It has been nearly seven months since I made the decision to take a year off from medical school to pursue a master’s of public health (MPH) degree in Baltimore and nearly eleven months since I last saw a patient. From attending a Public Citizen workshop on access to pharmaceuticals to competing in my first business case competition to meeting several members of Congress to brushing up on my gym routine, the time off has been rewarding professionally, personally, and spiritually.
But on the other side of the fence, I see my former classmates inching closer to Match Day. Their interview trail is wrapping up, the barrage of obligatory social media headshots passed by months ago, and several months of exotic vacations are to ensue. On rare occasions, I look down onto my Instagram feed (the modern-day equivalent of looking up outside the window and pondering) and let the counter-factual permeate my brain waves: if I had not taken the extra time to apply to MPH programs and to fill in the extra set of forms delaying my graduation, I could also be transitioning to the next stage of life.
Is it worth it?
The idea of a decision being “worth it” is shaped by one’s life, culture, personal circumstances, and other factors. From the perspective of Homo economicus, sacrificing a year of income-generating activity is viewed as a financial loss. From the perspective of the individualist consumerism we live through, anything goes “as long as it makes you feel good.” Often times, we think of something as worth it if the projection of our future self is satisfied and in a better place from the decision, also known as fantasizing.
Whether you are an ultra-capitalist, hedonist, or futurist, the ultimate value of a decision is best left to one’s own faith or a graduate philosophy seminar. What I offer in the brief time you have allotted me is to tell you some of the benefits I have personally seen during my gap year. I will slice the benefits into three categories: short-term, long term, and the really long term.
First, while an MPH comes with its own demands and difficulties, it should come as a year to refuel and refresh after a year on the wards. The grind of seeing patients all day and then going home to finish a UWorld set leaves little time for sustained engagement in one’s outside interests. The motto of the Bloomberg School of Public Health is “Saving lives – millions at a time.” While it may smack of the hero complex at first glance, working in a safety net hospital the year before quickly showed me that even for a well-respected doctor, his or her power is often diminished beyond the four walls of a patient room or operating suite. During the course of an MPH, you quickly learn that clinical care is but one segment of a larger set of forces determining societal health. For example, a quarter of all disease is caused by environmental exposure and public health achievements over the last century have led to record-setting declines in mortality.
Having a sense of your future specialty during your gap year enables you to narrow your interests to a few key areas where you can learn the tools to create your own ripple in society, perhaps through public health advocacy, biostatistics, strategic thinking, or spatial analysis. This year has allowed me to do things I would not be able to do in med school, such as listening to sixty hours’ worth of material on the evidence surrounding climate change, learning classical Arabic, and working on some interesting research about screening for heart disease in South Asian immigrants. Plus, an extra three consonants after your name certainly cannot hurt during residency applications and will give you plenty of fascinating material to talk about at an interview.
Second, if you think you may want to earn a supplemental degree one day, I can tell you that doing it earlier is easier than doing it during the prime of your career. When you are young, the 11:59 p.m. deadlines, short essay responses, and timed weekly assessments are a breeze. But as you move through the snowstorm of adulthood, having to juggle between a significant other, children, taxes, and patient billing makes it difficult to stay motivated towards a degree that you technically do not need. Unless you come from a family with a dire financial situation, forget the argument that a gap year now comes at the opportunity cost of $250,000 as an attending in the future: you have the vitality and creativity to pursue your dreams in the present, with no guarantee that your wherewithal will remain after years of residency or potential professional burn-out.
Third, medicine is changing: gone are the days of any doctor being able to dictate the nature and setting of his or her own practice without recourse to the evolving complexity of healthcare. This complexity is manifested in managed care, tightening budgets, the acquisitive nature of hospital systems, pharmaceutical merger and acquisitions, and the like. Having (or appearing to have) a basic knowledge of issues in healthcare and some experience in tackling them will help you move up the ladder.
For me, these new opportunities may involve innovative methods of running a clinical practice, joining the advisory board of a health technology firm, or improving the quality of health care through drug development in clinical trials. I have learned that some of the new doors that begin to open up will incidentally come along as you chart new waters. For example, I recently received an advance reader’s edition of Dan Health’s upcoming book, Upstream: The Quest to Solve Problems Before They Happen, due to public health-related activities listed on my LinkedIn profile.
At the end of the day, weighing the benefits and costs of “delaying” life by a year (along with the attending physician salary that comes with it) can be emotionally and mentally draining. Do get advice from parents, friends, and mentor figures around you, but do not take it as a life-or-death situation. An Eastern monarch once gathered his advisors to invent a new sentence that holds in all places and times. Their finished product? “And this, too, shall pass.”
Waqas Haque is a public health and medical student.
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