Interviews and discussing the reality of practicing medicine

[halodos]

Hello SDN,

So my buddy and I just finished reading "Doctored: Disillusionment..." by Sandeep Jauhar and it made both of us extremely depressed, since we are in the premed/application and have this romantic view of medicine to help others. To confirm, I talked to a cardiologist I work with, and he echoes that his mentor specifically taught him how "to play the game" in terms of referrals and getting the most money from using the "right" code for each procedure.

I never really considered this aspect of practicing since I am much more interested in the procedural side (which still has it, but to a lesser extent), but is there a kosher way to talk about this reality of practicing medicine in an interview? Will there be questions like this asked? I know everyone says clinical experience is necessary to see whether you really want to enter this field, but should you say you know of this side of medicine? It is apparently an integral part, but I don't think it would be a great idea to bring this up in an interview since it seems to me a super jaded and cynical view. The way I would talk about would be using phrases like, "the reality of practicing medicine which I learned from residents and attendings I work with..." or "dealing with physician burnout from managing..." and ending with something about balancing that with the human interaction or moment.

Thoughts? Thanks!

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[Goro]

Ask a clinician

"If you had to do it all over, would you?"
"If anything's changed for the worse since you were in medical school, what was it?"

Hello SDN,

So my buddy and I just finished reading "Doctored: Disillusionment..." by Sandeep Jauhar and it made both of us extremely depressed, since we are in the premed/application and have this romantic view of medicine to help others. To confirm, I talked to a cardiologist I work with, and he echoes that his mentor specifically taught him how "to play the game" in terms of referrals and getting the most money from using the "right" code for each procedure.

I never really considered this aspect of practicing since I am much more interested in the procedural side (which still has it, but to a lesser extent), but is there a kosher way to talk about this reality of practicing medicine in an interview? Will there be questions like this asked? I know everyone says clinical experience is necessary to see whether you really want to enter this field, but should you say you know of this side of medicine? It is apparently an integral part, but I don't think it would be a great idea to bring this up in an interview since it seems to me a super jaded and cynical view. The way I would talk about would be using phrases like, "the reality of practicing medicine which I learned from residents and attendings I work with..." or "dealing with physician burnout from managing..." and ending with something about balancing that with the human interaction or moment.

Thoughts? Thanks!

 

[halodos]

Ask a clinician

"If you had to do it all over, would you?"
"If anything's changed for the worse since you were in medical school, what was it?"

Yes, I've done this and they all tell me it's worth it. I'm just wondering if there's a way to mention what I described above without appearing jaded or cynical, since interviews are about the ideal and not what actually happens a lot of the time.

 

[halodos]

I'm sure there are both cardiologists who try to work the system and cardiologists who try to do what's best for the patient.

From what I understood, he deeply cares about patients and does the right thing, but it's the hospital that has armies of people looking for the most expensive code to categorize each procedure. It's not as cut and dry as you think.

 

[NickNaylor]

Yes, I've done this and they all tell me it's worth it. I'm just wondering if there's a way to mention what I described above without appearing jaded or cynical, since interviews are about the ideal and not what actually happens a lot of the time.

I would avoid bringing this up for fear of coming across as preachy. Even as a fourth year student, I start to get irritated when applicants start to tell me about how they're going to save the world because they're going to REALLY care about their patients and not let The Man get in the way of their care. I an only imagine that attendings get even more irritated.

By the way, that's not to say that these ideals aren't good or valuable or otherwise shoudn't be followed throughout your training and your career. But without any sort of real "in the dirt" experienceto back up what you're saying, you are more likely to come across as hopelessly naive rather than interested in correcting a problem.

If you have significant experience working on the administrative side of clinics (eg, some applicants work as case managers at free clinics), then I think this is less of a risk as you have likely had some of the disillusionment happen already. If the only experience you're bringing to the table is shadowing, though, I would really avoid this topic if possible.

 

[halodos]

I would avoid bringing this up for fear of coming across as preachy. Even as a fourth year student, I start to get irritated when applicants start to tell me about how they're going to save the world because they're going to REALLY care about their patients and not let The Man get in the way of their care. I an only imagine that attendings get even more irritated.

By the way, that's not to say that these ideals aren't good or valuable or otherwise shoudn't be followed throughout your training and your career. But without any sort of real "in the dirt" experienceto back up what you're saying, you are more likely to come across as hopelessly naive rather than interested in correcting a problem.

If you have significant experience working on the administrative side of clinics (eg, some applicants work as case managers at free clinics), then I think this is less of a risk as you have likely had some of the disillusionment happen already. If the only experience you're bringing to the table is shadowing, though, I would really avoid this topic if possible.

Thanks for the response. To clarify, I was thinking of bringing it up to recognize that this contributed to physician burnout (mitigated by managing expectations and balancing work/life), and just wanted to make sure that this topic is acceptable to bring up in an interview. I wasn't even going to suggest a solution which is way above my pay grade. As for the ideal, I meant the ideal where all doctors do is care for people 100% of the time, treat sick kids, yadda yadda yadda... which is the view of medicine I assume interviewers expect applicants to have, and not a more in depth and nuanced view, but I could be wrong. Although I guess this could go under healthcare questions...

 

[tymont12]

I currently work as a medical assistant / clinic manager for a disabled physician and I do all of the coordination of care / insurance paperwork crap for patients and for his practice. The administrative side of medicine is definitely demoralizing but it has made me realize more than ever that I want to work with patients, not their insurance forms.

I'm applying this cycle and have also been hesitant to discuss my 'jaded insight' in regards to medical practice. Over all, I've just mentioned that I have experience with the business aspects of medicine and what it takes to coordinate care. Then again, I am not a medical student yet so we'll see how it goes!

 

[Goro]

Then ask "what do you think when you hear of doctors who get jaded or burnt out by Medicine today?"

Yes, I've done this and they all tell me it's worth it. I'm just wondering if there's a way to mention what I described above without appearing jaded or cynical, since interviews are about the ideal and not what actually happens a lot of the time.

 

[DermViser]

Hello SDN,

So my buddy and I just finished reading "Doctored: Disillusionment..." by Sandeep Jauhar and it made both of us extremely depressed, since we are in the premed/application and have this romantic view of medicine to help others.

All the more reason you should be doing ECs that give you a REALISTIC view of what medicine is actually like esp. in an academic setting in which you'll spend at least (4) + (3 to 7) years in that setting. Don't blame your medical school, just bc you didn't fully research and experience the realities of medical practice beforehand and chose to put more notches in your gunbelt (not you specifically, but you understand what I am saying, hopefully).

 

[halodos]

All the more reason you should be doing ECs that give you a REALISTIC view of what medicine is actually like esp. in an academic setting in which you'll spend at least (4) + (3 to 7) years in that setting. Don't blame your medical school, just bc you didn't fully research and experience the realities of medical practice beforehand and chose to put more notches in your gunbelt (not you specifically, but you understand what I am saying, hopefully).

Yeah, I completely understand, which is why I do the things I do and talk to people in the know. I just have this feeling that ADCOM's don't care about the realistic view and want to select students with the romantic view.

 

[DermViser]

From what I understood, he deeply cares about patients and does the right thing, but it's the hospital that has armies of people looking for the most expensive code to categorize each procedure. It's not as cut and dry as you think.

Not at all shocking when you're a hospital employee, which will be more and more the norm.

 

[DermViser]

Ask a clinician

"If you had to do it all over, would you?"
"If anything's changed for the worse since you were in medical school, what was it?"

This is very specialty dependent. Also depends on personality, as many doctors don't want to crush a premed.