Many people feel that their doctor may be dull, uncreative and tired most of the time. But most would agree that their doctors work hard and are caring. But why is healthcare and the practice of medicine so stuck in place, an outmoded system, lagging behind almost every other creative industry? Here are some of my thoughts on perhaps why doctors and the medicine that they practice remain overall uncreative, and slow-to-adopt improvements.
One of the most precious resources in medicine, is the physician. A physician may have experienced between 8 and 15 years of continuous structured medical educational training before stepping out into the world of independent practice. Here's what those years may look like:
Four years of medical school
An internship year
Three to five years of a specialty residency
Optional postgraduate research (obtaining a masters or PhD)
One to two years of a subspecialty fellowship
Yes, it is long and arduous. But it is also highly predictable as one moves from stage to stage. The expectations are well-known, the work-load is well-anticipated. The volume and intensity of clinical care is no surprise. Essentially, this step-wise and sequential training experience has no element of uncertainty, surprise or particular challenge other than the lengthy duration, fairly constant work-load which is also known in advance. The only slight uncertainty is moving from program to program through various application processes where there may be interviews and visits to programs so that you as a person may be reviewed. And then you move on to the next phase of training.
There is a range as to how hard one might work depending on the specialty – general surgery and orthopedic surgery is more rigorous from an in-patient and duty demands, compared to say psychiatry - but the commitment is the same. You are a well-anticipated track to reach completion to the final product – independent practice.
Over the years, I have heard this period of training referred to as ‘the lost decade’, often taking away the years of one’s 20’s and early 30’s. What happened? I don’t know, I went to school and showed up and worked and did as I was told so that I could move on to the next stage.
Potential Problems:
By the time doctors have completed this period of training, we have not had to use much creative juice; things are as expected in terms of one’s day to day. You rarely can be fired from training, you eventually get through it. There are few ups and downs, it is fairly consistent and the expectations of trainees are fairly mundane. Once in a while you may have a run-in with another faculty member, or experience an exciting personality clash or have a falling out with a program director or have a run in with the law. Not many of us have had that kind of excitement in our training period.
But I would say that running into challenges can be healthy and even offer an enriching experience although highly unpleasant at the time. Having uncertainties along the way as part of the job - the possibility of being unemployed, having a tremendous failure (for example, being fired and then having no income) - may help people grow. The security of the physician training period, requiring mostly that one apply oneself, shelters doctors from career growing pains that build personal strength. People who find themselves in riskier work circumstances may be forced to be creative. Doctors just don't face these types of issues during the decade of training that is required.