“There are, in truth, no specialties in medicine, since to know fully many of the most important diseases a man must be familiar with their manifestations in many organs.”
—William Osler, The Army Surgeon, Medical News, Philadelphia, 64:318, 1894.
The focus of the modern day medical student has shifted from the broad to the specific. In keeping with the demand of the day, today, no med student just wants to be a doctor. Talking to the freshly minted first years in my medical school a few days ago, I realized they all wanted to be Neurosurgeons or Interventional Cardiologists or Cardiac electrophysiologists, and other such super-hyper-specialized stuff. No one just wanted Medicine or Surgery…
It is understandable given the propensity of society to pigeonhole doctors into brackets based on their levels of super specialization. The more training, the more degrees, the smaller a body part you deal with – the more the oomph your name carries. There seems to be a different tune to strut to for the ones on the top of the totem pole.
Let us not just blame the med students and recently qualified doctors for aiming high. Social, financial and academic pressure to specialize has become a part of the very fabric of medical education. Add to that the fact that med students are essentially very competitive people who will fight their way up to the top… and we have a malaise that has been setting in over a period of decades suddenly manifesting itself: The primary medical degree, MB BS, is pretty much a vestigial degree unless suffix more qualifiers to it.
Two letters to change your life!
The obsession with super-specialization has spawned a vicious system where immediately after completing their MBBS degrees, med students start to prepare for the Post Graduation degree. Internships, Junior Residencies in a discipline of one’s liking are no longer the de rigeur of a qualifying doctor. The essential thing is to get ahead enough in the rat race to book a seat in the race to get a post graduation degree.
And once post graduation is done, the race for a super specialization in the form of an MCh or DM degree begins.
In the mad rush to secure our futures, as doctors, we end up spending as many as 12 years just plowing our way through degrees. No matter how good a doctor you are, how sharp your clinical skills are, without the artillery of degrees trailing your name, the system rejects you. And hence we spend years in getting in and out of rat races without essentially furthering our careers all the time.
Maybe this is an overtly pessimistic stance that I am taking, but the fact remains this unhealthy obsession for recognition dogs us all. Some get it. Some give up the towel and settle for lesser. However, with more and more opportunities springing up every year, it becomes imperative to note that the scarcity of Internal Medicine guys keeps growing. The super-specialized departments keep growing apart from each other with one discipline hardly speaking the lingo of the other. The patient keeps getting shunted from one room to another, feeling like a machine with a malfunctioning set of gears rather than a complete human being. And of course, the urban-rural gap keeps increasing… surely, if I spend 10-12 years just getting my degrees, I deserve to stay in the cities to mint money?
The MB BS is a degree that is glorified only on paper. In reality, it is worse off than the appendix.