Not every medical student becomes a doctor. Although not a frequent problem, about 6 percent of medical students are unsuccessful in meeting their dream within seven years, according to a 2007 study from the Association of American Medical Colleges.
This failure is almost never an academic problem or an inability to handle the material. Admissions committees in the U.S. do not accept candidates they believe will fail to become physicians.
In some cases, students leave medical school because there is a conflict as to whose career goal they are actually fulfilling. Medical school requires great discipline and steals most available free time. If a student is living out the parents' dream instead of his or her own, the inner conflict can lead to unconscious sabotage.
Parents dream of their children having lives equal to or better than their own. In some cultures, bright students are expected to study either medicine or engineering - a comment I was at first surprised to hear, but I now understand its seriousness in some families.
Students who don't want to disappoint their parents, or have no plan of their own, may go along with their parents' wishes initially. Although admissions committee members try to discern if it is the student's own desire to come to medical school, they can be fooled as a student tries to convince himself or herself that this is the career path they want.
If you aren't sure, you shouldn't attend - try something else that you might prefer. The cost, emotionally and financially, is great and dropping out doesn't come without disappointing yourself or others.
Medical research is a frequent alternative for students. Multiple students I know have gone that route; some return to decide medical school is what they want for themselves and about half prefer research.
Others have chosen to go to physician assistant or nurse practitioner programs. Just because they achieved a dazzling 37 or 39 on the MCAT doesn't mean that medicine is absolutely their cup of tea. They like patients but not the length of time it takes to go through medical school and residency.
Still others have said, "I need to live my life for myself," and have gone to business school, entered the entertainment or cooking industries or chosen to become a stay-at-home parent.
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But a lack of desire to become a doctor isn't the only reason medical students are unsuccessful. An untreated or undertreated mental illness - be it an eating disorder, panic disorder, major depression, bipolar disorder or other mental illness - can also be a roadblock to success in medical school.
Students may deny their symptoms or be discouraged from seeking help by others. They may hear comments like, "Everyone is stressed in medical school."
Many students fear there is a stigma associated with seeing a mental health professional, and some families encourage that thinking. Other students are even afraid to confide in their parents for fear of disappointing them.
This becomes a snowball effect, with symptoms increasing steadily until the student is no longer able to complete their assignments or report to class.
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The student may be able to ask for a leave of absence but this will not necessarily solve the problem, as the stress of medical school will still be there when he or she returns. The bottom line is that psychological and psychiatric help is needed if the student is to return to school successfully.
If a leave of absence is granted, there is a limit to the amount time off students can take and if they have made no effort to face their own challenges and get help, they will eventually come to the end of the grace period. Promotions committees will dismiss them, or, in some instances, allow them to resign.
Some students come to medical school already knowing their vulnerability to a particular mental illness and will seek a referral early in the first year so that there is no break in treatment.
I have had students come to me during orientation week requesting contact information for good mental health professionals. These students have a high rate of success.
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When they notice they are starting to slip, they immediately go for an appointment. If they are on medication, they take it regularly and get adequate sleep, allowing them to keep stability in a stressful life.
Many of these disorders often present for the first time when students are beginning medical school and under increasing amounts of stress.
As a result, students may not have developed good coping skills and could be at risk of developing negative habits such as not getting enough sleep or increased alcohol consumption. This can also lead to disorders like depression, mood swings and panic attacks.
If a future physician wants to help others, he or she must be willing to look at themselves and correct behaviors that are damaging and unprofessional. Self-discipline, personal motivation and a willingness to seek help are the best guards against failure.
Kathleen Franco, M.D., is associate dean of admissions and student affairs at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. She previously served both as director of residency training and director of medical student training in psychiatry at Cleveland Clinic. She is board-certified in psychiatry, geriatric psychiatry and psychosomatic medicine and attended Medical College of Ohio--Toledo.