Before I went to medical school, my impression of the American healthcare system was neutral. I think a large part of that was my lack of experience with it. I grew up a relatively healthy individual and don’t really know anyone close who worked in the healthcare sector. But after my disastrous experiences (see Why I left medicine, Bipolar? Or just a healthy creative?), I came out with a very negative outlook regarding the US healthcare system that seems to be supported by objective evaluations. For instance, the Commonwealth Fund consistently ranks US healthcare last (by far) among high-income countries in overall performance–especially in regards to areas of access, equity, and health outcomes. This is unacceptable given that we are the country that spends the most on healthcare. Ours is a system that needs dramatic overhaul.
Now, keep in mind that I am just one individual who had a bad experience, but it seems like the pattern of being wronged by the American healthcare system is being echoed by a significant number of doctors in training, many of whom are too afraid to speak up perhaps because of the corporatization of the healthcare system and the fear of retaliation. What trainee has the resources to go after an entire enterprise? I did feel that when the negative experiences started to accrue, that other doctors in training began distancing themselves from me–both those in my medical school and the ones that I knew in college. It’s as if they wanted to cast a blind eye to the dark side of medical training. I’ve always wondered how I would have reacted if I were in their shoes? I think in a similar way? I don’t know. This is not everyone, of course. There were the off case individuals who I weren’t particularly close with in school who’ve stuck with me and have supported me on social media for over a decade after. I appreciate people like that. I really do.
Hear me out, I don’t think medical students are inherently “bad”. American medical students all go through a very strict filtering process to earn a spot in their class. However, it’s no secret that there’s a lot of money on the line if you’re an American MD, and I think money can change people. Money, as I’ve heard, brings out the true nature of an individual: the good, the bad, and the ugly. The fact that medicine is being centralized into these large corporate entities makes this field more akin to a business and I think shifts the emphasis to salary and efficiencies and perhaps less about the art of practice. I feel this is a shame, and I don’t pretend to have a solution.
Another concern I had with my experience is the high barrier of entry for those who are not familiar with the endogenous hidden curriculum. There was a recent New York Times article featuring the UC Davis School of Medicine (for its diversity) that said that the children of physicians are something like 22-23 times more likely to become doctors than their student peers. It was clear from my preclinical years in medical school that medical training is a rigorous process that requires strategy. It’s not enough to be intelligent, you had to know how to properly “play the game” because, the reality is, that the baseline curriculum and prescribed prerequisite premed courses alone were not enough for you to be successful. I didn’t know this and paid the price.
Overall-and this may stir up some controversy–I didn’t feel that the day-to-day work of the modern physician was commensurate with the level of status that this job has come to gain in the eyes of the American people. In China, for instance, being a physician is not a highly prestigious pursuit. It is regarded as a form of labor and medical school is reserved for people who didn’t perform top tier on the Gao Kao–the Chinese annual national exam. Chinese physicians make a modest salary compared to other professionals in the country. I think this is largely true in many other parts of the world as well. But in America, this job is glorified and paid handsomely, largely in part by the influence of the pharmaceutical industry and biotech corporations and maybe Hollywood. But that begs the question, just because you generously finance and put an overly positive spin on a job that inherently is still very labor intensive and perhaps not the most intellectual, does it make it more legitimate?
The Ivory Tower 
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