This marks the beginning of season 2 where I explore how to make integrative medicine possible in our healthcare system from the inside out.
In this episode, I sit down with my guest, Alisha Harrington, to talk about how doctors are trained today, how we combined two models of medicine in our training to deliver whole-person care, and how we imagine changing medical education to create the integrative physicians of tomorrow.
Alisha and I are each trained in Chinese and Western medicine, but we had to gather our training in different ways. Alisha is currently a fourth-year medical student at Western University COMP Northwest, an osteopathic school in Oregon. She is training to become a board-certified family physician after practicing as a licensed acupuncturist for nine years. I, on the other hand, went to medical school and residency, first, to become a family doctor, and then trained in Chinese medicine to become board certified in both fields.
Rethinking Medical Education
Imagine a healthcare world where you have the choice to get healthcare from one doctor with training in both traditional Western medicine and Chinese medicine. I’m not talking about a wellness clinic because most of these clinics are made up of practitioners trained in different ways and they bill you separately. If you have struggled to coordinate your healthcare team or spent as much on your health from both conventional and unconventional practitioners, you are not alone. In fact, this problem has been around for decades.
A 1993 landmark study from the New England Journal of Medicine reported that in 1990 “Americans made an estimated 425 million visits to providers of unconventional therapy. This number exceeds the number of visits to all US primary care physicians (388 million.)” Nearly 30 years later, little has changed in the demand for additional types of care and there are far too few medical doctors who practice more than just traditional medicine.
The Impacts on Your Third Opinion
Integrative medicine is an approach to healthcare that brings together conventional ( or Western medicine), lifestyle and complementary medicines (like Chinese medicine) in a strategic way to address the whole person. That’s like giving your auto mechanic more tools and knowledge to choose from when working on your car rather than having to take your car to two different mechanics to fix it. If your doctor knows about other types of medicine, especially ones you are seeking, they are more likely to listen to you and guide you to a healthier self.
If you want your physician to be able to practice integrative medicine, a lot needs to change in the healthcare system. The most fundamental changes have to start with the way people are trained as doctors. Did you know that there are no medical schools in the US that offer both kinds of training unless someone does this on their own by completing separate programs? That’s not only expensive, it’s preventing most physicians today from even considering it. The history of this is really complex, the separation of these types of medicine was intentional, and it’s worth knowing about how and why it happened. You can learn about it in an upcoming season 2 episode. Stay tuned!
In this episode, Alisha Harrington and I discuss:
- The definition of an osteopathic doctor
- The difference between how medical and osteopathic doctors are trained
- The difference between training as an acupuncturist and as a physician
- How rigorous medical training is for traditional doctors and the sacrifices they make to their personal health, which leads to:
- Increased rate of physician suicide
- Poor lifestyle
- Not being a good role model for patients
- What makes integrative training so beneficial for patients and doctors
- How integrative medical schools might be possible
- More reform should happen in the way doctors are trained in order to:
- build resilience
- prevent burnout
- Address patients needs on a more holistic and individual level
New England Journal Of Medicine report in 1993 on the patterns of use of nontraditional medicine in 1990 compared with traditional medicine: Unconventional Medicine in the United States — Prevalence, Costs, and Patterns of Use
Barbara: Welcome to Third Opinion MD Podcast. I’m your host Barbara de la Torre. I’m an artist and integrated physician asking questions about why we live with the healthcare system the way it is, I teach you ways to navigate the system, and I want to empower you to adopt self-care measures to ease your dependence on the system so that we can change it together.
We are going to move into the conversation of what makes a doctor. I’m bringing in a dear friend of mine, her name is Alisha Harrington. She is a fourth-year medical student at an osteopathic school in Oregon. The two of us have had integrated training. Alisha is now finishing her second phase of her integrated training as an osteopathic physician; she’ll be graduating in 2023. We’re going to have some very engaging discussion about: can we do this differently? Do we have to continue medical school the way it is? The way people are talking about doctors and their healthcare experience, I think it’s time to think about reframing education.
Welcome, Alisha. Tell us where you’re going to school right now.
Alisha: I go to Western University COMP Northwest in Lebanon, Oregon.
Barbara: You’re in your fourth year of osteopathic medicine.
