Medical students face grueling, expensive road to practice

04/17/2012 12:00 AM

10/08/2014 10:35 AM

For months, Brittany Lewis awoke early, padded into her kitchen and started each day the same way. Cereal. Juice. A medical book by her side. While her 5-year-old son slept in the next room, Lewis fixed her gaze on her computer screen and prepared for the biggest test of her life.

Last week, she reviewed her microbiology notes one more time. She then headed to a Fair Oaks testing center and took the $530 exam she hopes will bring her one step closer to her dream.

Lewis, a third-year student at UC Davis Medical School, took the United States Medical Licensing Exam, known as the medical boards. The seven hour, multiple-choice test is the first major exam medical students take on the road to becoming a doctor.

"It hasn't been easy, but I think all this work is going to be worth it," Lewis said. "Being a doctor is all I've ever wanted since I was a child. There's never been a second choice for me."

The national debate over health care and the Affordable Care Act that has roiled the country may have some questioning the future of medical care, but it has not dimmed the hopes of thousands of medical students such as Lewis.

Enrollment is at an all-time high, up about 30 percent over five years ago, according to the Association of American Medical Colleges. And many medical schools have waiting lists. UC Davis Medical School received a record high of about 5,000 applications last year. Only 105 were accepted, according to Dr. Fred Meyer, executive associate dean of the UC Davis Health System.

But for many new medical school graduates the enthusiasm quickly fades, experts say. The number of residency spots has not kept pace with the number of medical students, and finding a hospital to train in after most or all the classroom work ends has become more challenging.

"It's our biggest concern right now," said Christiane Mitchell of the medical colleges association. "There may not be enough residency training programs in the near future."

New doctors today face additional obstacles, including fewer employment options, complicated health care laws, and tens of thousands – often hundreds of thousands – of dollars of debt. The median debt for medical students who graduated in 2010 was almost $160,000, according to the Association of American Medical Colleges.

Last week, a survey reflected just how uncertain many young doctors are about their future. Fifty-seven percent of young physicians (age 40 and under) said they are pessimistic about the future of the U.S. health care system, according to a survey by the Physicians Foundation, a nonprofit group that promotes physicians working with patients.

"The overall mood is that they love medicine, but there is a much higher level of dissatisfaction than we expected once they finish residency and look for a practice opportunity," said Lou Goodman, president of the foundation.

He said the doctors polled cited the new health care law – that it would increase regulatory burdens – and their debt level as primary concerns.

Still, the demand for doctors is expected to remain strong as many older physicians prepare to retire. More than a quarter of the nation's physicians are age 60 or older.

To meet demand amid the changing environment, medical schools are broadening the types of students they select into their programs. At UC Davis, Meyer said, they look at a candidate's scientific expertise and grade-point average, as well as the ability to collaborate and empathize.

They're looking for students, Meyer said, whom "patients will want to have as their doctors one day."

Terribly busy days

In many ways, Lewis, 25, embodies that description. She has wanted to be a doctor since she was 5, the same age her son, Santana Jones, is now. She grew up in Elk Grove, attended Laguna Creek High School and was pre-med at Texas Southern University in Houston. At 19, Lewis married her high school boyfriend, and Santana was born July 28, 2006. Lewis never missed a day of class.

After their son was born, the family returned to California, and Lewis eventually enrolled at California State University, Sacramento. The youngest of three siblings, she was the first to graduate from college.

After a three-year marriage, she and her husband divorced and they share custody.

She and Santana live in a two-bedroom apartment in downtown Sacramento. Lewis spends most of her day studying; Santana is in preschool and proudly says he's "in the class of 2028."

Santana spends most weekends with his father, and Lewis' parents help with baby-sitting and meals. But they can't always be there. On a recent morning, Lewis was getting ready for a day of studying when Santana started coughing; she decided to keep him home from school.

"I didn't plan on being a single parent and going to medical school, but he's one reason I'm doing it," Lewis said. Last month, she was named recipient of the 2011-12 Virginia Tooms Scholarship, which is awarded to single parents in medical school. Lewis is grateful for the $4,000 she received.

"It's a drop in the bucket, but every drop counts," she said.

She receives about $60,000 a year in financial aid, with most of that going toward the $40,000-a-year cost of medical school. The rest is targeted for rent, utilities and expenses. Lewis expects to graduate about $160,000 in debt.

"Actually, I'm lucky compared to some of my classmates," she said. "Some of them have debt from undergraduate school; I don't."

She said the reality of paying back the debt will determine what type of practice she will seek.

"I'm not sure yet, but I'll probably specialize."

'A very new world'

Medical school graduates earn an average stipend of $48,460 in the first year of a residency or fellowship, according to a 2010 report by the Association of American Medical Colleges.

"They are entering a very new world of the practicing physician," said Mitchell, of the medical colleges association. "They are less likely to run smaller solo practices."

She said the costs of running a solo practice, such as maintaining electronic health records and an administrative staff, can be too high for doctors who are just starting out.

But that is still a few years away for Lewis. On the day of her medical boards, she arrived 45 minutes early and filed in with the other students. Each had to pass through security. Lewis lifted her sleeves to show she wasn't hiding anything, emptied her pockets and had a security wand passed over her body.

"A sign of the times," she said later.

Lewis knew a lot was riding on the test. The results would determine which residency programs she could apply to. For the next seven hours, she pored over the test, taking a 15-minute break every two hours.

When it was over, she met her family for dinner. Everyone, including Santana, wanted to hear how the test had gone.

Her results will arrive in two weeks – a long wait.

"I think I did OK," Lewis said a few days later. She was still thinking about some of her answers. "Whatever happens, I'm still moving forward."


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