The visible excerpt from my first email message reads, “Hello class, I hope your Monday has been productive so far.” For me it is 7:00 AM. So far, I have woken up, stepped onto the bathroom scale to measure the effects of my quarantine baking, and brewed a cup of dark roast. I have not yet begun the process of deliberating over and deciding what I will work on next, much less what I need to accomplish on this day of sheltering in place.
The eternal expectation of productivity already looms, without being summoned by an email greeting from a nebulous program coordinator. “Productive” is a word that conjures visions of lofty checklists, brutally demanding practice tests, research inquiries, and assignment submissions. And the truth is, determining where to put my focus during the lockdown has proven to be tremendously exhausting, without the familiar constructs of routine and habit that guide my motivation under normal circumstances.
A text message from my classmate interrupts my pondering: “The testing center just cancelled my licensing exam due to social distancing and now I have to reschedule it on top of a 100-hour work week during my surgery sub-internship, or either rearrange my senior rotations to accommodate it. I’m worried if I rearrange, I won’t match into residency without a letter of recommendation from a top surgeon at an academic institution.”
This person is shining star in our class; she has already passed the first enormous Step of her medical licensing exam. She has earned clinical honors in many of her clerkships, and successfully completed three years of MD coursework–all while serving vulnerable community members at weekly free clinics, mentoring underclassmen, and volunteering her time as a tutor and counselor. However, she is not catastrophizing the situation. Her seemingly outstanding productivity checks the proverbial boxes that nearly every other applicant has also checked. (We all share the same career advisors who work from the same set of acceptance data. This creates a considerable barrier in distinguishing ourselves as residency applicants.) In this society where doctors are clearly needed more than ever, my friend is correct that it will be difficult to match into a desirable residency program without the letter that she mentioned.
In fact, there are hundreds of medical school graduates each year who do not match into a residency position at all[OJK1] [1],[2]: qualified doctors who have dedicated their early adulthood to rigorous academic pursuit and the service of those who are suffering. An event such as the feared “mismatch” becomes particularly devastating when an applicant’s entire identity is entangled with their professional and academic achievement.
The malignant mentality that our worth as individuals is solely measured by our productivity in our work is regularly reinforced by our leaders and mentors. A dearly respected doctor recently advised my classmates and me that we should not expect to “make a difference in the world” if we are working fewer than 80 hours every week. This widely held expectation is problematic because it leaves little time for developing one’s identity outside of medicine. To believe my teacher’s admonition would be to concede that any “difference” I might make in the lives of my family and friends is negligible (or worse, that it is somehow tied to my performance at work). To practice in that manner indefinitely, I would need to choose between my mission to help patients, my desire to maintain important personal relationships, and my physiologic need for such entities as sleep, nutrition, sunlight, and exercise.
Seeking relief from my inboxes, I toggle between the email app and Instagram, where I find a tribute to a bright young doctor who has just died by suicide in New York City, after several weeks of watching COVID patients suffer in her emergency department. The idea of productivity returns to my consciousness as I empathize with how helpless this doctor must have felt, falling short in her tireless efforts to save lives.
Before this pandemic, there was already a plague festering in the medical community. The national burnout rate among medical students is over 70% and suicide rates among physicians exceed those of the general population by about 40% for males and 130% for females.[3] Our medical school has a basement study lounge known as “the dungeon,” outside of which you can hear first- and second-year MD students, story-topping one another around the clock. They tout how long it has been since they have seen the light of day, exercised their bodies, or eaten a real meal. It seems that “busy” is honorable and “tired” is noble. The expectation is perfection, which by convention, demands perpetual productivity.
Why is it that the individuals who dedicate their careers to the prolongation of life are hemorrhaging their own vitality in order to save others? As a premedical student, I hoped this antiquated mentality was on its way out, and I still want to believe that it is. A system that leads a well-meaning course coordinator to assume that the phrase, “I hope you are productive” is a synonymous replacement for the trite greeting of “I hope you are well,” warrants critical consideration. Those two states of being are unrelated, and if not properly balanced, wellness and productivity can become mutually exclusive.
After reading the memorial tribute, I lock my phone and place it face down on the coffee table. Perhaps the measure of a successful Monday at this point in time is less about productivity in terms of completing traditional work tasks or meeting impressive academic benchmarks, and more about producing sustainable practices that will allow me to survive (and even thrive) in this important career I have chosen, for decades to come. What if productivity is a fluid process that changes from person to person and from moment to moment? The silver lining of expectations is that we are allowed to set (and reset) the ones we hold for ourselves.
So to those who are still in pajamas, to those who are not sure how to feel right now, to those who are itching to join the front lines, to those who are at a loss for how to plan their futures in the midst of a constantly evolving pandemic, to those who customarily postpone sleeping until they have checked off their to-do list for the day, I want to say this:
You will be productive again in due time. For now, I hope you are well.
[1] National Resident Matching Program, Results and Data: 2020 Main Residency Match By the Numbers. National Resident Matching Program, Washington, DC. 2020.
[2] Murphy B. No match for you? SOAP offers last-minute options. American Medical Association. https://www.ama-assn.org/residents-students/match/no-match-you-soap-offers-last-minute-options. Published March 13, 2020. Accessed May 26, 2020.
[3] Kalmoe MC, Chapman MB, Gold JA, Giedinghagen AM. Physician Suicide: A Call to Action. Mo Med. 2019;116(3):211‐216.
