To MD or not MD

A preamble to an existential MS3's year of clinical rotations

Hey friends and my 200+ subscribers on Substack,

My apologies for not writing for a while - I’ve been heads down gearing up for our most intense year in medical school, our clinical year which officially kicks off tomorrow in-person 🙌

As we recently turned the corner on the halfway point of the year (and also my birthday! 🥳 ) this past weekend, I was re-inspired to share a short piece of writing from last year as I head into this penultimate year of medical school. It encapsulates a lot of the uneasy angst I’ve felt from balancing a budding career as a healthcare technologist/venture capitalist and an aspiring physician-innovator - but moreover, it serves myself a reminder that there is meaning at the intersection of these two identities, and to embrace our self-complexity (a concept I actually learned about my very first week of medical school)

I haven’t come to terms with how this publication will evolve moving forwards as I become even more strapped for time between my clinical rotations and studying for shelf exams. But I am committed as ever to help those around me - whether in medicine or out of medicine, explore the other dimension:

• sharing insights, inefficiencies and disparities I see from clinical medicine on the ground floor with my friends working on improving healthcare with technology or streamlined services

• sharing health systems innovation frameworks with my provider friends and colleagues to better advocate for our patients at a systems level

I imagine future posts will be published more sporadically, and that these pieces will be less polished/structured, but the focus of this publication and arguably one of my lifelong goals will always be the same — highlighting systemic issues in healthcare and medicine and thinking critically + creatively about how we could address them.

Tomorrow, I’ll start my rotations on palliative care taking care of patients with life-threatening illnesses. Though I’m nervous to be starting with such an intense focus on end-of-life treatment, I’m also excited to learn how we can better address the many non-clinical and social aspects of care (some of which I’ve explored in this Margins of Medicine piece on hospice care).

Please wish me luck as I start tomorrow and send me a note if there are systemic issues you care about that I can keep an eye out for as I begin my clinical rotations. For those of you that maybe similarly struggle with balancing a clinical and non-clinical career - I look forward to any of your thoughts/reactions from reading the below 🙏 as I head into this next chapter of clinical training.

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To MD or not MD

That is the question. From existential premed to existential medical student, the question has continuously festered inside me for so long. It feels so selfish - to have such a coveted spot out of the thousands of applicants that tried to make it here, into any medical school, so I keep it to myself. It feels guilty and full of sunk cost - after everything everyone has invested in me to get here, the mountains of tuition, their time, their knowledge, so I keep it to myself. It feels so counterintuitive, to intentionally give up another career to pursue medicine - so why do I feel less confident about this decision even when I'm in medical school? It reeks of privilege - I should be so grateful for the opportunity I have in medical school and the safety net of another career to fall back on, so I keep it to myself.

I re-read my medical school essays when the question becomes too unbearable
wondering if I still believe the things I've wrote. The patient anecdotes and
memories that inspired me to reconsider medicine used to give me brief glimpses
of optimism but seemed so far away from the endless amount of material and
extracurriculars that I juggle. "It gets better 3rd year", they say - when you get to
experience medicine first-hand, when you finally can leverage our pre-clinical
knowledge in practice.

But the same voice that asks me that festering question speaks up again..."What
if it doesn't?" What if medicine doesn't match up to everything I hoped it would
be. What if I can't find the same joy and passion that I know I've already found
working in other areas of healthcare.

People ask me all the time why I decided to return to medical school, to give up such
interesting career opportunities and high-growth experiences. I rehearse the same lines that used to inspire me and others, but I wonder now if they're just empty echoes -- that I want to treat patients, that what I was building to serve patients were actually
abstracting me away from working with them, that the patients I wanted to serve most could never be served by the technology I once believed so much in.

These rallying words complement the brave and optimistic face I put on for so many peers and so many others earlier in their existential journey who ask me if its worth it. If the opportunity cost to leave another career is filled by the intrinsic joy of becoming a physician.

I tell people all the time that it's a personal decision. That going to medical school makes you better at one thing only - caring for patients; it's not medical school that makes you a better healthcare entrepreneur, a better healthcare investor, a better healthcare thought leader...pursuing those paths I always joke is better done spending 4-7 years doing exactly that.

But when I hang up the phone and reflect on my own words, the brave smile disappears and the doubts creep back in...I ask myself regularly, what if I don't end up enjoying practicing medicine? How will I know if I enjoy it more than what I know I enjoy outside of clinical practice? Would it be selfish of me to give it all up if I find out in third year that it's not for me, selfish to stick out the rest of my schooling just to get the MD?

To MD or not MD?

That is the seesaw in my mind. From medical student to working professional, I run
back and forth between these teetering obligations at work and school. Where do you
find the time people always ask? I crack an easy smile and repeat the rehearsed
answers "Our medical school classes are actually pass/fail and there's only 1 class at any given time to focus on" "Zoom university makes the balancing act easier now that the commute is gone" but in reality and under the water, I'm sometimes paddling twice as hard — Squeezing in meetings and work emails by day and catching up on classes and flashcards by night. Flipping between lecture notes and startup slide decks. Jumping from zoom small groups to zoom board meetings. It makes me more efficient, I tell myself - to timebox school and work into their separate calendar events. But some days I find myself running out of breath, the balancing see-saw tips over, the juggling act becomes unbearable - who do I think I am to that I can take up both seats on this seesaw?

On days like this I excuse myself from studying another hour or reschedule a few meetings I have the next day and I reframe this frustrating question into a statement:

To MD AND not MD

^that is the truth, and it always has been - I've lived more of my life not as a medical student and not pursuing this MD and this tension should not define me. Contrary to what my doubts may say, doing two things at once does not mean I will fail at both of them. There IS value in embracing both of my personas and a feed-forward energy that allows me to be present in work and school. And with MS3 and residency around the corner, I look forward to the day when school will finally feel like work, real and meaningful work, work that directly serves and helps patients.

So to whoever else is asking To MD or not MD - I believe that each of us have more to offer this world than than just our MDs. Whether you start now or later, I encourage you all to find our balance -- to MD and not MD.