Barbara: One of the reasons why I wanted to bring you on the show is that I went to medical school to be a medical doctor and then studied acupuncture in addition to that, and you’ve done it the other way around. You studied acupuncture and then went on to practice, you were in private practice for a while.
Alisha: Yes, for nine years.
Barbara: Wow! What made you decide to go to medical school?
Alisha: Becoming an acupuncturist, I felt like I had a really good skill set to help with their physical illnesses as well as emotional illnesses, but I didn’t really feel like I understood what was going on at the underlying level of their health. So, I wanted to go back to school so that I had a better understanding of what was going on with my patients so that I could really help address their specific needs, and I really wanted to have a broad scope of practice being able to help patients on every level. I felt like I needed to be a physician to do that.
Barbara: I think I want to clear some things up. I might even play devil’s advocate a little bit on this one. When you’re saying playing to their specific needs, what kind of specific needs were missing when you were practicing acupuncture?
Alisha: When I was practicing acupuncture, they come from a healthcare system usually. You’re not usually seeing patients who haven’t had any healthcare previously. Patients would come in with a medical diagnosis, they would be on medications. I didn’t really feel like I knew what those medications did and what the potential effects of them could be that would be affecting my treatments, maybe limiting my treatments, or that my treatments such as herbal medicine might have a negative effect with their current medications. So, I didn’t feel like I had enough knowledge about what they had going on with their medical conditions and current treatments when I was seeing them as an acupuncturist.
Barbara: Essentially, what you’re saying is that you wanted to learn the other language that’s out there.
Barbara: It’s so interesting because a lot of people will go to acupuncture and think of it very separately. You and I are kind of different, where we think about you really have to understand what both sides are doing so that the patient doesn’t get harmed, for one, or redundancy doesn’t happen where they do the same thing.
What I also find interesting is I tried to reach out to some acupuncturists, and I remember one time I was reaching out to one saying, “Can you send me a report of what you’re doing,” and they almost doubled over like, “Are you kidding? No one asks us that.” It took a little while to adjust to that, but then I was getting those kinds of reports because I really wanted to know. But that’s not happening in general, so that makes perfect sense that you’re wanting to adopt both.
I’m assuming that you want to go into more of a general practice than a specialty. Is that correct?
Alisha: Yes. Right. I want to go into family medicine, and that allows me to treat patients of all ages and life stages and really work with whatever health condition may come in.
Barbara: I think that’s a really solid base. One of the things I wanted to ask is when you go to acupuncture school or when you did, how would you compare that to the medical school training that you’re getting now, how is it different?
Alisha: There are some things that are really similar.
We looked at different aspects of what acupuncture practice is or what Oriental medicine has to offer in terms of its skills. I had acupuncture training where we found the acupuncture points and learned how to use the needles. We had Tui Na, which is kind of a body work therapy that is the Chinese version of how we work with the musculoskeletal system. We also learned herbal medicine, which I guess would be akin to the pharmaceuticals that I learned in medical school. And nutrition, as well as other diagnostics, and as well as qigong.
In medical school we have a different kind of style. We have the clinical skill set, which is like how to use the stethoscope and a sphygmomanometer.
Barbara: You can’t use those big words here, by the way, without stopping to say what that is. [laughter] Let’s go back. Like a stethoscope or a blood pressure cuff…
Barbara: Slow down, med student. [laughter] I love those big words. There are some similarities, I agree. I think one thing that’s interesting is the nutrition part. You mentioned nutrition. I remember in medical school that we had maybe one or two nutrition classes. Was it different in acupuncture school?
Alisha: It was very different in acupuncture school. We had a whole bunch of nutrition classes. It was about not only what each food did energetically, like how we could use such things like a radish to help dry up phlegm, but we would also talk about how to create a nutrition program for a patient. It was pretty extensive in my acupuncture training.
Barbara: I’m going to go over a season on nutrition in Chinese medicine. It’s a whole, huge, amazing and elegant topic. One thing to keep in mind, as we’ll talk about things when we talk about nutrition, what Chinese medicine does is it translates food into pharmacy because each food has a particular property.
Let’s talk about the word energy. If we talk about energy flowing smoothly in your body means healthy, then you want foods that are energetically matching the condition or helping to complement the condition or energetic pattern you have. People come with an energetic makeup already when they’re born and then they acquire things, we call that a constitution. Then there are energetic properties of foods that you can match so that you are not making yourself worse, you can actually have the opportunity to improve.
