For those of you who responded to my instagram story with blogging ideas, thank you! I was so pleased to hear from you and inspired by your questions. The majority of suggestions were related to my job as a resident– how I picked internal medicine, what I like about it, how I stay motivated, etc. I got very specific questions about my views on the current state of healthcare and the direction in which it’s moving, and whether I think it’s still a field younger students should consider (spoiler alert, the answer is YES!) BUT that’s not to say I don’t have griefs with the current state of how we deliver care. So, I’ve decided to gather a few pros and cons of working in medicine :-)Let’s start with the worst so I can later counterbalance them with positivity:
1. The atrocious inefficiency of EMR (electronic medical records)
Any nurse, doctor, PT, OT, social worker (irrespective of age!) would agree with this one. The movement away from paper charting and into EMR was supposed to allow for continuity of care and better record keeping. In some ways this has happened– I can easily see notes and lab results for my patients back in the early 2000s that often aid in some mystery-solving. However, this is ONLY if my patient exclusively got his/her care within my institution; otherwise I still suffer the burden of paper-trailing my way through other medical system records requests. For very small, rural towns with only one hospital this may not be a concern, but for major cities with medical centers every quarter mile, the convenience of EMR for the sake of care continuity vanishes.
Furthermore, with the “convenience” of EMR and being able to click this and click that, our expectations to bill and chart certain ways works against us. In a recent study published in Annals of Internal medicine, half of physician’s time was spent on EHR (electronic health records) and paperwork, and a substantial portion of this computer time was during the patient encounter (you can read the paper here.) And doctors aren’t the only ones– I see nurses stressed, worried, because they are pressured to finish documentation in a timely manner which directly affects their ability to care for their patients. While I don’t want to revert back to paper charting, I do think we need major reform in EHR platforms and accept that this platform should be universal across medical centers.
2. The exorbitant amount of student debt accrued along the way
For all healthcare professionals (but especially physicians) the opportunity to have our job is EXPENSIVE. We are counseled starting in high school that the accumulation of debt is worth it, as the end result is a respected career with steady income. This may still be true but the line between “worth it” and “drowning in financial crisis” is getting thinner and thinner. With subsidized loans being stripped as an option, medical students start accumulating interest WHILE STILL IN MEDICAL SCHOOL when it is literally impossible to make any money. It seems unjust, but the average loan burden estimate upon graduating medical school (and starting residency making a very modest income) is roughly $170,000, with rapid interest rates adding to that number on a daily basis. Amongst all the physical, emotional, mental stress that healthcare providers must face to do their job it just seems unfair that there is the additional creeping anxiety related to finances.
The best we can do is educate our young generations interested in healthcare to make wise financial decisions. Apply for EVERY scholarship. Go to a quality state school for undergraduate. And my goodness,_ live within your means! _Financial stress is not relieved by indulging in a new flat screen tv. That is all.
3. The job is very often thankless
And by thankless, I really mean it. I’ve heard enough horror stories from healthcare providers to know that you only go into this field if you truly love it. Patients and their families will scream at you, blame you for all their pain and suffering, threaten to sue you, and try to demoralize you. We often take this abuse because we understand it is a reflection of their own discomfort, but it doesn’t take away the feeling of defeat.
We often go through great lengths to provide optimal care, yet the behind-the-scenes goes unnoticed. I’ve seen nurses skip lunch and dinner breaks to care for excessive needs of a patient. Physical therapists staying far too late so that a patient can get a safe disposition home to their families. I’ve listened in on attending physicians spending close to an hour on the phone with insurance companies, fighting for a prior authorization to waive the cost of an expensive medication. We should not expect to be doted upon for doing our job, but we are human and these extra efforts can wear us down. The good news is, the thankless moments are always canceled out by that one patient’s excellent outcome and delivering joy to their loved ones.
4. The guilt is real
There are few jobs that on a daily basis can impact the outcome of human LIFE. We often only think about bad outcomes in the operating room, when the stakes are high and the risks have been clearly discussed with the patient. In reality medical errors can happen in any setting and in the most subtle manner. Errors that cause morbidity or even worse, the death of a patient, can be as simple as delayed delivery of antibiotics or inappropriate administration of a medication. Even when a poor outcome or death is expected as a natural progression of a patient’s disease, we all rack our brains for what we did wrong. The ER tech will think, “was I too slow to deliver the EKG that clearly showed a massive STEMI?” and the nurse will consider his fumbling to get an IV line in fast enough to administer epinephrine, and the doctor will ponder, “Did I call the time of death too soon?” All the while, the primary care provider a few days will wonder if she might have missed anginal symptoms at the last yearly checkup.
