AMA request for all residents/fellows/attendings: Are the sacrifices worth it?

[ragalai1242]

I've read this article http://blogs.law.harvard.edu/abinaz...go-to-medical-school-a-gleefully-biased-rant/

and also cherrypicked some of the most meaningful posts (imo) from this thread: http://forums.studentdoctor.net/threads/re-why-you-should-not-go-to-medical-school.1076900/

:

- "It doesn't make you a bad person to not be very altruistic. But, I think it makes the practice of medicine and the training required much harder. If you don't get pleasure/enjoyment out of helping people, the day just gets that much harder, because honestly that is one of the big edges that medicine has over everything else. We make a difference in people's lives and health. You certainly don't have to have this quality (many don't) to survive medical training, but it just isn't worth it in the end for most if you don't."



- "being a physician is an absolute privilege, but until you have woken up at 3am in the morning to go to work, or been cussed out by patients, or worked several weeks without a day off, or worked for 36 hours in a row, you don't understand that there are elements of the job that just absolutely suck, and suck hard. To respond to point 8--there will be patients you dislike and there will be days you dislike humanity. That's the reality of the grind of the situation.

When I first applied to medical school, I envisioned myself going from room to room, being super excited, saving lives. Now that I'm in the field, there are some moments of excitment, but there's a lot more of hard work, a lot of busy work, and a crap ton of BS. Would I still go into medicine know what I knowing now? Probably. But until you're in the field, you don't realize how accurate that article is. You just can't. Hold onto you enthusiasm as long as you can, but you'll realize that as you control less and less of your life, it gets harder and harder to do so. But then as you re-emerge from your training, while you've lost some naivety and idealism, you get some of the joy and enthusiasm back."



- "It's very easy now for you to say what you want in life as a premed and are ok with years of delayed gratification in your life. It's another thing to experience it altogether, esp. when those are years you will never be able to get back."



- "I think what should be taken away from these posts is that students should very seriously look at how much they want to study medicine, undergo immense training, be around sick people so much, etc. I truly believe that college pre-meds can often be so laser focused on med school admissions that they never learn about the huge number of other career options. Being out of college for ~3yrs I was really amazed at how many things there are.

I think these posters are just saying that students should really research what they want and if money is a big factor for some students, well, they're in for a surprise that there are many people making as much or more without the same training/debt. A friend I know got 140k out of undergrad as a developer, another who finished her bio masters is raking doing very well in biotech sales. And I wouldn't say these are "exceptional" cases.

Medicine requires large sacrifices. The physicians/residents/med students posting the aforementioned comments understand that. Some pre-meds tend to overlook this.
"




For a bit of background on who I am:

I'm 2 years removed from a top undergrad, making 170k+ a year currently. All my premed related stats (gpa, mcat, LORs are decent) are great. I was planning on applying this upcoming cycle, but reading this article (multiple times) and (as a result) continually questioning my devotion to medicine has made me wet the bed.

I really enjoy helping people. I enjoy (60+% which is a waste of time imo) volunteering in ped rehab. I shadowed surgeons in college; I remember finding their work to be incredibly impactful on patients. But I haven't woke up at 3 am to do this ****. I haven't consistently operated on < 5 hrs of sleep. I haven't been placed in a position where my satisfaction is entirely dependent on someone else, who might judge and hate me at first sight. I value my work-life balance. I try to derive the most impact/value from the least effort. Seems like a bad mix for medicine...

I enjoy my current job, but I don't love it. It's just a job to me. Of all the sacrifices I might be making for medicine (financial, effort, time), the most important one is time. I don't want to spend time being miserable, which if I am consistently waking up at 4 am and not spending time with my SO/family, I imagine I will be. I envision a lot of the glroy of medicine being able to help people, and maybe you do; but to what extent, and how much personal sacrifice is entailed? (also, seems to me like the sacrifices vary greatly across specialty; derm, what sacrifices?)

So, I am asking you, current residents/fellows/physicians of SDN, what is the reality of your situation? Are you really working 80+ hours for minimum wage? Would you do it again if you could? What are the sacrifices you made, and how do you justify them to yourselves everyday? What are the sources of BS (paperwork?) as a physician? What percent of physicians (at your daily workplace) do you imagine doing it again if they could? Please give some backdrop too on your story. If you're part of the 1% of physicians that are academic orthopods who make nearly a mil a year, that might be useful info to know for a premed who hasn't yet gone through the churn.

