The rise of the consumer-student

Over and over in classrooms and lounges, I regularly overhear, ##ldquo;I can't believe I'm paying $50,000 a year to do this.##rdquo;.

Medical students complain endlessly about medical school. Considering the demands of medical training, they probably always have. But while the complaining may not be new, the types of complaints might be. In addition to the usual grumbles about sleep deprivation and high expectations, I increasingly hear a new gripe. Over and over in classrooms and lounges, I hear, “I can't believe I'm paying $50,000 a year to do this.”

Complaining about the cost of medical school reveals a cultural shift. Previous generations of students viewed medical school as a challenging academic hurdle, but today's students seem to see it as a commodity. Faced with the prospect of mortgage-sized debts, the student is becoming as much a consumer as a learner.

Courtesy of Mr Nahvi
Courtesy of Mr. Nahvi.

This is a crucial distinction. Medical students traditionally learn the most in their clinical years. Just by spending time with their team on the wards and being in the hospital, they gain knowledge and experience. There may be little in the way of explicit teaching—perhaps an hour of formal lectures per day—but much is learned. Along the way, something fundamental changes, and students go from feeling like college students to feeling like clinicians responsible for patients. The system may not be easy, or even pleasant at times, but it works.

Consumers, however, are very different from students. They have a unique set of expectations. And because they are paying a huge price, they make demands. A consumer who feels he is responsible for learning specific material is not interested in spending 12 hours in the hospital picking up bits of information that targeted teaching could impart in four or even two hours. Shaping a student into a clinician is crucial, and harder to accomplish when a consumer is focused on getting what he paid for—an education— and getting out. And, of course, the customer is always right. The customer is entitled and does not expect to be shaped by the curriculum but expects the curriculum to be shaped by him. Since practices learned in medical school last a lifetime, this shift in expectations is important.

This is not to say that medical education doesn't need to be improved.But creating a consumer culture in medical school, in which the customer is always right and makes demands, is not the way forward. A crucial part of medical education is being molded by the process—not just learning about treatment, but feeling responsible for one's team and patients. It takes a genuine student, and not a customer, to make that transition.

Medical students complain because medical school is hard. It has to be. The job of being a doctor is hard. There's no shortcut or easy way around the challenge, and it's wrong for students to expect a different experience simply because they're paying for it. Eliminating this sense of entitlement, and allowing students to simply be students, is yet another reason we need to tackle the snowballing costs of medical education.