Most experts recommend that premed students seek medically-related jobs to gain early proficiency and support their medical school application. There is nothing like valuable hands-on experience, they say, for students to demonstrate their passion and knowledge about the field of medicine. According to the article “25 Health Care Jobs To Get Before Medical School,” written by the Indeed Editorial Team, “students who fill their resumes with volunteer work, research projects and relevant work experience stand out as committed, stronger candidates within the medical field.”
Patrick Connolly, MD, MBA, a neurosurgeon practicing in Philadelphia, Pennsylvania, disagrees. Before medical school, Dr. Connolly worked at a restaurant where he learned how to set tables, prioritize tasks, cater to diners’ needs, and even make béarnaise sauce. Dr. Connolly learned the importance of teamwork, considered fundamental to the practice of medicine. Working in a restaurant instilled foundational skills and enabled him to discover the pleasure of serving others. A seemingly menial job before medical school prepared Dr. Connolly for a demanding career in neurosurgery.
While reading Dr. Connolly’s story, I had a flashback to the many mundane summer jobs I held in high school and college – stock boy at a women’s shoe store, jack-of-all-trades at a textile factory, and beer vendor at a major league baseball park. The beer vendor job, in particular, was etched in my mind. I had a captive audience on the upper deck; the fans were always thirsty for a cold beer on a hot summer night. The profits from selling beer were second only to hawking hot dogs.
I was able to convince the manager of the food concession that I was of legal age (21) to sell alcohol. I was only 19 years old, but I was never asked to produce identification. Did I feel guilty? Heck, yes. Did I worry about getting caught? Sometimes. But nobody paid much attention to the vendors, especially those working in the “nose-bleed” section of the stadium. We were viewed as misfits and social outcasts, arriving early at the stadium to gamble our previous nights’ wages at poker.
Vending at night games was a second or third job for some individuals. They were struggling to get by. “I’ll never be like them,” I thought. “They would never amount to anything, and certainly, there were no doctors or potential doctors among them.” I was dead wrong. My best friend, with whom I shared rides to the ballpark and was himself a hot dog vendor, became a family medicine physician.
My superior attitude no doubt stemmed from my own insecurity about being able to “cut it” as a premed student, as well as my fear that I would be viewed in the same light as the derelict characters collectively referred to as “vendors.” Most of all, I was embarrassed to be seen with them and indignant over the nature of the job.
Sure enough, one night, I encountered a high school classmate attending the game with her boyfriend. I sheepishly offered an explanation that I was working my way through college, hoping to get into medical school. Meanwhile, my classmate was already beginning to taste success as a fashion designer and was merely two years removed from high school.
I never discussed my job as a beer vendor with anyone who had anything to do with medical school. I omitted the experience from my medical school application, focusing instead on college “distinction” work at a children’s hospital. However, my ballpark experience came up during a “meet and greet” with the Dean of my medical school in my junior year. I was astonished when he included it in my “Dean’s letter” as part of my application to residency programs. I asked him to remove it, but he refused.
“It shows you have character and adds color to your personality,” he said. I thought peddling beer in front of half-stoned bleacher bums indicated I was a character. Who would want a buffoon for a resident shouting, “Cold beer!” and “Last call for alcohol?” I was afraid of being typecast as a loser.
The Dean did not share my perspective. “Not a loser,” he said, “a hard worker.” He believed the ability to interact peaceably with rowdy fans was a strength that would serve me well in psychiatry, dutifully noting his opinion in my letter. Still, I never shared with the Dean that I had lied about my age to get the job.
Quality guru Donald Berwick, MD, described a similar story. He was a medical student interviewing at Peter Bent Brigham Hospital for a residency position. The day before the interview, his resident supplied him with the answer to a difficult question usually asked of prospective residents. Berwick chose to answer the question rather than confess he had been prepped for it by his resident. He aced the interview, but guilt set in shortly afterward, and Berwick dropped Brigham from his match list.
Berwick commented, “A choice came, on little cat feet, and I did not see it at the time for what it was. This is the moral choice in its simplest, purest, most elemental form. To tell the truth, or not, when ‘not’ is perhaps in your short-term self-interest.” Lying was definitely in my short-term interest – not only to lie, but when the manager asked my age, I looked him squarely in the eye and said, “I’m 22,” inflating my age by three years and going one beyond the legal age.
The Dean was unaware I had a hidden agenda when I asked him to delete the job from his letter. My personal shame was not that I was a beer vendor; rather, I had told a bold lie to get the job. It’s a lie that haunted me for years afterward. I vowed never to let it happen again – especially in practice – and to become more aware of my blind spots. Yet, from my reading, I discovered there are times when lying on behalf of patients may benefit them. And, if you believe Pamela Wible, MD, one of America’s foremost physician advisors and advocates, doctors are actually trained to lie.
I emailed Dr. Connolly to congratulate him on his essay. He replied, “The stuff we do before we become other people shapes us in so many ways.” I would add that “the stuff we do” goes well beyond the job itself. Early career jobs unrelated to medicine help shape our moral fiber and set our moral compass. Ethics cannot be taken for granted.
Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.