That’s what all of these nutrition classes were?
Barbara: It’s hard to really simplify into one paragraph of what it is, but that’s the basics. We’re trying to tailor it individually to people. That’s one of the things that I think is exciting in your background, that you got to learn all this stuff about nutrition. It’s a whole branch of Chinese medicine called Chinese dietetics. Kind of like when we think of specialties, like you go to the orthopedic surgeon or the gastroenterologist, in Chinese medicine they have several branches.
We talk about acupuncture, and that’s what most people assume acupuncturists do, but actually they’re Chinese medical doctors. You were learning things like nutrition, that’s one branch, body work like Tui Na, moxibustion is another one where you’re taking mugwort and heating it either directly or indirectly onto areas of the body where the points are. Then there is herbology, that’s your pharmacy.
Pretty exciting. So, you noticed some similarities. How was nutrition?
Alisha: We’ll talk about the core curriculum that I had. We did a very minimal amount of nutrition. I think the standard is about six hours of nutrition content is what medical schools are trying to offer.
Barbara: That’s an improvement from when I was in medical school in the early 2000s.
Alisha: I think that’s the average across the country, so I think there are some who definitely do less and some who do more. We have a professor at my school who was a big proponent of lifestyle medicine, though, so we got to have a whole elective. Once a month we had a two-hour course on specific nutrition. It was after school, so it was like 7:00 PM. There was always a dinner, a plant-based nutritional meal. We got to talk about the content of the food.
Barbara: Was that free food?
Alisha: It was free food for medical students.
Barbara: For medical students that’s like bonus, that’s really good.
Alisha: It was always full. We had probably 75 to 100 students there every month who just went for this extra nutrition lecture. Maybe it was the free food, but it was excellent that we got to talk about nutrition.
Barbara: Hey, it gets people in the door. This is the thing. A lot of people I ask, they think these doctors don’t care, that they don’t know these things. They want to know these things. We wanted to know these things.
Medical school, whether it’s osteopathic school or traditional medical training, it’s still four years either way. There’s this saying that when you’re learning all this information in such a short amount of time it’s like drinking water through a fire hydrant. That’s the expression. The other expression is you pee when you can, you eat when you can, and you sleep when you can, meaning you’re so busy you’re running around like crazy to get things done.
Alisha: It’s a lot of material that you have to take in at one time.
Barbara: We keep learning. It really should be a longer period of time, because med school is not enough. You graduate, you don’t really hang a shingle. You technically can after a year of residency and call yourself a generalist, but just about everyone gets a residency type training, which is a minimum of three years generally, and can go longer with fellowships.
One of the things I was wondering if you could tell me, what’s the main difference between an osteopathic physician and a medical doctor?
Alisha: One of the big differences is that we do osteopathic treatments, which are a form of working with the structure of the body. We work with the skeletal structure as well as the soft tissues, and osteopathy is that practice. We also have these four tenets that guide the rest of our treatment. That is the idea that structure and function are interrelated and that the body has the innate capability of healing, and that our rational treatment should be based on those concepts.
That kind of goes along with the model of osteopathic medicine, that we need to address the body as a whole and we need to look at the interrelated parts. There are several other ways that we can look at that, so osteopathy also has the five models where we look at each system and how it’s interrelated and try to approach an effective treatment by addressing the aspects which are important to getting the patient back to a whole.
Barbara: You can go to osteopathic school and still be able to apply to the same residencies as someone going to medical school. You’re called a DO, I have an MD degree, but we are equals. That’s one thing that is commonly misunderstood.
You’re in such a great time right now. There’s a lot to do with politics, who is lobbying and who is defending their right to practice medicine. The history of medicine in the United States, you can see there were some that made it and some didn’t, but the osteopathic schools did and I’m really happy about that.
I didn’t go into osteopathic school because at the time, I think it was late ‘90s, I remember seeing something in the news where on the cruise ship off the coast that somebody got sick and they complained there wasn’t even a doctor, there was only a DO on board. That is a doctor, so they misunderstood.
I remember at the time I was wanting to study acupuncture, so I had a serious talk with mom and said, “I don’t want to go to medical school. I want to go to osteopathic school.” We both decided it was best probably that I went to medical school, because otherwise I might have faced some stigma at the time for pursuing two things that were misunderstood.