Also, as a side-thought...

over-working of physicians can be solved through more physicians (albeit lesser salary).
And paperwork/job BS can be solved through technology and price/outcome transparency.
Why hasn't it been done?

Seems like the industry has a fundamental conflict of interests with regards to improving population health. i.e. they need sick people to make profits. And of course, since they have complete control over procedural cost and result transparency, they can "protect" themselves from entrepreneurship that will ultimately better the system.

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[Spinach Dip]

Depends 100% on what you value.

I'll let the other members of this forum debate the finer points for the next 13 pages.

 

[mimelim]

Its funny, I knew the first quote was mine even though I wrote it over a year ago... Anyways...

Is it worth it? For some people, yes. For most people, no. It all comes down to what @Spinach Dip points out: values.

#1 Finances. Assuming that you make 170k+ 2 years out from college, medicine is a losing proposition. You will have 4 years of zero income, plus 3-7 years of ~50k/year and that opportunity cost for someone in an already high paying field. You would have to run the numbers for yourself (how much you would have to take out in loans, your cost of attendance, etc.) While your peak salary on average will be higher in medicine, the fact that you lose a lot of time means that overall, your purchasing power will be lower until at least your mid 50s and it may never actually cross over.

#2 In medical school, you generally get holidays off. Your first two years will resemble pre-med, the third and fourth, you will be working 50-80 hours/week learning to be in a hospital. You will likely get most if not all of the major holidays off and in general will get a minimum of one day off per weekend. For most people, even those with families, this is not particularly terrible. Residency is a different beast entirely. In surgery, expect to be occupied with work/hospital/research/studying 80-100 hours/week. Your time is not your own and your holidays are not your own. I worked Thanksgiving, Christmas and New Years my PGY1 and PGY2 years. Now, part of that was being at a program that didn't have a good system in place to balance these things (which I have changed since becoming a senior), but things similar to this exist all over the place. After residency, it is up to you what you do. But, the reality is that as a new attending, most people work their butts off to build their practices or make a mark. Maybe not as much as a resident, but certainly sometimes. Most physicians do not get regular phone calls at 3am. Our surgeons maybe once every other week or less. I also think that we are probably on the extreme high end of overnight disasters requiring something to happen.

#3 Residents do not work 80 hours/week for minimum wage. Most come out to $10-15/hour. Mine is equivalent to the local grocery store bagger.

I am writing too much, so I'm just going to directly answer your questions:

So, I am asking you, current residents/fellows/physicians of SDN, what is the reality of your situation? Could not be happier with where I am. I am a PGY4 in Vascular Surgery and likely am working as many or more hours than virtually any resident in the US.
Are you really working 80+ hours for minimum wage?
Nobody works minimum wage. Most come out to $10-15/hour. Mine is equivalent to the local grocery store bagger.
Would you do it again if you could?
In a heartbeat.
What are the sacrifices you made, and how do you justify them to yourselves everyday?
I see my parents and siblings less than I normally would. I can't remember the last birthday I celebrated that wasn't my wife's. I've missed most holidays over the last 3 years. This Christmas, I still don't know what my availability will be. My brother (close in age) is a high school teacher and I will not have as much purchasing power as him until I am in my mid 40s.
What are the sources of BS (paperwork?) as a physician?
Your boss. Insurance companies. Coworkers. Lawyers. The cost of doing business.
What percent of physicians (at your daily workplace) do you imagine doing it again if they could?
~90%.

Please give some backdrop too on your story. If you're part of the 1% of physicians that are academic orthopods who make nearly a mil a year, that might be useful info to know for a premed who hasn't yet gone through the churn.
Vascular Surgery, PGY4


http://forums.studentdoctor.net/thr...ughts-on-becoming-a-md.1106543/#post-15862254
http://forums.studentdoctor.net/threads/surgical-intern-answering-questions-tonight.936130/
http://forums.studentdoctor.net/threads/surgical-intern-answering-questions-tonight-part-ii.944769/

 

[molarmom]

What the heck are you doing two years out of undergrad that you're making 170k a year with a bachelors?

