Recently a reader left me a nice long note on my post about dropping out of medical school. His questions resulted in a week-long e-mail conversation about the experience. I’m afraid to say that these issues could easily turn into a series of posts, however I want to be careful to keep this part of my life compartmentalized. It’s not going to be the only topic that I blog about. You have to realize that some of my darkest, most painful memories come from this time in my life. Reliving them is quite depressing. That being said, I would love to offer hope and encouragement to anyone going through a similar struggle. I’m so glad that the pain is just a memory and not a close companion anymore.
The Questions
I am really surprised that your blog is one of the only ones I have found, considering that every year hundreds of people are faced with the same decision.
What does one do about the financial burden incurred during your time in medical school? If you are anything like the 75% of medical students out there you must have accumulated a good amount of debt in your 1st two years (the average for four years of medical school is now ~140k, but the reality is closer to 25%= 0-50k and 75%= 100-240k). How have you handled that?
You mention that you felt confused as to whether you could find something that would satisfy your career goals etc. Where did you begin? What sorts of things did you consider? Was this a job you had previous experience in? Did you look into other advanced programs? I am sure plenty of people could be found to submit their experiences on pursuing a different profession once the groundwork is laid out, be it blue collar, white collar, something else academic.
I am hopeful that this discussion will allow others to share their own experiences as well. Maybe your blog can become a resource for others in this situation.
My Answers
1. Request a One Year Leave of Absence – Rather than dropping out of school completely, I first requested a leave of absence due to my depression. My standing with the school remained very positive. I had a one year window to return to the school with no questions asked. Then I could have picked up with Step 1 before completing my education.
The details for this procedure vary from school to school. It helps if you have medical documentation of a disease (like depression or cancer) or if you have a concrete definable problem that the administration can understand (such as a sick relative that you intend to care for or a recent death in your immediate family). Failing Step 1 also works. If you request a leave of absence without a definable reason, your school may get a little squirrelly. My e-mail buddy had trouble with his leave of absence request, as you can see.
Something I had the most trouble with was the reaction of my school’s administration. This is definitely not the same everywhere. My school views time off with GREAT DISDAIN, unless it is used to obtain another advanced degree. My request was met with scrutiny, questions about drug and alcohol abuse (which I suppose could be pertinent in some cases for students), as well as a basic statement of “We’re not sure why you feel like you need this….How do you think it will further your education? Why should we let you resume studies?” Because our medical school terms do not operate on the same schedule as the college’s billing cycle they took the liberty of erasing that I had been enrolled that term ‘for my own sake’ and permanent records (even though billing-wise it was halfway over. i.e. I should not have to pay back anything). So I basically was left with a sour feeling towards the administration, as well as a bill for financial aid that had already been put towards tuition (that was not refunded) and living that had to be paid back before I could resume school. Fortunately our financial aid adviser really busts his butt for students, and we found ways to make that as painless as possible. Additionally they gave me a date I had to take step I by or else I would not be able to re-enroll for 3rd year…which is strange in my head because essentially I finished Med 2, and should just have to take the exam by the time current Med 2s should have to right? All in all my leave of absence was fraught with punishment, despite being one I took by choice.
2. Actively Pursue Other Careers- During your leave of absence, make it your mission to find a new career path. Start by analyzing your current situation. What did you love about your medical career? What did you hate? What things are essential for job satisfaction? How much money do you need to earn in order to stay afloat? Make a list of possible jobs and start researching.
I loved the fact that I could make a difference in people’s lives with medicine. I liked feeling smart. I loved the science and the studying. But I wanted more time with my husband. I wanted to start a family. And I wanted to feel like a good mother even though I wanted a career. My essentials for job satisfaction were – impacting lives for the better, family-friendliness and plenty of time off. I fell in love with teaching.
Be open to the likelihood of continuing education. You will probably have to be a student again before you will be qualified for the job of your choice. Try not to burn any bridges with the administration from your medical school, because they can help you with transferring credits. It would be a shame to waste all of that expensive education.
Divide up your leave of absence into stages. There should be a research stage, a trial stage and a deciding stage. After you’ve researched your options, spend time in the fields that you’re considering. I spent a week shadowing various teachers at a local high school. That week gave me a good feel for the modern classroom. It gave me enough encouragement to sign a one semester contract to teach. I knew that if I hated my job, I would still have three months left to decide if I wanted to return to medical school.
Consider obtaining your MD and using it towards another career. Plenty of doctors leave medicine to teach at the college level or to pursue a number of careers. However, you may find yourself overqualified for some jobs with an MD.
3. Get Financial Counseling – The decision to leave medical school will leave you with a lot of debt and most likely a lifestyle adjustment. You’re going to give up a lot of material stuff. It will probably sting a little when you visit friends who have nicer homes than you, or when you realize that your “new” car is a decade old.
