Medical school applications are climbing again after years of decline. More students are committing to heavy course loads and long hours to cross the finish line and earn their white coat.
What students don’t yet realize is that the clinical work of helping patients is only part of the job. The other, often more consuming, part is one that medical school rarely prepares students for: battling insurance companies, navigating changing health policies, and combating misinformation from all directions. That gap likely explains why applications to medical school are up while attrition among practicing physicians keeps climbing.
Across specialties, clinicians are hanging up their coats for good, and this drop-off shows no signs of slowing. Doctors are also leaving earlier in their careers, with the mean exit age dropping from 57 to 48. In addition, 11 percent never even practice clinical medicine after completing residency. I’ve seen it in my own specialty of neurology and headache medicine. Administrative demands are rising. Physicians are burning out.
I knew coming into the field that I would be working long hours. But I thought those long hours would be spent diagnosing patients, discussing treatment plans, and answering questions. Instead, my time is increasingly spent fighting health plans for the care my patients need. It’s an hour on the phone with an insurance company justifying my decision to prescribe one medication over another, only to hear that it won’t be covered. Another hour appealing that denial. And then, telling my patient, “I’m sorry, I need to prescribe you a different, less effective medication before your insurance will cover the one I’m confident will work.”
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That fight is wedging a gap between my patients and me. When they don’t know why care is delayed, that frustration doesn’t land with the system. It is displaced onto me. So, they turn elsewhere. To politicians promising simple fixes. To influencers promising fast ones. Can you blame them? An influencer’s answer arrives in 60 seconds. Mine arrives after delays, denials, and forced substitutions.
This is not the job that medical students are expecting. As a clinician and medical educator, I have the privilege of working with interns, residents, and early-career physicians. I’m humbled by their dedication, empathy, and brilliance. They are diagnosing, treating, and caring for patients. They are thinking critically, asking the right questions, participating in research, and moving science forward. Medical school has provided a solid foundation for those skills. Yet physicians are still not prepared for the practice of medicine within our health care system.
We need structural changes in medical school education that will prepare early-career physicians for the reality of practicing medicine. Medical school is rigorous. But as long as students spend four years training to become physicians, their curriculum should match the job. That could mean a health policy course, a lecture on navigating insurance, or a “combating misinformation” seminar.
Better yet, we need systemic reform outside medical school so that both physicians and their patients can experience patient-centered care. Not insurance-centered care. We need to restore the patient-physician relationship and rebuild trust in physicians as experts. Less paperwork and utilization management means more time with the patient, building a relationship and getting them the care they need quickly. Clinicians, patients, and the system all stand to gain. Without reform, patients will remain skeptical, and physicians, especially those just starting out, will look for their next career outside the exam room.
Everyone has a theory about why we’re losing young physicians. This generation doesn’t have the same work ethic. They’re lazy. Unwilling to put in the extra hours. But from what I’ve seen, that’s far from the truth. The pool of physician trainees is overflowing with talent and passion. We just need to ensure this next generation of clinicians can focus on patient care and be the force for good that attracted them to medicine in the first place.
The solution must be two-pronged. Physicians should be better prepared for the realities of the job, starting with updating medical school curriculum so they’re ready for what’s to come. We should also reform the system itself, reducing utilization management and insurance interference. With these changes, I have no doubt physicians will choose a lifelong career in medicine.
Amaal Starling is a neurologist.