 

[Oranges2]

What the heck are you doing two years out of undergrad that you're making 170k a year with a bachelors?

finance gigs can help you make this much

 

[luxetvoluptas]

.

 

[WedgeDawg]

But my understanding is that in most cases, unless you're a gunner at a target school, you won't be making this much money

OP said they were coming from a top undergrad and probably worked hard for a solid GPA and interviewed well/had connections, so no this isn't typical, but that doesn't matter because it is OP's situation.

 

[luxetvoluptas]

.

 

[sharkbyte]

I see my parents and siblings less than I normally would. I can't remember the last birthday I celebrated that wasn't my wife's. I've missed most holidays over the last 3 years. This Christmas, I still don't know what my availability will be. My brother (close in age) is a high school teacher and I will not have as much purchasing power as him until I am in my mid 40s.

How often do you see them? Just out of curiosity.

 

[mimelim]

How often do you see them? Just out of curiosity.

Once a year is typical. During research years maybe 2-3 times. We also live 1000+ miles apart.

 

[NickNaylor]

finance gigs can help you make this much

A classmate of mine in medical school dated a girl who went to a top 5 undergrad, majored in applied math, and then got a job at a hedge fund doing quant work and within 3-4 years was getting annual six figure bonuses. I have no idea what her actual salary was, but with that kind of bonus I'm assuming six figures.

These kinds of things do exist - just not for everyone.

 

[Bacchus]

So, I am asking you, current residents/fellows/physicians of SDN, what is the reality of your situation?
-PGY3 in FM. Signed my contract for my first job as an attending this past week. Professionally, very happy with the future. See my family and hometown friends at least once a month.

Are you really working 80+ hours for minimum wage?
-No. I would say over the course of an academic year I average 40-60 hours any given week with hospital service and night float reaching 70 hours.

Would you do it again if you could?
-Yes.

What are the sacrifices you made, and how do you justify them to yourselves everyday?
-I think I've sacrificed some of my personal life. Currently not involved with anyone. All my friends are getting married. Still young though (late 20s) so I am hoping to catch up.

What are the sources of BS (paperwork?) as a physician?
-Paperwork, the ancillary staff at our office, other residents not necessarily being as efficient/effective as they can be.

What percent of physicians (at your daily workplace) do you imagine doing it again if they could?
-Almost all of them (in my residency).

 

[Oranges2]

But my understanding is that in most cases, unless you're a gunner at a target school, you won't be making this much money

i don't think you have to be at a top school or gunner per se. I would say top 10, even top 20 is enough. you just have to know the right people and being in top 10 helps expand your school's reputation/network at these banks/funds and its easier to get your foot in the door regardless of gunner status (have to be competent obviously). I say half of my friends are making 6 figures after bonus and definitely so even before bonus after 3-4 years (all in finance).

but just as @NickNaylor mentioned, it's not for everyone.

 

[22031 Alum]

My situation:
Academic Ob/Gyn attending. I am faculty for a small program affiliated with a state medical school.

Am I working 80+ hours for minimum wage?
No and I never have. As an intern, earning my lowest salary it probably came out to $12 an hour. Even then, I think comparing my temporary (key word) "wages," with a guaranteed large increase, to someone who earns $12/hr for their lifelong job is short-sighted. Even taking debt into account it doesn't really compare.

Would you do it again if you could?
Absolutely!

What are the sacrifices you made, and how do you justify them to yourselves everyday?
I missed some family events because of the cost of travel and schedule inflexibility. This is very different from my current students and residents. They are almost all local and able to more easily make it to things I didn't even think of arranging coverage for- like birthday parties. I wouldn't trade my training for anything but I can understand why someone might choose not to go to a place a thousand miles from family as I did.

What are the sources of BS (paperwork?) as a physician?
I don't consider the electronic medical record BS, though I know some of my colleagues do. The difference between them and me is that they had to adjust to the switch from paper, while an EMR/CPOE is all I have ever known. My hospital chose a cheaper system, and that is often painfully obvious.

Working at a small program, I have to put a lot of time and effort into administrative and educational tasks. I wear several hats that a larger program could divide among multiple people. But it's what I signed up for so I don't consider that BS either.

For me, the main sources of true BS are state bureaucracy and hospital politics.

