Future Doctors and Nurses Don’t Want to See Patients

Students in healthcare are choosing different paths for understandable reasons

How medicine is practiced 12 years from now will vary greatly from how it was practiced 12 years ago when I started medical school. The reasons for this are numerous and include technological advances and staffing shortages created by the COVID-19 pandemic. By understanding what the expectations of future nurses and doctors are before they enter the healthcare workforce, it may be easier to understand the limitations of our current medical systems.

Elsevier Health recently did a study with 2000+ students in 91 countries to see their opinions on the changing landscape of medicine. A whopping 63% of medical students and 59% of nursing students in the United States agree with the statement, “I see my current studies as a stepping-stone towards a broader career in healthcare that will not involve directly treating patients.”

WOW.

At first, I thought this was just a USA issue, given that we have traded health outcomes to help insurance CEOs own multiple boats. But it turns out that the issue is global. Indian students share the sentiment, with an equal 63% agreeing. The UK, Middle East, and Europe hover closer to 54–57%.

Latin America, on the other hand, only has 37% of medical students who agree, but a similar percentage of nursing students also did not plan to work directly with patients.

So clearly, this is not just a problem in the USA, despite the “unique” for-profit system we have compared to other places in the world. One major reason for how medical students and nurses view their future career prospects has a lot to do with patient expectations and how they changed since COVID.

How the pandemic changed patient expectations

From my personal experience working in the emergency/urgent care setting from 2018–2022, I noticed a major shift in patient expectations. Although COVID initially kept people out of hospital due to fear and the unknown, it gave people a more de-personalized option that provided faster access: telehealth.

The rise of telehealth was interesting to watch. It had existed before the pandemic, but its need was clear during the rise of COVID-19. Patients needed questions answered, but many doctors were not seeing people in person for fear of COVID-19 exposure.

This meant they had two options: going to the ER or doing a tele-visit. For many, a telehealth appointment could identify whether or not it was necessary to be seen in person or if the issue could be resolved over the phone.

Plus, the modernization of medical care is expected in our increasingly digital world. In one survey, 71% of respondents wished their healthcare experiences “were as easy as their experiences in other areas of life, like online shopping.”

Another study showed similar results. For 98.7% of patients, telehealth was convenient, 96.4% stated that it saved time, 95.9% found telehealth acceptable to receive care, and 97.0% found telehealth improved their access to care. Most (62.6%) preferred in‐person consultations, although 86.9% agreed that telehealth was equivalent to an in‐person consultation.

Mia Levy (MD/PhD) gives her opinion on the topic when she says, “Almost overnight, asynchronous communication has become widespread, and expectations have shifted accordingly. Post-pandemic patients expect their doctors to be “always on,” and available for questions at their convenience. They want answers, fast. There are, of course, many benefits to this new digital care ecosystem when it comes to convenience and more efficient resource allocation. But the demand for real-time information has put significant pressure on providers as they try to deliver for patients both digitally and in-person.”

One example she talks about is the rise of over-the-counter diagnostic testing. Every facet of life depended on a PCR test for the last few years, so patients learned where to get these tests done, often at different places when access was harder. This introduced a lot of people to the idea of ordering their own tests.

Dr. Levy elaborates on this point. “Not only have the process and practical elements of testing become habitual, but for many people, the reliance on immediate testing for peace of mind has created a much different expectation of the role diagnostics play in health care. I’m seeing this first-hand in my clinic. Patients request testing for all types of things like vitamin D, cholesterol, and thyroid stimulating hormone, often just for peace of mind rather than due to symptoms or a known risk.”

This is both a good and bad thing. Not all tests are necessary, and often in medicine, we have a saying that “tests beget tests.” When you are not looking for something specific or do not understand screening guidelines, it is expected to find benign issues that lead to unnecessary procedures.

