For patients, being patient can be the most difficult part of receiving health care. For some, this entails endless hours in a waiting room; for others, it includes anxiously awaiting insurance approval, test results, surgery, transplants and, sometimes, even death.
In medicine, patients are not the only ones who need patience. It is equally important that aspiring physicians and medical students learn to be patient; often that is easier said than done for the typical type-A pre-medical student. From the minute the application to medical school is submitted, candidates are forced to test their patience. Indeed, the application process is notorious for keeping applicants waiting as secondary applications, interviews and final decisions come and go.
Medical schools often operate via a rolling admissions process in which students may hear back at any time within a nine-month window of submitting their application. Therefore, a medical school applicant may hear back after mere weeks, or it may take many months to find out if they were either granted an interview, were not granted an interview or (everyone’s personal favorite) that the decision whether to interview will be made later. Students may subsequently have to wait days to months to interview, followed by more waiting to receive a “final” admission decision, which may in fact be that no admission decision has been made yet (decision deferred) or (most commonly) that their application has been added to the infamous waitlist.
Why exactly is the use of the waitlist so pervasive for medical school admissions? First, schools cannot risk “overbooking” a class. To do so would hurt the school’s “yield” — the percentage of accepted students that matriculate — and it is not as easy to add hospital-based learning opportunities for a larger class as it would be to, say, a large undergraduate economics lecture. Waitlisting also provides students time to strengthen their application. Finally, many schools use the waitlist as a softer way to reject students that had been interviewed. The precise numbers for students waitlisted followed by a rejection are not publicly available; however, there are reported cases where zero students were accepted from the waitlist.
One potential benefit of the waiting process is that it can make matriculated students more grateful for the spot they received, motivating students to learn and view the rigors of a life in medicine as a gift. This outlook could be advantageous for students embarking on an arduous training process followed by a demanding career. Another possible benefit is that the waiting can help select applicants with the dedication and perseverance to endure these periods. Finally, patience is a crucial quality for time-pressed practicing physicians navigating the day-to-day complexities and frustrations of the health care system. Treating patients requires taking the time to listen, providing additional explanations, and giving patients the opportunity to process the situation. In this way, teaching patience becomes central to teaching how to provide proper patient care.
Conversely, subjecting applicants to excessive waiting periods may be an unnecessary source of stress and anxiety for aspiring physicians. Stress and anxiety are not benign and are associated with significant social and physiological costs. Because the admissions process is a student’s first official exposure to the medical field, it is conceivable that the stress of waiting for an admissions decision may foster associations between medical school and stress, ultimately contributing to students being less satisfied with their career path. Given the link between stress and depression, these stressed-out students are more likely to become depressed over time, especially if their admissions outcomes are not favorable. It has also been extensively documented in the literature that anxiety and depression strongly correlate with suicide attempts. The fact that student physicians (before even beginning their career) exhibit a 15 to 30 percent higher depression rate than the general population is deeply worrisome. Stress that begins building up early in medical students’ lives may ultimately contribute to higher burnout rates, increased career dissatisfaction and the high suicide rates amongst physicians.
The issue of burnout in medicine clearly extends beyond medical school. It appears to be in part rooted in the culture of medicine. Some physicians suggest that “burnout” may actually be a euphemism for “depression.” Michael Myers, a New York psychiatrist who exclusively takes care of other physicians, states that the culture in medicine is such that “burnout is almost a badge of honor.” It comes as no surprise that approximately 40 percent of practicing physicians report burnout.
While it is clear that the issues of depression and anxiety extends well beyond medical school admissions, it is important to ask whether the application process is the beginning of a long and slippery slope toward a life of anxiety and depression. For this reason, perhaps an admissions system without extensive, ambiguous waiting would be a more humane alternative to the current arrangement. Changing the burnout culture can start at the very beginning — after all, if medical students are expected to be compassionate, the medical education system should teach by example.