What percent of physicians (at your daily workplace) do you imagine doing it again if they could?
90+%

 

[Instatewaiter]

So, I am asking you, current residents/fellows/physicians of SDN, what is the reality of your situation? Are you really working 80+ hours for minimum wage? Would you do it again if you could? What are the sacrifices you made, and how do you justify them to yourselves everyday? What are the sources of BS (paperwork?) as a physician? What percent of physicians (at your daily workplace) do you imagine doing it again if they could? Please give some backdrop too on your story. If you're part of the 1% of physicians that are academic orthopods who make nearly a mil a year, that might be useful info to know for a premed who hasn't yet gone through the churn.

Also, as a side-thought...

over-working of physicians can be solved through more physicians (albeit lesser salary).
And paperwork/job BS can be solved through technology and price/outcome transparency.
Why hasn't it been done?

Seems like the industry has a fundamental conflict of interests with regards to improving population health. i.e. they need sick people to make profits. And of course, since they have complete control over procedural cost and result transparency, they can "protect" themselves from entrepreneurship that will ultimately better the system.

What is the reality of your situation: I am a cardiology fellow
It has changed for me. I was regularly working 80 hours per week as a resident. Now as a fellow I probably work on the order of 60 hours per week. When I did the math in residency it worked out to be about $10/hour. Now it is a little more. When I moonlight I make significantly more.

Would you do it again? Probably. For me it changes day to day. It is never a "no." Usually it is a resounding "of course". Today I am in a sour mood so that is why it is a "probably." Medicine is interesting, constantly changing and for the most part a stable job. But there is a lot of BS you have to deal with from paperwork to dealing with payors. Plus that salaries are decreasing. Add to that the frustration that the average person thinks doctors make too much yet have absolutely no concept of the hours, responsibility or sacrafices one has to make to be a doctor. Your salary could drop by 30% in one year if the gov't decides to change reimbursement or some disgruntled patient could sue you and take your livelihood for nothing more than a bad outcome. These are frustrating stressors that make the practice of medicine less than ideal. Luckily I have never had one of these bad outcomes above but it is frustrating to think that it could happen. In certain specialties it is all but a certainty

Sacrifices: If have missed at least half the christmases, thanksgivings, easters or New Years. Even when I get the day off for the holiday, I usually don't have enough time off to travel to see family. I have also missed a few weddings of friends. You get used to this and don't really ahve to justify it.

In terms of relationships- It is not what people make it out to be. I met my wife, got married, had kids all while in training. Sure you're not going to have tons and tons of time to date but you have more than enough time. I do think it is harder for women because there is the constant pressure that they need to have kids before they get too old but the same could be said about women in finance.

I am a PGY6 cardiology fellow.

 

[Slack3r]

... same could be said about women in finance.

Or any professional career.

 

[Cyberdyne 101]

Oh wow, @Instatewaiter made a pre-allo cameo!

I wonder where @Tired is...

 

[ragalai1242]

Wow. Thanks everyone so far for the responses! It's really great to see that doctors would still do it again if they had the chance, especially since often times what you hear on the internet is the most disgruntled few.

There certainly are a lot of sacrifices being made, but I'm really happy to see that "it is still worth it" is a very widespread phenomenon. Of course, the more responses the merrier!

 

[mvenus929]

Been a while since I've been in Pre-Allo, but stumbled upon this thread, so thought I'd offer my $0.02

So, I am asking you, current residents/fellows/physicians of SDN, what is the reality of your situation? Are you really working 80+ hours for minimum wage? Would you do it again if you could? What are the sacrifices you made, and how do you justify them to yourselves everyday? What are the sources of BS (paperwork?) as a physician? What percent of physicians (at your daily workplace) do you imagine doing it again if they could?

What is the reality of your situation?
I'm a PGY-2 in pediatrics. I keep going back and forth with myself as to what I want in life, but I think I've emotionally settled on Endocrinology, which pays less in general than general pediatrics, which happens to compete for psych for the lowest-paying specialty.

Are you really working 80+ hours for minimum wage?
I've gone over 80 hours per week probably 2-3 times in residency, and never oven 80 hours averaged. I probably average somewhere between 60 and 70 hours per week, slightly more (like 75) on inpatient months and slightly less in outpatient months. Last I calculated, I think I'm hitting somewhere around $13 an hour. So better than minimum wage. I also have some limited opportunity to moonlight for $25 an hour, but since I work so much already, I have tended not to take these opportunities often.

