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Katherine Sinclair is an MSc. candidate in the department of history at the University of Oxford

Dear Aspiring Medical Student,

Congratulations on your near-perfect GPA and your MCAT scores. Kudos, also, on your impressive (if slightly boring) list of extra-curriculars, and your volunteer work.

If I remember correctly, you'll be preparing your application this month. By the time of your interview (in February or March), you will have memorized 'Doing Right' (a guide to ethics for medical trainees). You'll have bought a suit (because you didn't already have one). Some polished shoes. You'll wake up early.

You will do everything right because you are a perfectionist and you have deduced all the 'correct' answers. You'll even have anticipated those questions which (they say) cannot be anticipated.

But if you're like me, the most difficult questions that you will face during the application process will have nothing to do with your skills or qualifications.

The difficult questions will have to do with your motivation. "Why do you want to be a physician?"

And if you are serious about getting in, you'll know that this is your cue to lie.

Because, we all know, the right answer is not the true answer.

"I want to be a physician because I want to help people" you say.

They nod, and stick a gold star on your application, but not before they ask the inevitable follow-up: "Why not be a nurse? Don't nurses do just as much to help patients as doctors?"

"Hmm," you falter, in mock surprise. "I guess I would rather be a physician because I want to be actively diagnosing patients, rather than simply administering treatments. I feel that my science background qualifies me to assume the broader work of managing a patient's case in addition to their bedside care."

This is the right answer – the one you've been trained to give – the one that conveniently omits all the other reasons that you want to join the Cult of Aesculapius.




These are the real reasons, though you'll never hear candidates admit them.

Physicians (even aspiring ones) will do anything to maintain an illusion of martyrdom.

"We are not in it for the money," they say. "We're not like the financiers or the Bay Street Lawyers."

Maybe they're not. But they aren't so different, either.

It would be ludicrous to claim that students don't go to medical school for the money. It's just that money is not the primary motivator. Fear is.

Medical students are not like other students. They are used to being the best, to being treated as if they are gifted (of course, many of them are gifted.)The thing with medical students is that most of them have never experienced failure. Not big failure, anyway. Maybe they got mono during their freshman year. Maybe they failed a test once, in the second grade. Still, they play it safe. Having achieved perfection in high school, their goal is simply not to mess it up. For this reason, they do not cope well with uncertainty. They want concrete rules that will make success a simple matter of obedience and effort.

Perhaps instinctively, medical students know that once they leave the artificial world of grades and prizes, there is nothing to separate them from their academically-less-gifted peers. Once they graduate, their 'merit' will no longer be judged according to familiar metrics. Their 4.0 averages will mean very little in the real world. In fact, students with poorer grades might actually outperform them. They might be better networkers, better coffee-getters, better elevator-pitchers. More importantly, they might have the real-world experience that medical students spend a lifetime in school avoiding.

Medical school is the easy answer. Once you are in, you are in, you can no longer fail. You can pack your stethoscope and check your baggage on a one-way trip to the upper-middle classes.

But medical school is only a deferral. Eventually, the real world catches up.

Toronto ER doctor Brian Goldman attributes burnout among medical residents (which he rates at 50 per cent) to systematic hostility in the hospital, where "it is possible to go years without hearing anyone say you're doing well."

Is this a symptom of hostility in the workplace? Or is this real life, finally catching up?

Most graduate interns (the coffee-getters, the phone-picker-uppers) would say that 'thanklessness' is part of the job description. Employers treat their interns just as badly as physicians treat their medical residents. The difference is that interns are prepared for hostility in the workplace whereas medical residents are not. And, unlike the average intern, they do not have the solace of 'doing what they love.' If they have entered the profession for the wrong reasons, the fault lines may not appear until they begin to work full-time in their late-twenties. By then, they will have invested four years and tens of thousands of dollars in their training. A change of mind is simply not an option.

So, dear aspiring medical student, before you pay that (rather hefty) application fee, ask yourself, "why am I doing this?" And be honest. Because the fact is, the leading cause of death among doctors under the age 35 is suicide. We could blame it on the hospitals, but we would be missing the wider truth. Your burnout starts here; when you apply for something you don't actually want and then kill yourself chasing it.

Caring for the sick is a noble goal, but it should not be the de facto destination for all straight-A students. This is the brain drain that no one is talking about. We are losing a lot of talent. Medical residents and their patients are paying the price.

I can say this because, like you, I chased the medical school dream. And when I got the acceptance, I almost convinced myself that I had to go.

Good luck with your interviews.

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