The Hardest Part of Becoming a Doctor – College vs Med School vs Residency

I decided I wanted to become a doctor when I was a freshman in college after getting diagnosed with Crohn’s disease. Back then, I was always very curious about what each stage of the process would look like, and I’m sure that many of you are as well. Now that I am a doctor, I can share with you what I’ve learned over the years, and tell you which stages are the most difficult.

If you haven’t already, be sure to check out our two previous comparison posts, one on College vs Medical School and one on Medical School vs Residency. Those provide a great foundation and framework of the big picture differences of each stage in training. In this post, we’re going to focus on the difficulty of each – the lifestyle, the day-to-day, the up’s and the down’s. There is one single stretch of time, a few months in duration, that is by far the most challenging time during the entire process. But before we get to that, we first need to start with college.

First, allow me to state that my college experience was far from the average student’s. Between my health and family issues, my life imploded in a spectacularly disastrous way. Antifragile was the name of the game. To this day, the beginning of my college career remains the most challenging time of my life. However, over the course of four years in undergrad, I got a solid understanding of what college for the typical pre-med entails. Being a pre-med in college is certainly challenging, don’t let anyone tell you otherwise. The main obstacles you’ll face are the following:

You’re finally out of the house and completely free, entirely on your own. It’s far too easy to get sucked into the partying and fun of college, and too easily lose sight of the importance of self-discipline and your professional pursuits. A lot of pre-meds end up changing their mind about medical school in the process. At my school, it was estimated that over 2,000 students entered their freshman year as pre-med, and by the time graduation rolled around, only 200 had applied. 

It’s more the culture than the actual quality of the competition. Less than 40% of pre-meds get accepted to medical school, and the average MCAT and GPA of matriculants is higher than the average MCAT and GPA of applicants. In other words, in medical school your classmates are going to be higher scoring than your pre-med counterparts, on average. Still, the pre-med competition is more fierce, and that’s because of the cut-throat culture.

This was my experience, but I’m sure that you have likely witnessed worse. I had one run in with a overzealous pre-med student in chemistry lab that gave me the wrong answer to a question I had on an assignment. He later made it clear that he knew it was the wrong answer and that I had been tricked. I was taken aback and shocked someone would intentionally sabotage a colleague like that – it just would never be something I would consider, something that would never be on my radar. Unfortunately, stunts like these aren’t uncommon amongst the most gunner of pre-meds.

To all the college pre-meds, I advise you to be cautious of those who may want you to do poorly. This cut throat culture obviously is highly variable from school to school. I’ve heard much worse stories than my own. Remember, never ever stoop down to that level, it will backfire on you. But more importantly, you’ll grow to despise and lose respect for yourself. Going back to my example, guess who ended up at a top med school with the highest available scholarship, and who ended up not getting accepted to any medical school?

It’s like the paradox of choice, where having more choices isn’t always a better thing. In medical school and residency, you have less time, so the thought of performing multiple extracurriculars isn’t even considered. In college, you are expected to have clinical experience, volunteer experience, research experience, some qualities that make you unique and memorable, all while scoring a perfect GPA and top MCAT score. It’s challenging, it’s confusing, as there are infinite permutations as to the various paths you can take. If you are a pre-med and need help figuring out how to situate yourself to be as competitive as possible, check out our advising services. For those on a budget, our Pre-Med Roadmap to Medical School Acceptance Course is a tremendously comprehensive resource.

Medical school will be a challenging adjustment for completely different reasons than college.

First off, the increased flexibility you had in college is gone. Don’t expect to pick up too many extracurriculars. Your expectations as a medical student are to study, become a competent future physician, and to perform some level of research, particularly if you’re applying to a competitive specialty for residency. Other than those three things, follow whatever interests you. For me, that was doing some design work for my medical school’s literary and arts magazine, lifting weights, cycling, and enjoying the San Diego beach.

The main challenge here is the lack of time. You will perpetually feel behind in your studies. There will always be something to do, and it may be challenging to make time for yourself to unwind or relax when you have deadlines looming over you. It’s easy for students to get stressed in this setting.

As they say, learning in medical school is like drinking water from a fire hydrant. The material isn’t necessarily conceptually difficult, but rather it’s staggering in volume. The biggest epiphany I had in medical school was how far my learning methods could be optimized. After a couple months, I was a studying machine. I had active learning, flashcards, mnemonics – the whole system in place. The funny thing is, if I knew how to study like this in college, undergrad would have been such a breeze!

Since you were four or five years old, you’ve been studying from books and preparing for tests. In the second half of medical school, gone are the days of the comfort of the classroom. Instead, you’ll be working in the hospital for the first time, with the bulk of your grade coming from evaluations from your attending and resident physicians.

Most medical students love the transition to the wards, as this is what you came to medical school for – to take care of patients! But rather than just learning information from a textbook, you now need to spend long and often unpredictable hours in the hospital and self study on your own to prepare for your shelf exams. This again requires tremendous adaptability and self-discipline.

The last part of your medical training is residency. Residency is challenging for an entirely different set of reasons.

The main challenges in residency come down to the increased responsibility. 

As a medical student, you had the resident above you who was actually responsible for the patient. If you made a mistake or didn’t know the answer, it wasn’t that big of a deal. In residency, you are the primary doctor caring for the patient. And sometimes that’s scary. I remember several nights where I was in call in the emergency department taking care of some nasty lacerations or hand fractures. Full thickness, oblique angle, facial lacs, gruesome hand injuries, you name it. And I was an intern. Luckily, your seniors are there for you. I shot them a text, some photos, and explained how I was planning on treating the injury – initial management,  suture type, number of layers, closure technique, etc. They would either agree with me or use it as a teaching opportunity and redirect me. And if I was ever in over my head, they would come to the ED to help me out. Overall, the increased responsibility isn’t all so bad. It’s actually quite rewarding, since for the first time, you are the primary physician for a patient and the impact you can make is quite fulfilling.

This increased responsibility sneaks up on you in multiple ways.

Now that we’ve gone over all three parts of training to become a doctor in the U.S., which one do you think is the hardest? In my opinion, it’s the sub-internships during the beginning of your 4th year of medical school. It should be noted, however, that I went into plastic surgery, and your sub-internship, also known as your audition rotation, will significantly vary based on your specialty.

Your sub-i’s are essentially month long interviews. You travel around the country and do a rotation of 2-4 weeks at programs you are considering for residency. In my case, I vividly recall the toughest week of medical school for me. I was at a top plastic surgery residency program for my first sub-internship and we were on triple call. That means when patients came in for hand injuries, face injuries, or plastic surgery-related emergencies, we had the pager and had to be in the hospital. It’s safe to assume that when you’re on triple call, you won’t be sleeping. We were on triple call for the entire week, and as the sub-intern, it’s my duty to impress everyone with my work ethic and determination. I spent three days in a row, working between 18 and 19 hours each day. When I went home, I had to prepare for the next day’s cases, because it’s a huge no-no to walk into a case unprepared, especially on your sub-i. And good luck preparing ahead of time, as the schedule is constantly changing. To say it was a rough week would be an understatement.

Again, not all sub-i’s are like that. One of my friends went into internal medicine, and his sub-internship experience was much more relaxed. If you’re going into something like psychiatry, it’ll be even more relaxed than that.

What stage of training are you currently in, and in your opinion, what’s the hardest part of training to become a doctor? Leave a comment down below.