The journey to medical school is long, tough, defeating, and can be isolating. There are plenty of news stories of physicians out there about job dissatisfaction, suicide rates, and suicides of medical students. Inevitably, there comes a lot of doubt when you’re on this journey and you’re probably still thinking if this is what you should be really doing because you love every aspect of it but people are saying not to do it.
Our guest for this episode is Dr. Shikha Jain, who was also previously on the Specialty Stories Podcast Session 08 where she talked about her profession as a hematology oncology physician. She recently wrote a great article on KevinMD, called Why I Would Still Encourage My Daughter to Go Into Medicine, so I invited her today to share with us why you should still consider a career in medicine despite all this negativity surrounding it and how our healthcare system is constantly in turmoil with every new administration that comes in.
If you’re having doubts right now or your parents are concerned about you doing this, listen to this episode and hopefully, we will answer questions for you.
[03:15] Being Drawn to the Field of Medicine
Dr. Jain started thinking about becoming a doctor at a very young age being exposed to her father who is a surgeon so she really enjoyed seeing patient experience. As she got older, she began volunteering in clinics and began to see the impact physicians have on people.
While in college, she was working up other opportunities and seriously considering other fields. In fact, she got a feedback from the P.I. at the research lab where she was working that she lit up more when she was doing other things such as when she started a volunteer organization. So she did consider it for a while. However, Shikha still found herself drawn back to medicine.
What really cemented her desire to do clinical medicine is patient interaction, being able to see them, talk to them, and explain things to them in a way they understand and help them take control of their own health and life which is very unique to medicine. It incorporates patient education, science, interpersonal communication and having that bond with somebody which you don’t get in a lot of other fields.
[06:36] Premed Struggles
As with any other premed student, Dr. Jain’s premed journey was just as tough. She said that regardless of where you come from, the premed tough is hard. No matter what your background is, there’s going to be something that’s going to be a hurdle. You may not be a good test taker or not understand the science behind it or not enjoy some of the fields. She admits she’s a bad test taker and multiple choice tests were difficult for her. In short, she struggled through her premed years just trying to get by just like any other premed does although having a physician father helped her in terms of knowing what to expect going to to residency. So it helped her to not become overwhelmed during that transition.
[08:30] How to Overcome Being a Bad Test Taker
Test taking was something she struggled with for a long time. For one, Dr. Jain went to the University of Chicago for college and majority of their tests were in essay form.
So one of her mentors in medical school set her up with a resident who was an excellent test taker and an expert in figuring out the tricks in answering multiple choice tests. He sat down with her and showed her how he broke down multiple choice tests; for instance, just looking at the question first and then figuring out the answer on your own before looking at the multiple choice answers.
As a result, she came up with her own techniques and learned how to become a better test taker which has help her throughout her career.
Her biggest issue was second-guessing herself, answering all the questions, going back to check them, and ending up changing her answers. To resolve this, she would go back not to check her answers but just to make sure she answered everything.
Her turning point was when she realized that your first run-through when you read it properly the first time is usually when you get the actual gist of the question and you’re not second-guessing yourself.
[11:25] The Hardest Part of Being a Premed
Students can feel there is not as much support and mentorship while there’s a lot of competition. Some competition is good but sometimes the competition that exists can become frustrating for students that they feel like giving up because they feel the competition more than the support they get. During college, Dr. Jain surrounded herself with more collaborative people and they have helped together through the years and even until now.
Collaboration, not competition. Competition is not just frustrating but isolating as well. So it’s very important to find those collaborative classmates and friends to work with them so you can all get through these premed years, medical years, and even through residency.
[14:35] The Hardest Part of Medical School and Knowing Your Why
Medical school is a whole new ball game where you walk in and you think you know a lot of things having gone through all these tough premed classes and you practically survived everything. But medical school is like starting from scratch. Sure, there are a lot of stuff from premed that will be helpful but there are more other stuff in medical school which you’ve never had any experience with. It’s like starting from the ground up and this can be overwhelming and almost scary to some students. Again, the most important thing is finding your mentors and people you can work with to make things go much smoother.
Dr. Jain definitely questioned herself at some points through her journey. There were definitely times of self-doubt and days when she and her husband (also a physician) questioned what they were doing. To overcome this, she focused on reminding herself why she was doing it and what she was getting out of it in the end. Having a father who is a surgeon, she saw the benefits of what he had and what he was able to accomplish so she used this as her “light at the end of the tunnel.”
So she treated medical school as the means to an end. She was learning all this stuff because she knew she was going to apply all of it for the rest of her life, sort of delayed gratification.
Medscape released a study regarding physician burnout and Dr. Jain said that this could be triggered by the fact that physicians have lost autonomy leading to loss of control over their medical practice which can be very frustrating. Way back, physicians could decide what patients they wanted to see or how long clinic hours would be or how many days they wanted to be on call or they wanted to round, pretty much the way they wanted to orchestrate their lives. Today, a lot of practices are becoming hospital-owned and practices are now becoming larger groups ran by non-doctor administrators. Many physicians feel administrators are only looking at the bottom line and the business side of things as opposed to physicians thinking about what’s best for their patients. As a result, the goals of medical practice are not aligned with the goals of the administration so they feel restricted in what they can or cannot do.