Everything is hindsight, and with something so precious as life, these feelings will never go away. The best we can do is aim for immaculate care all while recognizing our limitations and often unpredictable course of disease.
5. A job in healthcare can really be unhealthy
Especially if you work in a hospital, you are literally surrounded by disease. All the time. While having an intact immune system typically protects us from most communicable diseases we encounter, we still run the risk of exposure. Needlestick injuries HAPPEN and will require post-exposure prophylactic medications if the patient is positive for Hepatitis C or HIV (I already know of 2 co-residents who have endured this, and the medications are NOT without side effects.)
This is minor compared to the chronic health deterioration in a job that requires long shifts and constant switching from nights to days. The erratic sleep patterns cause fatigue, suppressed immune systems, weight gain usually related to increased cortisol, and frequent feelings of irritability. Of course one could argue to just take a different job. The truth is that many times our choices are limited. Resident physicians obviously don’t have a choice if we wish to be board certified one day. New nurses often have to take what jobs are available which are typically nights or locum tenens positions.
I could go on forever about poor work-life balance and the pressure for success in healthcare. Given that physician wellness has grown into a niche of mine, I’ll be writing more later about our responsibility in creating healthy work environments for everyone so that we may work smarter, be happier, and enjoy our careers for even longer. [NOTE: extremely giddy about meeting with other resident leaders to make a nationwide change in physician wellbeing! :-) ]
But here are some of the BEST parts–
1. Collectively, we save lives!
What an incredible feeling to know that your work prolongs and improves the quality of someone’s life. From the very smallest part of our jobs (refilling prescriptions, routine screening of medical conditions) to the biggest (emergent life-saving operations) they all matter. We all collectively aim to practice evidence-based medicine/nursing/therapy in a way that helps our patients.
2. Medicine is always evolving- we are never done learning
This is one of my favorite parts of my job. I will always be challenged. My mind can never idle and get comfortable in my practice, and I’ll always have to be open to change as new evidence comes out. My favorite educators in medicine are those with years of experience able to compare previous standards of practice with the present. They have done so well in their practice because of their adaptability.
I love waking up to Physician’s First Watch e-mails with highlights of most relevant recent publications. It’s so fun to curbside a specialist and learn the intricacies of a specific field of medicine you don’t practice. Always challenged, never bored– what a blessing to have this in a profession :-)
3. Your co-workers are basically the most awesome and reliable humans
There is nothing quite like an exhausting, exhilarating day in the ICU where everyone is fluid in their work and it just goes right. Lives are saved, mishaps get fixed, patients feel better, and we all actually had time to eat lunch. We genuinely had FUN. We laugh, we chit-chat, we work HARD. Everyone there has a role which is irreplaceable, and the respect is equal and mutual across the board.
To go into healthcare requires empathy, openness, acceptance, effective communication. These are basically all the qualities you’d want in a great friend, and here they are, all around you. This field attracts some high-quality people and what a gift to have incredible co-workers.
4. This job can also be very thankful
To counteract #3 from the worst list, we get a lot of praise sometimes– and it feels good. In people outside of healthcare, they can’t possibly imagine doing our job. The thought of bodily fluids makes them dizzy and we get a lot of respect for our nonchalance towards the gory blood scenes. Families are often overwhelmed with gratitude when a patient walks in with a deadly condition (heart attack, stroke) and walks out alive and well thanks to medical and/or surgical interventions. In the office, patient relationships develop over decades of partnership in health. To make those connections, to feel appreciations, makes every exhausting day worth the effort.
5. Mostly, we can’t imagine doing anything else
Last year I asked a bunch of co-residents what job they’d have if they weren’t in medicine. The responses were hilarious, mostly because no one had honestly considered it. “Um I don’t know, a psychologist?” “Maybe I’d open a taco truck. But maybe I’ll still do that while also being a doctor.” Sometimes for a fleeting second I fantasize about quitting residency and becoming a yoga teacher but it passes quickly. Most jobs are hard, really really hard. It’s called work for a reason. Not everyone gets to have a career though, especially one that has the potential to improve health and quality of life. It truly is a calling, which makes up for all the “worst.” <3