Burning Out Doctors Before They Reach Medical School

What extracurricular activities will make the medical schools happy?

Photo by Ousa Chea/Unsplash/Used with permission.

When I asked a fourth-year medical student, F.B., what she, as a physician, would owe society, she responded: “Listen, I worked my butt off to get straight A’s, did thousands of hours of extracurriculars, and worked three 'gap years' in a mitochondrial DNA lab to get here. I won’t owe anyone anything.” Her classmates agreed. I found this concerning.

Physician Shortages Loom

A.I., virtual care, and disruptive corporate invasion of the industry aside, severe physician supply shortfalls are projected for the 2030’s. One would hope, therefore, that the next generation of doctors are prepared to gird their loins and wade into the fray with great zeal and energy. Instead, I fear that we’re careening toward a provider meltdown.

Burnout rates among physicians are routinely estimated to be in the 40 to 60 percent range. This is bad enough, but it seems now that we’ve created a dynamic where we are physically, mentally, and emotionally exhausting our future physicians before they ever set foot in their respective medical schools.

New Medical School Selection Criteria

Yes, the selection process has always been hyper-competitive. What has changed is a near-ubiquitous inclusion of additional admission criteria beyond superior grades and MCAT scores. These criteria require applicants to “meaningfully” participate in several specific categories of extra-curricular activities. These categories include (but aren’t limited to): work experience in “healthcare settings,” participation in “community service” activities, involvement in graduate-level research, and the assumption of “leadership” roles in clubs/teams/jobs.

Okay, not so bad, you say. Extracurricular activities like these kind of make sense for a future physician. But here’s the rub: the medical schools don’t spell out which specific activities satisfactorily fit into each category. Nor do they divulge how many hours of each activity is considered sufficient, or whether the applicant must demonstrate superlative “commitment” to an activity from each and every category. The result is a melee of confusion, misconstrued messaging, wild assumptions, frenzied exchanges of “information,” and a plethora of abject misinformation: e.g., “I was told that medical schools prefer you to work as an EMT rather than as a nurse’s aide.”

An Extracurricular Bidding War

Not unexpectantly, an extracurricular activity bidding war has ensued. If 1,000 hours of bench research is good, 3,000 must be better (these numbers are not fanciful, by the way). If helping with vaccination drives in a rural clinic is good, doing so in a war-torn developing nation must be better. The pressure to secure and “max-out” “meaningful” experiences in each category is so great, that as many as 60 percent of applicants take one to three years off from their studies to do so (in what are commonly known as “gap years”).

As noted, a critical driver of all this is that the medical schools are loathe to share their actual selection criteria (which varies significantly from school to school). And goodness knows, they have a challenging job. Students typically apply to 20 or more schools (sometimes, many more). Each school must therefore wade through many thousands of applications for their one to two hundred openings. They necessarily depend on cut-off “filters” to cull the herd to a manageable load. It is therefore to their benefit to keep the specifics of said filters under wraps. The net effect, though, is that an applicant can’t look up online and say, “Aha, to get into this medical school I must have a GPA of at least 3.8, an MCAT score of at least 512, at least 750 'patient contact hours,' and at least 750 hours of biomedical research in a 'wet lab.'”

And so, our future doctors are left stumbling around in the dark—seeking to maximize their grades whilst filling every waking moment with oft-contrived extracurricular activities that hopefully fulfill med school admissions criteria, the specifics of which they are totally ignorant. Virtually every pre-med and medical student I’ve taught has told me that the process is de-humanizing and exhausting and that they have suffered through extended periods of burnout, if not PTSD. This is all before they face residencies and then the real grind of practicing medicine in an era of physician shortages and understaffed hospitals.

One has to ask: does this process help select superior future physicians? And does it contribute to their growth as human beings and doctors? What is the support? What is the data? And what message are we giving these students—that medicine is necessarily a no-holds-barred grudge match? That it is survival of the most obsessed? Could we be stifling their social development at a critical time in their entry into adulthood? Do we risk breeding within them an overdeveloped egocentrism, after all the self-denial and indentured servitude?

Burnout Essential Reads

What Interventions Are Effective for Psychologist Burnout?

The Truth About Burnout

Is There a Better Way?

Considering this, can we not somehow make the process less confusing, less degrading, less controlling, less narcissism-generating, less cruel? Certainly, we could advocate for complete transparency in the measurements employed by each school in making its selections. And, what if schools set defined commitment expectations on a series of mandatory extracurricular activities, and declared that further hours spent in said activities conferred no selection benefit—then observed what students actually did with their free time? Or, could a limit be set on the number of schools students could apply to—so the schools had the time and resources to truly delve into each student’s application? Or, how about setting a reasonable bar on entry criteria and then randomizing acceptance amongst those who clear it? This isn’t as evil a concept as it may sound, as selection currently is an act of splitting hairs between nearly identically qualified candidates.

Other ideas are out there. But it feels like we can’t continue on the current course of escalation if we want our future doctors to be healthy and resilient (and to give a darn about us). If you had control over the process, what would you do?