Negative perspectives

Do medical students have a negative view of the profession? Tiago Villanueva and Irina Haivas talk to students from different countries

Medical students have a bleak view of the medical profession and the organisation of health care, a Swedish study has found.¹ Perspectives about medicine vary and the situation in Sweden is not unique.

United States

Is medicine worth studying?

Aditi Joshi, the president of IFMSA-USA (the Inter­national Federation of Medical Students' Associations): "Most students enter training because of interest in the subject, to have a stable career, or for the love of science. As they progress, they learn that doctors in the US do not practise medicine only; much of their time is dealt with legal, business, and insurance issues. Also, because of the high media coverage of medical mistakes and the increasing access to medical information for patients on the internet, public perception has changed towards more patient autonomy and less trust in the doctor."

What are the downsides?

Adam Levine, the immediate past delegate, Medical Student Section, American Medical Association: "The average medical student graduating this year will be more than $110'000 (£60'000; €91'000) in debt. As a result, many students will find their original altruistic visions of practising in underserved communities or primary care specialties fade. Instead, they will pursue more lucrative areas that allow them to pay off their debt while maintaining a comfortable lifestyle.

"The number of malpractice lawsuits is increasing, as are the rising costs of medical liability insurance (which can be more than $200'000) and the long work hours experienced by residents and third and fouth year medical students. These lead to an increase in burnout among young doctors. Although new national rules that limit residents to 80 hour work weeks have helped substantially, a great deal more needs to be done to make medical training a more humane process."

Does medical school change people's views?

AL: "I think most people still apply to medical school for altruistic reasons, but the stresses and challenges of ­medical school and residency, along with the bitterness ­displayed by many attending doctors, serve to blunt those altruistic tendencies over time."

Canada

Is medicine worth studying?

David Hawkins, executive director of the Association of Canadian Medical Colleges: "Recently, we have been expanding our first year enrolment from a low of about 1580 to the current level of 2000. Canada still ranks quite far down the list of Western developed countries in terms of first year entry positions to medical school on a per capita basis. Because of the limited number of places, a large number of Canadians go outside the country, particularly to Australia, Ireland, and the Caribbean. Medical schools are funded by the provincial governments through their parent universities and at the same time set the entry quotas. Interestingly, some governments are pushing for more entries but not providing the necessary resources. Therefore, universities are refusing to take in more students."

Why go into medicine?

Anna Labuda, former student adviser of the studentBMJ, Canada: "It is a guaranteed job, as Canada is desperate for doctors. Furthermore, to get into medicine here, most schools require a three year university degree. Many students, once they finish their university studies, realise that there are not actually that many interesting jobs available with a BSc. So they decide to pursue another career, many trying for medicine, pharmacology, business, law, or dentistry. And there are, of course, the obvious reasons: altruism, wanting to make a difference, research, love of people, respect, money, and so on."

What are the key issues?

DH: "We still think that we are facing long term physician shortages which will add to the stress in the workplace and other problems. The provincial governments have also imposed considerable restriction on postgraduate training the number of positions offered each year. This means there is a restricted choice and limited opportunities to pursue an alternative specialty and almost no capacity to train international medical graduates, many of whom are actually Canadian citizens."

United Kingdom

Is medicine worth studying?

Leigh Bissett, chairman of the Medical Students Committee of the BMA: "UK doctors are still voted the ‘most respected profession' by the public and in the past four years there has been an expansion in the number of places offered at medical school. The recent reversal of a five year downward trend in applicants per place to study medicine may be a reflection of the increased number of places.

What are the negative aspects?

LB: "Future students may have to pay £3000 per year and BMA debt modelling suggests that final debt on graduation could be as high as £60'000 in the future. In addition, it remains to be seen what the effect of two other major reforms to working hours, which force the UK to be compliant with the European Working Time Directive, and to training through the ‘Modernising Medical Careers', have on improving the working lives of doctors in the future."

What are the key issues?

Emily Spry, IFMSA training support division director and former president: "Training should become more flexible, to account for people's different life choices. More should be done to show people the options in medical careers, dispelling the myth that there is a path that everyone must follow, leading to being a hospital doctor. Jobs like general practice, public health, and international health need to be given more status by careers advisers and medical schools and not be denigrated by classical hospital doctors. There must also be more intersectorial and multisectorial cooperation. It is up to medical schools to lead on this—helping the doctors of the future to be ready and prepared to work effectively with other health professionals."

New Zealand

Is medicine worth studying?

Triscia Briscoe, former chairman of the New Zealand Medical Association: "Medical students here still consider medicine worthwhile. However, the high levels of student fees mean that many now do not feel any loyalty to staying in New Zealand to work and contribute to the health system here. A decade or two ago, many New Zealanders worked overseas for a couple of years, but generally returned. Now many who leave do not intend to return."