[24:40] Healthcare Administration and Education on Health Care Policy
Not to mention, older physicians now have to keep up with the new technology, computerized systems, and paperwork. One element is their resistance to change, another is they don’t feel they have the time to get involved with administration or help make changes necessary for patient care or for the practice.
Dr. Jain thinks this is a communication gap because no one feels they have enough time to do everything that needs to be done. Dr. Jain believes 100% that this could be mitigated by educating medical students on the administrative side of things, specifically having one class a year for students to learn how the administration works.
When she was a medical student, Dr. Jain organized an elective on health policy to try to get medical students engaged in politics and understand policy changes. Healthcare administration and healthcare policy are two very important topics not covered in medical school.
Dr. Jain thinks physicians can only say they’re only going to take care of patients and not worry about anything else. However, many times, the decisions being made may not be good for the patients and the administration doesn’t understand that due to zero medical background. Physicians are then in a unique position as being advocates for patients while being involved to a certain extent in administration. The key is to keep your eyes open and pay attention to what’s going on around you. Getting a mentor is another key to help you figure out how you can best keep yourself abreast of what’s going on so you’re educated and you’re able to advocate for your patients.
Dr. Jain is currently in a group that meets with their administrators every other week to talk about the changes and their impact on patient care. So they’re able to come to a solution that would both increase the efficiency of the clinic and improve patient care.
[31:15] Why You Still Need to Go to Medicine
Dr. Jain would still encourage her daughter to get into medicine if she wants it and has the passion to do it because it is an amazing field.
The unique thing in medicine is if you have a passion for this field, the rewards can be amazing, regardless of whatever field you’re in. You get to change people’s lives in any part of medicine and that is a very unique thing. And if you really love what you do then it wouldn’t feel like a job and all the other stuff just becomes a background noise.
Five to ten years from now, Dr. Jain still believes she would have the same enthusiasm as she has now. She firmly believes going into medicine is a calling and the people who truly continue to enjoy are people who went into it because this is what they wanted to do. And if, for instance, you might not like one part of it, it could still open some doors for you to do so many other things. If you’re getting frustrated with something then you have the flexibility as a physician to change your trajectory.
She maintains her enthusiasm by always keeping the patient care aspect in the forefront of her mind. At the end of the day, it’s about affecting people’s lives one way or another and you have that privilege to do that everyday. And that’s what she reminds herself of during frustrating times.
[37:07] Dealing with New Administration and Policy Changes
It’s important to understand what’s going on and have a voice. At the end of the day, patient care is the definition of being a physician. Everything else will change around you but what happens behind that closed door is paramount.
If you’re interested in getting involved and learn the administrative side of things, Dr. Jain recommends looking up AMSA which also gives mentorship and guidance. Talk to somebody in your college and see if there’s someone you can touch base with and pick their brain.
Dr. Jain says mentorship is something that is underutilized a lot of times in medicine. It’s such a gift when you have a good mentor and a lot of times you have to seek them out but when you find a good mentor it can change your life.
[41:14] Final Thoughts
You don’t have to know everything about the administrative stuff but absorb as much as you can and just keep yourself up to date. Getting yourself educated to the best of your ability is your best tool. Don’t worry about learning everything. Just worry about learning as much as you can and enjoy yourself as you go through it. Dr. Jain thinks it’s all worth it in the end. Do this for the right reasons and hopefully you will come through on the other side happier, healthier, and more willing to continue to give back to your patients, to your colleagues, and to the profession.
Dr. Jain’s article on KevinMD – Why I Would Still Encourage My Daughter to Go Into Medicine
Dr. Ryan Gray: The Premed Years, session number 226.
Hello and welcome to The Premed Years, where we believe that collaboration, not competition, is key to your success. I am your host Dr. Ryan Gray, and in this podcast we share with you stories, encouragement, and information that you need to know to help guide you on your path to becoming a physician.
Welcome to The Premed Years, again my name is Dr. Ryan Gray and I host The Premed Years Podcast, the one you’re listening to now, as well as The MCAT Podcast, the Old Premeds Podcast, and our newest one, Specialty Stories. If you haven’t heard that one yet, I think it’s turning out to be one of my favorite shows because I get to talk to amazing physicians, specialists in their field and discuss what they like about it, what they don’t like about it, why they chose it, and what you as a premed or even a medical student can be doing if you’re interested in the fields that they are in. So go check those out, www.SpecialtyStories.com.
The journey to medical school is long, it’s tough, it’s defeating, it can be isolating, and along the way there are plenty of news stories out there about physicians who don’t like their job, about physician suicide rates, about suicide in medical students, and so there inevitably comes a lot of doubt when you are on this journey of whether or not you should be. Is this really what you should be doing? Maybe you’ve thought about being a physician your whole life, you’ve shadowed, you’ve gotten clinical experience, and you love every aspect of it, but everybody out there is saying, “Don’t do it. Don’t do it.” This week I had the privilege to speak with Dr. Shikha Jain. Now if that name sounds familiar it’s because she was on my Specialty Stories Podcast several weeks ago talking about her profession of hematology and oncology. And she wrote a great article about why she would still have her daughter go on to be a physician, and so I wanted to bring her on and share with us why you should still consider a career in medicine even though there’s all this negativity surrounding it. Even though our healthcare system is in such turmoil with our new administration and how probably every four years or eight years when a new administration comes in, that it’s going to continue to be in turmoil. The only constant is change with our healthcare system and life in general. So Dr. Jain is going to share with us why she thinks you should still consider this career. So if you’re having doubts, if your parents are concerned about you doing this, if your loved one is concerned that you’re doing this, listen with them and hopefully we’ll answer some questions for you.
