Stanford Medical School Offers New Course on Finding Meaning and Balance in Medicine

A new course at Stanford’s Medical School, “Meaning in Medicine: Staying Connected to What Matters Most,” seeks to “immunize” students from future physician burnout by inspiring them to explore and connect with their personal motivations for entering medicine. 

Examples of weekly topics include: What Wellness Means to You, Spirituality and Faith in Medical Care, and Grief and Suffering. And mini lectures cover topics such as how to manage conversations with patients facing serious illness, distinguishing values from goals and preferences, and finding mentors. Each of the weekly sessions also leave space for open dialogue where students can entertain questions of faith, empathy, and what it means to care for a patient while also caring for themselves and their own wellbeing.

The course, developed by Henry Bair, a resident physician and Stanford Med alum, and Tyler Johnson, an oncologist at Stanford Health Care, was inspired by a podcast the two host together. The podcast, A Doctor’s Art, explores themes that seek to reconnect the practice of medicine to its mission, which all too often gets lost in the day-to-day burdens of administration, electronic health records, staffing, and corporatization. 

The response to the course has been overwhelming. Nearly a quarter of Stanford’s pre-clinical students have expressed an interest in taking the course before and just after it opened. And, at the conclusion of the course, every student who participated said that they would recommend the course to others. 

“In medicine, where science converges with art, suffering meets solace, and the human spirit confronts the limits of the body, it is increasingly easy to lose sight of our purpose and of ourselves. But our students have shown an eagerness to cherish their personal, intellectual, emotional, and spiritual motives for entering the profession; this eagerness, in turn, instills the courage and wisdom to seek balance and meaning. All medical trainees ought to be afforded the opportunity to do so, for this, ultimately, is just about the most effective way to individually prepare future clinicians against burnout,” Bair and Johnson wrote in an article for MedPage Today.

State Medical Boards Drop Broad Mental Health and Substance Abuse Questions from Licensure Applications

In a win for physician mental health, 21 states have opted to remove broad mental health or substance abuse questions from medical licensure applications, according to data gathered by the Dr. Lorna Breen Heroes Foundation.

Among these 21 states, the licensing application language is consistent with one of three options: it asks one question that addresses all mental and physical health conditions (consistent with the Federation of State Medical Board’s (FSMB) recommended language), does not ask about applicant health at all, or implements an attestation model with supportive language around mental health and “safe haven” non-reporting options for physicians who are receiving care.

The Dr. Lorna Breen Heroes Foundation, whose namesake died by suicide after experiencing severe burnout while working in emergency medicine during the early period of the covid pandemic in NYC, advocates for better mental health practices for physicians and policies that reduce physician burnout. Two components of the Foundation’s mission include working with state medical boards to remove mental health and substance abuse questions from credentialing applications, and increasing transparency around states’ policies.

The mission is personal for the foundation. Shortly before Dr. Breen’s death, she had shared her reluctance to seek help with family members. She feared that she would no longer be able to practice medicine if she did so. And, Dr. Breen’s hesitance is reflective of the physician population. According to Medscape’s 2023 Physician Burnout & Depression Report, 40 percent of physicians said that they would not seek help for burnout or depression out of fear of repercussions from their employer or state medical board.

The Foundation is not alone in advocating for changes that support clinician wellbeing. Other organizations within the medical community have also voiced support for reform. In 2020, over 40 professional medical organizations, including the AMA, the American Academy of Family Physicians and the American Psychiatric Association, signed a joint statement in support of changing disclosure practices about mental health. And, the AMA and FSMB recommendations support questions that focus only on current impairments rather than historical struggles.

According to the FSMB, "Application questions must focus only on current impairment and not on illness, diagnosis, or previous treatment in order to be compliant with the Americans with Disabilities Act." Similarly, the AMA recommends that any questions required of physicians be restricted to “conditions that currently impair the clinician’s ability to perform their job." And the Joint Commission, an organization that accredits hospitals, removed the requirement for hospitals to question applicants on their mental health history. “We strongly encourage organizations to not ask about past history of mental health conditions or treatment," they wrote in a statement. "It is critical that we ensure health care workers can feel free to access mental health resources."

Stay up-to-date on state policy using the Dr. Lorna Breen Heroes Foundation tracker, here.

Katie Couric Commencement Address Urges Medical School Graduates to “Talk to Your Patients in Human”

Katie Couric, best known for her years as a broadcaster and outspoken advocate for cancer research, recently addressed the graduating class at UMass Medical School.  Her speech focused on the power of humanity and the irreplaceable role that empathy plays in the doctor-patient relationship, especially in our increasingly technological world. 

