One thing’s for certain. Your first MD job will be vastly different from those of your medical school dean, attendings, and even residents. Medicine is changing so rapidly that it’s hard to keep up, particularly when your life right now is just focused on surviving the next set of rounds or passing the next round of exams.

There are so many big changes that have either happened or are in the pipelines, and so many of these have been sculpted by people outside of medicine, whether they be politicians, administrators, or patient lobby groups. It’s not that all of these changes are negative, but there are always consequences to change, both predictable and unintended. As a physician, you will most likely be the first to be impacted by these changes or see the impact on your patients, and be faced with the challenges that they bring.

It’s easy to fall back on the fact that there’s no time. It’s true. Many times during medical school (and the rest of your career) you’ll feel like you are being asked to be superhuman. I remember planning my wedding during my clinical year, and how it sucked the fun out of it. More than once, I had to schedule dress fittings or cake tastings on post call days, and accounted for naps on the side of the highway in picking times. I remember asking the wedding planner at our venue to please not call me about how I preferred the napkins folded, because I truly didn’t care. So I get not wanting to make time to hear about legislation that may or may not be enacted, or just feeling angry that your medical school hasn’t revamped the curriculum to teach about these things (I think they should).

But all of these things are going to have a very direct impact on the way you practice medicine, and what your overall happiness with being a physician is. If you keep abreast of them during medical school, they will have a crucial role in your assessment of what the best medical specialty is for you. Knowing about things such as pay for performance, bundled payments and reimbursement cuts, patient satisfaction scores, your rights as an employee for a medical center, RVUs, changes in the insurance and pharmaceutical industries, and the increasing use of nonMD ‘providers’ will be paramount to understanding what your life as a doctor is going to entail.

So, while you navigate your rotations, keep an ear out. Listen to what your mentors are saying and complaining about, and ask questions about how these things have evolved and where they are going. Pay attention to how coding works. Ask about nonclinical responsibilities and how they factor into careers. Subscribe to medical newsletters that address these topics (usually free) and skim the headlines. Join groups and sign petitions about things that matter to you. These things will be the best investment you’ve ever made into ensuring that your hard work pays off.


Nisha Mehta, M.D.

Dr. Nisha Mehta is a physician and writer with interests in physician wellness, medical education, and health policy. Follow her on Twitter @nishamehtamd or on Facebook at


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