Shikha, welcome to The Premed Years, thanks for joining me.
Meeting Shikha Jain
Dr. Shikha Jain: Thanks for having me.
Dr. Ryan Gray: When did you know you wanted to be a doctor?
Dr. Shikha Jain: So I actually started kind of thinking about it when I was really young, when I was about six, seven years old and I used to go around with my dad in the hospital. He’s a surgeon and so I really enjoyed the experience, and seeing patients, and seeing him interact with people. So I really enjoyed that to start, and then as I went through I got older, I started volunteering in clinics, and I just started really seeing the impact I could have on people. So I started when I was very young, I went through a period in college where I kind of dabbled in some other things, but I wanted to make sure I was going into it for all the right reasons, I did some advertising kind of internships during the year, and I looked at some other opportunities but I always was drawn back to medicine. So I knew from an early age, I reevaluated as I got older, but nothing really could persuade me and no other field really drew me as much as medicine did.
Dr. Ryan Gray: So you’re that stereotypical ‘I couldn’t see myself doing anything else.’
Dr. Shikha Jain: Well kind of. There was a really interesting experience when I was in college where I actually worked in a research lab and the PI at the lab actually told me, she said, “You know, you light up a lot more when you’re doing other things.” Like when- I’d started a volunteer organization and she said, “When you talk about that, you really light up when you’re talking about this organization, when you’re talking about the promoting you’re doing for it, when you’re talking about the things that you do.” She said, “Why don’t you think about doing something along those lines like going in to work for an NGO.” And so I really seriously considered it for a while because I do enjoy doing all that kind of stuff, but what I realized was I could incorporate that type of thing in medicine. I didn’t necessarily like the bench work in a lab as much as some physicians do, so I guess I was kind of stereotypical in that I did know from a young age, but not as stereotypical because I did really seriously consider other fields when I was going through college.
Dr. Ryan Gray: What do you think drew you back to medicine and why didn’t research take you away from it?
Dr. Shikha Jain: So research is something I’ve continued to be involved in throughout my career, but I do more clinical research as opposed to bench research. The things for me that really made me know that I wanted to keep doing clinical medicine and have it be at least some part of my career was the patient interactions. Like when I see a patient in clinic, when I’m able to talk to them, when I’m able to explain things to them in a way that they understand, when I see kind of the lightbulb go off in their head and they say, “Wow no one’s ever explained that to me before.” And it’s helping them take control of their own health and their own life. For me that is something that is very unique to medicine, and it incorporates the fact of patient education, and science, and just that interpersonal communication, and having that bond with somebody which you don’t really get in a lot of other fields. A lot of other fields it’s just not possible to get all those aspects incorporated.
Effects of Having a Physician Parent
Dr. Ryan Gray: What was the premed journey like for you growing up with a dad who’s a surgeon? Was your premed path easier because you had a parent who was a physician, or was it harder, or was it just the same as for everybody else?
Dr. Shikha Jain: So I think the premed path is hard regardless of where you come from. I mean premed classes are not easy; organic chemistry, biochemistry, I mean I struggled in all those classes and it was rough. And I think that no matter what your background is, there’s going to be something that’s going to be a hurdle. You may not be a good test taker, you may not just understand the science behind it, you may not enjoy some of the fields. And I mean- to be perfectly honest, I’m a bad test taker, and I know a lot of people say it but multiple choice tests are just- they’re difficult for me. And so I struggled quite a bit in the premed years just trying to get by just like every other premed student does I think. And some people don’t show it as outwardly, some people kind of wear their emotions on their sleeve, so I think everyone has their own struggles. Having a father who was a surgeon I think helped me when it came to the actual practice of medicine because I kind of had an idea of what I was going into. You know when I started my residency I knew what to expect, where as some of my friends who did not have medicine in their lives in some way prior didn’t know what to expect going into residency. So I think it definitely helped me with that transition, and not being as overwhelmed as some people kind of went in blind. But the premed years, I think they’re going to be hard regardless of where you come from, and again everybody faces different struggles so there will be different battles different people have to face, but the premed years were hard.
Becoming Better Test Takers
Dr. Ryan Gray: You talked about being a bad test taker. I always joke that in medical school, you become a professional test taker. So you took the MCAT, a multiple choice test, medical school I’m assuming for you was multiple choice tests, the boards are multiple choice tests, your boards for your specialty are multiple choice tests. How do you overcome being a ‘bad test taker’?
Dr. Shikha Jain: That is an excellent question. It’s something I struggled with for a long time actually because when I went to- so I went to college at the University of Chicago where the majority of the tests that I had were essay tests. So there weren’t a lot of multiple choice tests going in. I mean obviously you take the SATs, and the ACTs, and things like that, and I did fine on those, but when it became a bit more involved it was just a very different experience. So what I actually did was one of my mentors in medical school actually set me up with a resident who was an excellent test taker. He just knew kind of how to figure out what they were asking, how to figure out the tricks that you look for, and he sat down with me and he basically said, “You know what? This is what I look for in a test. I first-” What his techniques were was he looked- he circled the last line that was the actual question in the question, and then went back and read the entire paragraph that came before it. He said he never looked at the answers, he would figure out the answer on his own before he looked at the multiple choice test- or before he looked at the answers, and that’s how he did it. So I came up with techniques and I kind of learned how to become a better test taker which definitely helped me throughout my career because we are professional test takers. Even when you become an attending, there’s still boards, and then you have to re-certify, and so multiple choice tests are a very important part of our training for better or worse. And so having that resident sit down and kind of show me how he did his tests, and how he kind of broke down the multiple choice test really helped me in the future.