Alisha: There is definitely still some worry, especially among students. That kind of comes because there is still some judgment from the MD schools and MD residency programs. When you apply to a residency program, just the fact that you went to an osteopathic school sometimes does make it hard to get into certain residencies, especially certain specialties.
Barbara: Which ones are the ones that are notorious for not understanding or for having bias?
Alisha: Essentially, everything except for family medicine. [laughter]
Barbara: You know what’s so ironic? I feel like you guys actually have a more diverse education than the standard medical schools do because of that incorporation of structure and the interrelatedness of the systems.
Alisha: Yes. We have the same content as a regular medical school, except for we have 200 extra hours that we spend learning about the structure of the body and different techniques that we can use to address that. We’re actually better than medical school.
Barbara: You can go ahead and say that here on this podcast. That’s what I want to highlight. First of all, it’s ridiculous. The schooling that we have is rigorous and it’s stressful, and it’s not conducive to healthy living, which I think is kind of ironic. The second thing is that once you get all of the schooling done, no one can be expected to memorize everything. I’ve had some people say, “That doctor Googled. They don’t even know.” If you knew how much information people have to know, it’s really hard.
That’s why I emphasize so much that we have to know ourselves best, because if we don’t, there’s no way the physicians can help as much as they really optimally could. We have to know ourselves best.
Alisha: That makes a big difference. When a patient comes in and has an idea of what’s going on with them, it makes the visit faster, it allows us to get to the content that’s relevant quickly. Sometimes people have vague symptoms. If they’re not really aware what’s going on with them, we have to spend a long time getting to the bottom of it.
Barbara: Some patients have told me that they’ve been dismissed for coming in thinking they know what’s going on. I literally was told this yesterday when I interviewed someone. They said the doctor said, “I’m the doctor here. I’m the one that’s going to tell you what’s going on.”
Alisha: That’s so unfortunate, because it is a collaborative relationship and we as physicians are there to help. Dismissing your patient is not a good way to start.
Barbara: That’s why you have to have this real knack for navigating through the system, because if you don’t, then you can be targeted or labeled in a certain way. It goes both ways. Patients sometimes will…there’s all these terms like beating around the bush or circumferential history where you’re just kind of talking around it. If you don’t know yourself really well, you can’t say what’s going on. On the other hand, the doctors are limited on time, they’re trained to speak a certain language, and it’s almost like things get lost in translation.
Barbara: It’s terrible to be sick because it’s like being homeless in your own body. It’s a really awful feeling, especially when you don’t know or you’re afraid it’s something that you’ve dreaded or could be extremely serious, you don’t know.
You have one more year. Is it four years or are you taking a fifth year?
Alisha: I took an extra year where I’m teaching that osteopathic curriculum to the first and second year classes.
Barbara: Why did you decide to do that instead of going into residency?
Alisha: There are several reasons. First and foremost, I wanted to be really good at doing osteopathic techniques, so taking that extra year and getting extra training to do it was a really great opportunity for me to hone those skills before I go to residency.
Secondly, being able to work on my teaching skills, I felt was very valuable to becoming a physician because really “doctor” means to teach. To become a physician, I feel like I need to be a teacher so that I can help my patients. To learn skills where I can effectively deliver information to patients, I think, is very valuable to me.
Barbara: I agree with you 100%. You’re going to plan on continuing with acupuncture afterwards, I’m assuming.
Alisha: Yes. I will be practicing acupuncture in my family medicine practice.
Barbara: Are you going to work for a big corporation?
Alisha: I don’t think so.
Barbara: Easy answer. Here’s the funny thing, though. A lot of people when they graduate from medical school or osteopathic school, they’re really not faced with many options. A lot of times the option is to take a job with a big company these days. How are you going to manage going out on your own?
Alisha: I was lucky that I had an acupuncture practice that I ran on my own for nine years, so I feel pretty comfortable with the business side of things. To be honest, that really opened my eyes to the business of medicine, which is one of the main reasons I do not want to practice in a big corporation.
Barbara: Do you have friends besides me who have worked in corporate medicine?
Alisha: It’s interesting because most physicians, like you said, do end up working in a corporation and getting a job at least with a large practice, or even a small size practice that’s usually eventually bought by a bigger company.
