Did you work in the service industry before becoming a physician?

Here’s a fun fact: A parent can hire a “medical school application advisor” for their child as early as eighth grade. It’s true—both inclusive packages and hourly rates are available.

Let’s think about that.

Before an adolescent sets foot in high school, an adult will carefully plot out exactly which subjects they need to take and in which order they need to take them to maximize their medical school acceptance chances. Not to mention which PSAT and SAT prep courses they’ll need. Advanced Placement (AP) courses appear to be de rigueur—the more the merrier. Why waste time in college on non-required courses like English, history, philosophy or any of those pesky humanities?

They can also get advice on which summertime activities they must start lining up and which extracurricular activities they will definitely need to participate in. Also, it appears it’s never too early to start logging the “clinical hours” that are supposedly near and dear to every med school admissions committee member’s heart.

You know, I get it. I really do.

We live in a world that boasts elite travel leagues for every youth sport and a ranking service for the country’s best 9U (9-years-old-and-under) baseball players. There are private academies and personal coaches for the motivated parents of preternaturally athletic children. Why should the aspirations and preparations for a career in medicine be any different? How long will it be, do you think, before some wily entrepreneur starts ranking the top 9U med school candidates?

Breaking the traditional physician mold

I was a hospital director of medical education (DME) for a long time. I worked with trainees from newbie clerks to advanced specialty fellows. I watched one of my children successfully navigate the admissions process. I evaluated candidates for residency slots. And I want to be clear about something:

I think we’re getting it wrong. At least part of it.

We’re laser-focused on accepting the best resumes. But these resumes don’t necessarily correspond with the best future physicians. And we seem to be forcing younger and younger aspirants into a tightly constrained and ultimately unhealthy mold that runs counter to what a practicing doctor’s life is all about.

One of my routines as DME was meeting with every new class of third-year med students when they arrived for their very first hospital rotations. I’d inquire a little about their backgrounds—finding out what their hometowns, undergrad colleges, majors and outside interests were. I always asked two seemingly throwaway questions:

1. Had they ever participated in a team sport or activity in high school or college (including band, choir, drama, dance, debate, etc.)
2. What was the worst/hardest job they ever worked?

Here is what 20 years of close but admittedly anecdotal observation taught me: Students who had been part of a team and those who had worked non-medical service industry jobs typically had a noticeably easier time adjusting to the stark realities of patient care, the training hierarchy and the general vagaries of the human condition. Intrigued, I began informally asking the same two questions of residents, fellows and colleagues. Those who appeared to be the most well-adjusted tended strongly to also have experience being on a team and working a service job. The more problematic and outright worrisome ones almost always hadn’t done either of these things.

Highly unscientific? Absolutely. Ridiculously consistent, in my experience? You bet.

I’ll admit there might be some confirmational bias. Before I started med school, I never had a job or outside activity that had the slightest connection to medicine. My summers and vacations in high school and college were taken up with mostly minimum-wage positions that included restaurant dishwasher, busboy, waiter, asphalt paving tamper/shoveler, dump truck driver, garbage man, stock boy and government file clerk. None of these jobs made me academically superior or burnished my resume. None of them had any direct bearing on my acceptance to medical school. But I believe every single one, eventually and often obliquely, contributed to making me a better practitioner.

There’s something to gain no matter how small the job

Being the smartest person on the back of a trash truck doesn’t count for much. But the jobs, the other summer helpers and the “lifers” I worked with all had something to teach me. Hard-case bosses and coworkers who had no time for a spoiled suburban kid leavened my sense of self-importance. So did the local citizenry, who saw a dirty, sweat-stained laborer, not someone who might someday be their doctor. I picked up dozens of small but useful tips and skills from mechanics, carpenters, waitresses and short-order chefs. A blue-collar education is still an education. Fixing a leaking drainage pipe, I came to appreciate, has a lot in common with fixing a leaking aorta.

Medicine is the ultimate service profession. So where are checkboxes for “Worked in a service job” or “Worked with the general public?” And more than ever, it’s a team sport. Perhaps we should be encouraging applicants to experience humanity—raw, unfiltered and unvarnished—and give out points for that. Finding that our fellow hominids are messy and difficult (not to mention sometimes snarky and non-compliant) shouldn’t come as a late shock.

In 1933, a Polish philosopher named Alfred Korzybski published a book called “Science and Sanity.” It was a treatise on general semantics and has remained continuously in print to this day. One of its most-quoted lines is “The map is not the terrain.” I would adjust that to “The application is not the individual.”

If you sit on an admissions committee, I’d ask you to look beyond the “map”—the sterility of mean MCAT scores, the carefully curated CVs and the masterfully manipulated GPAs. Ask your applicants if they’ve ever stood behind a serving line or a retail counter, worn a hairnet or a hard hat or engaged a non-science major in a non-scientific debate. Ask them what lessons being on a team taught them. If we select our future physicians from the experiential equivalent of a petting zoo, what do we really expect to happen when they’re released into the wild of training and practice?

Medical students arrive to learn the science. They have to possess the inherent intellectual abilities required to do that. But unless they plan to spend their lives in a lab, I’d argue that something more than a passing familiarity with the “real world” and the people who inhabit it may be the key to providing some much-needed sanity.

Coach Curt Cignetti took the Indiana football team to a decisive national championship without a single “Five Star” recruit. His mantra was “Performance over potential.” He valued actual playing experience over metrics like wingspan and vertical leap. I think there’s a lesson in that.

The map is not the terrain.

Related reading:

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The DO Book Club, July 2025: Summer beach reads with a medical twist