Dr. Ryan Gray: Okay, interesting. I think it’s such a huge struggle, and I hear it all the time about being a bad test taker and whether that’s just anxiety or not fully understanding the questions, or not trusting yourself to break down the answers. So it’s definitely an important thing to learn.
Dr. Shikha Jain: Well my biggest issue was that I second guessed myself. So I would nine times out of ten, I would pick the answer that I thought it was, and then I would go back and when I was going back to check all of my answers, which I would do if I had enough time, I would end up changing a lot of my answers which was a horrible idea. So what I started doing was I wouldn’t go back through and check my answers, I would go back through and just make sure I’d answered everything because then I realized when you start thinking about things and you start questioning, ‘Hm do they really mean this? Do they really mean this?’ But actually the first run through when you read it through properly the first time, that’s usually when you get the actual gist of the question and you’re not second guessing yourself. So that I think for me, when I realized I was doing that, was a turning point for how I managed how to figure out how to get through the rest of the test.
Dr. Ryan Gray: I think that is a huge take-away. I think never check your answers. Make sure you answered them all but never check.
Dr. Shikha Jain: Exactly.
Dr. Ryan Gray: It’s something I learned early on as well. What do you think was the hardest part- outside of the tests, the hardest part of being a premed student?
Hardest Part of Being a Premed Student
Dr. Shikha Jain: So I think that there is just- especially nowadays talking to premeds, I feel like sometimes students can feel like there’s not as much support, and not as much guidance, and not as much mentorship, and not as much support amongst their friends. There’s a lot of competition and there doesn’t seem to be that sense of lifting each other up as much as trying to be better than your friends. So I think that is something that is very difficult, and it’s a hard thing to come out of high school going into college, and then medical school, and having that constant competition. I think some competition is definitely good, but I think that the competitions that exist can sometimes become a bit more frustrating for students, and I feel like a lot of times people feel like they need to give up because they feel like they’re having more of a competition and less of the support. So I think that’s something that is definitely difficult in medical school and premed years.
Dr. Ryan Gray: So I think- well first of all, the student that’s listening to this podcast will hopefully not feel that because our motto here is collaboration, not competition.
Dr. Shikha Jain: Perfect.
Dr. Ryan Gray: And so super collaborative, and our Facebook group is very collaborative. I think though you said ‘frustrating,’ the competition is frustrating. I think it’s isolating as well.
Dr. Shikha Jain: Yes, absolutely.
Dr. Ryan Gray: And the premed journey is not one that you want to do alone. So I think it’s very important to find those collaborative classmates and friends and work with them to better yourself and better them, and then you can speak to this as well, that the fact that you come out of medical school and are in a collaborative environment, you’d better start learning these skills now.
Dr. Shikha Jain: Absolutely, absolutely. I will say that I was very fortunate in that some of my absolute closest friends in my entire life have come from my medical school and my residency years, and they are- I tell them this to this day, we helped each other get through the medical school years, through the residency years. And in premed I actually had a lot of friends who were not in medicine- or who were not going into medicine, they were social sciences, or economics, and different fields than me, and part of the reason I did that was to keep myself grounded, and to keep myself well-balanced. But then I did have some friends who were also premeds, and I really tried to surround myself with more collaborative people, and people who I felt like would- we could help each other. We could give each other advice, we could share notes, and things like that. That was the type of environment I tried to foster and create for myself, and it served me very well in that I have friends who I’ve known now for ten, fifteen years who I can’t imagine my life without.
Dr. Ryan Gray: Yeah, that’s awesome. Alright so the competition for premeds, what about medical school? Medical school is supposedly more collaborative, and a lot less cut-throat. What did you find to be the hardest part of medical school?
Hardest Part of Being a Medical Student
Dr. Shikha Jain: So medical school is a whole new ballgame. You walk in and you think you know a lot of things because you’ve gone through all these tough premed classes, and you feel like, ‘Okay I did pretty well, I came out, I managed to survive my premed years, I should know this.’ And you come in and it’s a totally different ballgame. So it’s kind of like starting from scratch almost because yes, there’s a lot of stuff that you learned in premed that’s going to be helpful, but there’s a lot of stuff in medical school that you have no experience with, you’ve never seen it anywhere else, so it’s kind of like starting from the ground up. And I think at least the first year of medical school, that can be a bit overwhelming. Things like anatomy lab, if you’ve never done anything like that, they can be very kind of scary almost to some students. But again, I think the most important thing is to find those mentors, find those classmates, find the people you can work with and when you break things down, and when you work with others, it really helps things go a lot smoother.
Dr. Ryan Gray: What do you think was the- as you’re going through this process, and you’re struggling with it, or you’re in the depth of it, did you ever question yourself and go, “Why am I putting myself through this torture?”