Just talking to people who are new residents or people who are finishing their residency and ready to go out to practice medicine, the most common answer I get is, “I’m not really someone who would be willing to be practice in a private setting because I don’t want to take care of all of the business of medicine.” That answer to me just shows that we don’t give enough education in how to run a practice and is one of the reasons that we have physicians going to practice in these big companies, because they don’t feel comfortable dealing with the business side of things, so they feel like they need someone else to do it.
Barbara: Are you going to be doing that in your teaching, helping medical students, giving them the business side?
Alisha: Since I’m a Fellow, that’s my role, is that I stayed back to teach the students. We also do extra lectures on the side. For the other fellows, I’m trying to get more workshops on things like billing and coding and how to run a practice, because those are the things that I think scare most people from trying to open their own practice, but it’s actually super easy and there are tons of electronic health records out there that do it for you and make it really easy. Hopefully, the more people know how to do that, the more willing they would be to consider their own practice.
Barbara: There are ways to practice medicine without dealing with the insurance companies.
Barbara: That’s probably the easiest way to go. That’s the way I went when I went on my own. It is very difficult to be in private practice and take insurance as a physician in this country. It is not easy. It’s expensive. It’s cumbersome. There are many rules. That’s why a lot of people give up.
Like you said, with the lack of education, they don’t look into how it’s possible with direct primary care or concierge practices or things like that. Then we have to deal with the other problem of access for people because they can’t all access that. Some people do better with big systems because of the multitude of issues that they have. My hope is that, as people get more savvy with learning about who they are and lifestyle medicine and preventive medicine, that they won’t need such a convoluted system to take care of them.
I invited Alisha, and she was very gracious, I said, “Let’s go and meet some people outside,” and I started to ask questions…
Unidentified: I spent some time in China. When I went, I got sick while I was there in Beijing. I was running, because I was an athlete in college. I was running a lot. I went to the doctor because I was feeling super sick. There’s a lot of air pollution in Beijing, and I didn’t really put it together.
When I got in there, the first they say is, “Tell me how your regular day is from sun up, when you get up to when you go to sleep. Just describe it.” Taking notes the whole time I’m telling them what I have for breakfast, my activities, etcetera. They took all of that into consideration with my diagnosis.
Whereas my experience in Western is you go in and they say, “What’s the problem?” That’s all they care about is fixing a problem. They don’t care about your overall health and your overall day to day.
Unidentified: My impression of medical training, I never understood why they put them through the crazy hours that they do. It seems like that’s just a way to kill any actual interest in humanity and just force the science down their throats. There’s no time. Nobody can operate under that kind of stress.
Unidentified: It was a horrible experience. Then I did some volunteer work and I just really felt like most of the people in that business are in it because they need the work more than the clients do. I felt like they do more harm than good.
Barbara: I want to know how we can make medical education more integrative. I’m putting it out there. It needs to be integrative. If we can do that, how would you propose we do that?
Alisha: I think that giving medical students the opportunity to have electives where they get to experience some of the integrative medicine styles. For example, we as osteopathic medical students, went to OHSU, which is an MD school here in Oregon, and showed them what osteopathy was, and they all wished that they had the opportunity to learn it, all of the students who went. If medical students had the opportunity to learn things like acupuncture and had the opportunity to learn more about nutrition, I think they would take advantage of that.
As far as acupuncture training, I feel like acupuncture training is so close to how we do medical training that I feel like if it just went a little bit further, you could be a fully qualified physician. It’s very focused on the Chinese medicine traditional aspects of medicine. I think you could be a fully qualified physician with just a little bit more training and fine tuning of the curriculum.
Barbara: There should be an integrated track. They talk about this with family medicine. Each specialty that you do residency training in, you have options to kind of tweak it a little bit. You could go on an OB track and take an extra year, or a sports medicine track fellowship, things like that to add on to your general training. I would envision longer medical school, but integrated.
It needs to be integrated. You know how they talk about wellness or integrative clinics where you have an MD, you have an acupuncturist, you have a naturopath, and you have a massage therapist, and you call that an integrated clinic? It’s not integrated unless they’re all talking about that patient in the same room, then it’s integrated. If it is truly integrated, that individual is even in the room, too.
Barbara: But that’s not what it is. It’s everybody billing separately. It all comes down to that, how they’re billing. My dream that I want to see is that we are training people to think like we are wanting to think. That’s why we had to go to two different schools to do it.
