> Also the format of US medical school has changed considerably in the last 20 years. There is plenty of free time in the preclinical years You're right about

> Also the format of US medical school has changed considerably in the last 20 years. There is plenty of free time in the preclinical years You're right about that, it's gotten worse. The perspective you're offering here contradicts basically all documented perspectives on the intensity and time demands of medical training. > Concerns about excessive content and curricular overcrowding in medical education have existed for more than a century. In 1910, Abraham Flexner noted that the packed medical school curriculum would “tax the memory, not the intellect.”1 The Rappleye Commission Report on Medical Education published in 1932 stated that “the almost frantic attempts to put into the medical course teaching in all phases of scientific and medical knowledge, and the tenacity with which traditional features of teaching are retained have been responsible for great rigidity, overcrowding, and a lack of proper balance in the training.”2 Since then, periodic concerns have been raised about this ongoing problem, notably in the Association of American Medical Colleges' Panel on the General Professional Education of the Physician (GPEP report) in 1984 and the Assessing Change in Medical Education (ACME-TRI) report in 1993, among others.3-6 > The problem has only worsened in the years preceding the pandemic. New pharmaceutical agents seem to appear daily, while our understanding of pathophysiology of disease continues to expand. In addition, we have needed to consider new and vital subjects such as cultural competence, care of LGBTQ patients, teamwork and interprofessional care, health care quality and safety, medical humanities, narrative medicine, and even wellness curricula, that have added pressure to the preclerkship phase of medical school, as ever more content is added. And little has been removed. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8463236/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8463236/ The relationship between empathy and burn out (especially in clinical practice) is also very well established. The whole system has a very strong selection against empathetic practitioners, whether through burning them out, or selecting a preference for their less empathetic peers.