Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Residency match system and flexibility: the hidden factors behind burnout

J. Tyler Bates, DO
Education
July 15, 2023
Share
Tweet
Share

ERAS is now open, and medical students all over are compiling their applications to match into residency. As someone who is in a field they desired to pursue while in college but took a circuitous route there (four years as a generalist in the Air Force, practicing after completing an internship), I cannot help but wonder if some of our residency match systems is a contributing factor to burnout.

Many studies and articles have been written about burnout; this is not one of those to rehash EMR burden, insurance drama, or “wellness modules.” All those and many more contribute to our plight, but my thoughts are inspired by one of my favorite books, Range: Why Generalists Triumph in a Specialized World by David Epstein. One of the things covered in the book is “match quality” which is how well a job fits the person’s interests and values. In medicine and the residency match system, we risk not finding match quality which when compounded with the end-of-time illusion and sunk cost effect, can lead to burnout.

One of my favorite chapters discusses cadets at West Point. The majority of West Point graduates serve their required payback time for their degree and leave the Army. These cadets, who were selected while in high school and showed aptitude to be the future leaders of the Army, were leaving. Ironically, the officers that stayed the longest were Officer Candidate School (OCS) graduates, who came to the Army after college and already in their careers. After a failed attempt at a monetary bonus system, the Army started researching the problem.

Initially, they studied “grit” to see why they were selecting the “weak ones” that would not continue with Army service. They found their people had grit but were pigeonholed into jobs that did not match them well. These people had the knowledge and skills to do other jobs but were not getting that opportunity in the Army, so they left. The Army started allowing people to change jobs, and retention increased. With this, it was revealed that people change! Look back ten years ago. You were likely a different person and will likely be so in another 10 years. Not thinking you will change is called the “end of history illusion.” Where does the largest change happen? During the time between graduating from high school, leaving home, college, and the first part of a career … or typically someone’s 20s. Which also happens to be the time that people do research, stress about O-chem, volunteer, take the MCAT, and get into medical school.

Once in medical school, the typical changes of the 20s are compounded by exposure to different people, social inequality, and the realization that life is not black and white. Oh, and somewhere in there, the realism of medicine in America hits, along with exposure to burnout. When that realization hits, many are already $250,000 in debt and have poured out blood, sweat, and tears for thousands of test questions and multiple marathon-length tests. At this point, we are almost too far along to quit. We are so close; think of how far we have come and all that we have sacrificed for this dream! This is the epitome of a “sunk cost effect.”

As mentioned at the beginning, ERAS is now open, meaning newly minted fourth-year medical students are working on their residency applications listing their work, volunteer, research experiences, and any little thing to boost their application. They are working on letters of recommendation, of which almost all specialties require letters from the chosen field. These students have just finished third year, where they have done core rotations such as family medicine, internal medicine, surgery, OB/GYN, pediatrics, psychiatry, emergency medicine, and an elective. Some get true general experience in those, but some spend their internal medicine rotation in a rheumatology clinic. This means for many students, to get that letter of recommendation in time to submit for residency, they must schedule audition rotations when only halfway finished with third year.

Only about a quarter of medical students end up in the same specialty as they initially thought they would pursue. At this same time, we are seeing a bloating of extracurricular activities and research from students that are going into highly competitive residencies. This bloat results in some students networking to start research before completing their first medical school exam, let alone even seeing a patient in their chosen field.

I strongly believe that a well-rounded general medicine third year is great for our learning as physicians and allows for better exposure across specialties than other careers, such as the West Point graduates (though they now have more ability to retrain). However, as medicine continues this path to hyper-specialization and becoming more competitive, we are actively losing what we have.

We are never done learning, growing, and changing. With the medical education journey exceeding a decade in length, the end of history illusion is in strong effect, and the sunk cost fallacy keeps many stuck. Furthermore, cross-training in another field, like the Army started offering, is rarely an option for physicians. Medscape surveys show many physicians who would have chosen medicine all over again but would have done a different specialty.

While many things need to change within medicine, I hope we can allow ourselves and others to change. Third year needs to stay general! Non-traditional students need to be valued. Taking time to decide and experiment should be rewarded and not punished, as we allow medical students time to explore their interests prior to deciding on a life path. Maybe we should allow ourselves that exploration as well.

J. Tyler Bates is a physical medicine and rehabilitation resident.

Prev

How legal liabilities and skewed decision-making plague clinical encounters

July 15, 2023 Kevin 2
…
Next

Physician burnout is a threat, no different from the spread of a virus—here's how to fix it

July 15, 2023 Kevin 3
…

Tagged as: Medical school

Post navigation

< Previous Post
How legal liabilities and skewed decision-making plague clinical encounters
Next Post >
Physician burnout is a threat, no different from the spread of a virus—here's how to fix it

ADVERTISEMENT

Related Posts

  • What Caribbean medical students need to know about the residency match

    Samir Desai, MD
  • If medical students are already experiencing burnout, how are they going to survive residency?

    Misha Armstrong
  • To the AAMC: Recommend an interview limit or else this year’s residency match may be a disaster

    Jordan Hughes, MD
  • 9 ways international medical graduates can boost their residency match outcomes

    Heli Patel, Monica van de Ridder, PhD, Vijay Rajput, MD
  • Residency training, and training in residency

    Michelle Meyer, MD
  • How minor fixes can help with resident burnout

    Daniel Orlovich, MD, PharmD

More in Education

  • How listening makes you a better doctor before your first prescription

    Kelly Dórea França
  • What it means to be a woman in medicine today

    Annie M. Trumbull
  • How Japan and the U.S. can collaborate for better health care

    Vikram Madireddy, MD, Masashi Hamada, MD, PhD, and Hibiki Yamazaki
  • The case for a standard pre-med major in U.S. universities

    Devin Behjatnia
  • From rejection to resilience: a doctor’s rise through the Caribbean route

    Ryan Nadelson, MD
  • The hidden cost of professionalism in medical training

    Hannah Wulk
  • Most Popular

  • Past Week

    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • How federal actions threaten vaccine policy and trust

      American College of Physicians | Conditions
    • When the clinic becomes the battlefield: Defending rural health care in the age of AI-driven attacks

      Holland Haynie, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
    • How humor builds trust in pediatric oncology

      Diego R. Hijano, MD | Physician
    • Putting food allergy safety on the menu [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • Putting food allergy safety on the menu [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • Why “the best physicians” risk burnout and isolation

      Scott Abramson, MD | Physician
    • Why the Sean Combs trial is a wake-up call for HIV prevention

      Catherine Diamond, MD | Conditions
    • Why real medicine is more than quick labels

      Arthur Lazarus, MD, MBA | Physician
    • New surge in misleading ads about diabetes on social media poses a serious health risk

      Laura Syron | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • How federal actions threaten vaccine policy and trust

      American College of Physicians | Conditions
    • When the clinic becomes the battlefield: Defending rural health care in the age of AI-driven attacks

      Holland Haynie, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
    • How humor builds trust in pediatric oncology

      Diego R. Hijano, MD | Physician
    • Putting food allergy safety on the menu [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • Putting food allergy safety on the menu [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • Why “the best physicians” risk burnout and isolation

      Scott Abramson, MD | Physician
    • Why the Sean Combs trial is a wake-up call for HIV prevention

      Catherine Diamond, MD | Conditions
    • Why real medicine is more than quick labels

      Arthur Lazarus, MD, MBA | Physician
    • New surge in misleading ads about diabetes on social media poses a serious health risk

      Laura Syron | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...