Would you do it again if you could?
I would, personally, but it's definitely not something for everyone. I literally cannot see myself being happy in another career, and that includes the dozens of other medical careers I've been exposed to since entering medicine and medical school. I enjoy the relationships, the thought process, the challenge of unusual cases, being the leader of the team (though I'm not quite *the* leader yet), and teaching, and the combination of all that is hard to find elsewhere.

What are the sacrifices you made, and how do you justify them to yourselves everyday?
Well, I'm still single, which is made painfully obvious to me each and every time one of my friends (especially medical school classmates) gets married. I live really far from my close family and have drifted away from them some. On the flip side, I've seen my dad (who I"m not as close with) more in the past 5 years since moving closer to him for medical school than I had seen him in the previous 10. I really want a pet, but feel that as a single resident, I couldn't adequately take care of it (though there are a number of residents in my program who have). I'm hundreds of thousands of dollars in debt and while I'm chipping away at one of my loans, the others are growing far more quickly than I could possibly pay them down.

But I keep on doing it because at the end of the day, I do love the career I've chosen for myself. There are a lot of frustrations with my particular job now, none of which are particularly unique to my program, but I work with an amazing group of people (residents, attendings, nurses, and support staff alike), and most days I look forward to taking care of patients.

What are the sources of BS (paperwork?) as a physician?
Lots and lots of paperwork. Notes, billing, prior authorization forms. I feel that I am mostly shielded from these in my program (at least the billing, prior auth, etc) because our attendings take care of most of it, but notes can be a bear. And the stupid documentation rules mean that there is a ton of redundancy in the system that doesn't actually help the patient and just wastes the time of the people who could, in fact, spend more time with the patents and treating them properly. (As an aside, check out this petition). The problem with most of the paperwork we have to do is thrust upon us by a system that is not designed by people in medicine, and we, as physicians, are not standing up for ourselves in this mess. Which leads to more paperwork and less time to lobby, and it's a never-ending spiral.

There's also considerable debate over the use of CME. But as I don't have to deal with it quite yet, I'm not diving into the debate just now.

What percent of physicians (at your daily workplace) do you imagine doing it again if they could?
Hard to say, but pediatricians are among the least burned out and more happy physicians around. So I'm guessing that most of them would do it again. Though I could probably identify a couple who wouldn't.

 

[WinslowPringle]

What is the reality of your situation?
-PGY-1 in General Surgery.

Are you really working 80+ hours for minimum wage?
80+ hours/week at $9/hr.
So, not quite minimum wage.

Would you do it again if you could?
Depends.
Would I do it again if (after finishing residency) I could start all over again in undergrad but still retain all my surgical knowledge and all the experiences? Nope - why would I? Given that opportunity, I'd want to experience as much else as I could. But, knowing what I know now but not being able to retain that knowledge other than to choose to go through it again? So far - yes. I like where I am. Life is pretty good. It could sure be a whole lot worse.
(I'd probably change my undergrad majors, though.)

What are the sacrifices you made, and how do you justify them to yourselves everyday?
I don't think I make many sacrifices. My family, however, makes sacrifices.


What are the sources of BS (paperwork?) as a physician?
1. Paperwork
2. ICD-10
3. Stupid online training things that stupid managers in stupid offices working their minimal 40hrs/week job think up for us to complete so they can look good and justify their positions
4. Stupid trauma consults on stupid isolated fractures and stupid falls and head bleeds and stupid drunks...
5. Stupid complications because of stupid intern ....(me...)


What percent of physicians (at your daily workplace) do you imagine doing it again if they could?
No idea.

 

[Goro]

Every one of my clinical colleagues love what they do and thier patients.

I've read this articlem.

 

[getdown]

What is the reality of your situation?
I'm a PGY-3 in Anesthesia

Are you really working 80+ hours for minimum wage?
At my program we typically work 60-70 hours per week which includes a 24 hour call roughly once a week. The only time I worked over 80 was during my SICU rotation which included a 30 hour call. I worked out the hourly wage and it fell between 10-12 dollars an hour.

Would you do it again if you could?
I love anesthesia and I would probably pick it again as a specialty. My feelings about medicine in general vacillate day to day depending on how the day went but ultimately I couldn't think of any other field that I would have been interested in.