I think it is great for patients to understand what tests are needed and how to go about understanding one's own health. The problem is that since COVID, it seems patients know what they want and are harder to sway from their position. When this position is informed and based on data, I am all for it. But I think disinformation plays a big role, and this has a lot to do with the issues we see now.

Disinformation and distrust of medical workers

The first spark towards distrust in medicine was the lack of clear messaging from the federal government about COVID-19. It started with masking, evolved into discussions about ivermectin and bleach, and now we are at a point where vaccination adherence is very low for a disease with long-term consequences.

Dr. H, a friend of mine who quit as an ICU physician due to PTSD from the pandemic, told me a story around the time he decided to step back from his position. He said that he had a patient who was ventilated for close to one month and essentially was being kept alive only by machine due to lung destruction from COVID.

The family kept pushing Dr. H to give ivermectin, which he knew had no role in helping this patient. He simply said, “I cannot be a doctor when I am being told I am doing the wrong thing by patients and their families, although I spent a lot of my life learning how to do this job well to help people.” He now works for a pharmaceutical company.

Losing a physician like Dr. H is a huge loss to medicine. He gave himself to his job, and the experiences with COVID broke him. Early on in the pandemic, he had to hold the hands of patients taking their last breath multiple times a day while their families could only say goodbye with an iPad. Later in the pandemic, he had to explain to families why their opinions based on something they read on the internet were not the same as evidence-based medicine. This would break anyone, and it broke one of the best doctors I know.

But the lies continue and are spread by those in charge of the dissemination of information. Just yesterday, Elon Musk was interviewed by Joe Rogan (Halloween truly is terrifying).

Rogan: “Like 80% of the people they put on ventilators died.”

Musk: “This is what actually damaged the lungs, not COVID. The cure is worse than the disease.”

By that logic, CPR, which has a success rate of about 10%, causes people to die.

And if these notions are spewed by people who have MILLIONS of followers, then what chance do physicians, nurses, and healthcare workers have in truly getting the right information across to their patients? We get to see patients for 15-minute visits every few months AT BEST. They can listen to Joe Rogan interview someone spewing disinformation for 2 hours daily! And that is just one source of disinformation. Given how fast information is disseminated, it is impossible to tell what is true and what is false. When it comes to medical care, this is dangerous because it causes anger and frustration in those seeking care.

Lack of access, increased wait times, and disinformation have all contributed to increased violence against medical workers. Here are just a few examples:

A patient who was angry about his continuing pain after a back operation walked into St. Francis Health System in Tulsa, Oklahoma, in June and shot to death the surgeon, another doctor, a receptionist, and a visitor.

A man distraught over the death of his parents at Ochsner Medical Center in Gretna, Louisiana, in January, punched unconscious a nurse in the intensive care unit (ICU).

In a survey of physicians conducted by researchers at four schools of medicine in Chicago, published last year, 23% reported “being personally attacked on social media.” The attacks were primarily about social and political matters (including guns and abortion), race, religion, and patient care.

Although this last point is not about physical violence, I have seen it directed toward the most caring, most amazing physicians I have had the pleasure of working with. One of my mentors who trained me has all five-star reviews except someone who started ones that mention her political affiliations. Since when do political affiliations have to do with practicing proper medicine?

Conclusions

Couple this rhetoric and violence with a lack of trust among some patients to whom you have dedicated your life to helping, and you can understand why medical and nursing students are stepping away from direct patient care.

But that is not sustainable. We have already given medicine up to the corporations, venture capital, and insurance companies to do as they please. For it, we are left with some of the worst health outcomes of all developed countries for more than double the price. And ultimately, patients will be left scrambling for care.

We are already seeing this in how long it takes to find a new primary care doctor who takes your insurance and how long a person needs to wait to see them (I have heard up to 9 months). Hence, the rise of doc-in-a-box clinics at your local pharmaceutical corporate giant.

Something needs to change quickly, and students in healthcare are sounding the alarm. I just hope we listen.