MD offer letter

Due to the sensitivity of the post, the author wished to publish the following piece anonymously. 

Dear Student,

On behalf of the Admissions Committee, we are pleased to reward you an offer of admission to the Doctor of Medicine Program!

This year our Committee received over 5,000 applications, and extended less than 250 offers of admission. However, medicine is not a meritocracy. Upon meeting peers from diverse backgrounds, you will quickly realize that applicants differed in their advantages throughout the admissions process. “Not every applicant had the same access to opportunities to demonstrate or enhance his or her commendable qualities”. You will continue to benefit (and be disadvantaged) from the resources you have (not) accumulated over your lifetime as a result of your economic background, social position, postal code, (dis)ability, and other markers of identity. You will participate in a demanding (hidden) curriculum that expects you to pass the “would I have a drink with this person” test, even if you did not grow up in rooms like that, with people like that, or drinks like that. Furthermore, by accepting this offer, you will join a community where over 1 in 4 physicians experience burnout, and 34% meet the criteria for clinical depression. Here, you will connect with faculty members and clinicians that are equally burned out.

Upon accepting this offer of admission, we will send you information on the following:

  1. The national and global footprint of our program. Our graduates and faculty are leaders in medicine, but despite some improvements in representation amongst the student body, our leadership suffers from a leaky pipeline. Women, BIPOC, 2SLGBTQ+, and people with disabilities are still less likely to be the faces you see on the walls of our historic institutions. When we do introduce ‘diversity and inclusion’ mandates, ‘diverse’ peoples are still ‘included’ within the confines of oppressive institutions.. In this way, ‘diversity and inclusion’ practice isolated from collective action against systems of power and oppression only serve to perpetuate cycles of marginalization.
  2. Details on student societies and groups that represent diverse identities in medicine. Student groups are a source of solidarity for people that have endured injustices for far too long. However, historical legacies and ongoing effects of racism and colonialism are uncomfortable to discuss. Medical education is still largely ahistorical, despite some efforts to “infiltrate the curriculum”. For example, while learning nutritional science, you may not realize that one of the most celebrated paediatricians in Canada “administered colonial science” because they “view Aboriginal bodies as ‘experimental materials’ and residential schools and Aboriginal communities as kinds of ‘laboratories”. Furthermore, curricula on ‘vulnerable populations’ (read: “people we oppress through policy choices and discourses of racial inferiority”) may ensure that you learn about risk factors, but it will often lack meaningful discussions on how our institutions have been, and continue to be, implicated in medical violence. Regardless, we will be sure to include a cultural competency lecture to ensure you understand how ‘Other’ people experience health, illness, and disease.
  3. Wellness and resiliency training. We will continue to promote our novel wellness curricula that are being introduced to encourage resiliency amongst medical students. Here, we will talk about the benefits of mindfulness exercises, but we are still only starting to meaningfully discuss disability, mental health, and structural causes of burnout. In the meantime, you “must be able to tolerate the physical, emotional, and mental demands of the program and function effectively under Adaptability to changing environments and the ability to function in the face of uncertainties that are inherent in the care of patients are both necessary”. Demands of medical training that we deem to be inherent and integral to the care of patients include, but are not limited to: financial debt, up to 100 hour work weeks, racial discrimination, and toxic quizzing (ie. ‘pimping’).
  4. Information on the social determinants of health. As institutions with a social responsibility mandate, our curricula will introduce you to the social determinants of health. However, limited attention will be given to the structural determinants that make people sick.‘Vulnerable patients’ will often be considered to simply be in a state of poor health instead of human beings who have been impoverished of their right to health. As a result, despite being framed as “a path to equity”, teaching the social determinants of health might actually be “a road to nowhere”. This gap in your education may lead to burnout because you are unprepared to treat marginalized patients and “send them back to the conditions that made them sick in the first place”. However, refer to Point (3) for more information on our innovative curricula to promote resilient medical students.

To respond to this offer you must:

  1. Select “Choices/Offers” and then click on the “Offer” to accept the status quo.
  2. Experience a serious case of cognitive dissonance as you join a profession with a social responsibility mandate.
  3. Once you have indicated your response to the offer, please mentally prepare yourself to practice resiliency in response to systemic failures.
  4. If you have done this successfully, you will receive a confirmation of losing your sense of self on the last screen.

However, if you are unsatisfied with the information presented above, you may choose an alternative path to medicine that re-centres social justice and equity in your education and clinical practice.

Should you choose to embark on this path towards health justice, you must consent to the following conditions:

  1. I commit to learning and thinking about health that is liberated from systems of power, privilege and oppression.
  2. I will use the power granted to me by lending support to community-led social justice movements.
  3. I will ensure that my organizing and activism are a collective effort such that I step outside the confines and comforts of the medical institution that is implicated in the very violence I am striving to dismantle.
  4. I acknowledge that liberatory praxis necessarily requires me to dismantle and uproot the very systems from which I may benefit.
  5. I understand that I must be prepared to resist a lifetime of professional acculturation in pursuit of health justice.
  6. I intend to seek out and connect with faculty members and clinicians who continue to challenge the status quo for mentorship and guidance.
  7. I expect to be inspired by classmates who are also dedicated to reforming medicine.
  8. I am committed to cultivating friendships, and forming networks of solidarity that will last a lifetime.
  9. I will respect the intellectual and emotional labour required to create meaningful change, and will ensure that I am kind to myself and others who embark on this path of resistance.
  10. I will continue to be hopeful.

