There’s a great irony that exists within medicine. We are taught to critically examine all scientific evidence; however, there are a series of beliefs we learn about the profession as a whole that we’re meant to accept without question.
Essentially, during our medical training, we are indoctrinated with a set of harmful beliefs about what it means to be a doctor. These beliefs harm not only us as individual physicians but the profession as a whole. In this article, I will break down four of the most toxic ways that we are indoctrinated during medical training.
“Medicine is a calling.”
While I was interviewing for both medical school and residency, these exact four words were said repeatedly. They were mentioned in opening speeches over continental breakfasts, used as a type of “rallying cry” to prepare us for the road ahead. Yes, you are going to work long hours and sacrifice your sleep, but “medicine is a calling,” and that’s just what is required.
The idea is nice enough. Medicine is not just a regular career. It takes someone special to become a physician, someone who is highly altruistic and dedicated to the well-being of others. While that sounds great in theory, there is a dark side to this idea of medicine being “a calling.”
By emphasizing the noble and selfless nature of medicine as a calling, hospitals can invoke a sense of guilt or obligation in physicians. This can easily turn into emotional manipulation that leads physicians to work longer hours, take on more responsibilities, and sacrifice their personal well-being. Work-life balance starts to feel impossible because boundaries are not encouraged. We take the job home with us because we are the job.
When our occupation is “a calling,” this also implies a lifelong commitment. Most physicians can’t even entertain the thought of leaving medicine without being overcome with guilt. We continue to feel constrained to the profession, even if we are severely burnt out or unfulfilled. This limits our exploration of other career paths or opportunities and ultimately keeps us stuck.
“You’re either in the hospital or you’re in the hospital.”
My chief resident said this exact sentence to me during my intern year of OBGYN residency. He was explaining that we weren’t supposed to take “sick days” as residents.
We were expected to show up for work unless we were so sick we were admitted to the hospital. You’ve got a cold and a mild temperature? Take some OTC meds and power through.
But this isn’t just about being discouraged from taking sick days (which is already problematic). The even more malicious subtext here is “your needs are less important than your job performance.” Or worse, “As a physician, you shouldn’t really have needs.”
Over and over again throughout our training, we are taught to suppress and be ashamed of our very real human needs.
Do you have the need to take medication for your mental health? Or maybe you need to get therapy to cope with the emotional toll of saving lives every day? You are going to have to hide that. Exposing the fact that you have “mental health issues” could mean you are unfit to be a doctor and could prevent you from being board-certified.
Do you have the need for 8 hours of sleep a night? That’s adorable, but no, as a physician, you should be above that. You are expected to be awake (and functional enough to make high-stakes, life-or-death decisions) for 24 hours straight.
Doctors are human, just like all of the patients that we treat. But we are taught that our human needs somehow make us lesser physicians. Signs of humanity are signs of weakness.
“It’s going to get better when ____.”
No one does the arrival fallacy quite like physicians. We are the kings and queens of telling ourselves that “things will get better” right after the next milestone.
When I was a 2nd-year med student, I was told, “It’ll be better after step 1 is over.”
In my 3rd year, I was told “just wait until 4th year, it’s so much better.”
In residency, we were repeatedly told, “It’ll be worth it when you’re attending.”
All along the way, we are told that it’s going to get better. We operate under this idea that if you pay your dues now, you will reap the rewards later.
While this may be true for some of us, it is oftentimes not the case. Each next step along the pathway to becoming a physician comes with its own set of challenges. There is never a time when the challenges go away entirely or even diminish significantly.
The classic wisdom that “it’ll be better when …” you get to your next step is usually no more than an empty promise. It teaches us to ignore the very real pain and discontent we are experiencing now under the guise of a better future just over the next milestone.
We keep waiting for things to get better instead of realizing this is what it’s like to be a physician. A more honest approach would be to say: this is hard, and being a physician is hard.
If you don’t think the rewards are worth the struggles at this point in your training, you may want to reconsider the profession.
If you can’t accept the hard now, this might not be the right path for you.
“It’s not about the money.”
How many times have we been told, “It’s not about the money”? It’s a cute sentiment. We went into medicine purely for altruism. We want to help people, and we don’t care about making money. We are shamed and discouraged from choosing specialties that are more fairly compensated instead of going into primary care. If “the money” is a reason for choosing a certain specialty, we absolutely should not disclose that.
Devaluing the importance of money allows us to be taken advantage of financially. When our mantra is “the money isn’t important,” we are less likely to advocate for fair compensation and benefits. We feel guilty asking for a higher salary or adequate pay for overtime because “it’s supposed to be about the patients,” not about the money.
We are more likely to agree to excessive amounts of unpaid labor. We skip our lunch breaks to participate on hospital committees, with absolutely no additional pay. Ultimately, we don’t value our own time and are overstretched and overworked.
Acknowledging the value of money and the importance of being adequately compensated for our time does not diminish the commitment and dedication physicians have to their patients. Receiving proper compensation does not inherently make something less altruistic. It doesn’t have to be “we care about money” or “we care about patients.” That is a false dichotomy. The truth is, we are in a much better position to take care of our patients when our financial needs are met and we are well compensated.
These are just four of the ways that we are indoctrinated during medical training. In challenging these toxic beliefs, we can work towards a more supportive, compassionate, and sustainable health care system—one that values both the well-being of its providers and the quality of care for its patients.
Chelsea Turgeon is a former OB/GYN resident and a physician coach.
