I am a hematologist-oncologist with more than 15 years of experience in a teaching hospital. I consistently ask the internal medicine residents I work with the same question: “What do you intend to do after completing your residency?” The answers I have received in recent years have become a source of concern. Increasingly, residents respond, “I do not know what I want to do, so I’ll just be a hospitalist.”
My issue is not with the decision to become a hospitalist, but with the use of the word “just.” There are numerous valid reasons for choosing to be a hospitalist. For instance, if someone believes they can enhance care coordination throughout the hospital system, facilitate transitions from inpatient to outpatient settings, or maybe they appreciate the structure of a one-week-on/one-week-off schedule. I would find all these responses commendable. However, stating that one will “just” do something due to indecision is troubling.
I often challenge my residents to consider whether “just” doing something is appropriate. Drawing inspiration from the pioneers of medicine, I emphasize that medicine should be both a passion and a calling, demanding complete dedication. However, I also question whether the substantial student loans, extensive hours in the hospital, sleepless nights on call, and emotional toll of residency justify a lackluster approach to their future. Rarely does anyone affirm this; such a question typically elicits a forlorn expression and a shake of the head.
This prompts me to ask: Where does the problem lie? Some posit that residents lack sufficient time to explore various specialties. How can one choose a future without adequate exposure? Yet, I am unconvinced that this is the main issue. Others argue that it is a generational phenomenon, with younger individuals facing broader decision-making challenges. It seems that each generation of physicians judges the subsequent one harshly (after all, I had it worse than any of these residents will ever know!). Nevertheless, I fear the problem may reside elsewhere. I worry that I am part of the problem. We may be emphasizing the advantages of specialist care and the necessity for them to follow in our footsteps to mitigate a shortage. Many fields of medicine are expected to face a major shortage of physicians moving forward. In the world of oncology, it is expected that demand will rise by 48%. However, supply of services would only grow by 14%. We have done a tremendous job of helping patients with terminal diseases such as cancer enjoy unprecedented improvements in survival. But the need to care for these patients presents challenges. Groups are trying to determine how we can mitigate the shortage by promoting teamwork, involving other specialties to help with survivorship or palliative care, and working toward medical home models of care (essentially a team-based approach to care delivered under a single roof). However, these methods and models still require our trainees and students to accept the added burden of extra years of medical training. They need to observe the benefits of the sacrifices we expect them to make. Yet, they observe me arriving at work already defeated. When asked how I am, I often respond, “I’m tired, beat up, the usual. I can complain but it won’t get me anywhere.”
As my burnout has intensified and my hairline receded, the atmosphere and energy in my work environment have shifted. This has not gone unnoticed. And this is not unique to my individual clinic. This has been a growing phenomenon throughout the practice. Perhaps this is where the problem truly lies. Maybe the residents perceive the “satisfaction” of mid-career physicians. Perhaps the enthusiasm and joy of medicine they initially felt at the start of medical school have been prematurely eroded before they even complete their training. Perhaps it is these residents, whom I urge to see medicine as their calling, who have observed me just trying to get through my day.
Training the future of the medicine should be the same passion and calling as choosing a career in medicine. As we teach our residents, we have a responsibility to help residents feel “just-ified” in their decisions.
What answers have you heard from new doctors about why they chose their specialty? Share in the comments.
Dr. Landau is the medical director of hematology telehealth for the Medical University of South Carolina. He has served many roles throughout his career at different organizations including Chief and interim Chair.
Image by z_wei / Getty