Her speech included a quote from Jeremy Faust, MD and Editor-in-Chief of MedPage Today. “My friend, Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital, put it this way: ‘Use every bit of technology that you possibly can to prepare for each patient. But then drop all that and do the one thing that technology never can do: Look at your patient and think, ‘What would I do if this were my mother or my brother?’ No machine will ever be able to know that feeling and it will change what you do, more often than you’d expect.’”

After Couric’s speech, Faust expanded upon his quote in a blog post published on MedPage Today. In it, he provides tactical advice about what “speaking human” and the marriage of technology and human connection can look like for a physician. 

We’ve provided highlights from his post here, as well as links to the full text of Couric’s speech and Faust’s blog below.

• Introduce Yourself. Not only should you introduce yourself, but ensure that the patient also identifies themself by name. This does the double-duty of starting politely and also confirming that you are in the right place with the right person. Take the time also to meet and understand the role of other family members or friends who are present. 

• Make the Human Connection. Create a connection through the means available. When applicable, Faust said that he will share a relevant personal struggle that parallels the patient’s experience. This can help him to demonstrate his understanding of what a patient is facing as a person. Additionally, he mentions that he’ll often invoke his own family as he discusses potential options. This communicates to the patient that he is thinking through his advice to them with no less rigor or personalization than he would his own family. 

• Make Your Professional Experience a Part of the Conversation. Establish credibility by being upfront with how experienced you are with a particular situation. Let the patient know that you’ve seen similar situations often (or, for newer physicians, that you have observed similar cases and are working in partnership with an experienced attending physician). Conversely, if you don’t have the experience, make sure to let the patient know that you’re calling on the advice of someone who does. Either way, providing the patient with an honest evaluation establishes confidence and trust. 

• Make Technology an Open Part of Your Workflow. Use technology to gather ideas, or to level-set with a patient who you think has already turned to technology. Share your use of technology with them as well as your assessment of the findings. Review with the patient which ideas are worthy of exploration, as well as those that are not. Faust contends that technology is a meaningful resource for physicians. “If I look something up, I'll tell a patient. That’s not ‘cheating.’ That’s going the extra mile,” he wrote. 

Find the full text of Katie Couric’s speech here.

Find the full text of Dr. Jeremy Faust’s blog here.

Given the Choice, Most Physicians Would Choose Medicine Again. Most Would Even Opt for the Same Specialty.

Medscape recently published its 2023 Physician Income report. For this year’s report, over 10,000 providers, across 29 specialties, submitted responses.

We provide highlights from the report below:

Amidst the well-documented physician shortage and effects of the pandemic, which further reduced the supply of providers, it is not surprising that physician incomes are continuing to increase. From 2018 to 2023, the average physician income increased from $299,000 to $352,000. In 2023, Specialists’ compensation averaged $382,000, and Primary Care Physicians (PCPs) averaged $265,000. Male physicians continue to make more than women, with average salaries 19 percent higher for PCPs and 27 percent higher for specialists. The gap between the sexes, however, is smaller in 2023 than it was in previous years for both groups.

The top 10 highest paid specialties have remained relatively unchanged for the past decade with the exception of Plastic Surgery, which now garners the highest annual compensation ($619,000). Average pay increased the most from last year among Oncology (+13 percent), Gastroenterology (+11 percent), Anesthesiology, Radiology, Critical Care, and Urology (all +10 percent). The specialties with the biggest declines from last year include Ophthalmology (-7 percent), Emergency Medicine (-6 percent), Physician Medicine and Rehab, Nephrology, Allergy & Immunology, and Rheumatology (all -5 percent).

Most physicians (52 percent) feel that they are compensated fairly. Satisfaction does not correlate perfectly with average compensation, as physicians in some of the lower-paying specialties are among the most likely to report that they are satisfied. Physicians who work in Psychiatry (68 percent), Dermatology (65 percent), Public Health and Preventative Medicine (65 percent), and Critical Care (63 percent) are the most likely to feel compensated fairly. And, with the exception of Dermatology, none of the specialties fall within the top ten highest paid. Physicians working in Infectious Disease (35 percent), Ophthalmology (42 percent), Internal Medicine (43 percent), and Nephrology (43 percent) are the least likely to feel satisfied with their pay.

Almost three-quarters (73 percent) of physicians reported that they would choose medicine again and most would choose their specialty. Almost all Plastic Surgeons (97 percent), Urologists (96 percent), and Orthopedists (95 percent) would opt for their specialty again. The least likely to say that they would choose their specialty again are physicians working in family medicine (66 percent) and Internal Medicine (61 percent).