In presenting you with two offers, one that adheres to tradition, and another that is revolutionary, you may choose how you intend to learn, think, and practice medicine. Always remember that many of you chose this profession to care for members of your community. We hope that you will take this offer as an opportunity to reflect on not only how you wish to learn medicine, but also how you wish to practice it.

Congratulations - we look forward to welcoming you this Fall!

10 thoughts on “MD offer letter

  1. vwjsis

    So sick of SJWs twisting everything into political dribble. Advocating for equality is one thing, injecting it into every possie happy moment is another.

    Reply
    1. lia

      it’s understandable that folks want to be happy on their acceptance to medical schools. i don’t think the author was trying to minimize anyone’s acceptance, but instead was trying to convey the need for humility as one embarks on this path.

      Reply
    2. Kathy Woodcock

      Yes, you can be happy but knowing is important too.
      If 34% meet the criteria for clinical depression that strongly hints at a systemic and structural problem that could impact 1 out of 3 of your future peers. Worth considering as you begin because resiliency is fundamental to success. Best to do any hard thing with yours eyes wide open. Change needs awareness.

      Reply
  2. While the author(s) request for anonymity in crafting this letter is understandable, is it fair to ask if they have any real experience in or around patient care? I ask not out of sarcasm, but confusion. Amidst all the demands that medical education be reformed to place "health justice" at the center of the curriculum, is there any acknowledgement of the basic good that is compassionate, dedicated patient care?

    We can teach medical students about colonization and racism and neoliberal economics all the livelong day. We can (and certainly should) reexamine the shameful histories that underlie too many medical traditions. We should demand that diversity in medicine not merely be an exercise in optics and political correctness, but that women and visible minorities and persons from marginalized groups be made leaders in their own right. And we must absolutely do better than our hapless, pathetic mindfulness/resiliency based approach to mental illness in medical trainees.

    But at some point medical students need to learn how to set a fracture, break bad news, prescribe a contraceptive, suture a laceration, comfort a widow, reduce a hernia, deliver a case report, tell mania from psychosis, stop a seizure, discern a malignant from a benign lymph node, dictate a discharge note, and hundreds upon hundreds of important, meaningful (and often mundane) tasks patients and their families expect from doctors.

    Nobody in 2019 can argue that the "medical model" of disease is adequate to understand everything that ails individuals and society and expect to be taken seriously. We've simply got too much evidence and shared experience within disadvantaged groups to pretend germ theory is all there is. Nor is it adequate, however, to assert that post-modernist politics *is* the be-all and end-all. It's another lens through which one might interpret the world, nothing less and nothing more. It too surely isn't enough to capture everything in the MD job description, if it captures anything at all.

    Setting aside the tone of the letter, which to my eyes reads like a political manifesto rather than a plan to reform medical education, I have a question. Does what the author asks of would-be doctors in this letter - dismantling institutional violence, resisting professional acculturation, supporting social justice movements - constitutes medicine at all? If not, then why bother with medical school? And if yes, this is what medicine must and will become, has the public been brought on board with the plan?

    Reply
    1. Frederick Martel

      Yes it does. Justice is the society we must strive for. I never remember having to use multiple anatomical structures I was forced to memorize but I do daily have to know that physicians do influence social change, whether we want to or not, so yes the 20+ hours learning about fractures is important but why did they get the fracture? And so then why we're they in that circumstance? The doctor cannot simply say I don't treat social problems, it comes with the patient and cannot be overlooked...But that's justice.

      Reply
  3. Bonnie Larson

    As our society's most educated, least oppressed, and wealthiest group that is ascribed with (often undeserved) social capital, physicians can and should be BOTH compassionate human beings AND doctors.

    Reply
  4. Profound gratitude to the author for this important and beautifully written blog post. It is adding energy to an ongoing dialogue among my colleagues within the physical therapy (PT) program where I am a faculty member about how our profession and pre-licensure programs unwittingly reproduce systems of inequality.

    I’d love to use this post (with attribution) as a teaching tool whereby we task our students with rewriting this “offer letter” for PT. This would involve: (1) recognizing points that are transferable across disciplines (e.g., the myth of meritocracy, leaky pipeline), (2) articulating unique ways that the field of PT reinforces systems of privilege and oppression (e.g., through the biomedicalization of disability, the colonial underpinnings of PT outcome measures, the reproduction of whiteness as the norm), and especially (3) embracing and expanding the helpful list of conditions for “embarking on this path towards social justice”.

    Thank you, anonymous author.

    Reply
    1. Anonymous Author

      Dear Stephanie,

      Thank you for your kind words. I have been following your work for quite some time now (love the coin analogy!), so it is incredibly humbling to have you read my work. I am glad that my words and personal experiences with receiving an offer to medical school resonated with you. I would of course have no issue with using this framework and the letter for PT students to reflect on the enormous privilege that comes with being a part of the healthcare system.

      Reply
      1. Stephanie Nixon

        Thanks!

        And here is a webinar introducing the "Coin Model of Privilege and Allyship" for folks interested in learning about the coin analogy:

        Reply

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