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Can We Save Medical Students from Bureaucratic Burnout?


Bradley Pfeifer
ACP Council of Student Members

Creighton University School of Medicine, Omaha, NE



Michelle Tan
ACP Council of Student Members

Emory University School of Medicine, Atlanta, GA


Medical education is currently posed at an interesting intersection, with rapidly growing clinical knowledge and the growing complexity of business in health care due to COVID-19. Medical school preclinical curriculums have largely shifted online, clinical education is experiencing a less-diverse array of patients for students to learn from, and students are left feeling less confident about their education as a whole. This is not meant be critical of medical education but simply to point out that students are more stressed about their educational experiences than ever before. Unfortunately, this is not all medical education lacks. Most medical schools meet minimum requirements for teaching important topics not in the limelight, like racial disparities in health care, LGBTQ health care, and the business of medicine.

Focusing on the business of medicine specifically, the lack of exposure during medical school leads to students being underprepared for note-writing, billing, coding, practice management, and other bureaucratic business-related tasks they would be responsible for as residents. From personal experience, trying to start a business in medicine lecture series at my medical school was met with great difficulty in finding dedicated time for students to access this parallel curriculum. Additionally, students are pressed for time and do not feel the current need to focus on these topics because they do not immediately affect their current studies. In addition, their current studies stress them out more than the concept of future business-related tasks. With less than anticipated engagement, medical school leadership was not confident about continuing the series in the future. All in all, without dedicated time and a reason to learn business in medicine (such as making this subject graded material), the fear that the medical community is doing our medical students a disservice for their future mental health and well-being in residency is legitimate.

It's no secret that burnout is an increasingly prevalent problem in the medical field, and the road to burnout starts well before becoming an attending. The lack of preparedness for the business-related aspect of medicine is one significant contributing factor to the disconnect between the medical student experience and that of the resident. As an anecdotal example, I recently spoke to a resident who expressed that she had consistently found working in the outpatient clinic to be one of the most enjoyable and fulfilling settings she experienced while she was in medical school. She recounted that working as an intern has been changing her outlook, because she now feels frustrated dealing with the aforementioned administrative tasks and external quality measures to which she, like many other students, did not previously feel prepared to devote her time and energy.

This narrative is a common theme as medical students enter residency. How can the medical education community correct this? To start, it is important that all members of the medical community remember the damage done to students by not fully preparing them for tasks that likely hurt their mental health and overall continued education and training in medicine. Some degree of stress and learning in a new environment is to be expected. However, the potential shock, anger, and burnout caused by administrative burden on young physicians is too great to overlook and be silent about. It is difficult to call to mind one physician colleague who would take on more of these tasks with a smile. As such, this call to action will hopefully strike a chord among medical educators to help better prepare medical students for the real world of health care.

Back to the January 2021 issue of ACP IMpact