Physicians feel rewarded by their expertise and their relationships with patients, although they name many challenges. Just under one-third of respondents (30 percent) said that the work itself or “being very good at what I do” is the most rewarding part of the job. An additional 24 percent named “gratitude/relationships formed with patients,” and 19 percent said “helping others and doing good”. When asked about the challenges, physicians responded with a variety of items, including rules/regulations (21 percent), long hours (16 percent), dealing with difficult patients (15 percent), dealing with Medicare and/or insurers (13 percent), and working with electronic health records (13 percent), among others.

On average physicians spend 15.5 hours per week on administrative duties. This includes an average of nine hours on EHR documentation weekly. Specialists who spent an average of 18 (plus) hours per week on these duties, include Physical Medicine and Rehabilitation (19 hours), Critical Care (18), Internal Medicine (18), Nephrology (18), Neurology (18), and Oncology (18). On the other end of the spectrum, Anesthesiologists (9) and Ophthalmologists (10) spent fewer hours on administrative work.

Medical Students Offer Recommendations to Improve Medical Schools’ Ability to Promote Student Wellbeing

A group of medical students (Marie Walters, PhD, MPhil, MD1; Taiwo Alonge, MD, MPH2; and Matthew Zeller, DO3) recently published an article in Academic Medicine describing the challenges medical students have navigated during the pandemic. They noted that while some pandemic-era challenges were unprecedented, long-standing issues were also brought to light, and that medical schools can use learnings from this period to implement reforms that promote mental health and wellbeing within the medical student population.

Below are the authors’ recommendations. You can find the full article here. 

Improving Communications: The pandemic and the “intensified sociopolitical conflicts” affected students’ wellbeing and academic focus, and amplified the need for timely and transparent communications. The authors recommend that administrative leaders partner with student government to provide information, facilitate frequent and consistent town hall meetings, and incorporate the CDC Crisis Emergency Risk Communication (CERC) guidelines into communications. 

Adapting Preclinical Education: Prior to the pandemic, medical schools required students to attend daily, in-person activities that made follow through on any personal commitments difficult. The move to online learning provided flexibility, but it created a lack of differentiation between school and free time. It also created uncertainties around the curriculum’s ability to properly train and assess students in preclinical skills (e.g., physical exams, dissections). The authors recommend that schools maintain flexibility by making recordings of learning activities accessible to all students, provide discounts for proprietary study materials, remove attendance requirements and associated limited access to course materials, and continue to promote virtual networking spaces. 

Enhancing Support Services: An increasing number of medical students reported signs of burnout and some students, from communities more heavily impacted by the pandemic, were unable to return home for funerals or to assist with caretaker responsibilities. Student isolation made it difficult to find support from community, mental health, or wellbeing services. The authors recommend that schools put in place formal mental health checks for students, increase access to mental health support, and, should purely virtual learning need to occur again, offer virtual group clinical opportunities and study sessions.

Adapting Clinical Education: Pre-pandemic, many schools followed “rigid time-based curricula” that lacked flexibility to accommodate students’ outside lives. Students were expected to work while sick, and faced “blackout” days when they were not allowed to request time off. The authors contend that this rigidity is harmful to those who are “already disadvantaged due to financial, health, or social factors,” and recommend that medical schools continue the flexibility that the pandemic necessitated. The authors also say that schools should move to “individualized and flexible competency-based curricula” and/or allow students to make up missed mandatory activities.

Addressing Racialized Trauma: The pandemic provided a clear view of the disparities in healthcare and criminal justice, and created a period of trauma for students, particularly those identifying as Asian-American, Black, or Brown. The authors recommend that schools take a proactive approach to acknowledging current events and injustices in a timely and empathetic manner, noting that this should not just come from diversity offices, but by medical school leaders. 

Empowering Medical Student Activism: During the pandemic medical schools spoke out on structural racism, which amplified activism among medical students. Racially minoritized students took a larger role in this activism. This may have harmed racial minorities compared to non-minorities by taking away time to study or enhance their medical CVs in order to do critical activism work. The authors recommend that medical schools take more tangible action to promote diversity, such as increasing funding for DEI efforts, changing institutional policies to promote internal equity, and creating relationships with expert consultants or community leaders. The authors say that schools should also ensure, to the extent possible, that students engaging in activism are not harmed by spending time on these efforts. Additionally, schools should create strategic plans to improve on DEI measures with clear short-term, incremental, and long-term goals.