What are the sacrifices you made, and how do you justify them to yourselves everyday?
The biggest sacrifice is that I'm giving up the best years to essentially be in school and working for next to nothing while my friends are earning income, going on vacations, buying houses, having families and generally moving on with their life while I stuck in "school" mode. During med school I saw my parents about once a year. Since I've started residency I've seen them twice, not counting the time they helped me move in. Everyone is generally very understanding of the situation. But sometimes it definitely hits you and you just feel frustrated you can't be enjoying all the things your friends are doing. Thankfully I met my girlfriend during residency and she's the best thing to have happened to me so far. She helps me get through those rough days and makes residency much more bearable.

What are the sources of BS (paperwork?) as a physician?
In my field in particular, the biggest source of BS are the CRNAs and hospital administrators who want to replace us with cheaper labor. Because medical advancements and monitors have made anesthesia a very safe field in general now everyone thinks it doesn't require a lot of training to just watch monitors (this is what the AANA wants you to believe). And a lot of times, in healthy, stable patients that is true. But the difference arises when bad complications happen or when you're managing an ASA 4 patients with multiple comorbidities. Small details matter. Unless you've actually been in the OR and seen a CRNA practice vs an MD practice you can't really understand the difference. Easiest way to describe it: nurses follow algorithms to help them decide what's going on while doctors know when an algorithm doesn't fit a particular situation.

Hospital politics is also a huge pain in the ass. Dealing with primadona surgeons is also a huge challenge.

What percent of physicians (at your daily workplace) do you imagine doing it again if they could?
Hard to say. Generally satisfaction is high but due to the above BS issues I also know a lot of them that are somewhat disillusioned

 

[Winged Scapula]

So, I am asking you, current residents/fellows/physicians of SDN, what is the reality of your situation?

I am a surgeon specializing in the surgical treatment of breast cancer in private practice with adjunct appointments at a local medical school and a local residency program.

Are you really working 80+ hours for minimum wage?

No; I work less and for significantly more. Even as a resident, when we started under $40K (and there were no work hour restrictions), I earned more than minimum wage (but then again, MW was $5/hour back then). However, as I recall we figured it was around $7/hour or so.

Would you do it again if you could?

Yes. However, truth be told (and there are SDN posts that verify this): I was pretty miserable as a resident and thought about quitting every other day.

What are the sacrifices you made, and how do you justify them to yourselves everyday?

Time with family; probably health during residency, delayed gratification in terms of the "big house/car" etc that my friends had. I don't have to justify anything to myself or anyone else. I'm happy with my life, I'm doing what I want and I'm respected and paid well for it. Had I wanted children, that may have been a sacrifice, but I didn't so not an issue for me as it would be for some other women.

What are the sources of BS (paperwork?) as a physician?

Personnel management at the office. Documentation and paperwork especially with a highly litiginous specialty. Stupid hospital rules that don't change patient care.

What percent of physicians (at your daily workplace) do you imagine doing it again if they could?

All of them.

 

[NickNaylor]

What is the reality of your situation?
Psychiatry PGY-1

Are you really working 80+ hours for minimum wage?
Here's my duty hours as I've logged them so far. I take home roughly $1,500 every 2 weeks after taxes, insurance, and other deductions, so you do the math. Per the average at the bottom, I'm earning ~$13/hr with a range of ~$10-15/hr depending on the rotation.

Would you do it again if you could?
Absolutely. Medical school was a beating at times, but overall I enjoyed it, particularly after I got into the clinical years. Residency has been more stressful but even more enjoyable than medical school. I'm looking forward to getting out into practice and am excited about my future work. I enjoy working with patients, I enjoy learning, and I enjoy the core work of clinical medicine. Unfortunately, there's just a lot of nonsense that gets tacked onto those "core functions" which distracts from clinical work that can be frustrating. But in my field especially it's common to go into private practice and operate a cash practice to avoid dealing with insurers. This is something I intend on doing in when I'm done with training in order to focus on patient care rather than the downsides (of which there are many) of working as an employee and dealing with payers.

