Dear Interns: We Have Your Back

Dear Interns,

Every July the same tired “the new interns are starting: be scared to go to the hospital” memes and jokes appear. I disagree. I believe that July is as safe as any other month to go to the hospital.

July should be celebrated. Medical students and resident physicians are the lifeblood of our profession. Clinical physicians have never felt more exhausted, harassed, commoditized and defeated by the “healthcare machine”. We need your eagerness, your wonder at the miracle of the human body and medicine, and even your naivete to renew us. One day you will be the new leaders of medicine, and I pray that we guide you well. You remind us of our younger selves and of our own love of the science and art of medicine, even if we are not good at showing it.

Congratulations! As newly minted MDs and DOs starting your first day of work, you are no longer a medical student, but a physician. Until next June 30 you will be known as first year residents, PGY-1s (Post Graduate Year-1), or by the most commonly used term, “interns”. Wear this badge with pride! You have achieved what 99.6% of the U.S. population did not and most could not. You have delayed gratification: you were studying hard while your high school and undergrad classmates started careers, were saving and making investments, bought houses and cars, got married and started families. You sacrificed personal relationships and other professional opportunities to answer your calling. Most of you are sacrificing your 20’s. We are grateful that you joined our ranks. The hard work and sacrifice are not over, but we know that you are capable and worthy.

Internship may mark the widest breadth of your didactic medical knowledge. However, as an intern you are terrified for good reason: for four years of medical school you have been exposed to the incredible breadth and depth of human illness in a way that is unmatched by any other profession. The secret is that a part of that terror always remains, as it should, for any physician who cares for patients. Welcome to the club!

Our duty to patients necessitates a certain degree of fear of dereliction of our duty. The practice of medicine can be likened to perpetual internship in a way. Even the most experienced physicians can rapidly alternate between confidence in our training and experience, and the terror of what we do not yet know and can never know. What I would give some days for instant encyclopedic knowledge and a crystal ball! Alas! We must all earn our wisdom through fire, time and humility. 

Dear interns, when you feel discouraged, remember your achievements! You successfully drank from the fire hydrant of information that compromised the first two years of medical school. You passed USMLE Step 1 which may have been the single most difficult exam I have ever taken in my life, before or since. You have also passed USMLE Step 2 in your 4th year of medical school, a 2-day exam which concentrates on the breadth of clinical medicine which is the focus of your third-year medical school clerkships. You have earned your position.

There is a beauty and wisdom in the design of physician training. The easiest way to illustrate it is by using a familiar saying in medicine: when interns (or medical students) hear hooves they imagine zebras (not horses) because of the broad differential diagnosis they have been trained to consider. Residency will give you an additional 3000-4000 closely supervised clinical hours per year. You will eventually learn to distinguish the sounds of zebras from horses, and even the subtle differences among breeds of horses in your specialty. With practice, discernment and continual learning, you will eventually be an expert in your chosen field. 

Dear interns, you are leaders in the making! Patient care is a team-sport. All teams need a captain. Compared to physician education, the training of nurse practitioners and physician assistants is very limited in scope and much less rigorous: they may be trained to recognize some of the most common diagnoses, but have no training in less common conditions. By the end of medical school alone you will have 5000-6000 closely supervised clinical hours under your belt, while a physician assistant graduates with about 2000 clinical hours and a nurse practitioner as little as 500-1500 mostly observational clinical hours. Whereas an intern hears a zebra, a non-physician practitioner may not even hear the hooves to begin with nor even know of the existence of zebras! No one can diagnose a condition they do not even know exists. Our training and expertise illustrate why physicians should always lead patient care teams. 

Be kind, be humble and learn from everyone. Your senior residents and attending physicians will guide and teach you. You can also learn from the different professionals on the healthcare team: nurses, respiratory therapists, pharmacists, etc. And don’t limit your learning to patient care: self-care is important, too. As a brand new intern I received one of the best tips from a hospital parking attendant who advised me to always park in the same area of the uppermost covered level of the hospital parking garage, so that I would not find myself post-call wandering the garage looking for my parked car. It was valuable advice. 

Dear interns, keep your chins up! Do not be discouraged by those who make disparaging remarks about interns or the dangers of the hospital in July. Most who mock you have not nor could not achieve what you have. Maybe they say these things now, for they know that one day you will surpass them in working knowledge and wisdom. If there are any physicians who disparage your role, ignore the chip on their shoulder and vow not to repeat their behavior. You have earned your place. You are exceptional. You are invaluable today and tomorrow. Please know that there are many, like me, who have had the privilege to go before you. And we have your back. 

Mercy Hylton, MD is a pediatric emergency medicine physician in Indianapolis. She is active in physician legislative advocacy and is an aspiring writer and physician leader. She is the married mother of three children, who is working toward her masters in business administration.