PRE-MED HANDBOOK

I. The Decision To Pursue A Career in Medicine

One of the most important decisions that you will ever make is the choice of a career. This choice will determine to a large extent the lifestyle, earnings, and prestige that you will enjoy and it will have many other influences that are too numerous to catalog in this brief discussion. A great many young people enter college expecting to become medical doctors but with little real knowledge of what is involved in the practice of medicine. They know that physicians have better than average incomes, that medicine is a highly respected profession, and that an opportunity exists for service to others. The role of a physician is unique among the professions. A physician will usually be present when people are born and when they die, plus during many times of crisis in between. But many students have little real understanding of the trade-offs that are made when choosing medicine as a career goal (and all career decisions involve trade-offs), particularly concerning the pressures and demands made by the profession on its practitioners.

You should be aware that the competition for admission to medical school is very intense. Only about one-third of those who now apply gain admission even though many of those rejected would likely be able to complete medical school and would make competent, dedicated physicians.

As a pre-med student, what can you expect during the next dozen years or so? During the four undergraduate years, there will be a great deal of competition from other very bright students and the courses required for admission to medical school will be quite rigorous. There may be an uncertainty and anxiety as you prepare to take the Medical College Admission Test (MCAT) and decide where to apply for admission to medical school.

While it is beyond the scope of this booklet to describe in detail the program plus the pressures and demands of a medical education, a few comments are provided to help you understand a bit more about the realities of medical school. In a conventional medical school, the MD degree requires four years of study. The first two years, called the preclinical years, are spent primarily in a classroom and laboratory settings studying the basic medical sciences. The first year concentrates on the healthy human body with classes in anatomy, biochemistry, physiology, etc. The second year emphasizes human disease with courses in pathology, infectious diseases, pharmacology, etc. At the end of the second year, medical students write Step 1 of the US Medical Licensing Exam (USMLE), a test taken by all medical students. Most medical schools require passing scores on this test before beginning the "clinical clerkships" in medicine, surgery, pediatrics, psychiatry, obstetrics/gynecology etc. during the third year. The fourth year is a continuation of clinical training. Most programs provide elective opportunities so that students may gain experience in an area they are considering as a specialty. The third and fourth years are spent working with patients in a clinical setting under the supervision of experienced physicians. Note: The USMLE replaced the National Boards. This three-step exam is currently the only route to be licensed to practice medicine in the US.

There is considerable stress on most medical students. The greatest stress is probably due to the workload. Most medical students agree that the amount of material required during the first two years of preclinical study goes up by a factor of two or more compared to their workload as undergraduates. During the clinical years pressure generated by constantly working with people who are sick and often dying is emotionally difficult for many students. Seeing death first-hand makes most students much more aware of their own mortality, sometimes leading to emotional pressures.

There is pressure and uncertainty as medical students compete for a spot in a good residency program, and there are the physical and psychological demands made by very long hours of hard work. These demands do not cease upon completion of residency training as those who are familiar with the long hours required for the successful practice of medicine can testify. Such stresses are often difficult for the spouse of a medical student. Many are unable or unwilling to accept the fact that the demands of the profession must often take precedence over the social needs of the family for a person in medicine. It takes an exceptional spouse to adjust to this fact and not make demands on his or her mate that will ultimately cause them problems professionally and personally.

The work itself is sometimes unpleasant and can be highly stressful (as anyone who has been involved with trauma cases will agree). Some of the things that must be done to patients who are often seriously ill or injured will be unpleasant. In some of the primary care areas (particularly pediatrics and family practice) the work may be routine, often unstimulating intellectually, and sometimes boring. Most of the situations encountered in medicine are not like those seen on television.

Financing a costly medical education is an additional stressor for many students. The national average debt for medical students graduating in 1996 was more than $75,000 and this figure goes up each year. Students graduating from South Carolina medical schools accrue approximately $64,000 in debt.

It is true that a physician will have the expectation of a better than average income after completion of the many years of training and the economic hardships that often result from these long years. However, if the primary motivation for entering the medical profession is to make a great deal of money, certain areas of business such as some fast-growing retail business or service should be considered instead. If the same amount of time and talent is invested in your own business as is required for a successful medical practice, the economic returns will probably be greater in business than in medicine over the long run, particularly if the years of lost earnings during the long years of training are considered.

These comments should not be interpreted as a recommendation not to aspire to a career in medicine. It is an honorable profession that will continue to reward those who have the talent and dedication to practice it competently and compassionately.

If you have doubts about whether or not you should continue in pre-medicine, you should keep your options open. Medicine is not for everyone and there are few successful physicians who have not at times questioned whether or not the rewards are worth the long years of training and the hard work required. Nevertheless, most physicians cannot imagine themselves in any other profession and they would make the same choice again. The decision whether or not to stay in pre-medicine can probably be deferred through the first two years of college without loss of credit when changing to another major, for the suggested program during the first two years consists primarily of courses that can be applied to many degree programs. Indecision about a career is usually corrected with time, if a real effort is made to learn more about the career. The people who most often feel trapped by circumstances are those who have lost their ability to make logical choices because they made a premature commitment that is not easily reversed. A major objective of the pre-medical advising program is to prevent this from happening to you.

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