Dr. Shikha Jain: All the time. We would- after exams my friends and I would go out and we would think of alternate careers. We would sit down and we would say, “You know maybe we should be doing this, or maybe we’ll start a bakery, or maybe- we really love restaurants, let’s open a restaurant.” So we definitely questioned ourselves, and my husband and I both- we’re both physicians, we met in medical school, we think back to it and say, “Would we go back and do it all over again?” Because it was, it was a long road. And there were definitely times of self-doubt, there were definitely times of, ‘Am I good enough for this? Is this really something that I’ve been chosen for? Is this something that I’ve chosen to do? Is this something that is in line with my future goals and career? I feel like I’m in the library all the time.’ One of my funniest memories from medical school was my husband and I were dating at the time, and we were studying in the library, and one of my very good friends from college who now works not in medicine was calling- she was in MBA school and she was talking how tired she was because she had to go to all these networking events, and it’s so exhausting, and every other event was at a restaurant, or it was some kind of party. And my husband and I were like, “We are in the wrong field. We are tired because we’re studying all the time, we’re tired because we’re taking all these exams, and she’s tired because she’s out having a good time.” And so we definitely had days where we questioned what we were doing, but I think for me especially, it was always I knew what I was going to get out of it at the end, I knew why I was doing it, and so I tried to focus on that. And that’s one way in which I was fortunate in that having a father who was a surgeon, I saw the benefit of what he had and what he was able to do and accomplish, and so that’s kind of what I used as my light at the end of the tunnel.
Dr. Ryan Gray: Very important. I’ve talked about that before, about knowing your ‘why’ and keeping that top of mind as you’re a premed struggling through the MCAT thinking, ‘Why am I doing this?’ Or through organic chemistry, ‘Why am I doing this?’ And thinking back and it’s one of the reasons a lot of students as they’re studying for the MCAT, or they’re doing other things and getting super involved, they kind of cut down their shadowing time, or their clinical experience time, and I tell them, I’m like, “Go keep doing that because you’ll be reminded why you’re doing this.”
Dr. Shikha Jain: Exactly. Exactly. It’s really important to keep that at the forefront of your mind because there are going to be days where- we used to study in the basement of our radiology building and you wouldn’t see the sun for eighteen hours at a time because you’d be ordering food in to the building, and we’d be sitting there, and we’d all be commiserating and saying, “Why are we doing this to ourselves? These are our twenties. We should be out enjoying life.” And you really have to realize that one, you have to find a good balance of studying and keeping yourself healthy, and enjoying yourself, and spending time with your friends. But the real purpose is it’s a means to an end. You’re learning all of this stuff, and you’re learning all of these really interesting things that you’re going to be able to apply for the rest of your life. And I don’t think- especially in medical school, I don’t think you really see that or understand that until your clinical years, and when you start studying things, and then being able to apply them to patients, the day it happened to me it was like a lightbulb went off in my head. I said, ‘Oh this is why I’ve been reading so much. This is why I’ve been studying so much. I just helped this pediatric patient on the wards figure out why his stomach was still hurting.’ So it’s delayed gratification almost because your first two years, most medical schools I know don’t do as much clinical, but I agree you should definitely keep yourself involved in the clinical aspect as much as you possibly can throughout your entire training.
Dr. Ryan Gray: You’re out of training now, and when you look at physicians surveys and reports, and MedScape is one of the biggest reports out there, it talks about physician burn-out and ‘would you consider going into medicine again, would you consider going into your same specialty again?’ And a lot of physicians out there, at least the ones that are doing these reports, are saying no. The majority are saying, “No I wouldn’t do this again.”
Dr. Shikha Jain: Yeah.
Physicians Losing Autonomy
Dr. Ryan Gray: But you wrote an article for Kevin MD that talked about why you would still encourage your daughter or child to still go into medicine. Let’s start off with the first part about these surveys and reports. Why do you think these physicians are reporting so much burn-out and negativity towards medicine?
Dr. Shikha Jain: So I think there’s a lot of things that are kind of leading up to physicians being this frustrated. I think- you know the biggest thing that has happened in the last 35 to 40 years in medicine is that physicians have lost their autonomy. And by losing autonomy, a lot of physicians have lost control of their practice, of what they think is important, of how they want to practice medicine, and that is very frustrating. So when my dad started-
Dr. Ryan Gray: Go into that. What does that mean, ‘losing autonomy’?
