A Letter To Premedical Students: Stay The Course

This article originally appeared in Forbes.

The holidays are now long over and college students everywhere are beginning to return to campus after spending several weeks away at home.

Many of you were subjected to an earful of career advice—both solicited and unsolicited.

If you are an aspiring physician, there is a strong likelihood that you heard an increasingly familiar call from well-meaning relatives and friends: Don’t do it.

They tell you some version of the following:

Medicine isn’t what it’s used to be. The training is too long and intense. The work is no longer satisfying. The pay isn’t good for the amount of work and the debt you must incur. There is too much regulation, too much paperwork, and too much frustration. If I had to do it all over again…I wouldn’t…and neither should you.

To which I would advise you to do the following: listen carefully, absorb and internalize every source of frustration and begin thinking about how you can be a part of the solution to every problem that you hear. Don’t be deterred.

To be sure, the healthcare industry is in a period of transition.

The work of being a physician is changing. Unwieldy information systems are increasingly infiltrating and disrupting clinical settings—while creating new stores of data that can be used to improve health.

Patients suffer from broadly recognized problems in access to care, medical errors and disparities—and physicians have only recently begun to be empowered to solve these problems.

Healthcare payers and insurers are working anew to find ways to reward and reimburse high-value care—while physicians are problem-solving ways to deliver it.

The simple image of the physician-patient relationship that draws many of us to medicine—the dedicated physician, the thankful patient—is no longer.

It has been replaced instead by one in which the patient is at the center—and the physician is part of a broader team managing the health not just of one patient at a time, but of whole populations.

For those who practiced medicine in simpler times, the transformation underway may seem altogether untenable—and, as they advise, not worth the trouble.

But, in fact, there has never been a greater need for extraordinary talent—you—to enter medical school.

Medical schools have historically selected students who could demonstrate mastery of organic chemistry, scientific curiosity through basic and clinical research and compassion for humankind through volunteer work.

The highest aim for a physician career was that of a physician-scientist, someone who could translate scientific discoveries into treatments for previously incurable diseases.

While the need will always be great for brilliant and capable physician-scientists, also necessary today are physicians who have a passion for patient care and can simultaneously serve as engineers of a new healthcare system.

Our healthcare system desperately needs physicians who are skilled not only at clinical science, but also at delivery science—how to build and sustain systems that reliably produce clinical outcomes 100% of the time.

These systems will be richly enabled by technology, fueled by clinical insight and driven by entrepreneurial spirit. As fresh eyes on many problems, you will be uniquely able to enact the needed change.

In short, every problem in American healthcare represents an opportunity—and today’s medical students can be tomorrow’s change leaders.

Medical schools all over the country have finally begun to recognize this shift—and have begun to build new programs, departments, centers and curricula to sustain it.

Indeed, attending medical school in 2016 won’t be like it used to be—and you should be excited by this.

Medical schools nationwide are increasingly playing hosts to hackathons and accelerators that provide infrastructure, support and education to students and faculty who aspire to change healthcare delivery—and solve its biggest problems.

At Harvard Medical School, Dean Jeffrey Flier last year announced a new department of biomedical informatics led by Isaac Kohane to better integrate data science into the research and teaching of the medical school; this announcement dovetailed with the appointment of Google Ventures guru Krishna Yeshwant as a special advisor to promote entrepreneurship at the school and the creation of a Center for Primary Care led by Russell Phillips and Andrew Ellner to promote reform of primary care.

At the Vanderbilt University School of Medicine, a new department, chaired by health reform leader Melinda Buntin, focuses on healthcare policy and systems, following a growing national trend of greater integration of healthcare policy into medical schools and curricula.

The number of medical schools offering MD/MBA programs has grown from 5 in 1993 to 65 in 2014; and residencies, too, are now incorporating management and leadership training.

Some universities are scrapping the old book on medical education altogether and writing new ones. Clay Johnson leads the University of Texas Dell Medical School that is focused on transforming the way people get and stay healthy. Kaiser Permanente is launching a new medical school headed by Christine Cassel that will focus on learning how to deliver highly integrated care enabled by technology.

Many of you will undoubtedly wonder whether it is necessary to complete four years of medical school (in addition to four years of undergraduate training) and at least three years of residency to lead change in the delivery of healthcare.

To which I will respond with an unabashedly biased perspective (shaped by personal experience and journey):

There is nothing more valuable than the experience of delivering clinical care to inform your compassion for patients who receive care and the people who deliver care.

So, yes, all that training is worth it. And, for many of you with a true calling, remember, you don’t really have a choice.

Don’t let anyone deter you.

The med school naysayers are right. It is a different job. It is a different profession. It is changing. If you are looking for a stable job in a stable industry, there are probably better places to look than medical school. All the problems they have told you about (and even the ones that they haven’t) are, in fact, real.

But if you want a career that is challenging and stimulating, and in which the only certainty will be massive change (that you can help shape), please don’t be deterred.

Your healthcare system needs you.

The author of this article, Sachin H. Jain, recently delivered the keynote address at the last Primary Care InciteHealth Pitch Night. View his address!

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