A Good Cause

May 25, 2007
Surgical Rounds®, August 2006, Volume 0, Issue 0

Bernard M. Jaffe, Professor of Surgery, Tulane University School of Medicine, New Orleans, LA

Bernard M. Jaffe, MD

Professor of Surgery

Department of Surgery

Tulane University

School of Medicine

New Orleans, LA

a good cause

As a 4-week clerkship on my surgical service was ending, I chatted briefly with the medical student on rotation and told him I had lied on his behalf earlier that day, reporting in my evaluation that he was an excellent student (which he actually was). He replied that he was worth it and the “lie” was for .

a good cause

Obviously, medical students are . They are the future of our profession and deserve all the encouragement, support, and assistance we can provide. Medical school was a tough road when I attended more than 40 years ago, but I’m convinced it is a lot harder now. I cannot begin to recall the number of times I have been asked if either of my children opted for a career in medicine. Although both of them have chosen demanding professions—Mark in the computer industry and Debbie as a college math professor—they shied away from medicine because of how difficult it was (or seemed).

One of the most obvious reasons medical schools are tougher now than in the early 1960s is because there is so much more to learn. Although we thought that science was spectacular 40 years ago, it is breathtaking to realize how far we have come. The helical structure of DNA had been described, but sequencing it was only a dazzling dream. As students, we were taught the number of chromosomes in the human nucleus, but not where deletions or truncations caused specific diseases, and genetic engineering was not yet even a dream. The structure of antibodies, types and functions of specific immunologic cells, the spectrum of chemical mediators, and molecular biology and its methodology are but a few examples of information that today’s medical students are required to learn which were not in the curriculum for my generation. To further complicate the situation, rather than correspondingly prolonging the time devoted to medical student education, curricula have virtually all been shortened in the interest of kinder, gentler lifestyles. Go figure!

The style of education has also changed over the past 40 years. Gone are the days when faculty spent all their time actually teaching. The fiscal realities of today’s medical system require that faculty earn their own keep, either through research grants or by clinical practice. Recognizing they are not being paid by the university to teach, many faculty members give short shrift to their educational responsibilities. Medical schools have yet to comprehend the adage “you get what you pay for.”

I completed medical school owing what I considered to be a small fortune. My wife, Marlene, was a student herself during most of my medical student career, and even with a fulltime job, I could not generate enough funding to pay NYU’s tuition and live. My debt, however, was miniscule by current standards, even when adjusted for today’s dollar. Most students graduate owing $200,000, a simply staggering sum, and to compound the problem, most have to start repaying the principal upon graduation, whereas yesterday’s loans were deferred until residency was completed. This fiscal burden is one of the major reasons many bright students elect careers in fields other than medicine.

When I obtained my medical degree in 1964, my fellow students and I expected to earn a handsome living, even in academics. While that was not the main motivation, we had a level of confidence and financial security that is denied today’s graduating students. Reimbursements have been drastically cut, making it much harder to earn a comparable living. Public confidence in the medical profession has also severely eroded, and young physicians do not attract the same level of respect in their community. Unfortunately, these disadvantages are not likely to be reversed in the near future. In fact, the only major change I can foresee is the possible conversion to a socialized system in which physicians will function more as employees than practitioners.

Yes, medical students are a good cause. With increased educational re­quirements, more debt, and somewhat limited financial and societal horizons, they need all the help we can give them. To be selfish, those of us who are aging need assurance, after all, that superb physicians will be available to provide the same quality of care that we have offered our patients throughout our careers.