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Medical Student Exhaustion has been a big social problem in these years. It is aware
that exhaustion and burnout are common for medical students and physicians. This
problem has gone on for at least 40 years, but people still not have solutions for it. The
exhaustion of medical students and physicians may cause the decrease in the quality of
care and increase of medical error. We should take Graduate Medical Education (GME)
Advocacy to urge Congress to increase federal funding for medical schools. The consequences of exhaustion it not only detrimental to medical students, but also
to the public. On one hand, the exhaustion of medical students may cause insomnia,
dreaminess or anorexia, which will hurt their health, reduce their vigor. A research for 60
medical students in Case Western Reserve University shows that almost 100% students
suffer from stress and exhaustion. In the table, 54.5% students strongly agree that
students suffer from stress and exhaustion, 45.5% students agree, no one disagrees. They
said that heavy schoolwork and extra works make them feel completely exhausted. What
is more, the research also shows that also 100% students encountered much stress during
medical school (Lee, Jungkwon and Antonnette V Graham). Even they graduate and
become physicians, their situation is still unpromising. There are more than 400 doctors commit suicide per year, and exhaustion is one of the
important factors (Over 400 Doctors Commit Suicide in the USA Every Year. 9-10).
On the other hand, exhaustion of medical students is also baleful for the public. A
record of Columbia University said that “interns made twice as many electrocardiogram
reading errors after working extended shifts (24 h or more) compared with after a normal
nights’ sleep” (Grunstein, R. R. and N. L. Rogers, 1). Which means the exhaustion not
only hurts medical students’ health, but also affect the quality of care for the public
because exhaustion will increase the medical errors. Makary MA collects data about
death in United States and finds that “the medical error will be third leading cause of
death in the US if it is included on death certificates or in rankings of cause of death”
(Makary MA, “Medical error—the third leading cause of death in the US”) Medical error
caused by exhaustion makes up a high proportion of these deaths. Nobody wants to hear
that there is a hospital shears or a roll of gauze in his chest after one operation.
Exhaustion of medical students will harm both medical students and the public, so we have to take actions to reduce and solve the problem.
Graduate Medical Education (GME) Advocacy by the AMA (American Medical
Association) is a good solution to exhaustion of medical students. The core of GME is to
“urge Congress to maintain current funding for GME, remove the existing cap on
residency positions and to support innovative solutions to expand GME.” (SaveGME,
AMA). Because in recent years, the
congress and the law put caps on the
number of federal funding for medical
schools, the physician shortage forces
each medical student and physician deal
with more patients. This is one of the
important factors of exhaustion. GME is
the source-based solution to exhaustion.
GME is a necessary and urgent
policy for the United States. There is a
shortage of doctors in the United States. The result is “roughly 40% of all charity care in
the U.S. is provided by teaching facilities where residents learn. Specifically, teaching
hospitals deliver 20% of all hospital care, providing for seniors, veterans and patients in
underserved communities” (SaveGME, AMA). Compared with the 325,150,700
population of United States (U.S. and World Population Clock, United States Census),
there are only 1,045,910 doctors in the United States. Compared with the data in 2013, the number of physicians per 1000 populations grows
from 2.554 to 3.111. However, the level of the number of physicians per 1000
populations in the United States is still lower than the average of the world. Which means
that there is still a large shortage of doctors in the United States. The Association of
American Medical Colleges even forecasts that “a physician shortage of between 40,800
and 104,900 by 2030 unless we increase the number of physicians trained” (SaveGME,
AMA). Even government and congress start GME policy immediately, we still need to
wait 2 to 4 years for the graduation of new generation students. Apart from accepting
more students, medical schools can use these funding to build more hospitals and update
their equipment to provide higher quality of care for the public. It can also reduce the
amount of charity care for teaching facilities. To address the needs of the future, GME is
a necessary and urgent policy for the United States.
GME is also an equitable policy. In fact, AMA (American Medical Association) has
another policy Medical Student Debt Advocacy, which support reducing medical
students’ debt. It says “With an average medical school graduate indebtedness of
$176,348, debt plays a major role in career decisions and impacts the supply of our nation's physicians.” (Reducing medical student debt strengthens the physician
workforce). However, Medical Student Debt is an unfair policy. It only supports
government reduces medical students’ debt. Not only medical students have problems,
other major students also have their own problems. If the government takes the Medical
Student Debt Policy, whether it should take other majors’ own subsidy policies or not. If
government takes all majors’ subsidy policies, the cost of all policies will be a lot.
Otherwise, government will be charged with inequity. However, if government takes
GME policy, the funding will be used for medical schools to accept more medical
students. In other words, the treatment of each medical student will be amended. The only
thing will be altered is just the number of medical students. Medical students still have
the same treatment with other majors’ students. Compared with Medical Student Debt
Policy, GME policy is more evenhanded.
