Ravi Bhatia, a third-year medical student at UCLA, often arrives at Cedars-Sinai Medical Center well before sunrise, starting a busy day that will not end until late into the evening.
Halfway through their medical school careers, students like Bhatia begin working in a medical setting with real patients, and their lives become filled with hospital rotations, lectures, six-day work weeks and few holidays.
“It’s definitely a huge change from the first two years, when there’s sufficient time to keep in touch with family and friends,” he said. “I think the hardest thing is when there’s a wedding or family event on a Saturday, and now you have to work on that Saturday.”
Medical school is also a costly endeavor for doctors-in-training, as it is much more expensive than an undergraduate education. Many students end up taking out loans, and many, like Bhatia, are not paid for their work.
“We have to pay for everything,” he said. “Once (you) become interns you get paid, but for the number of hours interns work, I believe they get paid around minimum wage,” he said.
Though medical school may involve unpaid hard work, short vacations and many late nights, a love of medicine ultimately convinces many students to devote their time to helping others.
“The third year of medical school can be tiring, but this is the year that you really get to see a glimpse of why we entered this field in the first place,” Bhatia said. “Lectures and class time are great, but the motivating factor for becoming a doctor is the opportunity to work with patients.”
On a typical day, Bhatia may get to the hospital at 6:30 a.m.
Currently completing his rotations in the pediatrics ward at Cedars-Sinai, he begins his day with pre-rounding.
“First I pre-round on patients, which means I check their vitals, look at their charts and check in with the nurses to see how the patient has been doing,” Bhatia said.
Pre-rounding, which usually involves going from one patient’s bed to another, usually lasts until 7:45 a.m., he said, at which point rounding begins.
During rounding, which usually lasts an hour, Bhatia is responsible for presenting each of his patients to the health care team in which he works, which consists of doctors, residents, interns and other medical students.
Medical students are assigned a team based on the department in which they are working.
“A typical team includes the attending doctor, a couple of senior residents, maybe a second-year and third-year resident, a medical intern and a medical student,” he said.
After meeting with his team, Bhatia then has a morning report, a lecture given by a senior resident, around 8:45 a.m.
During the one-hour lecture, patients from different teams are discussed along with relevant topics that pertain to the patients.
Following the morning report, Bhatia spends his time from about 10 a.m. until noon following up on his own and other patients.
“As medical students, we have three or four of our own patients, but we also help out on any of the residents’ patients,” he said.
“Residents can have up to eight or nine patients at a time, so it’s our job to do as much as we can to help them with their work.”
Then, at around 12:15 p.m., Bhatia enters another conference.
“The 12:15 p.m. conference usually lasts until about 1 o’clock,” he said. “On most days from about 1 o’clock on, it’s spent with newly admitted patients. We basically admit patients from about 1 o’clock until we leave around 6 p.m. or 7 p.m.”
But Bhatia said this rotation, consisting of a 12-hour day, is actually a relatively light load compared to some other days.
“The rotation that I’m on now isn’t as long as days that we’re on call,” he said. “As third-year medical students, we are required to be on call every fourth day that we work, which usually keeps us at the hospital until about 10 p.m.”
Bhatia said it is hard to know what any given day will hold for him.
“It’s hard to quantify how many tasks there might be, but it ends up taking an entire day at the hospital,” he said. “Not to mention there are hour-long talks that students are required to attend at the hospital in addition to regular work.”
The average day of a medical student can vary greatly, depending on a student’s rotation and whether they are admitting patients or on call.
Mish Mizrahi, a third-year UCLA medical student, is completing her rotations in Santa Monica at a family medical clinic and works a roughly 8 a.m. to 5 p.m. rotation.
“In family medicine, you see patients from all different complaints and age groups,” she said. “So on any given day as a medical student, I go in and I’m the one that talks to patients, checking on the patient and then presenting their condition to the doctor.”
The rotation of a medical student determines the type of schedule that student will have.
Medical students must complete rotations in internal medicine, including inpatient and outpatient care, psychiatry, surgery, neurology, obstetrics/gynecology and pediatrics, Bhatia said.
He added that the medical student workload may keep him busy, but he said he recognizes that it allows him to get as much experience as possible before applying for residencies.
“Night calls and admitting patients gets really hectic, because you have so many patients and you have to work with the doctor to see which patients should be admitted and which should get discharged ““ it’s a difficult task,” he said. “But I think it’s important to get as much exposure as possible.”
Another challenge is the emotional drain that can come with the job and the risk of becoming too attached to patients.
“There’s always that fine balance that you want to be close to the patient and feel what they’re feeling, but if that happens, it almost becomes so draining it’s difficult to carry on with your path,” he said.
And even on a normal, non-call day in the pediatrics ward, Bhatia is not finished once he has caught up with each of his patients.
“There are other things medical students have to take care of in an average day,” he said. “This could mean getting a referral, getting another team or patient to talk to a patient, like a cardiologist, or having an x-ray or MRI taken.”
Ultimately, however, the third year of medical school gives students the hands-on experience of life as a doctor.
“Basically you’re practicing being the doctor, and you do what you think the doctor would do if he were with the patient,” Mizrahi said. “You present what you’ve decided is going on with the patient to the doctor, and he tells you if he thinks you’re right and why.”
Bhatia said at this point in his medical school career, he is given a real taste of what it’s like to be a doctor.
“The first two years of medical school is predominately class time,” he said. “There’s some clinical work and some shadowing opportunities, but the first years are mainly just to bring everyone up to speed on the science behind medicine.”
Ali Shefizadeh is a first-year medical student.
“The basic outline of my day is lectures Monday through Friday. We have PBL, problem-based learning, in small groups from 8 a.m. to 10 a.m. Then on Tuesday, Wednesday and Thursday, students split up into three groups to study either histopathology, anatomy or doctoring. It’s a busy day, but you’re still expected to study independently on top of that,” he said.
The third year switches to a busy life of rotations, hospitals and clinical work, Bhatia said, and by the fourth year students are generally not attending lectures.
“If you have lectures, it’s all in a clinical atmosphere,” Bhatia said. “The fourth year is transitional, giving fourth-years time for research and applying for residencies.”
Mizrahi said patients are usually welcoming of medical students because students have the time to sit and talk with them.
“On rare occasions, patients say they’d rather speak with the doctor, but usually it’s okay with them. The med student usually has a lot more time, so a lot of time patients are really happy to be able to sit and talk with the student,” she said.
Bhatia added that he found his patients to be respectful and that they reaffirm his decision to be a doctor.
“The majority of the time, patients give me as much regard as a doctor or a nurse,” he said.
“They really look at medical students as great values, and we’re close enough to them that we can find answers and help them.”