Early MCAT Registration Numbers Show Significant Interest in Medical School

The AAMC announced a positive outlook for future medical school classes. When the MCAT registration opened in early May, after having been closed in March and April due to stay-at-home orders, 62,000 people registered online. This is a significant increase from the typical 10,000 to 12,000 on the opening day of registration. Similarly, registration for the American Medical College Application Service in early March showed an increase of 50 percent (in the number of applications started in the same period last year) in the first three days. While not all these prospective students will submit applications, it does provide reason for optimism about the future.

President and CEO of the AAMC, David Skorton, MD, said, "We're very encouraged by students' strong interest in registering for the MCAT exam. We're starting to see hints of strong interest in people entering the field overall, even though it's quite early in the medical school application process. It is a great sign if this preliminary trend continues, because our country needs more doctors."

Proposed Federal Budget Will Negatively Impact Medical Students in Need of Loans

The average cost of medical school tuition, fees, and health insurance for the 2019-2020 academic year ranged from just under $38,000 for an in-state, public institution to $62,000 for private school or public school for non-residents, according to the Association of American Medical Colleges (AAMC). The median debt for students at graduation totaled $200,000. As such, prospective and current medical students should pay particular attention to how student loan funding and forgiveness will change as a result of the President’s recently proposed Fiscal Year 2021 budget. Below, are a few proposed budget changes that would directly impact medical students and residents.

• The capping of GradPLUS loans to $50,000 per year and no more than $100,000 in a lifetime. The AAMC says that 47 percent of medical students rely on these loans to fund their education. Capping the total amount allowed per annum and over a lifetime at these values, which are lower than the full cost of medical school, will force students to seek funding through private financing, which typically carries less favorable lending terms.

• The elimination of public service loan forgiveness programs. Currently, an AAMC survey of graduates estimates that about one-third of them are interested in pursuing public service loan forgiveness programs, which allows graduates—who work to benefit the community and make timely loan payments for ten years—to receive loan forgiveness. These programs are an important recruiting tool for many public-facing organizations, including inner-city hospitals, community health centers, and teaching hospitals, and is critical to providing healthcare services to communities in need.

• The cutting of Medicare funding for Graduate Medical Education (GME). The budget proposes funding GME solely through new grant programs from general revenues, rather than Medicare’s trust fund. However, the cuts to Medicare are so substantial that even given the new proposed funding stream, hospitals would be asked to absorb cuts of over $50 billion in funding, which could result in fewer physicians and resources at teaching hospitals.

Doctors Seek Additional Training as Technology and Big Data Converge with Patient Care

Classes in data analytics, artificial intelligence, and technology may sound like the course load of an MBA student, but a recently released report shows the immense value of this subject matter for medical students as well. The Stanford Medicine Trends in Health 2020 report entitled “The Rise of the Data Driven Physician” describes a future for physicians where data and technology are increasingly intermingled with effective patient care.

The report, which includes a survey of physicians (n=523), residents (n=133), and current medical students (n=77), analyzes how trends in medicine impact those on the front lines of patient care.  The health care sector, the report claims, is undergoing “seismic shifts, fueled by a maturing digital health market, new health laws that accelerate data sharing, and regulatory traction for artificial intelligence in medicine.”  And the report’s findings show that while there is acceptance and even enthusiasm around the benefits of data and technology among providers, there is also a real gap that exists between the training that physicians, residents, and students receive, and the demands of the evolving profession. Lloyd Minor, MD and Dean of the Stanford University School of Medicine says, “We’ve found that current and future physicians are not only open to new technologies, but are actively seeking training in subjects such as data science to enhance care for their patients. We are encouraged by these findings and the opportunity they present to improve patient outcomes. At the same time, we must be clear-eyed about the challenges that may stymie progress.”

The respondents appear keenly aware of the changes occurring within medicine and both physicians and residents say that they expect about a quarter of their current duties to be automated using technology over the next 20 years. Students predict that, on average, 30 percent of their duties will be automated. Further, just under half of the physicians surveyed (47 percent) and about three-quarters of the students surveyed (73 percent) say that they are currently seeking out training to better prepare themselves for innovations in health care. Among physicians who said they are currently attending training, the most popular subjects are genetic counseling (38 percent), artificial intelligence (34 percent), and population health management (31 percent). Students seeking additional training courses are taking advanced statistics and data science (44 percent), population health management (36 percent), and genetic counseling (30 percent) at the highest rates.

When asked about which innovations have the most potential to transform health care in the next five years, physicians as well as students and residents (grouped) were both most likely to respond with personalized medicine, followed by telemedicine. Both groups also see potential in artificial intelligence, wearable health monitoring devices, and genetic screening.