GME policy is the policy that faces the future. Apart from solving the possible
shortage of physicians in the future, taking GME policy also helps government create the
future of medicine. Each graduate medical student needs nine years of specialty training
to graduate. These medical students receive clinical training at teaching hospitals that
produce cutting edge research. They fight “at the cutting edge of innovative health care
delivery, which includes a focus on team-based care, quality initiatives and patient
safety” (SaveGME, AMA). Their development is human beings’ development. In these
medical teaching facilities, many exciting and significant technologies continue to spring
up, like the first pediatric heart transplant and the first successful bone marrow transplant.
These innovative technologies are all come from medical teaching facilities. These
medical students contribute their youth and intelligence to these technologies. In the past, some geniuses can drive one subject’s development of their own prodigious talents, like
Newton, Gauss, and Euler. However, with the development of medicine science, it is
impossible for a genius to find some striking theorem or make some new drug. Medical
corporations need to employ several hundred-people teams, spend several billion dollars,
and use several years to develop one investigational new drug. The base of the advance is
these graduate medical students. In other words, the more graduate medical students we
have, the faster our medicine science develops. GME policy is the policy that will face
the needs in the future.
GME policy is a fundamental solution that can solve the root of the problem. One of
the important factors of exhaustion is physicians and medical students must deal with
much more patients than their limit. But if the government takes GME policy, the
shortage of doctors will be controlled for several years. To solve exhaustion of medical
students, the only way is to increase the number of graduate medical students. Each
doctor can receive fewer patients that he can deal with. Since the factor of exhaustion is
committed, the situation of exhaustion will become better after implementing GME.
Other policies cannot solve the source of the problem. The only method they can use is
controlling. For example, Case Western Reserve University decides to make a program to
decrease students’ exhaustion and insure their personal wellnesses. Their action is to add
wellness elective courses in medical training. Even though they get good responses from
students that almost students support school add wellness elective courses during
training. These courses only can help students manage and reduce their exhaustion.
However, these courses are helpless for them to destroy the sources of exhaustion. In fact,
these students still suffer from exhaustion, they just learn to monitor and reduce exhaustion make it not become to
worsen. These other policies like try to
stop water from boiling by scooping it
up and pouring it back. Obviously,
they do not function because they do not catch the root of the
problem. However, GME is
the method that takes away
the firewood from under the
cauldron. It finds the root and
hit the weakness for the root,
so it can solve the problem in
a short time.
The opposition may question the cost of GME is
too high. Nonetheless, the
cost of GME is necessary and
indispensable. The cost is brought up because we miss too much in past years. According
to the information provided, “Despite the value of training physicians for our
communities, Congress repeatedly considers cuts to GME. The current law put caps on
the number of federally funded residency training positions, freezing the number
available to that which existed in 1996. This lack of funding limits physician training, hindering access to care.” (Save GME). Obviously, the law in 1996 cannot match the
situation in 2017, we need to fix the error and make up for prior years that we wasted. Iit
is necessary for the United States to spend money on GME policy.
Fortunately, the government and congress of the United States also envisage the
exhaustion of medical students, and begin to take actions. “In working towards a solution,
Congress introduced H.R. 1117, the "Creating Access to Residency Education (CARE)
Act of 2015 and S. 1148/H.R. 2124, the "Resident Physician Shortage Reduction Act of
2015."” (Graduate medical education, AMA) These actions focus on the shortage of
doctors. They provide federal support for medical schools to increase the residency
training. For the foreseeable future, we will see more graduate medical students graduate
from medical school and ensure all patient access to care.
In conclusion, GME policy can cause the increasing of medical students to solve the
exhaustion problem, to develop the quality of care in public, and to create the future of
medicine. GME policy is the best solution for exhaustion of medical students. Work Cites 1. Dahlin, Marie, et al. "Factors at Medical School and Work Related to Exhaustion
among Physicians in Their First Postgraduate Year." Nordic Journal of Psychiatry,
vol.
64,
no.
6,
Dec.
2010,
pp.
402-408.
EBSCOhost,
doi:10.3109/08039481003759219.
This article talks about the relationships between exhaustion and performance-based
self-esteem. I use contents of this articles to find the reasons of the exhaustion. This
source is reliable because it is a scholarly article from Nordic Journal of Psychiatry.
2. Dyrbye, Liselotte N., et al. "Burnout and Suicidal Ideation among U.S. Medical
Students." Annals of Internal Medicine, vol. 149, no. 5, 02 Sept. 2008, pp. 334-W70.
EBSCOhost,
search.ebscohost.com/login.aspx?
direct=true&db=a9h&AN=34229455&site=ehost-live&scope=site.
This article talks about the result of exhaustion: commit suicide. It can help me prove
another source about doctors commit suicide in United States. This source is reliable
because it is a scholarly article from Annals of Internal Medicine.
