1-800-IDEA-MAN: Requiring work experience before entering medical school

December 14, 2007 at 11:32 pm (1-800-IDEA-MAN)

Before entering graduate business school, applicants must spend a minimum of two years in the corporate world gaining experience and applying the knowledge earned from the undergraduate career. I’ve been thinking more and more recently that medical schools should take the same approach. For starters, we have too many immature people that enter medical school. For example, in my class, the vast majority of the students were accepted directly out of college and were only 22-years-old. Their lack of leadership and work experience showed from the very first day of classes. However, that ignorance and inexperience is now more apparent during the third year than ever before. Now I’ve come to the realization that medical schools should require several years of postbaccalaureate experience before even considering applicants. My take on it is that the whole dynamic of the medical profession would change simply by requiring work experience as an entry to the field.

In my case, I used to be an engineer before coming to medical school. I can use my engineering mindset as a problem solver to get around many issues that I come across on the wards. I can anticipate problems based on prior incidents and adapt to become more efficient in the future. One of my classmates was an investment banker. His knowledge of finance is astounding, and I would gladly trust him with the school’s budget so that he could deliver to us better health fairs and an outstanding graduation party.

Unfortunately, the vast majority of medical students have no touch with the outside world. For them the half study/half party life of college gets translated into the half study/half party life of medical school, which then leads to disastrous results. In addition to the disenchantment that so many medical students experience, there are a small minority that leave the field altogether before completing the four years. Many students feel as if they are being abused-and rightfully so. This dissatisfaction with the American medical schools is at an all-time high. However, requiring work experience would change several things:

Students would no longer accept inefficiencies. The current method of training involves long class hours, Physicianship Training sessions, and endless rounding on the wards, that only leads to scutwork and a secretary-like lifestyle. A new breed of medical students with real-world experience in hand would never tolerate this bullshit. They would demand that class be run more efficiently. They would realize that courses in ethics and professionalism are unnecessary because either students are ethical and professional before school starts, or they are not ethical and professional, and no amount of lecturing will ever change that. They would not accept scutwork as a method of “training.” They would demand that techs be hired to take the place of holding retractors, calling consults, and fetching old medical records.

This new breed of students would lead to a new breed of residents which in turn, would lead to a new breed of attendings. Those would be the type of attendings I would want working on me.



  1. The Happy Hospitalist said,

    My first week as a private practice hospitalist was like an awakening. After 5 years of clinical scut work as a med student and then internal medicine resident, I found myself getting pretty much everything I wanted. I’ll tell you what though, I sure learned an appreciation of all the crap that goes on behind the scenes.

    If I wanted a cardiac echo at 2 am on a hypotensive patient, I wrote the order and it happened.

    If I wanted a leg doppler on a sundary afternoon, I wrote the order and it happened.

    The private world is a different beast.

    I still give the professional courtesy of calling all my urgent consults myself and even most non urgent consults. In the groups of docs that “block” access”, by setting up elaborate phone barriers, I try and avoid them are simply have the clerk call.

    Otherwise, the skut is left to social workers with our guidance.

  2. JaneMarieMD said,

    There have always been immature students in medical school classes. I remember discovering to my astonishment that many students and classmates did NOT have altruistic motives driving their desires to become physicians–and this was 25 years ago. I had classmates who were in a 6-year program that started with undergrad and ended with medical school graduation; but some of these kids did become great doctors. However, when I sat on an admissions committee in the 1990’s I thought the most interesting medical school applicants were those who had done something OTHER than major in biology and go straight to med school from undergrad, and I believe a better major for being a physician would be English, since what we clinicians do day in and day out is communicate.

    I am not optimistic that a class with more older and experienced med students would be able to force changes in the training such as you describe. Believe it or not, I think the scut is a bit less then it used to be, and the hours might be better (because they used to be horrendous, so maybe now they are slightly less so!). I hope no one passes off scut and fetching medical records as being legitimate ‘training” but they are tasks that have to be done, in order to care for a patient. You are essentially trading servitude (at a high price–tuition) for a certain number of years, for the priviledge of joining a profession that you cannot enter otherwise. Personally, for me it was absolutely worth it, including the loans I needed 15 years to pay off.

    Your comment about ethics and professionalism is spot on–but did you know other professions require credits in these topics also? My husband is an attorney and I have always found it silly that he had to take a class in professional responsibility, as well as answer Bar exam questions on the same topic. For my Texas license I had to get an hour of CME in ethics every year, but I did manage to find interesting lectures to do this. It is doubtful that patients are any better off, however.

    Good luck with your training!

  3. Erik said,

    It’s not just the young medical students who are immature – plenty of older ones (with work experience) are also immature, whiny, and self-centered.

    There are plenty of academics who have never functioned in the real world. Medical school is not designed to each you about hwo function – it’s supposed to teach you how not to kill someone. Maturity is a bonus but not a requirement.

    How would we test for it anyway? I had many med schools professors (and residents and attendings and nurses and…) who were less mature than I was at the time. I’m sure my experiences were not that unique.

  4. Margauxzs said,

    omg.. good work, guy

  5. Apollo said,

    Very interesting idea (even though I’m in that straight-out-of-college group). I like the heart of it, but I have thus far found that immaturity is not necessarily a function of age (and the majority of the most public displays of immaturity in my class that I have witnessed are by students who are 3-5 years out of college). I suspect that it might be more useful for students to show some proof that they have taken the opportunity to work on teams (in whatever field or job) and have accomplished something with that work.

  6. Jane said,

    In my personal experience it is those who know what they want at an early age and strive towards that goal who are the most keen and mature. Just because someone has worked as an engineer or an investment banker and various other things and then gives medicine a go doesn’t mean that they are going to be the best doctors. Maybe they are not focussed enough at anything and can’t stick things out. As for myself I entered med school at the age of 17, just because I knew that was what I wanted and I worked my ass off to get there. I don’t think I am any less mature than other class mates who are older than me. Med school and then subsequent specialty training is long enough, please don’t campaign to make it even longer!

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