I was talking with a pre-med student recently.  He had completed his very first medical school interview and was, understandably, excited.  But he told me the interviewer had asked him what he thought would be the outcome of the current health-care reform measures.

I laughed to myself.  After 17 years in practice, even I don’t know the outcome, though I have my suspicions.  It seemed a loaded, almost unfair question.  After miring students in biology, physics, chemistry and every known application-padding activity, after expecting volunteerism and activism, I’m not sure why they would expect this young man to have any earthly idea about the reform measures from his current position in the medical biosphere.

But I wondered, since I’m not a medical educator, was there a right answer?  And I wondered even more, what do we want in our future physicians?

Since I can’t speak for the young man’s interviewer, I’ll give the benefit of the doubt.  I suspect that he was trying to see if he could think, if he had a courageous opinion, one way or the other, about a controversial topic. Like one of my residency interviewers who asked my opinion about giving abortions to minors without consent; which led to a brief disagreement … and to my attending a different residency.

I hope that the interviewer wouldn’t have doubted the young man’s capacity if he had said, ‘I’m for repeal!’  I don’t know the details of his answer, but I doubt if that was his opinion.  Pre-med students aren’t known for their valient, unpopular stands on social issues.  Pre-med students tend to follow the current that ends in medical school, and do their best not to rock the boat.  I know that’s what I did.

I do know that the pre-medical students I meet are very energetic, very savvy, very enthusiastic.  But what sort of enthusiasm do we desire to see in them?  In times past, we sought physician candidates who were self-motivated, independent in thinking, courageous in uncertain situations:  not always right, but always confident.  Is that what we still want?

Speaking from private practice, I would say yes.  I want future partners who are bold, who have solid opinions that sometimes fly in the face of government and culture.  I want partners who have their own set of moral values and abide by them, despite the trends and tendencies of society.

Is that also what we want?  Or is it better to have malleable students?  Is it better to have students who love rules and love following them?  Is it better to have students who adore government initiatives and are always willing to go lock-step into whatever reform, whatever ideal, whatever policy comes to them from on high?  Are they expected by admissions committees to be the kind of people who agree, or the kind of people who sometimes don’t?  Can they be admitted if they are politically at odds with their interviewers or future professors?

Maybe a better question is, what sort of student does the government want to see training as a physician?  I imagine they would like to see physicians willing to work more and cost less.  It fits budgetary priorities.

But I’ll bet they also want  physicians comfortable with that most horrible trend in American, and Western, culture. The trend of hyper-regulation.

I growl and grump against new rules all the time.  Against excessive time-outs, encrypted pass-words, too much data on charts and payment schemes too complex to understand.  Each new year seems to bring something else designed to cause me to retire early; as if I could.  But does it rankle the young?  Does it bother those who grew up with a surplus of rules the way some of us grew up with a surplus of heroes?

Does the country want physicians who find rules and regulations to be impediments to patient care?  Or does it want physicians who follow any rule if they’re told it’s a good one, and if someone (someone in authority over them) flashes a double-blinded, placebo controlled study to justify it?

I’m just asking; I don’t know the answer.  We used to choose physicians for their autonomy and individuality.  For their willingness to open their practices, do what they thought was right and serve within the context of their own morals.  The reward for their autonomy, and for their service to the sick, was their relative freedom.

What does the future of reform hold?  I don’t know.  But I do know it may require an entirely new species of physician.  Myself, I have a chilling sense of impending extinction.

Edwin Leap is an emergency physician who blogs at edwinleap.com.

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