I had a certain level of (I thought well-justified) terror anticipating the start of intern year. No longer able to hide behind the protective “I’m just the medical student” blockade, I was worried about not being able to live up to the burden and the privilege of being someone’s doctor. Third year was rough and I could only imagine the horrors that awaited me as an intern. Yes, it has been a difficult year, filled with long hours and intense days. However, what I found was that contrary to my fears, intern year has been so much better than medical school. If you recently walked across the stage and accept your diploma, congratulations! Here’s what you have to look forward to:
1. No more pencils,
No more books,
No more teachers’ dirty looks
Welcome to intern year – you’re not being graded any more. For someone who has been in school for something like two decades, this is a surprisingly liberating feeling. In high school, you needed good grades to get into college; in college you had to continue to excel to get into medical school. Once the celebration of being accepted into medical school was over, suddenly there emerged the subtle and not-so-subtle pressure suggesting your entire future career depended on how you performed on Step I. Then there was the microscope of third year, during which time even deciding when was an acceptable time to run to the bathroom was filled with angst. There was the pimping during rounds and then the constant need to acquire the awkward evaluations from residents and attendings (at which point you asked yourself, does this surgeon even know my name?). On the horizon, another test always loomed.
As an intern, I still worry about not making a fool out of myself – that is a deep-seated character trait, and probably has a certain long-term advantage. We wouldn’t be where we are without a certain level of perfectionism. However, not worrying about a test at the end of a rotation or a particular evaluation is surprisingly liberating. I can ask questions of the attending without the constant fear that it will reveal my level of ignorance. When I am done for the day, there aren’t a huge stack of UWorld questions I need to complete. I can look up what is relevant for patient care, read about things I am curious about and not constantly wonder will this be on the exam?
2. “Hello, I’m Dr. Riddle and I’ll be taking care of you while you’re here.”
Gone are the days of being awkwardly being introduced as the medical student – or often not introduced at all and left to hover near the back of the room in anonymity. As a medical student, even when you are treated as a valued member of the team, you still straddle an awkward divide, no longer a civilian but not yet a professional. While most patients are tolerant, there is the constant sense that you are completely dependent on their good graces, as well as those of your residents and attendings. Now, though, you have crossed the Rubicon. There is a sense of fitting in and belonging, even as you switch services each month. When interacting with patients, introducing yourself as the doctor leads to a certain level of confidence, and often has a therapeutic effect on the patient, as they are relieved to tell you what is going on in the hopes that you can do something about it. As a resident, you can be the first to hear the story, rather than the last. While it can feel awkward at the beginning of the year, whether you feel like you entirely deserve it or not, being able to introduce yourself as someone’s physician is a place of privilege.
3. What you’re doing actually counts (even if it’s mostly just for billing).
Yes, I do spend a large chunk of my day writing notes (although, as the year goes on, this is less and less), which is not the most satisfying part of the job. However, at least they can bill for my notes now, rather than in medical school when notes were merely sent into the EMR ether, never to be seen of or heard from again. Plus, people actually read the notes. This is definitely a step up. So much of medical school was sitting around, trying to make oneself useful until someone had the kindness to release me home. Now, when I’m done with my work and the patients are appropriately tucked in, I hand off to whoever is on call overnight. If someone is sick and I need to be there, I stay later. Much more work, but much less thumb-twiddling.
4. My fellow interns
To be clear, I really liked my medical school classmates and made lifelong friends. We bonded in the trenches of medicine and surgery clerkships and enjoyed the freedom of fourth year together. There remained, however, a whisper of competition as each of us recognized only a portion could get honors, that there was still the hurdle of getting into residency. As interns, this competition drops off (see point #1 above). Intern year, you develop bonds borne of long hours and late nights and improbable situations. It’s some combination of best parts of high school meets sleepaway camp, with inside jokes and shared stories of (mis)adventure. Faced by common challenges, you share each other’s tragedies and triumphs. When at times you wonder who could possibly understand what I’m going through? you realize the intern sitting next to you in the workroom is likely going through the exact same thing, or has at some point this year. You become each other’s supporters and confidantes. My fellow interns are some of the most creative, interesting, intelligent people I know. Which is good, considering how many hours I spend with them. . .
5. A sense of purpose
The decision to enter medical training is largely an act of faith. Despite all the shadowing you did in undergrad, let’s be frank: there is no real way to know what it is like to be doctor until you actually are one. After exploring many, many options, I thought psychiatry was probably the best fit, but even putting in my application as a fourth year, I had lingering doubts, less about being a psychiatrist and more about being a doctor entirely. Despite the hours, intern year has managed to erase that doubt. While this is not universal, for me, this year has helped to solidify my career choice and given me a sense that I am moving closer to where I am supposed to be.
The upcoming year will be challenging. At times, you will be pushed to your limits and beyond. But, in the end, it is well worth it. And so much better than medical school.
Megan Riddle, MS MD Ph.D., is board certified in both adult psychiatry and consult liaison psychiatry. She attended Western Washington University and received a Bachelor of Arts in Spanish with minors in Latin and English before deciding she wanted to pursue a career in medicine and research. She received a Master’s in Biology at Western Washington University with an emphasis in genetics and then went to Weill Cornell Medical College where she earned a medical degree as well as a PhD in neuroscience. She completed her residency training in psychiatry at the University of Washington, where she was chief resident, before completing a fellowship in consult liaison psychiatry, also at the University of Washington. She is currently a Courtesy Clinical Instructor with the University of Washington Department of Psychiatry and Behavioral Sciences and enjoys teaching and supervising residents.