What are the sacrifices you made, and how do you justify them to yourselves everyday?
Much the same as the above: missed weddings, missed birthdays, etc.. But ultimately I've made it a point to make time for myself and my family a priority, often at the detriment of my academic performance in medical school. My wife is understanding of my hours now and probably puts up with my fatigue more than she should, but particularly at the beginning of medical school the hours were a big source of frustration for her. She just didn't "get it." Now, though, I think she's used to it and it's less of a point of contention, though it's difficult at times to muster up energy to use my day(s) off doing things beyond being lazy and resting at home. But I make the most of it.

I think the largest sacrifice I've made was being ~1000 miles away from my step-mom as she was dying from cancer. I'm not sure I can justify that to myself, but it happened, and that's life.

What are the sources of BS (paperwork?) as a physician?
Since I'm shielded from insurance issues for the most part, most of it has to do with administrative nonsense or nonsense from nurse managers. On my current rotation especially the nurse managers are hypervigilant about following all kinds of nonsense protocols which have little to do with improving patient care and, at times, actually worsen the care we give to patients. It's a waste of time for everyone involved except the people that get to gripe at you for not following XYZ protocol. I've had to talk to payers a couple of times in order to "argue" for why a patient should be inpatient vs. observation, but in those cases the case manager classified them as the wrong status when submitting to the insurer (i.e., classifying as inpatient when they should've been observation), so in neither case did I have to do much "arguing" as I agreed with the payer's assessment. On my current rotation, though, my attending somewhat regularly has to perform peer review to argue for more covered inpatient days at least once a week if not more frequently, despite the fact that we have a nurse on the unit whose entire job is to deal with payers.

What percent of physicians (at your daily workplace) do you imagine doing it again if they could?
Most attendings enjoy their job. Many of the senior residents seem more disillusioned but I get the sense that they would still do medicine and psychiatry specifically again.

 

[styphon]

My situation:
Attending family medicine physician for Indian Health Services.

Am I working 80+ hours for minimum wage?
I was close to that during residency, but at that time salary was 34k (at 80 hours/wk is about 9$/hr). Of course as an attending I make more, and actually work less.

Would you do it again if you could?
Without a doubt I would do it again

What are the sacrifices you made, and how do you justify them to yourselves everyday?
It most likely cost me my marriage. Med school+residency put a tremendous amount of stress on me and it was hard to deal with others during that time. I think this actually worked in my favor over the long term as we didn't have the best of relationships

What are the sources of BS (paperwork?) as a physician?
As an outpatient family medicine I do tons of disability/SSI/SSD paperwork, although the one I hate the most is prior auth.
I also dislike people with Health admin degrees trying to tell me how to practice medicine - people who couldn't tell me what an opiate is try to tell me how to prescribe it.
I don't mind EMRs, as they were taking over while I was in medical school - I was also very into computers when I was younger.

I went into medicine to help people that mainstream society ignored. This helps me carry on and gives me great job satisfaction.

 

[WingedOx]

But my understanding is that in most cases, unless you're a gunner at a target school, you won't be making this much money

And even if you are, those jobs can be soul killing. You're essentially highly-compensated grunt work often with insanely stupid hours. I'm in my 30s and I've seen WAY too many burnouts in finance who I wouldn't switch places with. (though I'd love to have their 401ks by this point in my life)

 

[themockjock]

So, I am asking you, current residents/fellows/physicians of SDN, what is the reality of your situation?
PGY-1 Integrated cardiothoracic surgery. Aww yeah.

Are you really working 80+ hours for minimum wage?
Depends on the rotation. Busy CT/gen surg rotations, yeah roughly that. Chill cardiac imaging rotations... less so. My program is backloaded though and the real pain comes in the PGY-3 and above years where I will always be at the 80 hour mark...

Would you do it again if you could?
In an instant. I couldn't imagine doing anything else... I was actually pre-law (ugh) my first 2 years of undergrad and realized something along the lines of "what the f*** am I doing with my life?" I ended waking up one morning and deciding to go to med school (no, really) and never looked back. It has its moments of pain and misery and can be completely emotionally exhausting (especially in my specialty where things go spectacularly and unexpectedly bad sometimes), but the highs of taking a 20-something kid completely on death's door from fulminant bicuspid aortic valve endocarditis to walking out of the hospital a week later make this whole thing completely worth it. Now, if I was in most other specialties my answer would likely be completely different. I respect the hell out of my EM/FM/etc colleagues but I absolutely would NOT be happy in medicine titrating BP meds or dealing with vaginal bleeds at 3am.

