First reported in January 2020, COVID-19 is a viral respiratory illness that is commonly spread from person to person and can present with symptoms such as fever, cough, and shortness of breath. You can find more facts about Coronavirus on this fact sheet. Since its detection, COVID-19 has been forcefully making its way through the world and now the United States, wreaking havoc on individuals, families, and healthcare workers and systems. The Centers for Disease Control and Prevention (CDC) reports that as of April 6th, 2020, the United States has experienced 330,891 total cases and 8,910 deaths as a result of COVID-19.
There is no doubt that this pandemic has disrupted life as we know it. There is one population that I want to specifically address: our nation’s current medical students. While students in other fields have transitioned to online learning with ease, medical education – much of which is clinical, hands-on training – has been upended. Medical schools have been forced to explore alternative ways of teaching and training the next generation of physicians without compromising the quality of the education.
This may not affect many 1st and 2nd year students, who are typically in both the classroom and online learning settings under normal circumstances. However, 3rd and 4th year medical students were rotating through hospitals, seeing patients, and participating in hands-on learning and training prior to the pandemic. COVID-19 has dramatically affected what they can do and how they are able to learn, being that they have been pulled away from their clinical obligations for their safety.
In addition to the disruption in learning, some schools have called upon current medical students to participate in voluntary clinical duties. While this may seem harmless since opting in is “voluntary,” I believe that this is a very dangerous line to traverse that can muddy the waters even further. Albert Einstein College of Medicine in New York, for example, states that it plans to either “provide elective credit or note your efforts in your Medical Student Performance Evaluations” for students who participate in COVID-19 initiatives. Elective credit and student evaluations are both of key importance for graduation and residency applications. Not only does this approach put the health of medical students, who will be eventually resuming their medical education in the near future, at risk, it can also create a sense of obligation and competition if it is known that there are advantages to opting in. Medical students are an ambitious people. We are inherently driven, motivated to succeed, and as a result of our path, bred to be mindful of our curriculum vitae (CV) – the equivalent of a resume. In my opinion, it is disappointing and coercive for an institution to provide incentives and academic advantages to medical students in order to pressure them into assisting during this pandemic. If truly voluntary, let those individuals who want to help do so without any academic or professional incentives potentially driving or confounding the motivation.
In my opinion, the best thing a medical student can do during this time is to focus on their studies and learning so that they can become the skilled doctor that they hope to one day be, who can properly assist during times like these. We must acknowledge that medical students are in the process of learning medicine. They are not doctors nor are they yet trained to provide life-saving medical care. At best, medical students can provide assistance with paperwork, medical charting, and basic needs during this time, which can also be done by non-medical professionals. It may be in the nature of a medical student to volunteer for every opportunity that they can (especially a public health/medical crisis such as this one), be ready to step up on the frontlines, and to seek out any advantages that may advance future goals. However, this is one time that I implore that medical students consider themselves first. Students should not feel obliged to put themselves or anyone that they interact with at risk by volunteering to be on the frontlines of this cause. It would be unwise to risk the lives of the next generation of physicians in order to temporarily have a few extra, untrained hands on site. We are the next generation of healthcare providers, and we need these medical students to make it to graduation, to residency, to the frontlines of healthcare that will exist long after COVID-19. To my fellow medical students and peers: take care of yourself during this time, focus on your academics, and learn all that you can now to better equip you for the future.
My medical school, Rutgers New Jersey Medical School, is one medical school among many in the nation that have announced that they will allow students in their final year, who are expected to graduate in May, to graduate early and be eligible to begin their residencies. This will allow for a new wave of healthcare providers to join the frontlines and provide critical healthcare during the COVID-19 pandemic. This is of vital importance in New York and New Jersey, two states that have been hit the hardest by COVID-19 and that are in desperate need of more healthcare providers.