Dr. Shikha Jain: So you know when my dad started his practice 35 to 40 years ago, he started a private practice from the ground up, and he could decide what patients they wanted to see. He could decide how long his clinic visits were going to be. Him and his partners- eventually he had partners, they could decide how many days they wanted to be on call, how many days they wanted to round, how many- the way they wanted their clinic set up, the way they wanted to orchestrate their lives, and if they wanted to take a day off it wasn’t a big deal, you just had to talk about it with your partners. Now what’s starting to happen is a lot of practices are becoming hospital owned, or practices are just becoming kind of absorbed and becoming larger groups that are run by administrators that aren’t physicians. And so a lot of times what physicians feel is that the administrators are looking at the bottom line, and looking at what is the best way to make this business successful, and that is something that physicians don’t necessarily think about as much because physicians are thinking, ‘What can I do that’s the best for my patients?’ And so what’s happened is a lot of the people in power in these hospitals and in these practices are not physicians. And so the goals of the practice have come completely in some cases an opposing kind of purpose as opposed to the goals of the administration. And so a lot of physicians feel that they are being restricted in what they can and cannot do because the administration says, ‘This is not in line with our bottom line.’ And the reason that’s happened is because physicians are so- most physicians are so kind of focused on patient care, and have so much other stuff they have to do now that medicine is changed. For example the older physicians don’t understand how to use the computers as much, or there’s all this paperwork that needs to be completed, or the people who are in charge keep changing our coding system so each year we have to learn a whole new coding system as to how we’re going to bill. So what happened I think was, in my opinion, was 30 years ago physicians didn’t want to deal with all that stuff. They wanted to take care of their patients, and they didn’t want to deal with all the administrative stuff, so they said, “Okay we’re going to allocate this stuff to somebody else because we just want to take care of patients, you guys take care of all the administrative stuff.” What’s happened now is that the administrative stuff has become something that’s very important to making the physician’s practice run so that they’re making a profit. And so I think those are just not necessarily in line with each other, so I think a lot of physicians lose the ability to dictate their own schedules, to decide what treatments they want to do in some cases, and run their practices, run their clinics the way they want without this oversight that they think is often unnecessary and often not what we believe, or what physicians believe is in the best- is best for patient care. So I think that- does that kind of answer your question as to the loss of autonomy?
Dr. Ryan Gray: Yeah I think so. There’s some element in there that I think is just normal human psychology of not liking change as well, and I think that’s a big driver.
Dr. Shikha Jain: I agree. I think part of it is not liking change, I think part of it is when everyone went to a computerized system a lot of physicians were very frustrated because they said, “Well the old way was fine, why now change it?” So I agree that’s definitely a big part of it, but I do think especially when I was in medical school, I worked with AMSA, and I tried to do some lobbying, and a lot of physicians that I talked to as a student weren’t interested in changing healthcare. They just wanted to come in, see their patients, and go home, and it’s because as physicians we do end up reading a lot outside of work, we do end up doing a lot of stuff outside of work unlike somebody who has a typical 9:00 to 5:00 job, so when it comes to it a lot of physicians don’t want to worry about all of the other administrative stuff. The problem is the physicians who have been in practice for a long time, now that things have changed, they don’t necessarily like the way things are changing, but they don’t feel like they have the time to let their voices be heard, or to come to committee meetings, or to get involved to make changes, or to help make changes in ways that they think would be effective for patient care and for the practice, or for the hospital, or for the administration. So I think it’s just a communication gap and part of it is because no one feels they have enough time to do everything that needs to be done.
Importance of Educating Students on Healthcare Policy
Dr. Ryan Gray: Do you think some of this could be mitigated with educating medical students on the administrative side of things during medical school?
Dr. Shikha Jain: 100%. I think coming out of medical school, we always joked that we have no idea how anything works when it comes to billing, when it comes to insurance, when it comes to anything administrative because there is so much to learn from a medicine standpoint, but I think even one class a year would be very useful to at least learn how health administration works. I actually- when I was a medical student I organized an elective that was on health policy, and trying to get medical students engaged in politics, and understanding how bills become laws, and how healthcare policy changes, and how we can make a difference. And I think that both healthcare administration and healthcare policy are two very important topics that are not covered in medical school at all, and I think it really puts us at a disadvantage when it comes to starting a career. If someone wants to start a private practice, there’s no resources for that, there’s no way to talk to somebody to figure out how do you do that? Or if someone wants to go into healthcare administration. So I think incorporating that into med school would be extremely useful.
Dr. Ryan Gray: So how is a premed that’s going through this process now, what would you recommend to them so that when they get out of medical school and are practicing in whatever environment they’re practicing in, that they either A) understand everything that’s happening around them and are okay with it, or voice their concerns when they’re not okay with it, or B) just understand that their role as a physician doesn’t necessarily need to interact at all with the administrative side, and their goal is patient care, and they should focus on that.
Dr. Shikha Jain: So I think the most important thing- and I don’t necessarily agree that regardless of whether you decide now to be in administration or not, I don’t think that as physicians in this day in age we can say, “I’m only going to take care of patients and I’m not going to worry about anything else.” Because the problem is what happens is a lot of times the decisions that are being made may not be good for your patient, and the administration may not understand that because they don’t have a medical background. So we are in a very unique position in that we can advocate for our patients while being involved to a certain extent in administration. I mean that doesn’t mean everybody needs to go into healthcare administration, everybody doesn’t need to go to all these meetings and committees, but I think keeping your eyes open and paying attention to what’s going on around you is extremely important. I think getting a mentor who has done something similar to what you want to do is key because they have the experience to help guide you and to help you figure out in the section of medicine that you’re in, in the field that you’re in, how you can best keep yourself abreast of what’s going on so that you are educated and able to advocate for your patients even if it’s not on an everyday administrative level. If something- I’ll give you a perfect example. So I’m in a group right now where we as a group meet with our administrators every other week, and the reason we do that is because the practice, the way it’s run is changing, and it’s been changing over the last two years, and the administration was making some changes that were not good for our clinic flow. And so we shot them and email and said, “Hey let’s sit down and talk about this,” and we explained to them in moving this person here, or changing the way that the front desk staff handles this is not necessarily going to be good for patient care, it’s actually going to be less efficient. And in their mind they were looking at it from an administrative standpoint, from our mind we were looking at it from a clinical standpoint, and we were able to come to a solution that worked to both increase the efficiency of the clinic and improve our patient care. So I think that keeping yourself engaged and keeping yourself abreast of what’s going on at least to a certain extent will help your patient care. So I think it directly affects how you treat your patients, so I think it’s very difficult in this day in age for us as physicians to say, “Oh we don’t want to be involved or know anything that’s going on, just give us patients.” I think if we want to be happy and have job satisfaction and have some ability to control our schedules, control our lives, control what our patients are receiving- the type of care they’re receiving, we have to have at least a small amount of engagement in these types of things.