The long and the short of it just comes down to making do with what you have. Hubs and I decided that it was better to be poor and happy, than rich and miserable. We made the decision together. His job as a cop and my job as a teacher leave us with enough income to pay all of our bills. On good months we even have a little extra left over. We don’t use credit cards. We don’t buy name-brand designer items. We don’t live in a big house. We don’t have expensive furniture.
I highly recommend that you use Crown Financial Ministries and/or Dave Ramsey. Design a budget that you can live with and try to stick to it before your leave of absence expires. Look into consolidating your school loan(s). There’s no way we could have afforded to pay back our original ten year loan. We had to consolidate.
There are many aspects to this decision. I’ve tried to hit the highlights. If you have any further questions, I’d love to hear from you. This discussion is open to anyone who has an opinion on the topic. I hope my experiences and advice have been somewhat helpful to you. Please feel free to leave a comment below.
Filed under: how to's, med school stuff
This had to have been such a hard decision. Your experience can help others, I’m sure. I would think it would be better to be happy and in a place in life where you want to be, regardless of the financial cost.
The thing that really strikes me as being crazy is how unsupportive medical schools are. They HAVE to know that rates of depression are almost *double* in medical school and suicidal thoughts occur in 10% of medical students. But the counselors, at my school at least, act as though it is somehow the student’s FAULT… as though they are just being stubborn and noncompliant. Its absolutely nuts. And to get a year off is amazingly difficult … to get one without being seen as a problem-student is even harder. Its as though they believe that once you start being a med student, you stop being a person.
In fact *any* year-off program — research, clinical, translational, international — is a GREAT way to buy yourself 1-2 years to think and recuperate. Depression wont keep you from winning some very prestigious fellowships AND you can even delay taking your boards until the end of your research year if you play your cards right. Year-off programs are one of the few reasons for time-off that your school will not only tolerate but applaude. You get paid. You often get to leave your home med school. AND you get to explore another career (in any PhD program or programs in public health/sociology/law/ etc) Plus, if the student DOES go back to medical school, the only thing a residency program would see is a prestigious year-off program (not how the student was depressed or struggling). You can even get publications and better Letters of Recommendation.
A second option: In fact, if you KNOW what field you want to go in to, there is a second option — apply for a dual degree and never finish the MD. The advantage is that your medical student loans are still deferred through your second degree (though the unsubsidized loans might accumulate a little interest on the bulk amount — but you can often pay a LITTLE out of your grad student stipend to keep that under control). You could get anything from a masters to a JD to a PhD without having your med school loans come due while you are an impoverished grad student!
Whenever I run across a med student who is miserable but not totally sure if leaving is the right thing to do, I strongly encourage finding a year-off program that sounds fun and applying. I think some time to decompress can either (1) let the student realize that they are not suited to medicine and move on to something they DO like or (2) sort out whatever other issues may exist allowing them to be better more committed doctors! Its good no matter how you slice it.
Damn, to put all that effort into your undergrad and then drop out. Hard decision indeed!
Luckily I made my decision to drop premed my Freshman year of college, I just didn’t feel like it was the right path for me.
Not to mention the hypercompetivity was a putoff. :p
I am grateful to have found your story, thank you for writing it. I have just recently requested a 1 year leave of absence for my own long list of reasons, many of which I have not shared with very many people. I would say that my depression began in my first year as well, but I ignored it until it demanded attention. Like you, I want more time. Time for my relationship, which was 1600 miles away at a dangerous job, and time to pursue other passionate interests outside of my education or career.
So I left. It took me about a week to pack up my life and drive the 1600 miles to be close to my best friend and the only person who can understand why I might not want to be a doctor anymore. I am so sad and feel so lost and still cannot believe that medicine has threatened to take so much away from me. I am left with no idea what my next move should be, scared of my debt and afraid that it’s going to push me in the wrong direction.
I am very seriously considering an accelerated second degree program to get my BSN, but have decided on this too late to apply for the spring of 2010. I guess the good news is that I have more time to explore the different programs and to think about nursing as a career, but I’m so upset about what to do for money in the meantime. Can financial counseling be helpful when I have no income? My head is spinning.
Continuing education is always an option, I could go to school forever, but I don’t want to waste anymore time or money. Everything sounds great to me though, when compared to the life I was headed toward in medical school, and I don’t know how to decide. Your suggestions have been very helpful and I will take the time to make a list and explore as many career choices as I can.
I am struggling with the decision now of whether to look for work with my BS or to enroll this fall and start working on the few prerequisites I am missing for nursing. I feel so rushed because my payments will begin in 5 months if I’m not in school. And I guess I am also in a hurry to fall in love with something else and let go of medical school. I want to know that I’m making the right choice more than anything. I want to move forward because I feel as though I’ve just taken 10 steps back. It was not a terribly difficult decision for me to make because I have not dropped out, but I am afraid it has so much potential to be a terribly difficult decision to live with if it means that I will not return- although the idea of going back right now seems unbearable.
Good to see that this page is generating some discussion.
I posted on the other page about a year ago, as I was preparing to take step I during a one year LOA.