When the groups were asked about how helpful their education has been in preparing them for new technologies in healthcare, just under 20 percent of both students and residents (18 percent) and physicians (19 percent) responded “very helpful.” Current students and residents were more positive overall, with 58 percent responding that their education was “somewhat helpful.” Only 23 percent responded negatively. Among physicians, 36 percent found their education somewhat helpful, and the remaining 44 percent replied negatively.

The most notable gap, perhaps, is the one highlighted below, which showcases the difference between the perceived benefits of medical innovation for patients and how prepared the provider is in implementing that innovation. The two charts, students and residents (grouped) and physicians, show the group that agreed an innovation will be “very beneficial to future patients” compared to the group that said they feel “very prepared to use the innovation in practice.” Some of the gaps are marked. For example, over half of students and residents (55 percent) and physicians (51 percent) believe that personalized medicine will be very beneficial to future patients, yet only five percent of students and residents and 11 percent of physicians feel prepared to deliver it. Personalized medicine showed the largest gap between perceived benefit and preparedness for both groups, while virtual reality showed the smallest. Both groups feel very prepared to work with electronic health records, but there were lower levels of perceived benefit to the patient.

Gap Between Perceived Benefits to Patients and Provider Preparedness

This report demonstrates the changing nature of the medical profession, its current and continuing intersection with technology and big data, as well as the need to provide opportunities and training to medical providers so that they can use these innovations to improve patient care. Prospective and current medical students will want to carefully consider how they are using their time prior to and during medical school. It may be beneficial for them to spend time speaking with physicians and residents to gauge what technologies and research are driving change. Taking classes prior to medical school, in statistics and data modeling, as well as technology and AI may have a positive impact on their ability to bridge the gap between present demands and the traditional medical school curriculum.

UNC Kenan Flagler Provides Alumni with Strategies to Avoid Post-MBA Burnout

Earlier this month, the Financial Times published an article on workplace wellbeing and burnout. The article included the results of a reader survey on how employers support employees’ mental health. Two-thirds said that their work had a somewhat to extremely negative effect on their health. Forty-four percent said that they did not think their organization took mental health seriously and half said that they either didn’t know where at work to go or had nowhere to go if they needed support. While the survey respondents were self-selecting, the results show a significant issue with employer support of mental health, including stress, burnout, anxiety, and depression.

 The article warns us that the problem runs across sectors, but may be particularly relevant to graduates of law, business, and medical schools; the authors note that “Fields such as law, finance, and consulting seem particularly prone to intense, demanding workplace cultures, but the issue affects people in all sectors. One doctor dies by suicide every day in the US.” Similarly, Blind, an anonymous social app for tech employees, surveyed its users in May 2018 and 57 percent of the 11, 487 respondents said that they were burned out. Only five of the 30 tech companies represented had an employee burnout rate below 50 percent, and 16 of the companies had a burnout rate higher than the average (57 percent). Later surveys, also by Blind, found that 52 percent of tech workers responded that they do not have a “healthy work environment” and that 39 percent of tech workers said they were depressed.

The FT survey also found that reasons behind burnout clustered into four themes: overwork, cultural stigma, pressure from the top, and fear of being penalized. The article suggested that many experts point to an epidemic of overwork resulting from the common expectation that employees be available and responsive to client needs 24/7. “In his book, Dying for a Paycheck, Stanford professor Jeffrey Pfeffer posits that this crisis is getting worse over time, amid stagnating wage growth and an increasing reliance on the gig economy. ‘We are on a path that is completely unsustainable,’ Pfeffer says. ‘The CDC [Centers for Disease Control] tells you that chronic illness is 86 percent of the $2.7tn US healthcare spend. Many come from stress-related behaviours. If you’re going to solve the healthcare cost crisis, a piece of that solution has to go through the workplace.’”

In an acknowledgment of the intense positions that many post-MBA graduates find themselves in, Robert Goldberg, an affiliate UNC Kenan-Flagler faculty member, recently led an interactive session for UNC alumni to build awareness of and strategies for preventing burnout.

First, Goldberg encouraged alumni to explore various “energy zones” which, described below, he adapted from The Power of Full Engagement (Loehr & Schwartz, 2003).

