Beyond the Fauci effect: As medical school application rates soar, medical students struggle

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I am sitting at my desk, scribbling down notes as my pre-recorded lecture races ahead of me at two times speed. My phone buzzes with another New York Times notification about the spread of coronavirus variants. I regret turning on push notifications about breaking news, but I can’t look away now. When I consider changing the setting, I am reminded that I shouldn’t look away. I have a responsibility to be in the know about every pandemic-related update. I am a medical student, adjacent to the trenches, yet so far removed.

I have seen the news articles circulating about the toll that the coronavirus pandemic has taken on health care workers. I’ve also seen it firsthand. My professors come to class unprepared, stressed, burned out, and our teachers are constantly subbed out as each person takes their turn to work on the inpatient COVID floor. My research mentors are falling behind, stressed with caring for patients, battling misinformation, pressures to shift their research focus to COVID-related projects, and caring for children who are learning from home. I watch the people I look up to struggle every day. I hear stories of patients who died alone, first-hand from the doctors who couldn’t save them. When I asked a mentor for some advice recently, she said, “I wouldn’t have chosen this specialty. No, it’s not that. I wouldn’t have chosen medicine at all if I could do it all over again.”

While New Yorkers clap for “health care heroes” and pre-medical students report feeling “inspired” to enter the field by prominent physicians such as Dr. Anthony Fauci, medical students are privy to the internal challenges brought on by the pandemic, as well as the ongoing problems that the pandemic has exposed. These include a health insurance system that prioritizes profit over patients, a society that consistently devalues the authority of science, and a medical institution that is built upon white supremacy and the oppression of marginalized people.

In the early months of the pandemic, medical students were energized to use their unique position in society to help. Students across the country organized programs to secure PPE for health care workers and to support them with childcare and other responsibilities. As the country has reckoned with our racist history and the continued perpetuation of white supremacy, medical students formed coalitions, wrote letters to their institutions, and worked with administrators to attempt to address racism and improve recruitment and support for Black students and other underrepresented students in medicine. As the months dragged on, however, it has been challenging to keep up the pace. As anti-racist book clubs died out and administrators continue to push back on student demands, many medical students have begun to feel powerless. Students from underrepresented groups have conducted the majority of this advocacy work; therefore, they face the brunt of institutional pushback, stacked on top of the pre-existing cognitive and emotional load of personally experiencing systemic oppression. Once something we dreamed of being a part of, the institution of medicine has been exposed as deeply flawed right before our eyes, and it can feel that our efforts hardly make a dent.

In addition to the disillusionment that many medical students are feeling, the pandemic has also impacted our ability to learn in clinical settings. The first two years of medical school are traditionally lecture-based, but many schools supplement with clinical experiences, such as preceptorships, shadowing, and clinical skills workshops. Encouraged by my deans to seek out shadowing experience, I was excited to work with a physician whom I admire. As soon as I set up a time to work with her in the clinic, however, we received an email stating that all shadowing is canceled for the foreseeable future due to a rise in COVID cases. These precautions are necessary to protect our patients and communities, but they also cut into valuable learning time for medical students. Having very little patient contact also means few reminders of why we entered medicine in the first place.

The pandemic’s toll on medical trainees will be multi-pronged. Some of my peers have taken the year off of school to focus on their mental health or their families, hoping to re-enter when the pandemic has waned. Many are wondering if they should leave the profession altogether– get out while we still can. The debt is overwhelming, but the fear of entering a profession where we will be burnt out and miserable may be even worse. Mental health struggles are a particular danger, as medical students already have high rates of depression and suicide, although exact statistics are hard to find because medical schools often do not report these numbers. In January alone, multiple medical students in the United States have died by suicide. While depression and suicide have no singular cause, medical students’ pressure and moral injury are undoubtedly harmful.

Young people entering medicine don’t need a hero to inspire us; we need a system to support us. Beyond the “Healthcare Heroes” signs, we see the physicians stretched thin, faces scarred from N95s, living out of basements, garages, and hotel rooms to keep their families safe. We see ICUs full of patients on ventilators, struggling to survive, while our Instagram feeds are full of snapshots of people eating in restaurants and gathering in groups. We see doctors crying tears of relief after receiving the COVID vaccine, while vaccine misinformation spreads rampantly like a second virus online. The pandemic has opened our eyes to how selfless health care workers can be, and it has also shown us how poorly systems support those on the front lines. We must do more to support our health care workers. We must also remember the health care workers of tomorrow.

Natalie LaBossier is a medical student.

Image credit: Shutterstock.com

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