Here are my thoughts having resumed school after a LOA…
First…I think everyone should have a year off during med school. PERIOD. I know that idea isn’t going to ever take flight, but if it was in place and schools did a good job of arranging projects and opportunities for students I am sure most people would graduate happier. Be it for research, MPH’s, to work, do international projects, to spend time with family, etc. It is amazing how much one can appreciate that time having been really busy for the last two years. And don’t get things mixed up…I worked full time through undergrad, did all kinds of extracurricular stuff, entered medical school with several major research publications, and did plenty of good old hanging out and partying, so I was never “not busy”. Med school is just a different kind of busy. I can say that med school at the very least has given me a totally different perspective on downtime and how much I enjoy my hobbies, family, and friends more than ever. As well as subjects I miss studying.
Although I was never officially in bad standing with my school, I did not pursue another degree during my absence. I think the advice to do so is REALLY SOLID. Anyone reading this, and toying with the idea of a LOA or just leaving med school all together should examine that as an option. At the very least, if you do decide not to resume med school you will have a qualification at hand which may help you land a job. In my case, I did construction, which although really let me take a huge step back and decide about my path, will probably hurt me some come time for the match process and interviewing. I accept this. For me it was the right thing. The physical labor and endless fresh air really helped me rid myself of a lot depressive symptoms I was experiencing, develop clear thoughts on what I wanted to get out of school, and reorganize my values a little.
Step I…..I wish I could say my year off made all the difference in the world, but I don’t think it did. I worked, saved up, took time off (~month) to study, did just that, and took the test. I was getting 230s on my question bank and practice exams, and did not score near that. I passed, but my glass ceiling is definitely visible. I am ok with it. For anyone disappointed with their step I score, there are tons of us out there. For those that have failed (as I have had several friends fail and have to make the decision to retake/leave), it is most certainly not the end of the world. You can retake it, and will already have at least some sort of a system going (plus one thing that is irreplaceable, exerience). If you get a failing score, and replace it with a 220+, it is quite easy to just say come residency interiview time “I don’t know what happened, I probably had a bad day”, and they will most likely believe you, whereas if you pass but do poorly you will not get that chance. Step II is still there to do better as well, which is something I am banking on.
I started back up into 3rd year quite happily this past summer. So far I have been doing well. I wish I could say my depression from before was totally solved, but despite coming strong into 3rd year I can still feel it lingering. I have just given myself breaks when I need them, spent time with friends sometimes instead of studying every single evening, and tried to be as physically active as I have time to be. This seems to be working for the most part. I have received stellar evaluations from faculty, residents, and a lot of good advice on choosing a path. And although I am not blowing the shelf exams out of the water, I am satisfied, and I am learning about 10 fold what I did during med I/II. Sure, occasionally I have had to work with people that seemed like robots, had terrible senses of humor, or were just plain mean…but lets face it not everyone is awesome, no matter what field you are in.
I can also say this. I think med I/II are conducive to depression because…
A) it can be hard to set new goals during that time since the majority of your energy is spent just trying to learn the material, not choose a definite career path. even though on some level you are supposed to be doing this.
B) there is a lot to learn, and unfortunately i think med school is almost too concise for its own good. the material is really not presented in a very intellectual manner, and really just shows how good you are at blatantly memorizing facts that are marginally related. this makes sense, because to present each subject in its entirety would add years onto med school. for those of us who learn by truly understanding this can be a really frustrating time.
If you find yourself hating 3rd year (which is tough because you are probably knee deep in debt) my main advice, and this is opinion of course, is to stick it out and finish. Maybe the patient care setting isn’t what you thought it would be. Maybe having to live everyday in what some treat as a rat race (gunners are THE WORST) is hell’ish…well yeah it can be. But I can offer this piece of advice. If you are trying (not a blatant screw-up), and are a fun person, not knowing the tiniest details about this or that disease is not going to submarine your evals, but being a backstabbing gunner that doesn’t know team dynamics most certainly will. Believe it or not, but there are lots of jobs out there that will pay enough to stay a float with loan payments where having an MD will not hurt you. You can always go into research (which I am still considering despite really liking patient care) and make REAL medical ADVANCEMENTS as opposed to just exercising other people’s discoveries. There are endless biomed engineering firms that NEED your knowledge and help finding applications for their products. Law, business, insurance, government, the list goes on and on. Most likely you came to med school because you found the subject interesting. Well, there’s more than one way to skin a cat, and there’s more than one way to use a degree.
Lastly….
I find it unfortunate that “job” (residency) placement uses Step I scores so heavily…but that is life. So far I have found that the best people to work with, who can put in long hours next to you without eating your soul, and seem to have good interaction with nurses, clerks, etc. are not people who all blew the Step exams out of the water (some of them are, some aren’t). But rather, people who are just interested in doing a good job, having fun at work (without making mistakes), and helping the team as a whole get everything done.
I hope to be starting a blog of my own soon talking about med school issues that I have encountered, advice on working through problems, funny experiences, and jsut some general chit chat. This is of course dependent on time. not much there now, but check back another time.
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