A LETTER TO ANYONE CONSIDERING A CAREER IN MEDICINE
By Ria Mulherkar, MD
I decided I wanted to be a physician when I was 18 years old. I had good grades, I liked the sciences, I came from an Indian family, and so naturally it was the logical next step. I was a little more aggressive than usual in my pursuit of medicine. Rather than entering a four-year college as a premed, and then applying to medical schools, I applied to a few combined medical programs (known as BS/MD programs) and ended up committing to the only such program where I was accepted – Drexel University and their College of Medicine. At age 18, I moved to Philadelphia for college, and I have never looked back.
Flash forward eight years. I write this in 2021 as I am finishing up my intern year and preparing for four more years of residency in Radiation Oncology. I cannot say I have any regrets. My journey has been exciting, challenging, and rewarding. Everyone is different, but I appreciate that my path ahead has always been clearly laid out. Though I did not know at 18 which specialty I would pursue, let alone where in the world I would be, I always knew the next steps—college, medical school, applications and interviews, then residency. The BS/MD program was wonderful for me, as it took immense pressure off the medical school application process, and allowed me truly relax and enjoy my undergraduate years. Though there were only three of them (the Drexel BS/MD program used to be only seven years long, three years of undergrad plus four years of medical school), and I still had to maintain a certain GPA and score well on the MCAT, my undergrad years felt fun and carefree.
The part that came after was a little bit different. I always knew medicine was hard work, but there were a lot of surprises that I did not expect. Let’s be real. I had almost no idea what medical school would entail when I committed to a BS/MD program. And I came from a family of numerous physicians, including my own mother.
As I continue to navigate through the world of medicine, I am constantly shocked by how freaking hard it is. Medical school sometimes felt like swimming blindly in the middle of an ocean, and residency is the same, but throw in an occasional hurricane. Perhaps I was unprepared. Perhaps my 18-year-old self should have done a little more research besides diligently viewing ten seasons of Grey’s Anatomy. Throughout my journey, the only thing more shocking than the hardship was how surprised I was at every turn.
It shouldn’t be that way. It shouldn’t be so hard for a field as crucial and pervasive as medicine to be candid about the journey to becoming a physician. I am by no means an expert on career counseling. However, I think I have some insight to offer anyone in high school, undergrad, or beyond who is considering a career in medicine. If you think you want to be a doctor, there are a few things I think you should definitely know. And I am here to share them with you.
#1: The Grind
If you didn’t get the gist of what I was saying earlier, medical school is HARD. And for most students who take the traditional route and apply to medical from college, the travail begins prior to starting. You have to study diligently in college, get good grades, maintain a high GPA. You also have to study for the MCAT, a seven-hour exam which tests on all the sciences, verbal reasoning, psychology, and sociology. You need to volunteer in hospitals and do service work outside of hospitals. You need to show leadership skills by heading clubs, and research interest by working in labs and starting on projects. And on top of all this, you need to stay well-rounded and maintain your hobbies.
Then you get into medical school. And then the real grind starts. My medical school curriculum was split into two didactic years followed by two clinical years. During the didactic years, we studied a lot of the same classes as in undergrad, but in light speed. My very first hour of medical school was a lecture that felt like three weeks of undergrad Biochemistry packed into sixty minutes of fear. We also studied some of the classic courses that make you feel like a true medical student—Gross Anatomy, Microbiology, Pathology, Pharmacology. For one year, I could not get the smell of formalin out of my head.
I honestly didn’t think I had it in me to study that much. Then in medical school, I found myself spending anywhere from 10 to 14 hours a day just studying. There were days that I left campus past 11:00 pm because I had stayed late at school to study. I think I took a total of fifty-four exams in my first year of medical school alone. Then I stopped counting. At the end of my didactic years, I took the first USMLE board exam, called Step 1. There are three USMLE board exams you have to take by the end of your internship. Step 1 and 2 are typically taken during medical school. Step 3 is usually taken during internship.
After Step 1, I finally felt like I knew something. I could diagnose somebody with asthma, or hypertension, or a heart attack, or depression. I knew all these facts, and I was exploding with knowledge. Halfway done with medical school!
And then it was time for clinical rotations. In medical school, we spend our third year rotating through the core specialties—usually Internal Medicine, Surgery, Obstetrics/Gynecology, Family Medicine, Pediatrics, and Psychiatry. I started off on Internal Medicine, and let’s just say it was a slap on the brain. All of my knowledge was important, but useless in practice. I spent third year trying to understand how to apply everything I had learned so far to actual clinical practice and taking care of patients. I had learned how to interview patients and perform a physical exam in the first two years, but third year was when I really practiced these skills and developed my style as a future physician. I would spend all day, up to twelve hours a day, rotating in the hospital and learning from experience. We were graded on our performance in clinical rotations. We had to be on top of our game. Then I would come home and spend one to two hours a night studying and preparing for shelf exams for every core rotation. At the end of third year, I took Step 2.
Somewhere in there, I made time for research, extracurricular activities, leadership, volunteer work, and hobbies. And just like that, it was fourth year.
Fourth year is the most rewarding year of medical school, but of course overwhelming in its own rights. By this time, most students have chosen their specialty. We spend the first part of the year rotating as sub-interns. Sub-internships are nearly the same as third year rotations, but fourth-years are expected to perform at the same level as interns, or first-year residents. These rotations are challenging, because you have to perform well. You are graded on your performance, and your evaluators are the ones you will ask for letters of recommendation for your residency application. You want to be eager, but not too eager. You want to be smart, but not over-smart.