What are the sacrifices you made, and how do you justify them to yourselves everyday?
Everything listed above. Seeing less of friends, family, my dog, too much bad cafeteria food vs going the entire day subsisting on the graham crackers they keep for patients in the PACU, not exercising enough, not sleeping enough, etc etc. See previous answer for how I justify it... I actually enjoy the challenges of my job and of intern year in general so it is worth it to me - I actually enjoy showing up to work every day...

What are the sources of BS (paperwork?) as a physician?
Paperwork, inane documentation, case management/social work issues not relevant to my training, and all of the spectacular administrative time wasting (classes on healthcare communication training, days worth of online modules on such stimulating topics as "Saving energy at the hospital" and "Preventing fires in the operating room," etc etc) that are required of a major corporate hospital.

What percent of physicians (at your daily workplace) do you imagine doing it again if they could?
The people who go into CT surgery are generally a pretty self-selecting bunch who know what they're getting into. I think despite all of the pressures and issues within the field, people generally like the job. The attendings at my institution work incredibly hard; they're probably the hardest working group of staff I've seen anywhere and they all just seem to really enjoy operating and derive a lot of satisfaction out of the job in general - despite the pressure and the hours.

 

[Doudline]

I approve of this thread. Should end up in a sticky.

 

[Law2Doc]

Agree with mimelim's post above.
This field isn't for everyone. For the right people it's great, for anyone else it's probably the inner circles of he11. Yes in many specialties you periodically will go over 80 hours a week, both in residency and beyond. You will work holidays in residencies and beyond. Yes, beyond. Your salary will be low for at least a decade on this path. If you are at $170k now, if you factor in the "time value of money" you'll likely never catch up in medicine. If you are looking for people saying you won't get woken up by unappreciative patients at 4 am, I'd say sorry but that's really not uncommon. If you are saying you want an easy life, high pay and lots of free time I'd say this really isn't the right path. Its a job that exacts big time trade offs, hard work, sleep, holidays, family events, particularly during training but often beyond. Go in with your eyes open. Again it's a great job for some but definitely not for everybody on here.

 

[OrthoTraumaMD]

what is the reality of your situation?
-ortho attending specializing in trauma

Are you really working 80+ hours for minimum wage?
-not anymore. I still work 80 hours but much of it consists of admin/research/educational efforts. Clinically it's anywhere from 40-50 depending on how much trauma comes in.

Would you do it again if you could?
-in a heartbeat.

What are the sacrifices you made, and how do you justify them to yourselves everyday?
-As a resident, i did not spend much time with my family/parents (saw them once every few months when i could drive back to my home city-- residency was in a different state). i am an only child in a tiny family so spending time with them was important, and i definitely didn't do that for 5 years. my personal life suffered in terms of keeping my romantic relationship - simply put, there were mistakes made on both sides, but for my part, my mistake was just focusing entirely on work and making my sig other the "last thing on the to-do list" at the end of the day-- a survival strategy for surgical residents, but one i would not recommend (although after many years, we have reconciled). delayed family planning was probably the most significant impact - most of my friends have children and i do not, and that is a source of concern because older mothers are at higher risk... however it is not insurmountable and i would still do things the same way if i had the chance. as for "justifying," my ultimate goal never changed and i do what i love and help people. i don't feel the need to justify anything because i knew what i was getting myself into. those who loved me understood that you couldn't have your cake and eat it too, and they always supported me (even if they did grumble over my long absences).

What are the sources of BS (paperwork?) as a physician?
-EPIC, more EPIC, some more EPIC. Having to adhere to "meaningful use" standards that take my time away from patients and force me to check off useless boxes in electronic notes. Political machinations at my hospital that have nothing to do with me but end up affecting my practice or patient care.

What percent of physicians (at your daily workplace) do you imagine doing it again if they could?
-I'm an orthopod, so all my partners naturally love what they do and would absolutely do it again. we are the happiest specialty for sure.

Please give some backdrop too on your story. If you're part of the 1% of physicians that are academic orthopods who make nearly a mil a year, that might be useful info to know for a premed who hasn't yet gone through the churn.
-i am indeed an academic orthopod, but i don't make a mil a year. few do these days, unless they do spine! haha.