In her KevinMD article, Janet Constance Coleman-Belin describes the overwhelming difficulties increasingly being seen by many during their medical education and now facing many more of our young, bright minds as they choose and migrate into their future life’s work.

I suggest that a majority of these difficulties are pressures witnessed and felt as these students begin to enter clinical workplaces—the same pressures being experienced by more and more of all hands-on health care workers—but having the greatest impact on those who make and will make critical patient care clinical decisions.

Burnout, depression, and moral injury have become overwhelming issues for health care providers. The suicide rate for physicians has now risen to over twice that of the general population and continues to escalate. Multiple other health care workplace disruptors weigh heavily on all those who are trying to provide care to our patients in an environment that increasingly makes optimal care delivery more and more difficult, while still remaining legally liable for clinical outcomes in these increasingly suboptimal patient care environments—environments for which they now have almost no control!

To add to all this conundrum for students is the huge debt burden and many years of non-earning time being accrued in order to be allowed to enter this fractious arena.

Some telling quotes from the Coleman-Belin article:

• “Far too often, we are met with poor teaching, bureaucratic hurdles, insufficient support, and a culture that prizes endurance over well-being.”
• “Many of my colleagues are crippled with exorbitant debt from this long path.”
• (During a counseling session) “Their well-intentioned responses included, ‘Half of the medical students are on antidepressants,’ and ‘Your feelings are totally normal; my classmate killed himself.'”
• “But, when I evaluate the personal, mental, and spiritual costs of not just finishing medical school but also thriving in residency and beyond, I wonder whether it’s truly worth it.”
• “I feel conflicted about pursuing a career path where antidepressants could be as essential as scrubs and stethoscopes.”

I recently heard from a colleague about their daughter who has just completed her four-year undergraduate work with a degree in business and marketing. She is obviously a very bright young mind, having been top of her classes from K–12 and valedictorian of her graduating high school class. She had investigated a career in health care, even shadowing a nurse, a doctor, and a dentist and doing summer and other part-time work in several health care venues. But after these further explorations, she decided on a business career degree.

I am told that one job offer she has now received comes with a starting salary (after a six-month training period) of around $350,000 per year plus a full, substantial benefits package. When I asked if this is some kind of executive senior management position, I was told that this is a starter business degree position with this company.

Now, I have no knowledge about business degree careers to know if this offer is an employment norm. But what bright young mind—in consideration of the seven-to-ten-year additional medical training time investment, with the attached debt economics and increasingly at-risk physical and mental health, versus increased potential for workplace happiness for themselves and for a future family—would now choose the destructive duress more and more frequently being seen in a health care career over an opportunity even vaguely similar to the one I just described?

My take

The abusive, destructive, and increasingly violent conditions we now see in more and more of our health care workplaces take their toll on all health care workers and now impact many of those considering or exploring health care careers.

Is it any wonder that a 2023 survey of medical and nursing students found that almost 25 percent of medical students, after experiencing the destructive nature of many of today’s clinical workplaces, reported seriously considering quitting and changing careers? An additional 61 percent of medical and nursing students said that they would complete their degree program but would never see a patient, choosing instead to go into alternative pursuits, such as research or administration.

Where will this all end up?

The shortfalls in current numbers of doctors, nurses, and other hands-on health care workers are already critical, and the exoduses out of clinical health care continue unabated. To add to this, the increasing numbers of young, bright minds that are now turning away from hands-on health care, along with the arrival of the upcoming population expansion bubble, will make these losses truly non-sustainable and will lead, if allowed to continue unchecked, to the rapid demise of our health care system as we know it.

Opinions expressed are mine alone and do not necessarily represent the opinions or stances of my employers or affiliates.

Harry Severance is an emergency physician.