What are the negative aspects?

TB: "It's what I call the ‘name, shame, and blame environment': high education debt, low level of payment for some specialties, such as general practice and psychiatry, and medicolegal aspects."

What can be done to improve the situation?

TB: "Jobs for doctors in New Zealand, including the work environment, remuneration package, and work-life balance, have to be competitive on the international market."

Panama

Is medicine worth studying?

Anthony Nosa Imudia, former president of IFMSA-Panama: "The perspective of people that go into medical education in Panama varies; some people want to study medicine just because one of their parents is a medical doctor and want to keep the family profession. Others choose medicine because they want to be rich in the future or they may want to help others in need."

Does medical school change people's views?

ANI: "The real perspective of the career is never clear at the beginning. It becomes clearer when we see medical doctors interact with their patients. This is when we start to think about our aims. At this point some people get frustrated and leave the career while others are able to make a good readjustment."

Egypt

Is medicine worth studying?

Ahmed Ibrahim, Standing Committee on Public Health director of IFMSA: "Egypt has always played an important role in the region influencing many societies' cultures, development, and sciences. Medicine has always been important in Egypt—the first medical schools in the Arab world and the Middle East were in Egypt. Until a very few decades ago, the chance to study medicine was confined to the higher classes of society—a doctor has a very prestigious status."

What are the negative aspects? AI: "There are currently 13 medical faculties in Egypt educating about 16'000 graduates every year, which is excessive to the country's needs, generating unemployment, and making some doctors consider other employment opportunities. Students may be lacking suitable role models from the outset. Teaching staff in Egyptian medical schools are selected on the basis of the highest grades. This does not mean at all, however, that this teacher is qualified as a tutor who can lead a teaching process and can efficiently communicate with students."

Nigeria

Is medicine worth studying?

Chibuzo Odigwe, medical student, University of Calabar, Nigeria: "Many students in Nigeria certainly feel it is worth all the trouble continuing to study medicine. Many of us still want to do clinical medicine, because in spite of all the trouble involved, I think nothing compares with the job satisfaction one derives from treating patients and seeing them get well."

What are the negative aspects?

CO: "The frequent strikes and disruptions, which delay graduation more; the stress of trying to raise the funding to finance your studies; and the low wages of doctors all take their toll. The equivalent of a preregistration house officer in Nigeria earns less than £250 a month."

India

Is medicine worth studying?

Mohit Singla, treasurer of the IFMSA: "Students in India have a dark perspective on the medical profession. It is very difficult to get an admission into medical school, and you have to invest years of study in it. Without a specialisation, there is not much value for medical undergraduates. Most people do feel that the long years of studying and efforts that go into the profession actually pay off."

What factors currently contribute to a negative view on a medical career?

MS: "Things may sound negative from medical students, but premedical students are eager to get into medicine. Every year in India 250'000 students apply for admission to 10'000 places. It is still India's most desirable profession."

Switzerland

Is medicine worth studying? Hervé Spechbach, fifth year medical student, University of Geneva: "Medical students know that they will have work for sure, as there are not enough doctors in the country. This also allows us to choose our specialty."

What affects views about a medical career?

HS: "We have the problem of long working hours. At the beginning of our careers, we will work like 60 hours per week for a salary of a4000, which is not a lot per hour if we compare with other professions."

What are the key issues?

HS: "Doctors will soon be working fewer hours a week and have a higher salary. But it will take some time to change, because the costs of health care are higher each year. Political and economic decision makers say that doctors are responsible for the increase of costs."

Norway

Is medicine worth studying?

Hans Jacob Westbye, current IFMSA liaison officer on medical education issues: "Most students still think it is worth studying medicine in Norway. However, things are changing. More doctors are educated, which might lead to a surplus of doctors and lower wages. This will make the medical profession less desirable."

What affects views about a medical career?

HJW: "The change towards a women dominated medical profession might lead to a loss of reputation for the profession itself—we have seen this with other professions that went from being male dominated to female dominated (for example, teachers)."

What are the key issues?

HJW: "It is important that universities focus on the doctors becoming more then just body engineers. Through this they will take a major role in shaping the general perspective on the medical profession and change it from a profession, in the general public view, of arrogant, distant, and god-like doctors, to a profession of understanding, caring, and humane doctors."

Tiago Villanueva, final year medical student, University of Lisbon, Portugal

Irina Haivas, fifth year medical student, University of Freiburg, Germany
Email: ihaivas@yahoo.com


studentBMJ 2005;13:265-308 July ISSN 0966-6494

1. Holmstrom I, Sanner MA. Swedish medical students' views of the changing professional role of medical doctors and the organisation of health care. Adv Health Sci Educ Theory Pract 2004;9:5-14.

