By Ben Reinking, MD

As I led small group sessions during our medical school’s recent orientation, I was struck by the nervous excitement and hope radiating from our new first-year students. Their enthusiasm was palpable yet tinged with apprehension about the challenging journey ahead. Two themes emerged from our discussions. The first was a desire to dive in and tackle challenges ahead. As one student stated, “Enough talking, let’s start doing.” The second was a hope to maintain some semblance of work-life balance. These concerns echoed my experiences from nearly 30 years ago, reminding me of the enduring challenges faced by those entering the medical profession.

I have two vivid memories from my medical school orientation. The first is of a slide showing the massive increase in medical knowledge and information. The purpose of the slide was twofold. First, the presenter wanted to impress upon us the rapid pace of medical advancements. Second, it was to prepare us for the vast amount of information we would need to learn. Although the slide was meant to inspire, I remember feeling a sense of dread. Throughout orientation, we heard about the challenges of medical training. I kept thinking, if medical school was hard for the previous generation, how could I get through it with even more information to learn?

The second memory is of an icebreaker near the end of orientation, where we identified what we valued in our lives. During the exercise, we were asked to name identities or roles significant to us. People mentioned being a parent, a son, a daughter, a sibling, an artist, an athlete, and so on. At the end of the activity, the group leader said we could now add “medical student” and, eventually, “doctor” to that list of identities. The presenter also mentioned that holding on to our other identities was important, but there would be times in our medical training when we must set those non-medical identities aside and prioritize being a student and physician. After all, the patients under our care would have to come first. This message of prioritizing professional identity over personal identity has been repeated multiple times throughout my medical education and professional life, becoming a central part of the physician’s mindset. As a small group leader, I questioned whether I wanted to repeat the same message and reinforce the culture of putting aside personal fulfillment for the sake of professional duty.

The concept of delayed gratification is deeply ingrained in medical education and training. It’s the idea that by resisting immediate rewards and making sacrifices now, we will reap greater rewards in the future. This mindset is often promoted as a virtue during medical training. However, as we explore its impact on job satisfaction, burnout risk, and personal growth, we find that delayed gratification in medicine is a double-edged sword.

The journey through medical education is a story of delayed gratification. While their peers enter the workforce, medical students continue to study, accumulate debt, and defer many aspects of adult life. Residents work grueling hours, often without typical employment benefits like employee match retirement accounts, all in pursuit of future rewards. This pattern of deferring satisfaction can breed frustration, especially when the expected rewards materialize more slowly than anticipated.

The constant refrain of “I’ll be happy when …” becomes a mantra for many as they pursue their dream of becoming a doctor. Premeds study hard and look forward to starting medical school. Medical students grind through the preclinical years and USMLE exams to start rotations, and residents dream of completing their training with the anticipation that life will become easier afterward. While life does change after training, the realities of medical practice often fall short of these idealized expectations. The long hours, high stress, and steep learning curve of early practice can lead to a profound sense of disappointment. Moreover, at some point, the fleeting nature of time spent away from loved ones and personal passions amplifies the emotional and psychological cost paid during medical training.

This pattern of delayed gratification may inadvertently set physicians up for burnout and job dissatisfaction. The constant push towards future goals without enjoying current achievements can lead to emotional exhaustion. There’s a risk of neglecting self-care and work-life balance in the relentless pursuit of long-term dreams. The bitter irony is that after years of sacrifice, many physicians find themselves still waiting for that elusive moment of fulfillment, realizing they may have missed countless opportunities for happiness along the way.

However, delayed gratification is not all bad. When appropriately managed, it can provide a sense of purpose and direction, particularly during the intensity of certain rotations. Medicine is, after all, an inherently challenging profession. Delayed gratification can potentially add meaning to some of the necessary trials of training and reduce burnout risk. The key lies in finding a sustainable balance between working towards future goals and finding satisfaction in the present.

Delayed gratification can also be a powerful catalyst for personal growth, developing discipline, and enhancing our ability to set and achieve long-term goals. It should be noted, however, that physicians have more discipline and resilience than their non-medical peers. Furthermore, an overly rigid adherence to delaying joy can hinder spontaneity and creativity, leading to an all-work, no-play mentality that exacerbates work-life imbalance.

To summarize, the impact of delayed gratification on our professional lives isn’t black and white. While it can help us navigate the challenges of medical training, it also carries risks. We may miss out on crucial personal development in early adulthood. The disappointment can be crushing when we finally finish training and realize that medical practice is all-consuming. Not developing interests, hobbies, and relationships outside of medical training increases the risk of burnout.

We must strike a balance to harness the benefits of delayed gratification while mitigating its risks. Set long-term goals, but remember to celebrate small victories along the way. Work hard towards future rewards, but find ways to enjoy and find meaning in your current role. Put the patient first when necessary, but remember to put yourself first sometimes. True success isn’t just about reaching a distant goal – it’s about growing, learning, and finding fulfillment throughout the journey.

As medical educators and mentors, we have a responsibility to help our students navigate this complex terrain. We must encourage them to pursue their dreams while also emphasizing the importance of self-care, work-life balance, and finding joy in the present moment. It’s crucial to teach students the value of leveraging daily choices as a means to balance delayed gratification with immediate fulfillment throughout their medical training journey. By making conscious decisions each day that align with both long-term goals and present well-being, students can cultivate resilience and satisfaction. Self-care is not selfish; choosing to care for yourself also benefits patients and the medical system. By instilling these principles, we can help cultivate a new generation of skilled, dedicated, resilient, and fulfilled physicians who understand the power of patience in achieving their goals while also appreciating the present moment.

Ben Reinking is a board-certified pediatric cardiologist, medical educator, and certified physician development coach.