• Performance zone: Passionate, enthusiastic, engaged, optimistic, alive, challenged, and absorbed

• Survival zone: Anxious, impatient, angry, irritable, defensive, fearful, and frustrated

• Burnout zone: Hopeless, exhausted, sad, discouraged, lost, empty, worried, and depleted

• Recovery zone: Calm, peaceful, grateful, relaxed, receptive, relieved, rested, and renewed

Goldberg said that to stay in the performance zone, you must enter the recovery zone before you enter burnout. As such, those in intense professions may need to spend time recovering every working day. This can be done using various energy management techniques, including physical (stepping away from the desk at regular intervals), mental (prioritizing competing demands), emotional (feeling valued and appreciated), and spiritual (connecting work to higher purpose). 

Finally, Goldberg addressed the importance of “personal resilience” to maintain strong performance, defining resilience as “the ability to become strong, healthy, and successful after something bad happens.”

Goldberg shared the following five factors, summarized below, for building resilience capability:

• Perspective: Take some space to view a situation, accepting the negative aspects and finding opportunities. “Recognize what can be changed and what can’t.”

• Emotional intelligence: Become present in your emotions and name what you’re feeling. Don’t feel guilt or shame over the emotions that you experience, but give yourself time and space to process them.

• Purpose, values, strengths: Be aware of the purpose that you find in your work, and how it relates to your larger moral compass. Use this awareness to stay centered during chaotic times.

• Connections: Form relationships with your friends and colleagues and give and receive support from this network.

• Managing physical energy: Take care of yourself. Exercise, eat well, and have hobbies and activities to engage in apart from your work.

Graduate students, particularly within business, law, and medical school, may want to consider incorporating these strategies into their lives now. Building healthy and sustainable stress management habits, within the hectic graduate school environment, will be good preparation for managing career stress, avoiding burnout, and maintaining wellness in the future.

Medical Schools Focus on Student Wellbeing and Mental Health to Reduce Burnout

In our recent newsletter, we highlighted the topic of burnout among today’s working population. Burnout, or the experience of chronic stress which leads to physical and emotional exhaustion, cynicism and detachment, and feelings of ineffectiveness and lack of accomplishment, remains a pressing issue within the medical student population. A literature review published in late 2018 “confirmed that suicidal ideation in medical students remains a significant concern” and cites studies showing that “medical students in their first year of studies have similar rates of psychological morbidity to the age-matched general population, but experience a worsening of their mental health as they progress through medical studies.”

Medical students and residents, who are often under intense pressure physically and emotionally, suffer from a lack of sleep, extremely long hours of work and study, as well as the emotional, life and death decision-making involved in the work. This is often compounded with a subconscious need to avoid seeking mental health professionals for fear of negative judgment from those around them or even endangering their medical licenses.

The accumulation of data on the mental health of medical students, coupled with the recent high-profile losses of medical students in New York City and California have spurred action and a recognition of the need for additional support for physicians in training. The Accreditation Council for Graduate Medical Education is promoting the importance of wellbeing, which goes beyond addressing burnout, and has compiled and posted a tools and resources page on its website: https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/Resources.

Moreover, many medical schools are showing that they too are committed to changing the culture of medical education to improve students’ wellbeing. Prospective students should pay particular attention to the following when further evaluating the schools on their list:

• Commitment to wellbeing: Many schools have codified their commitment to their students by creating wellbeing mission statements and making significant investments in wellbeing resources. At the Icahn School of Medicine in NYC, a wellbeing task force was created in 2016. In addition to creating a mission statement to focus momentum and drive steady action, the school has renovated student housing to include a wellness center.

• Accessible, confidential, and judgment-free mental health resources: This may include access to psychologists or psychiatrists, confidential check-in surveys or interviews, and/or counseling sessions during hospital rotations. At USC Keck Medical School and the University of Pittsburgh School of Medicine, mental health teams have been put in place to ensure the schools do not lose sight of the mental health and wellness needs of their students. Both are working to decrease the stigma around using mental health resources as well as increasing confidential mental health evaluations and services.

• Culture promoting a healthy academic environment: Some schools are taking tangible actions to create an academic environment that promotes rigor but not burnout and depression. Many programs also encourage collaboration, provide wellness curriculums, and promote comradery within the classes through social activities (appropriate for various personality types) and occasional days off. Examples include Duke School of Medicine’s wellness curriculum starting with a resiliency course at orientation, USC’s requirement for students to take several “mental health” days to combat burnout, and Icahn’s assessment and restructuring of grade distributions.

In September of this year, Weill Cornell is partnering with AAMC, AMSNY, and the American Foundation for Suicide Prevention to put on the National Conference on Medical Student Mental Health and Well-Being. It is billed as being the “first comprehensive, multidisciplinary forum to examine the mental health needs of medical students.” Change is underway and it is an exciting time to be considering medical school. However, prospective and current students must engage in the dialogue, stay informed, and ultimately commit to making their wellbeing and health a priority.