   

           

	CAREERS Negative perspectives       Tiago Villanueva, Irina Haivas (July 2005)
	Sina Abdollahzade (July 20, 2005)       3rd year medical student, Tehran University of Medical Sciences s_abdollahzade@razi.tums.ac.ir
	Dear editor I read with great interest the informative and interesting article by Tiago Villanueva and Irina Haivas entitled "Negative perspectives". This article indicates that the medical students share a rather dark view of both the medical profession and the organization of health care, which seems to be related to several factors. It is reasonable to assume that the views of medical students differ depending on the country and medical school which they study. As proposed in the article, the students of highly developed countries have mostly concern about high education debt and long working hours but in developing countries, inappropriate health policies lead to excessive numbers of medical doctors generating unemployment for them. This uncertainty of future career is increasingly make students apprehensive and would influence the students' perspective on medical education. In Iran, after a very difficult university entrance exam, called "Konkour", soeme of the best qualified students enter medical schools and medicine is one of the most desirable academic fields as many countries. After that, they realize that several general practitioners, who graduated in recent years, are unable to get a good position. Therefore, specialty becomes so important and every one wants to get a specialty in any field even he/she doesn’t like. (OF course, it is impossible for every medical student to get a specialty and we need general practitioners, as well).As a result, I would say that the same problem exists in here. Recently, the Ministry Of Health and Medical Education of Iran carried out "the family physician project and referral system" in some provinces. In this project, one doctor would be assigned to every four thousand people in rural areas and serve them as their family physician. This will improve the health care level in these areas and give chances to young doctors to have a stable career with a good salary to support the life and do what they dream before entrance to medical school!

	CAREERS Negative perspectives       Tiago Villanueva, Irina Haivas (July 2005)
	Mr Sistu Sri Krishna Prakash (July 20, 2005)       SHO in Urology, Ysbyty Gwynedd, Bangor mrsistu@hotmail.co.uk
	Dear Editor, The article titled ‘Negative perspectives’ by Tiago Villanueva and Irina Haivas about the growing negative attitude towards profession is interesting and I rather felt sad to find the same tune in the voices of medical graduates from different parts of the world. It cannot be denied that there is not much untruth in the fact highlighted in the article that there is a downtrend in the enthusiasm towards medical profession and decreased optimism in the medical graduates now a days. I graduated in about 9 years ago and even at that time many of us felt much the same. I see the reason behind this as - because everyone of us think before entering into the medical school that our future is secure although this is not true in reality. I feel that even now medical profession is still a noble profession despite of the litigant side of the practice. It gives immense pleasure and happiness to see people getting better and especially if you play a honest role in the process of making them better. I feel that no profession for that matter is has advantages and disadvantages and each one of it needs some degree of sacrifice .So also is medicine. I finally would like to congratulate Tiago and Irina for bringing out such an important and interesting article and I hope this negative perspective towards the profession will fade away in due course of time with proper understanding.

	CAREERS Negative perspectives       Tiago Villanueva, Irina Haivas (July 2005)
	Dr.Satheesha Nayak B (July 22, 2005)       Selection Grade Lecturer in Anatomy, Manipal Academy of Higher Education, Manipal, Udupi District, Karnataka State, INDIA. 576104 nayaksathish@yahoo.com
	Editor, it was nice work by Tiago Villanueva and Irina Haivas to collect the medical students' view about the medical profession. I would like to congratulate the authors for their effort. "Medical students have a bleak view of the medical profession" is not an agreeable concept. The questions asked in the study are "Is medicine worth studying?" "Why go into medicine?" "What are the key issues?" "What are the negative aspects?" I feel that the researchers had a negative perspective about the medical profession and they were expecting the interviewees from various countries to have negative perspective. The study would have been better if they incorporated the following questions "What is good about medical profession?" "Is there anything better in medical profession when compared to other professions?" "Is medical profession your choice or you are forced into it?" "Did you know about the pay that you would get when you become a doctor?" "Did you clearly know about the competition, scope, workload and outcome when you become a doctor? If yes why are you complaining now? If no why did you join the course?" I am not trying to say that the study is invalid but we can also get some important information from the interviewees when we reframe the questions. Didn’t all the doctors know about the scope and opportunities in their field? Did they blindly join the course and are regretting now? May be they expected more and are getting less. The unsatisfied professionals should discourage their children joining the same field. They also make others aware about that. I see many students in our university who are children of doctors. If all the doctors had negative views about medical profession, they wouldn’t have sent them here. There are many who are proud about it also. Once we are in a profession, we have to like it and do justice for it, whatever it is. Instead of complaining that there is no way, can’t we make a new way for us and for others to walk? It would be an interesting study to interview on positive side of the medical profession and let the student population know about it.