We had an interview dinner for a young doctor recently at the home of one of my partners. We have nearly a hundred doctors in our group and we, frankly, need quite a few more. Board-certified emergency physicians are at a premium and, for the most part, they can throw a dart at the map of the U.S. and practice wherever it lands. After dinner, my wife and I were driving home.
“Seemed like a really nice guy; I really liked his wife, too. Where did he go to medical school?” she asked.
I thought about it for a second: “Beats me, somewhere out east.”
“What about his residency program?” she replied.
I glanced over at her. “Hell if I know.”
“What do you mean you don’t know, doesn’t it matter?” she asked, slightly confused. I thought about it a second and looked at her.
“No, it really doesn’t matter. He’s board certified, he completed an approved residency in emergency medicine. That’s all that matters to us. He likes the outdoors and football, but otherwise, I can’t tell you a damn thing about him. I don’t care if he plays piano, studied in France, served in the Peace Corps or raises alpacas and knits his own line of scarves from their wool. We need doctors to work in the ER. He seemed like a very nice guy, a good communicator who carries himself well, and his wife seems like a gem. As far as I’m concerned, he’s hired.”
It got me thinking, though.
Medical schools spend a ton of time trying to recruit just the right student, ask the right questions, try to separate the cream from the whey. What traits embody the perfect student to the interviewer? Who are they looking to accept to medical school? What do they think is important?
We have about 70 to 100 students rotate with us in our ER each year. They come from every walk of life, socioeconomic status, ethnicity, age, race, religion, sexual orientation, etc. Ask my partners to describe a great medical student and they will tell you.
The best are tough, self-motivated learners, driven, hard working, friendly to staff and usually endowed with a good sense of humor, strong self-confidence and the strength of character to laugh at themselves. Seems simple enough. How do we find these students, though, in the pre-medical student phase of their studies? As I will explain in a bit, this is where it counts the most.
There is a push to expose more pre-medical students to humanities, expanding their understanding of cultural diversity and introducing them to the arts, for example. Indiana University and Purdue University at Indianapolis is doing just that. I think this is great; the more we know about each other, the better. But interestingly enough, while there seems to be studies showing these students are more empathetic or better communicators, we know nothing about whether they are more likely to practice medicine long term. And, to be honest, that’s a hell of a lot more important to us and it should be to you, too. We need butts in the seats, doctors in our hospitals, and we need them there for years.
Meanwhile, medical school acceptance committees seem confident that they know just what kind of pre-medical student will make a good doctor. They want them worldly, well rounded, filled with lots of outside interests. But we in medicine as a whole are kind of clueless as to the characteristics that perhaps can identify the pre-medical student that will go on and practice full time medicine for 25 years after medical school. There is just not any data out there and it has real-time implications on the health of our country.
Sure, academia seems to understand what leads to burnout, but they seem at a loss to explain how some burned out physicians still show up and do their jobs. It is those doctors that help keep the medical machine moving. We’ll take an average doc who will be with us over 25 years way before the empathetic valedictorian who might be with us for five.We can help guide a motivated, hard-working doctor to become a better communicator, hone his or her empathetic gene, so to speak, even help prevent them from becoming burned out. But we can’t make someone driven. That has to be identified much earlier in the process.
Medical school is unique in that the maximum number of practicing physicians four years from today is set in stone by the applicant acceptance pool of medical students this year. Every time a physician retires or decides to practice part time, there is that many fewer doctors in America to provide care.
We are faced with a national physician shortage and, while we spend an extraordinary amount of energy trying to pick just that perfect student to enter medical school, perhaps we are asking the wrong questions.
“Tell me about yourself,” should be replaced with, “tell my about yourself in 2038.”
“Convince me you have what it takes to practice full time, 25 years from now.”
These are the questions we need to know. CAN you be a doctor is much more important than WHY you want to be a doctor. We need doctors — and nurses, for the matter — for the long haul if we are to provide healthcare to the masses.
By the way, if you go into emergency medicine, completed a residency and became board certified and are looking for a job, we’re hiring. We’ll even throw in a piano.
Dr Louis M. Profeta is an emergency physician practicing in Indianapolis. He is one of LinkedIn's Top Voices and the author of the critically acclaimed book, The Patient in Room Nine Says He's God. Dr Louis holds a medical degree from the Indiana University Bloomington.