As Physician Demand Will Continue to Outpace Supply, Medical School Admissions Committees are Particularly Interested in Applicants Committed to Practicing Primary Care in Underserved Locations

The AAMC recently published updated results of its physician workforce analysis, which modeled physician demand and supply to project the needs of the 2030 workforce. The analysis shows that physician demand will continue to outpace supply, which will lead to a physician shortage of between 42,600 and 121,300 full time equivalencies (FTEs) by 2030.

Within primary care, the shortage is projected to fall between 14,800 and 49,300 physicians, which incorporates various assumptions about the supply and partnership of Advanced Practice Registered Nurses and Physicians Assistants in the future, as well as the current estimated need for 13,800 physicians to reconcile the primary care shortage from currently designated shortage areas.

Projections for non-primary care specialties, including medical, surgical and other specialties, show an estimated shortage of between 33,800 and 72,700 physicians. The greatest projected gap is for surgeons, which is between 20,700 and 30,500 by 2030. While the supply of surgeons is projected to stay steady over time, the demand is expected to increase. “Other” specialties, which include emergency medicine, anesthesiology, psychiatry, radiology, and others, has a projected gap of between 18,600 and 31,800.

The main driver behind the increasing demand for physicians is the growing and aging U.S. population. Between 2016 and 2030, “the U.S. population is projected to grow about 11 percent, from about 324 million to 359 million. The population under age 18 is projected to grow by 3 percent; the population aged 65 and older is projected to grow by 50 percent; and the population aged 75 and older is projected to grow by 69 percent.”[i] Similarly, on the supply side, the aging population of physicians and their associated retirement decisions will impact the severity of the gap. “More than one-third of all currently active physicians will be 65 or older within the next decade. Physicians aged 65 and older account for 13.5 percent of the active workforce, and those between the ages of 55 and 64 make up nearly 27.2 percent of the active workforce.” [ii] Physicians’ weekly working hours are also currently trending downward across all physician age groups.

The report also modeled access to care, which is another factor that may impact demand in the future. There are currently inequities in access to care based on geographic, economic and sociodemographic factors. While projected physician shortages based on these factors was not included in the long-term projection estimates, the 2016 models show that if the country commits to improving access to care for disenfranchised groups, the demand for physicians will be drastically increased.

The AAMC is currently advocating for a multipronged approach to address the physician shortage including the improved use of technology, team-based care, and delivery innovations, as well as the increase of federal funding for additional residency positions. The AAMC is clear that the U.S. government needs to act in the short-term to expand graduate medical education to address the long-term physician demand identified in the report, as physician training is a ten-year process. Federal funding for residency positions has not been expanded since the 1997 Balanced Budget Act. While there have been two pieces of legislation recently introduced (explained below), which would provide funding for additional residency spots,[iii] neither have gained much traction since introduction.

• The Resident Physician Shortage Reduction Act of 2017 provides comprehensive reform to federal funding for graduate medical education.
• Lifts the funding cap placed on the number of residents and fellows funded by Medicare
• Adds an additional 3,000 federally-supported residency positions each year for the next five years
• The Opioid Workforce Act of 2018 specifically targets and funds residency training for areas of critical need.
• Adds an additional 1,000 federally-supported resident positions over the next five years in hospitals that have, or are establishing, programs in addiction medicine, addiction psychiatry, or pain management

Prospective and current medical students should familiarize themselves with this report, especially when considering their future fields of study.  Many medical schools are echoing the demand for students interested in primary care, as well as those committed to working in rural or otherwise underserved locations; In 2017, the AAMC reports that nearly 30% of those entering medical school plan to work in an underserved area. Additionally, these topics are likely to come up in interviews and at networking events.  

The AAMC has committed to updating the projections on an annual basis and makes the report available online.

The final report for 2018 created by IHS Markit Ltd for the AAMC is available here: https://aamc-black.global.ssl.fastly.net/production/media/filer_public/85/d7/85d7b689-f417-4ef0-97fb-ecc129836829/aamc_2018_workforce_projections_update_april_11_2018.pdf

[i] https://aamc-black.global.ssl.fastly.net/production/media/filer_public/85/d7/85d7b689-f417-4ef0-97fb-ecc129836829/aamc_2018_workforce_projections_update_april_11_2018.pdf

[ii] https://aamc-black.global.ssl.fastly.net/production/media/filer_public/85/d7/85d7b689-f417-4ef0-97fb-ecc129836829/aamc_2018_workforce_projections_update_april_11_2018.pdf

[iii] https://www.forbes.com/sites/brucejapsen/2018/05/17/congressional-bill-would-add-1000-doctors-to-fight-opioid-addiction/#60926102684a

Waitlisted? Don’t Give Up Hope. Write a Letter of Intent.