Alisha: I just heard about this model, so maybe I’m just really excited about it, but some family medicine programs are making it so when you enter medical school you actually are already matched into that residency program as well. You have this really longitudinal track where you start out with some of the basic medical education, which a lot of that I think could be done in undergraduate if you had a fast-tracked medical program rather than the kind of multiple layers of undergraduate pre-med medical school and then residency.
If those were all combined, I think you could do it better. You would have more of a chance for having that integrative medicine track because the students are there the whole time and you could interweave that throughout all of that curriculum.
Barbara: This is of course something they probably won’t do, but I think everybody who goes to medical school needs to do some kind of service industry work. They need to wait tables, they need to work in a grocery store, they need to do some kind of service to be out there, to know what it’s like to not be in school, because the folks that go straight through school don’t go through life learning enough. We’re in school so long that we get isolated from what’s happening in the real world.
I was a nontraditional student, so I actually turned 30 my first year of med school. The average age of my class was in their late 20s, early 30s. It’s a different cohort than folks in their early 20s where you see them by the time they get out of residency, they’re in their mid to late 20s and then they’re already getting promoted to chief of a department? Come on! They don’t have any life experience. Patients know that, they can smell that from a mile away if somebody has been in school for 10 or 12 years and never out in the real world.
You’ve had that opportunity where you’ve been out in the real world and now you’re going back. It’s really, I think, a cool perspective.
Alisha: Yes. It gives you a little bit more… I feel like I have good emotional regulation because of that, and that helps me.
Barbara: Exactly. There’s this emotional quotient or emotional intelligence that a lot of people already don’t have. As providers, as physicians, we should have it. It’s already a stressful job, but it’s also a relatability to say, “I’ve been there. I know what that’s like.”
There are people that are told to go right back to work. You’re seeing that with COVID where people have long COVID symptoms, and they are told to go back. Some people can go back if they’re sitting at a desk, but some people who are on their feet all the time can’t do it very well. I think it’s that understanding, that compassion and empathy.
Alisha: It really reminds me that as physicians our role is very relational. Our role is to really see who our patients are and help them with whatever aspect of their health they need help with. That role is being a guide. The only way we can do that is by understanding who we’re guiding. If we can’t step outside of our shoes and into the shoes of our patients, it’s really hard to do that.
I think that’s where a lot of burnout comes from in physicians is when they’re not able to relate to their patients. Either that’s a time constraint because they have 15-minute visits, or they just are so stressed with all of the paperwork that they have to do that they can’t really focus on the person in the room with them at the time. The more we can create that environment and the people who are prepared to relate to their patients and really connect in that few minutes that they’re with the physician and patient, I think that would make medicine a lot better.
Barbara: What’s your vision of a practice that would give you balance in your life?
Alisha: I’ve had the opportunity to go work in several different healthcare settings. That’s part of medical school, we do rotations and get to go to different clinical settings to experience what that practice is like. I’ve tried to get the most broad experience that I can so that I can envision what I want for myself.
I can see myself having between 300 and 500 patients that I know pretty well. That I can know their dog’s names, and they’re a family of five and they’re five of my patients, and I might see their grandma as well.
Barbara: I’ll be one of them. Hurry up. [laughter]
Alisha: Just four more years.
Barbara: What do you think family medicine residency is going to be like for you?
Alisha: If I get the family medicine residency program that I’m hoping for, I think it will be pretty great. While it is rigorous and does have a lot of constraint on the way you can practice and the time that you have to practice in, I think it will prepare me for the diverse practice that I hope to have. I think there are a lot of opportunities in some family medicine programs to do things like mindfulness-based stress reduction training and to do some other lifestyle medicine training, and to continue with my osteopathic training so that I can really have a really good set of skills to address whatever needs my patients have.
Barbara: And you have good support where you are?
Alisha: Yes. I do have really good support. I have good support from the faculty at my school helping me find what that niche is that I’m going to fill. I have a lot of support from residents that I know that I’ve reached out to, to see how I can get into the residency program that I’m hoping for. As well as family support. My partner is also a medical student and started his intern program this year. So, I have some support knowing what the path looks like.
Barbara: I’m really glad because you need that support with the kind of demands that are set for what you have to do to finish.
Alisha: I think that’s something that people don’t understand is how much doctors give up to be doctors.
