luck - she sounds like a good one.

  4. It's funny -- I was thinking after my post-partum ob visit that I should've stuck with my gut in medical school and gone into ob/gyn (instead of EM). As of three days ago, I was envious of my ob's office schedule and ability to have occasional holidays off. I guess the grass is always greener ;).

  5. We had a really amazing med student at our clinic recently, who was deciding between our field and a few other lifestyle specialties. It was really hard for me not to try to talk her out of going into my field, PM&R. PM&R has a great lifestyle and I love it, yet I felt like since she was a very competitive med student, she could do better.

  6. I have 1st & 2nd year students from local medical school rotate through my Internal Med. office for introduction to ambulatory care. All enthusiasm at the beginning. When I get followup from them later, none opt for Primary Care (Int Med, FP, Peds). It's a combination of life style and money. And I can't blame them. The life style part is manageable for a profession I love. But there is no more respect for primary care, even among our own colleagues in other specialties, and the finances don't allow the students to pay of their debts.

  7. I encourage students who aren't yet too invested to consider careers outside of medicine. Sometimes I regret doing this. But what else would I do? Nothing else would satisfy me.

  8. I think it is very important NOT to disillusion med students about specialties they have an interest in. Primary care has already gotten such a bad rap (deservedly) that no-one is choosing it. We don't need to drag those numbers down more and the worse thing for students is to see cynical, burned out, angry docs. (not that anyone commenting here is that...but they are out there).

    We do need to be candid about lifestyle and income. We may be the only industry where that is so hidden from our younger colleagues. As they do rotations, they can see what that practice style is all about and decide for themselves. Telling students to run away from a field they may enjoy is not our role as educators. Giving them accurate facts and trusting them to decide for themselves is the best gift.


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