And then you apply for residency. Applications cost money. You interview at programs that are interested in you. And then you go through the most peculiar process to obtain your first job as a physician—The National Resident Matching Program. Applicants rank all of their programs in their order of preference. And residency programs rank the applicants they interviewed in their order of preference. From there, a predetermined algorithm sorts through the rankings and matches applicants with their future residency programs. Some applicants end up at their number one choice, but most do not. Some applicants do not match at all. It’s a strange sort of process, but once the match is complete, residents are committed to those programs. From there, it’s three to seven years of residency training depending on your specialty, and even longer depending on whether you choose to pursue a fellowship. (Full disclosure—fellowship follows the exact same match process.)
It’s a strange concept in medicine. We grind for four years, paying hundreds of thousands of dollars for this education, and at the end of it all we will go wherever we are accepted, for whatever pay, with the agreement to work however hard they want us to. I never read my contract when I started internship. What difference did it make? It was a non-negotiable document, and of course I was going to sign.
When I started medical school, I could barely conceive the idea of studying for six hours in a row, let alone working a 28-hour overnight shift. But, to quote my favorite workout instructor—it doesn’t get easier; you get stronger.
The grind is hard. But it’s doable. What makes it worth it?
#2: The Glamour
To everyone who is wondering, how much spontaneous sex will I be having in the hospital on-call rooms? What you should be asking yourself is, will I be having sex at all? Everyone thinks being a physician is an expensive bottle of chardonnay. I’d take that down a notch, perhaps several. Try maybe an expired box of rosé.
There is nothing sexy about this job. You will learn details about your patients that you do not even know about your significant other. You will know (because you will ask) if they’ve passed gas since their surgery, the color of their last bowel movement, whether their urine is frothy or bloody, whether or not their vomit contained any bile. You will obsess over their blood pressure, their urine output, their potassium level. It is exhausting, and at times it is thankless.
But man, does it feel good to wear that white coat for the first time. The long white coat is like a superhero cape. It comes with a lot of pride, but also a lot of responsibility. “Thank you, Doctor.” “What do you think, Doctor?” It took me months to get used to calling myself “Doctor”.
I will say, it’s not all urine and vomit. One of the greatest rewards of becoming a physician is that this career opens so many doors for a fulfilling lifestyle of your choice. Medical school and residency are tough, but they craft you into so much more than a physician. Depending on how you carve your path through training, you can emerge as a humanist, a scientist, a researcher, an educator, a writer, an entrepreneur, a leader. There are so many specialties within medicine with a range of lifestyles and training expectations. And within each specialty, there is tremendous opportunity to specialize, generalize, and incorporate other fields including business, education, and public health. The true glamour of medicine is in its immense possibilities and potential to reward.
The highs are everything, because the lows can be soul-sucking.
#3: The Grief
I don’t think I can explain this part of the job. The grief is something you have to live through to understand. People get sick. Some will get better. Some will die. And some will live, even if they are not better.
A physician’s number one priority is his or her patient. But in a sense, we also care for the patient’s family and loved ones. The caring is in the daily updates we provide. The caring is in how break the news that their loved one will not recover, or that their loved one has died.
We have to deliver upsetting news on a frequent basis, and we have to navigate the feelings of patients and their loved ones while facing the emotional consequences of that news ourselves.
These are the things they don’t teach you medical school. They don’t teach you how to tell a hopeful cancer patient that she is dying with no further treatment options. They don’t teach you how to call a man’s son when he has died and is actively being coded. They don’t teach you how to look a fourteen-year-old girl in the eye and tell her that her father has no chance of surviving his illness. And they certainly don’t teach you how to drive home from work every day with the weight of this burden resting on your soul.
These are the things you learn by experience. These are the stories you keep with you because forgetting is not an option.
#4: The Good
Before I committed to medical school, I truly always imagined myself as an attorney. This notion had everything to do with the fact that my favorite movie is Legally Blonde, and it was loosely supported by my love of public speaking and my experiences in mock trial.
Then I learned that in my entire family, there had only ever been one attorney, a relative of my mom’s. In his first trial, he defended a man against a crime and won. He went into the trial thinking his client was innocent, and only after winning did he come to learn that the client was guilty after all. He never went to court again.
No matter how hard or how sad my job is, I am always morally at piece knowing that I am doing something good. When we take the Hippocratic Oath at the start of medical school, we make a promise to do no harm. It does not matter who the patient is or what he or she has done. A patient is a person, and it is our job to help him or her however we can.
Sometimes, help means urgently getting them to the operating room when their internal organs have ruptured. Sometimes, help means convincing them to take a medication they have been avoiding. Sometimes, help means taking away the aggressive interventions and allowing them to die peacefully. Sometimes, help just means squeezing their hand and telling them you care. Whatever it is, it is good.
I did not write this piece to convince you to become a physician. Nor did I write it to dissuade you from doing so. I wrote this piece to honestly share my experiences in medicine with the hopes that it will help you solidify your decision, whatever that may be.
I’m not sure how my 18-year-old self would have responded to the hard truths I’ve laid out in here. All I can say is, boy am I glad she thought she wanted to be a doctor.