From pre-med, which is four years, to getting into medical school, you have to score very highly on a standardized exam, the MCAT, to get into medical school, which is a lot of pressure. It’s a six-hour exam that’s very difficult. You have to be at the top of your undergrad class. Once you get into medical school, which could be anywhere in the country, you just have to stick it through. You are in class most days or studying basically 8:00 AM to 10:00 PM.
You basically give up your 20s to be a medical student. Then you have to go to residency, and that’s also very rigorous. You apply to 20 to 80 programs, hoping to get 16 interviews. Then you just kind of put a gamble on where you’re going to live and where you’re going to practice your first few years of medical residency. It’s a lot. It’s definitely very demanding and very draining. Without support, I definitely couldn’t do it.
Barbara: I agree. I actually remember a couple of med students in my class that developed mental illness. It was along with the statistics that we were seeing at the time. Another medical student committed suicide afterward. Not during medical school, but later after being trained as a physician.
Alisha: That’s something we also don’t talk about enough.
Barbara: It’s heartbreaking.
Alisha: Suicide rates are much higher among physicians than they are among other positions. It’s unfortunate because we are supposed to be a model for our patients. We have to give so much to our patients, and we often don’t give back enough to ourselves.
The whole culture of medicine is, frankly, toxic. I think that starts because of the training programs and what is expected of physicians.
Barbara: It’s unrealistic. It’s unsustainable. It did not prepare them for what they’re going into.
Because it has changed, because the autonomy is gone now, it’s gone unless you do what you’re doing, because you have the knowledge and the experience to go out on your own, but for the 90%+ of graduating residents, they’re going to work for a company, and those companies do not care about their wellbeing at all. Unless it’s forced, which is really sad… A lot of people talk about unions, but the fact that we have to go to unions means that there is a system problem anyway.
You’re studying so long. For some people, it’s their 20s. I lost my entire 30s in training. A lot happens. That’s supposed to be kind of a golden time. I was lucky to have supportive family, but it still takes a toll.
I think part of medical education should be learning how to be a healthy person and keep people healthy more than what they’re doing. Really, you need to back up what you’re saying. If they say we care about you, they need to show it. They need to show it by allowing people to rest. I don’t know why we still have this resident schedule. I don’t know why we still have these horrendous calls.
I even drank the Kool-aid and said, “Yeah, if you’re not trained that way, all of the things happen overnight,” which there is still a part of me that thinks about that. That you have to work well under stress and learn to be a doctor. That’s kind of true, but do we have to be in a war zone for 10 years? I really don’t think so.
I think the idea of building resilience and capacity comes from taking it in doses where it’s not too fast and too much, and that we have that support. Why can’t we build that resiliency into our education where it’s dosed and not drinking water through a fire hydrant?
Barbara: Just some food for thought. We’ll have more conversations. I want to really keep up with where you are. I think maybe we can bring you back when you’re in your next stage when you’re in family medicine. It will be interesting to see where you are. Let me just tell you, I’m not worried about you at all.
Alisha: Thanks. I’m glad I have your support. You’re definitely someone I look to help me.
Barbara: You’ll always have my support. I think you have really solid footing. The fact that you have the Chinese medicine background first beforehand will help a lot, because then you can kind of see neurons are blending these things together somehow, which I think that’s happening all the time.
I want to thank you so much for taking the time. First of all, I had a blast when we went walking around, it was really fun and meaningful to me.
Alisha: It was super fun, and I’m totally happy to do it again.
Barbara: So, there you have it. Two women who have trained in two types of medicine to practice in an integrated way. It’s not far-fetched, it’s not ridiculous. In fact, it’s totally possible. Medical education does not have to be set in stone. We need to get out of the 19th Century, or at least the early 20th Century, and get into today.
I urge all of you to look more into this. If you are interested in going into medicine and becoming a physician, think outside the box, don’t take the status quo. As you’ll find out in the next episode, I’m going to be interviewing a historian who studied fraudulent medicine and the movements against healthcare fraud and defining the boundaries between orthodox and unorthodox medicine. It’s not as simple as you think. Stay tuned.
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Third Opinion MD Podcast is produced by me, Barbara de la Torre. Music is licensed through AudioJungle. Any comments made by the host or guests on Third Opinion MD reflect opinions about healthcare and self-care. Please consult with your own physician for any medical issues that you may be having.
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