Dr. Jain Still Encourages People to Pursue Medicine
Dr. Ryan Gray: So being a physician is hard is what I’m hearing, and obviously having experienced it, there are a lot of things to juggle. You’re dealing with sick patients, and making sure they’re happy, you’re dealing with administration, making sure they’re happy, you’re dealing with all of your ancillary staff and making sure they’re happy. Why do you still encourage- why would you still encourage your daughter to go into medicine?
Dr. Shikha Jain: Well I really think medicine is an amazing field. I think that I am very fortunate in that I’ve been able to practice medicine. I think if my daughter wants to do it, and if she feels that she has a passion for it, I would highly encourage her because all of this other stuff; the administration, the changes, all that stuff that happens, it’s going to keep happening and it happens in all fields. The unique thing in medicine is if you have a passion for this field, the rewards can be amazing. Regardless of whether you go into oncology, or surgery, or psychology, whatever field you go into- or psychiatry, there are an amazing amount of rewards that come with it. And so we always learn in medical school you’ve got to talk to patients about risk benefit, and risk assessment, and kind of comparing the pluses and minuses of different decisions, and when it comes to medicine I think that the real benefit we get out of it is we get these rewarding- whether it’s patient interactions, or if you’re a pathologist you get to help diagnose people with things that someone else might not be able to find, if you’re a radiologist you get to see images and help people diagnose pneumonia, help treat people for- diagnose an early cancer that can be curable. You have the ability to really change people’s lives in any field of medicine, in any part of medicine, and I think that is a very, very unique thing for this job. And I really believe that if you love what you do, it doesn’t feel like a job, and all of this other stuff, it kind of becomes background noise where you know you have to deal with it, and you deal with it to whatever extent you want to, but you still get this reward. No matter what happens, you still have that reward. You can still go home at the end of the day and know that you impacted somebody in some way, and I don’t think you get that in a lot of other jobs.
Dr. Ryan Gray: Alright so I’m going to play devil’s advocate and challenge you a little bit.
Dr. Shikha Jain: Absolutely.
Dr. Ryan Gray: So you’ve only practiced- you’ve been out in practice for a year and a half, is that correct?
Dr. Shikha Jain: Yes.
Dr. Ryan Gray: How much of this positive outlook that you have is the fact that it’s still new and shiny for you? And how do you keep this same outlook in five or ten years?
Dr. Shikha Jain: Sure. So I think probably a little part of it is that it’s new for me, but I can tell you from speaking to other physicians, especially after I wrote that article I’ve had a lot of physicians come to me and say, “Thank you so much for writing that, that’s exactly how I feel and I didn’t know how to verbalize it.” And these are physicians who’ve been in the field for fifteen, twenty, thirty years. Two of my partners have been- one’s been in practice for about seven years, and I think one’s been practicing for about ten to fifteen years, and they both have the same enthusiasm, and the same passion, and the same kind of I guess you could say positive outlook on medicine because I really think it’s a calling. I really think going into medicine is a calling, and I think the people who truly continue to enjoy it are people who really went into it because they thought this is what they wanted to do, and the great thing about medicine is let’s say in a couple years you realize, ‘You know what? I don’t necessarily like this part of medicine.’ It opens the door to do so many other things, and I think a lot of physicians, what they’re learning especially in the times today, is if you’re getting frustrated with the administrative aspect, if you’re getting frustrated with all these other things, then you have the flexibility as a physician to change your trajectory, change what you want to do. So I mean going back to my father, you know he was in practice for 35 to 40 years, and he still felt that way at the end of the day. I mean he would come home and obviously we would hear him grumbling about other issues, but at the end of the day it still came back to patient care. And so I think- I totally agree with you, part of it is because I’ve just started, but I’ve talked to a lot of physicians who’ve been in practice much longer than me who still feel this way. And to answer your question as to how I maintain it at this point? Well for me the biggest thing is always kind of keeping my eye on the prize so to speak, where when I have a really bad day I come home, I talk to my husband, I play with my daughter, and then I go back the next day and I know that each day is going to be different, it’s going to be faced with its own challenges, but I always keep the patient care aspect in the forefront of my mind because at the end of the day I will have multiple patients who I’ve affected their lives in one way or another. Whether it’s in a way where I’ve been able to help them, or if it’s a way that I’ve given them news that I need to guide them through, or if it’s something where I’ve changed their life in one way or another. So I have the privilege of doing that every day, and so I just remind myself of that when I start getting too bogged down with all of the other stuff that can get really frustrating.