3. Goel, Akhil D., et al. "Longitudinal Assessment of Depression, Stress, and Burnout in
Medical Students." Journal of Neurosciences in Rural Practice, vol. 7, no. 4, OctDec2016, pp. 493-498. EBSCOhost, doi:10.4103/0976-3147.188625.
This essay indicates theta stress will cause exhaustion. I can use it as my evidence.
This source is reliable because it is a scholarly article from Journal of Neurosciences
in Rural Practice.
4. Grunstein, R. R. and N. L. Rogers. "Medical Work Hours: Time for a Maggie's Law
for Doctoring?." Internal Medicine Journal, vol. 35, no. 5, May 2005, pp. 269-271.
EBSCOhost, doi:10.1111/j.1445-5994.2005.00810.x.
This article records exhausted doctors made errors in 1971. I can use it as my
evidence to prove this is a historical problem. This source is reliable because it is a
scholarly article from Internal Medicine Journal.
5. Gwande, Atul, Better: A surgeon’s notes on performance, Picador, Metropolitan
Books, Henry Holt and Company, New York, 2007.
This book is written by a surgeon so I can use it as example. Another reason I use this
book is all of us in class has read this book, so examples in this book will be
approachable.
6. Lee, Jungkwon and Antonnette V Graham. "Students’ Perception of Medical School
Stress and Their Evaluation of a Wellness Elective." Medical Education, vol. 35, no.
7, July 2001, pp. 652-659. EBSCOhost, search.ebscohost.com/login.aspx?
direct=true&db=a9h&AN=4724074&site=ehost-live&scope=site. This articles proves data from 60 students. It can help me prove that medical students
all have stress. This source is reliable because it is a scholarly article from Medical
Education.
7. Lane, John, et al. "Self-Efficacy, Self-Esteem and Their Impact on Academic
Performance." Social Behavior & Personality: An International Journal, vol. 32, no.
3, May 2004, pp. 247-256. EBSCOhost, search.ebscohost.com/login.aspx?
direct=true&db=a9h&AN=13224337&site=ehost-live&scope=site.
This article proves that higher grades students get, higher self-esteem they have. Then
I can deduce that medical students have higher self-esteem than other major students
because they have higher grades. This source is reliable because it is a scholarly
article from Social Behavior & Personality: An International Journal.
8. Makary MA, Daniel M. “Medical error—the third leading cause of death in the
US”,BMJ 2016;353:i2139， http://www.bmj.com/content/353/bmj.i2139
This article introduces the harm of medical error. I use it to tell readers exhaustion
need to be solved because it can cause medical errors.
9. Mayor, Susan. "Emotional Exhaustion and Stress in Doctors Are Linked." BMJ:
British Medical Journal (International Edition), vol. 324, no. 7352, 22 June 2002, p.
1475.
EBSCOhost,
search.ebscohost.com/login.aspx?
direct=true&db=a9h&AN=6893627&site=ehost-live&scope=site.
This article says that stress can cause exhaustion. Then I can talk from exhaustion to
stress.
10. "Over 400 Doctors Commit Suicide in USA Every Year." Pulse International, vol. 14,
no. 24, 31 Dec. 2013, pp. 9-10. EBSCOhost, search.ebscohost.com/login.aspx?
direct=true&db=a9h&AN=103060016&site=ehost-live&scope=site.
This article provides data about number of doctors who commit suicide. I can use the
data to make my proof more reliable.
11. Total Graduates by U.S. Medical School, Sex, and Year ，
AMMC ，
https://www.aamc.org/data/facts/enrollmentgraduate/148670/total-grads-by-schoolgender.html These data help me computer the acceptation rate of medical schools.
12. SaveGME, AMA (American Medical Association), https://savegme.org/ Require government increase the number of GME (graduate medical education). The
reason is the number of doctors do not match the number of citizens.
13. Reducing medical student debt strengthens the physician workforce, AMA (American
Medical
Association),
https://www.ama-assn.org/sites/default/files/mediabrowser/public/mss/student-debt-mss-advocacy_0.pdf
It is an advocacy published by AMA. It urges congress increase the medical student
debt to reduce their stresses. I think this advocacy is absurd and difficult to achieve
because if congress give additional funding for medical major, other major will also
require additional funding.
14. U.S.
and
World
Population
https://www.census.gov/popclock/ Clock, United States Census, This website tells me the population in United States. It is reliable because it is a
government website. By simple calculation, I can find the latest rate of doctors to
populations in United States. This data provide evidence for my argument.
15. Graduate medical education, AMA, https://www.patientsactionnetwork.com/graduatemedical-education
This article introduces the latest progress of GME policy and the necessity of GME
policy. It helps me understand the importance of GME policy.