Now more than ever in medicine, one must adapt to survive
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“Only the Strong Survive,” written by Jerry Butler, Kenny Gamble and Leon Huff, became the most successful single of Butler’s career.
The song, performed by Butler in 1968 and released on his album, “The Ice Man Cometh,” reached No. 4 on the Billboard Hot 100 and stood at No. 1 for 2 weeks on the Billboard Black Singles chart in March and April 1969.
However, the statement “only the strong survive” often is attributed to Charles Darwin, who has been quoted as saying: “It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.”
Survival of the fittest
Survival of the fittest — made famous in the fifth edition (published in 1869) of “On the Origin of Species” by the British naturalist, biologist and geologist — suggested organisms best adjusted to their environment are most successful in surviving and reproducing. Taken from Darwin’s theory of evolution, survival of the fittest has been conceptualized as the advantage that accrues with certain traits, allowing an individual to both thrive and survive in their environment by outcompeting for limited resources. Darwin transformed the way we understand the natural world with ideas that, in his day, were nothing short of revolutionary.
I mention Darwin’s quote because today more than ever in medicine, to survive one must adapt to one’s environment. I’m not talking about the 80-hour workweek for residents that prohibited resident doctors from working more than 80 hours per week over a 4-week period. Nor about virtual meetings with colleagues or virtual “visits” with patients that the COVID-19 pandemic has created, although we certainly have adapted. Adaptation to one’s medical environment occurred long before COVID hit.
It’s more about the everyday work ethic of the physician completing residency. Those who have had the experience of recruiting in medicine over the past several years know the conversations during interviews will lead to questions about protected administrative time/mental health timeouts, whether your institution has a healthy well-being program, on call no less than every fourth night, and the number of hospitals to cover on call, especially on the weekends.
Don’t get me wrong. These are not inappropriate questions. Certainly after my residency I would never ask them, especially because there was no such entity as a healthy well-being program. Residents would seek my advice when they felt they didn’t have time to complete their manuscripts. After reviewing their activities during the day and evening, I would go over better time management. However, I always added, “there are always Saturday and Sunday when you are not on call to catch up on that manuscript.” It worked all the time but not so much today. Nevertheless, I still use it, so I haven’t quite adapted! However, the environment has changed, in some aspects, for the better.
Work-life balance
Today’s graduating residents want not only a better quality of their professional life, but one that rolls over to a better quality of their personal life. It is no secret that work-life balance has always been an issue for all generations. In this day and age, medical school graduates are faced with high debt loads, which is stressful enough. You can’t blame the students for gravitating toward high-paying specialties with good work-life balance. Perhaps dermatology comes to mind.
Frankly, because of a better quality of life, today’s young physicians will probably live longer than my generation, since we know that stress is not a positive factor for longevity. So, if you want to be successful in recruiting and, just as importantly, in retaining quality physicians in your institution, you have to adapt to the environment in order to survive. If you don’t, you’ll have fewer successful recruits and won’t be able to retain the quality physicians you have.
Darwin was right. “It is not the strongest of the species that survives. ... It is the one that is most adaptable to change.”
Stay safe.
- Reference:
- Whitburn, J. Top R&B/Hip-Hop Singles: 1942-2004 (2004). Record Research. For more information:
- Nicholas J. Petrelli, MD, FACS, is Bank of America endowed medical director of ChristianaCare’s Helen F. Graham Cancer Center & Research Institute and associate director of translational research at Wistar Cancer Institute. He also serves as Associate Editor of Surgical Oncology for HemOnc Today. He can be reached at npetrelli@christianacare.org.
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