Dr. Ryan Gray: I think now is an important time to remember that information because we’re going through a change with our new administration with where is healthcare going? Is the Affordable Care Act going away? What’s going to replace it? And a lot of premed students are looking at that and determining, ‘Well should I still go into medicine if healthcare changes?’ And I think what you’re saying, and what I say all the time, is it’s important to understand what’s going on and have a voice, but at the end of the day patient care- and the way I say it is what happens behind the closed exam room door will never change. That interaction with the patient, with their family, that will never change and that’s what is the definition of being a physician. Everything else will change around you, and it will as you progress through your career, but what happens behind that closed door, that interaction, that communication with a patient is paramount.
Dr. Shikha Jain: Absolutely, I totally agree. I mean and that is the one thing that has been a constant since I was four years old when I used to round with my dad. I still have that connection with my patients and that is not going to change, and that is something- even if we have to document more things on the computer, or we have to go through all this other frustrating stuff, my patients are still people that I am becoming a part of their lives, and I appreciate that, and I think that it is something that really we have to remember as things change, the administration changes, the healthcare system changes. I mean the healthcare system has changed significantly even since I started college and medical school. So I think that it is a very important thing to continue to remember, is that the patients are always your prime concern, and that will never change.
Recommended Resources to Premed Students
Dr. Ryan Gray: What resources would you recommend a premed student start looking at to get involved in maybe the politics side of things, or the policy and the administrative, and trying to learn the administrative side of things as well?
Dr. Shikha Jain: So when I was in medical school AMSA was very good at doing things like lobbying, and policy work. AMSA is the American Medical Student Association for anyone who doesn’t know. And it is a very- they had national conferences, we went to- I organized a couple of events where we lobbied both at the East Lansing capital of Michigan as well as in D.C. So AMSA was a really great resource as a student because it gives you the ownership of learning about policy, but also it gives you a lot of mentorship and guidance. So I think if you’re interested in that, that is something that is extremely useful. If you’re interested in more like the administrative side, there’s not as many resources I don’t think for someone to reach out for that. I would recommend talking to somebody in maybe- if you’re a premed still, talking to somebody in the college career guidance counseling and seeing if there’s somebody who you might be able to touch base with or talk to and just pick their brain, get an idea of what would be good things for you to be focusing on or doing when you start medical school. And as a medical student, I think finding an administrator and just asking- a lot of them would love to talk to you. And just set up an appointment with them and say, “I’m so-and-so, I’m an M1 medical student, and I’m thinking I might be interested in learning a little bit more about health administration after I’m done with medical school. Do you think you could spend a little bit of time just explaining to me what you do, or how I can get involved, or is there something I could do while I was going through medical school to keep myself abreast of medical administration. So I really think mentorship is something that is underutilized a lot of times in medicine, and I think it is something that is such a gift when you have a good mentor. And a lot of times you have to seek them out, but when you find a good mentor it can change your life.
Words of Wisdom to Struggling Premeds
Dr. Ryan Gray: So the premed student listening right now is freaked out with everything changing, and with everything that we have to know and be involved in. What do you say to reassure them that if they’re doing this for the right reason, they’re on the right path, and the goal at the end of the road is worth it?
Dr. Shikha Jain: So the first thing I would say is don’t be freaked out about learning everything. You don’t need to know everything about how the government works, you don’t need to know everything about how the administration works, you don’t need to know everything about everything and that is a very hard concept for a lot of premed and medical students to grasp. That you’re not going to know everything. I think that absorbing as much as you can, and knowing that you’re going to have to learn things five or six times in a row, you’re going to have to repeat things, you’re going to have to be re-taught things, I think those are all really important things to remember. And not only that, just keep yourself up-to-date on the news. Get a CNN alert update on your phone. Get the Washington- the New York Post or the New York Times or Wall Street Journal. Get that on your phone so when you’ve got some downtime you can look at it. It’s not something you need to be obsessed about, I would not use it to start getting anxious. I know a lot of people are really anxious with the administration change especially with healthcare, and there’s a lot of anxiety going around. I think getting yourself educated to the best of your ability is going to be your best tool moving forward. Don’t worry about learning everything, just worry about learning as much as you can and enjoying yourself as you go through it. Because I think a lot of premed and medical students don’t enjoy their time as much as they should, and it really should be an exciting time for you because you’re learning things that are going to- you’re going to be utilizing for the rest of your life. It’s very different from some of the classes you take in college where you may never see organic chemistry again, but when you’re learning about biology, and about the human body, and you’re learning about physiology and anatomy, it’s just- it’s something amazing that you’re going to remember. Oh I had a teacher back my first year of med school who had this acronym that I’m now using and I’m using it and explaining it to my patients. So just enjoy it, really enjoy it as much as you can, and enjoy the learning process because it is a process. It’s not instantaneous, it’s going to be a process, it’s going to take a lot of time, but I really think it’s worth it in the end.
Dr. Ryan Gray: Alright there you have it. Hopefully if you’ve been struggling on this journey, questioning yourself at every turn, this podcast will help answer some questions for you and maybe the answer for you is, ‘No I don’t want to do this,’ and that’s okay. But ask yourself the questions, go through this process, make sure that you’re doing these things for the right reason, and hopefully you’ll come through on the other side happier, healthier, and more willing to continue to give back to your patients, to your colleagues, and to the profession.
I hope you have a great week, don’t forget to check out everything else that we’re doing at Med Ed Media by going to www.MedEdMedia.com.
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