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A Word From the President: Pomp and Circumstance, Excitement and Concerns

AAMC Reporter: June 2015

Commencement season just ended at our nation’s medical schools. Of all the opportunities I have to visit our campuses, these ceremonies are among my favorites. The feelings of accomplishment, energy, and excitement are palpable among our graduates as they finally receive their long-awaited medical degree and advance to the next step in their training.

While the ceremony itself is always a highlight, I especially value the opportunity to speak with individual graduates about their medical education up to this point. I am particularly interested in getting a sense of their mindsets as they begin their residencies. My conversations with students and graduates this spring left me feeling overwhelmingly positive about the quality of the physicians we are graduating and training in our medical schools and teaching hospitals.

Most of the new graduates and students with whom I spoke expressed their eagerness to work with patients, their enthusiasm for scientific and clinical innovation, and their gratitude for the teachers and mentors who have played a key role in their education. They also described a medical school experience that reflects our ongoing efforts to create a positive learning environment, and they highlighted the ways in which our medical schools have incorporated technology and alternative learning models, such as flipped classrooms. Digital natives since birth, today’s students and new doctors seem quite comfortable with the ways in which medical technology will play a major part in their careers as physicians. They are eager to leverage new technologies to better diagnose and care for patients, and they are excited about the potential for data analytics to improve our ability to research, understand, and treat diseases.

However, despite their enthusiasm for starting their careers as physicians, this year’s graduates shared some serious concerns. They worry about the state of our nation’s health care system and the course that its transformation will take. In contrast to some physicians of my generation, tomorrow’s doctors wonder whether the pace of change is rapid enough. Since enrolling in medical school, they have seen the gaps in our system—the ways in which failures in care coordination, lack of cultural sensitivity, and physician shortages lead to poor outcomes for our patients. They want to practice in a world in which we have solved those problems—and because we are not there yet, they want to be a part of the solutions.

When we discuss choosing a residency program, they no longer ask which ones I think are “best.” Instead, they ask which programs are embracing technology, teaching the social determinants of health, and training interprofessional teams of health care professionals—in short, which programs will best train them for the future of health care. Our students foresee sweeping changes in our health care system, and they wisely are planning ahead and seeking out the very best training they can find to prepare them for this new world.

Increasingly, as they weigh which residency programs to apply to, they face another concern: Will I get a residency in the specialty that I want? The competition for residency positions and the anxiety that accompanies the Match have become palpable among medical students. As I mentioned in a recent column about Match Day and our new AAMC physician workforce projections, we continue to see graduates of our medical schools failing to obtain a residency position despite a national physician shortage that will deepen over the next two decades. We need all the doctors we can get, and the congressional cap on residency slots creates a real burden on our students and on our country.

Lastly, our graduates and students continue to express concern about the burden of debt they take on to attend medical school. Eighty-four percent of medical school graduates in the class of 2014 had educational debt, with a median amount of $180,000. That number can sound daunting for graduates as they enter their residencies and begin repaying their loans. However, I try to reassure them that according to recent AAMC analyses, a career in medicine remains an excellent investment. These future physicians will have good job security and strong earning potential that should enable any medical school graduate—practicing in any specialty—to both repay educational debt and provide for a comfortable lifestyle and retirement. I also encourage them to take advantage of repayment options, including public service programs that dramatically reduce physicians’ total loan repayment in exchange for providing high-quality health care to vulnerable populations.

As I finished my last commencement address this year, I felt as enthusiastic as ever about our future physicians. They are bright, caring, and energetic, while actively working to find solutions to our country’s biggest health care challenges. They have expressed their hopes and concerns about the health care system they are entering and bring a fresh perspective to a set of issues that affects them personally. Working together with them, I am confident we can bring about the changes we all want to see.

Darrell G. Kirch, MD

Darrell G. Kirch, MD

“In contrast to some physicians of my generation, tomorrow’s doctors wonder whether the pace of change is rapid enough.”