News you have been waitlisted at one of your top-choice medical schools can bring a range of emotions. It’s not the desired outcome, of course, but the game isn’t over. Their admissions committee still sees you as a worthy applicant, capable of handling the rigors of the program.

The number of students who are admitted each year from the waitlist varies based on the school. Highly ranked and competitive programs will typically admit fewer from the waitlist than those further down in the rankings, as they will have a higher yield (acceptances resulting from initial admissions offers).

You can influence your chance of being selected from the waitlist of any school by continuing to showcase your interest in their program. Just as it is critical for medical schools not to overfill their incoming class, they do not want to have empty seats when the school year begins. Therefore, if you can show that you will improve their yield, a key component in medical school rankings, they will be more likely to send to you a letter of acceptance. Engagement with the program through visits and meetings with professors, admissions directors, and current students is an effective way to show interest. But don’t forget to craft a compelling letter of intent too. It should include the following:

• Meaningful updates since you’ve submitted your application. Did your research study finally get published? What have been the key takeaways in that internship you began in August?
• Reiterate your interest in the school by citing specific courses, experiential learning opportunities, professors, etc. that make sense given where you’ve been in your life and career so far and where you want to go. Why do you believe you are a good fit?  What will you bring to the incoming class? How will their program help you achieve your goals?
• Mention any experiences you’ve had on a campus visit/tour or during your interview that increased your commitment to the school.
• The Yield Protection Statement: “Medical School X is my first choice and, if admitted, I would absolutely attend.” If you can make such a statement, this will be the most impactful component of your letter.

As the waiting game continues, keep in mind that many schools do not use “rolling waitlists.” Instead, they often wait until they have received final admissions decisions from prospective students on May 15th. After this date, prospective students will only be able to hold a seat at one medical school. While prospective students can withdraw from a school if they are accepted from the waitlist into a preferred school up to the point of matriculation, students cannot hold a seat at both schools.

Good luck!        

The Medical School Application’s Work and Activities Section: Key Tips to Consider Before You Begin Drafting

Crafting a compelling Work and Activities Section is an important priority for any medical school applicant. It will allow you to provide depth on your most meaningful experiences and communicate how a particular research position, teaching opportunity, or clinical exposure inspired your interest in the study of medicine. It will also give you the chance to show through anecdotes such characteristics as intellectual curiosity, adaptability, empathy, as well as your aptitude in critical and creative thinking, or your ability to thrive in a collaborative environment.   

The AMCAS application allows for a total of 15 entries, with three designated as “most meaningful.”  While all of the entries allow for a 700-character (including spaces) description of the activity, the three most meaningful entries include an additional requirement of 1,325 characters (including spaces) where you can provide further context on the perspective you gained and lessons you learned.

Key tips to consider before you begin drafting:

• Take advantage of all 15 entries, considering the various experiences you have had that influenced your decision to apply to medical school. To start, brainstorm and write them all down in chronological order, limiting yourself to college or post-graduate experiences. This section is purposely broad and can include activities from a multitude of categories (listed below). If you find that you do not have 15, carefully consider even one-day community service events that had a particular impact on you. Keep in mind that while not all experiences will be equally meaningful, several experiences are probably still worth sharing if they influenced your path in some way.

• After brainstorming all the potential activities, make note of the 15 most relevant, making sure to span a diverse array of categories. Pay particular attention, however, to clinical activities, research, and community service.

• When selecting your three most meaningful experiences, highlight first those that demonstrate a commitment to medicine and service to others. After that, consider work/activities that are unique and, therefore, will help differentiate you to the admissions committee.

• When you describe your work/activities, be sure to clearly articulate what you did and what the outcome(s) of your participation included. In your descriptions, highlight also the qualities that you used or developed through your involvement, noting your academic/intellectual growth, maturity, sound judgment, and compassion, as well as ability to interact well with others. It is also important to include, where possible, the impact of the activity on your decision to apply to medical school.

• After writing your descriptions, read them aloud, and edit. Confirm that you are within the allotted number of characters. Such a stringent character limitation emphasizes the importance of tight, clear language and perfect grammar.

The Work and Activities section gives the medical school admissions committee a summary of all those experiences that ultimately inspired your interest in and commitment to a rigorous, yet rewarding career path. Thus, it is vital to ensure each word moves your candidacy forward in a compelling way.