Burnout’s Roots May Lie in Young M.D.s’ Expectations of Themselves

“Please go around the room and introduce yourselves,” the new workshop leader instructed our class of second-year medical students.

Without prompting, each student gave his or her name and planned specialty of choice. Among medical students, this was a common introduction, as if asking us our life plan was as much of an icebreaker as asking us to share a hobby or an interesting fact. As the students responded more enthusiastically and assuredly than those before them, my internal anxiety grew.

One classmate said “Dermatology,” another “Neurosurgery,” and then eyes turned to me.

In this moment I found myself questioning whether I deserved to be in the room with these overachievers who knew with certainty where they would be in four, six, and even 10 years. I ran through my CV in my mind, comparing myself with others, wondering how they got to be so much better, smarter, and more successful than I. I attempted to relax by reminding myself that we still had two years left in school, but it was hard to trust this thought. Instead, I found myself debating in my mind if it was even possible for me to catch up. This must be how burnout starts.

When I finally spoke, I bluntly replied, “I am not sure I even want to be a doctor.” With that statement, I threw a rock at my falsely serene surface.

Gasps and looks of extreme confusion or shock emerged around me. They were quickly followed by somewhat awkward laughs, as if my statement had to be a joke. Now I wonder if perhaps they were defending themselves against the possibility that they might actually share my uncertainty—and their laughter was simply a way of acknowledging their fear out loud.

But what are we all so afraid of? What is truly leading us to ignore our feelings until it is too late?

Perhaps there are certain expectations for what makes a “good” medical student that start long before we put on a white coat, and we are all desperately trying to be perceived as one. We can’t “just” get good grades and test scores—to be accepted, we must also excel in extracurriculars and show commitment to the career. We can’t “just” be in medical school—we must also be doing research in our chosen specialty and find a way to be unique among our star classmates. With students taking research years and obtaining masters degrees or Ph.D.s, is it any wonder that some of us are left with the impression that we can’t “just” be an M.D.?

With the bar set so high for ourselves, appearing “different” feels like a weakness, and showing uncertainty feels like a failure. Staring at the faces around me, I reacted with shame and guilt, not comfort or pride. Imagine if I had told them I was depressed; no wonder most physicians go untreated. And it’s no wonder that medical students who are shaped in this environment grow up to be burned-out doctors. There is always another paper, another patient, another shift, and someone else who we feel like is inevitably doing better than us. By the time we get a second to stop, after premed, med school, residency, and fellowship, life can feel pretty unsatisfying Without learning to make time for ourselves, or cultivate our own happiness, we are left burned out.

As it turned out, I was not alone in my feelings of loneliness and ostracism; I was only alone in talking about them. I believe that the expectation medical students bring to their careers (or that they acquire in training) to define ourselves by our accomplishments is hurting us.

No one should be suffering in silence. Instead, we need to redefine what it means to be a “good” medical student. This student should admit weaknesses, ask for help, and acknowledge imperfection. This “good” medical student should grapple with uncertainty and should be willing to share his or her story. This should be the norm.

It is time to become the norm. Consider the conversation started. ■