But what does this mean for those students? It may seem like a no brainer to you and me that these students would drop what it is that they are currently doing – vacation time, relocating, finishing academic requirements – to assist during these times, but this decision is one that many are not making lightly. These students have just completed four (or more) years of a grueling medical education, and their final year is usually filled with significant vacation and flexible time to regroup, relax, get all of their requirements in check for graduation, and plan out the necessary life changes that need to be made to begin residency. Not to mention the few months between graduation (typically in May) and starting their residency program in June/July is an extended period of time off – uninterrupted vacation time – that they may not have again for many years.
In addition, there is a significant difference between caring for the sick and stepping up earlier than intended, putting yourself in harms way. We show great respect and appreciation to the healthcare providers who are working tirelessly to flatten the curve, but by the same token, we should not judge those who are not willing to voluntarily put themselves and their families at risk, especially when there are many places that do not even have the basic personal protective equipment (PPE). Even with all of this said, if an individual is capable, willing, and particularly moved to take the call for action to graduate early and join the frontlines of this crisis, I wholeheartedly support their decision and hope that they are safe and well during this time.
An unfortunate reality is that medicine and medical training is founded on exploitation. It is the elephant in the room that everyone sees and knows exists, but not many will address. It begins in medical school, when students put themselves into hundreds of thousands of dollars in debt, working full time and sometimes more in hospitals with no pay – for the sake of learning. It continues into residency, as residents are overworked and underpaid. Most residents work 50-70+ hours per week, and the average resident salary is $61,200. While this practice is egregious and unjust, especially in a profession that is vital to the health and well being of this nation, it is one of those things in life that are just “the way things are.” It is a known evil but one that all medical doctors go through and are told they will get through.
According to the annual Medscape National Physician Burnout, Depression, and Suicide Report, among physicians, 44% reported feeling burned out, 11% were colloquially (non-clinically) depressed, and 4% were clinically depressed. Contributing factors to the feeling of burnout included: too many bureaucratic tasks, spending too many hours at work, lack of respect from employers/administrators, colleagues, or staff, insufficient compensation, and lack of control and autonomy. As to be expected, the percentage of physicians who are burned out rises with the number of hours they work each week. While many physicians combat burnout with the use of positive coping skills such as exercise and communication with loved ones, many others fall into maladaptive coping mechanisms such as isolation, drinking alcohol, and drug use.
In the United States, the equivalent of one doctor per day commits suicide – the highest suicide rate of any profession. Risk of suicide during residency is highest earlier in residency. Because of the unrelenting nature of burnout, exhaustion, and discontent, many doctors have learned to normalize their misery, rationalize it, and work through it. While healthcare organizations and academic centers have become more proactive and implemented strategies to combat physician burnout and stress, it is still an issue that is plaguing our healthcare systems.
Unfortunately, COVID-19 and the current state of healthcare has exacerbated the already existing structure of exploitation in medicine. Doctors are putting their lives on the line and being overworked without hazard pay, final-year medical students are being called on to graduate early to serve on the frontlines, and current medical students are being incentivized to step into the war zone to “volunteer.” Never has it been more evident that healthcare is riddled with exploitation and unfair practices. Serving others and helping to improve and save lives is engrained in the personal mission of all individuals who pursue careers in healthcare, and this is taken advantage of by the very system for which these professionals work.
COVID-19 is bringing about new norms, forcing the nation to adapt and be flexible during this time in order to keep everything operational. I hope that this crisis opens the eyes of the powers that be – making it very clear that our healthcare system is in desperate need of change and restructuring at all levels.
We are living in unprecedented times. Through this experience, our eyes are being opened to many things, including our nation’s preparedness (or lack thereof) in response to a global pandemic, the functionality of our healthcare systems, the sacrifices willing to be made by many to assist and serve others, and just how important facts, proper reporting, and education are in informing the public. I hope that you and your family are healthy and well during these times. Please be safe, follow the guidelines of our health professionals, and take care of yourself. We will get through this!