American College of Physicians: Internal Medicine — Doctors for Adults ®

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Serving tables to better serve patients

From the September ACP Hospitalist, copyright © 2012 by the American College of Physicians

By Farzon A. Nahvi

As a third-year medical student, I was constantly surprised by how well my background prepared me for my clinical rotations. I'm referring not to my first two years of medical school, my research projects, or even my time working at my school's free clinic. I was specifically impressed with how my decade of experience working in the food service industry prepared me for life in the hospital.

I started working at age 13. Over the years, I've held many positions, from ice cream server and waiter to busboy and bartender. It has been these experiences, far more than my academic ones, that taught me about cheerfully working with a team, negotiating, resolving conflict and communicating effectively. And it's not just working in the food service industry that helps develop these talents. Employment almost anywhere develops these skills and, in many respects, is surprisingly great training for a career in medicine.

Courtesy of Farzon A. Nahvi.

Courtesy of Farzon A. Nahvi.



Physicians are often accused of too much proscribing and dictating, and not enough listening and negotiating. After years of learned subordination in medical school and residency, this should not be surprising. To exacerbate the matter, for many medical students, the first full-time job they ever have is as an attending, at which point the only model they've seen is a top-down, superior-to-subordinate approach. Employment, as opposed to academic, volunteering, and shadowing experiences, offers more opportunities to work with others on the same level, as equals. Because of that, it is the best way to develop these communication and negotiation skills that are so essential to being a good doctor.

Beyond developing these skills, performance in the work world is probably a good predictor of how one will perform in one's future career. Just as past test scores predict future academic potential, prior experiences working with a team can surely predict future success in this sphere.

As medical schools are increasingly concerned with structured teaching of these social skills—mandating extra courses, standardized patient experiences, and the USMLE “clinical skills” exam—using prior employment as a predictor for future success is an idea worth examining. Rather than continuing to accept students based principally on their academic merits and then trying to force-teach them the social components of health care during medical school, admissions committees could use employment history as indicators of potential to succeed in medicine.

Of course, this is not a novel ideal. Business schools already do this. Concerned with future management potential, business school admissions committees put significant weight on applicants' prior work experiences. While medical training is too long to require years of work experience as a prerequisite, admissions committees can, at the very least, take into deeper consideration the applicants who do have such experiences.

It's no silver bullet, but a different emphasis during admissions could go a long way in training doctors to be more team-oriented and more understanding of patients. After all, we wouldn't ignore an academic record and simply expect to teach students the science of medicine by force. Medical schools across the country are actively working on various ways to teach communication, empathy, and negotiation skills to their up-and-coming physicians. Considering that employment experience both helps develop essential social skills and may predict future success, it is something that medical school admissions committees should probably view more seriously.

Mr. Nahvi is a fourth-year medical student at New York University School of Medicine.

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