A faculty-wide email recently announced that shadowing in our emergency department would no longer be recognized as a valid educational activity. I wrote back asking why. The reply was brief, dismissive, and telling:
“It doesn’t pay the rent.”
That line has stuck with me—not just because it was flippant, but because it revealed something deeper about how we now view education.
Shadowing has long served as the first bridge between curiosity and calling in medicine. To remove it—especially under that justification—is to admit that education now serves the spreadsheet more than the student.
Medical education should be driven by mentorship, curiosity, and the call to serve—not financial metrics or bureaucratic efficiency. People teach because they care. Because someone once cared for them. We become educators not for the payout, but because we remember what it meant to be mentored. Yet decisions like this send a different message: That unless something is billable, trackable, or incentivized, it has no value.
That’s not education. That’s business.
Shadowing matters. It is the earliest window into the physician-patient relationship. It gives prospective students a real glimpse—raw and unvarnished—of what it means to be a doctor. The smell of the ED. The silence after bad news. The weight of a decision. These are things you can’t learn from a podcast or a social media feed. You feel them. And once you do, you either step toward the fire—or you walk away. That’s the point.
Dismissing shadowing because it doesn’t “pay the rent” ignores the fact that many of us only made it into this profession because someone once let us look over their shoulder, stand quietly in the corner of a trauma bay, or follow them through a long overnight shift. These moments don’t show up in EVU spreadsheets—but they plant seeds. They inspire futures.
Yes, we must be mindful of resources. And yes, tuition-paying students deserve our time and effort. But do we really believe that early exposure disincentivizes teaching? Or is the deeper issue that we’ve lost the plot—confusing education with deliverables, and mentorship with liability?
We now ask if teaching is worth it unless it’s counted. Unless it appears on an accreditation report. Unless there’s a line item or a payout. That’s a dangerous shift.
We’ve built entire systems around hard metrics: RVUs, EVUs, evaluations, outcomes. But we’ve neglected what the military long ago named as equally critical—soft skills. A hard skill is knowing how to fire your weapon. A soft skill is knowing when to put it back in the holster.
If we start closing the door to medicine for those still on the outside looking in, we lose more than just potential applicants. We lose perspective, diversity, and the humility that once defined our profession. We reduce teaching to a transaction and mentorship to an obligation.
That should worry us.
Because when we exclude the curious, we betray the very spirit of education. We send a message that there’s no place for wonder here—only dashboards and deliverables. And we forget that somewhere, someone like you or me is still waiting for a first chance.
Shadowing may not pay the rent.
But it invests in something even more valuable—our future.
Matthew Ryan is an emergency physician.
