Enter med school at 44?

[TheTao]

IMHO, if there's anyone prepared for the task in their 40's, it's Ji Lin. And there are a number of reasons for that which she's outlined, but I'll focus on 2. First, she's already IN a hard core medical environment as an ICU Nurse, no less. Second, she knows something about how to struggle and over come. And that's a tenacity that will shine through in ANY profession she choices.

These debates, why a person over 40 should think twice about med school, always come back to these two things as far as I'm concerned. A Banker from a wealthy background, just may struggle in the abusiveness of a medical environment. But take ANYONE from a disadvantaged background and especially a disadvantaged minority,and throw them in the meat grinder that is med school, and I'm reasonable certain that their "response/perspective" in abusive/tough/demanding environments will likely be VERY different. At least that's what I've seen in the almost 30 years I've worked in primarily medical research environments/hospitals/other clinical institutions ie the NIH clinical center.

One more thing I'd like to address that pursuing Nursing ie the DNP, isn't always the best answer for scratching that medical itch when you're over 40 and don't already have a nursing degree. In fact the time from BS in "insert science degree" to the DNP can take at long 7 years. In that time, an MD + FP residency would have been completed.

"The last one, all I can say is that there is certainly a BC/BE attending pathway that can work for anyone. The problem is getting there, you have a 7 year stretch that is unforgiving."

Having worked in a few hospitals run by "suits" not Docs, I'd also be perfectly content to finish med school, followed by a residency in Clinical Informatics (maybe coming back to my current school?), and then filling that Consulting role I talked about earlier. When you're over 40, going into this process with good health AND a plan B & C is just plain common sense.

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[jl lin]

The Tao, we share many similarities. Please PM me or keep me informed of your progress, and I will do the same. It's early yet for me to make a declaration, but my leanings are for FM or IM/Peds or just general peds. My concern with FM is that I would like to have a nice % of pediatric patients. I have grown to love this population and their families as a RN. They have their own sets of demands and challenging as compared with the adult population. I also want to work in more remote areas, as I have worked mostly in academic urban centers as a nurse practically my whole life. I have also loved teaching, and if my evaluations are any indication of things, I am pretty good at it--that's a we'll see too.

I am taking one day at a time; but was a little concerned that any specialization will just be too many extra years. Was considering the need for endocrinologists for peds and adults in many areas--but that's a longer path.

I'm also concerned about the grind of IM part of residency--as I have seen many residents get beaten up by the grind of IM. Surgery (definitely) and ED, though I have such an ED personality, is off the table for me. But I will say that I have learned to appreciate a variety of patients and problems, so I am pretty set on primary care. You aren't supposed to project your desired area of medicine; but at my age I have to good sense, especially after working as an acute/critical RN all these years, to use good sense about what would be most appropriate for me.

One day at a time. No one has any promise that they will be here tomorrow. Today may truly be all I have.

 

[Gfliptastic]

I can't speak for others, but my purpose isn't directly to squish or criticize someone's dream. I am always one to play devil's advocate. As someone who is already through the process, going through intern year.

I find it interesting that so many of my colleagues and classmates are saying: "WTF?!" about actually being a (supervised) doctor.

Not sure why this is really leaning towards a debate in resiliency? Honestly, NO ONE, privileged, old, young, disadvantaged, man, woman, will get through the 4 years of med school w/o any degree of resilience.

Anyways, I like to stand as a "gatekeeper". To make sure all of you who have "awesome" experiences as pre-meds in shadowing experiences know there's a whole heck of a lot that goes on that you don't see. To be in the business of medicine. You see the tip of the iceberg. You don't see the iceberg.

I agree that people already in the field and want to make the change to physician know a whole heck of a lot about what I try to relate to others. Politics. Bureaucracy. And I'm sure their physician co-workers gripe all day about the documentation. If you are dedicated to a dream of being a physician, just make sure you understand the rose-colored glasses that can factor into your decision. Consider me "informed consent"

Best of luck to everyone who is dedicated and informed about his/her decision. For real!

 

[jl lin]

I can't speak for others, but my purpose isn't directly to squish or criticize someone's dream. I am always one to play devil's advocate. As someone who is already through the process, going through intern year.

I find it interesting that so many of my colleagues and classmates are saying: "WTF?!" about actually being a (supervised) doctor.

Not sure why this is really leaning towards a debate in resiliency? Honestly, NO ONE, privileged, old, young, disadvantaged, man, woman, will get through the 4 years of med school w/o any degree of resilience.

Anyways, I like to stand as a "gatekeeper". To make sure all of you who have "awesome" experiences as pre-meds in shadowing experiences know there's a whole heck of a lot that goes on that you don't see. To be in the business of medicine. You see the tip of the iceberg. You don't see the iceberg.

I agree that people already in the field and want to make the change to physician know a whole heck of a lot about what I try to relate to others. Politics. Bureaucracy. And I'm sure their physician co-workers gripe all day about the documentation. If you are dedicated to a dream of being a physician, just make sure you understand the rose-colored glasses that can factor into your decision. Consider me "informed consent"

Best of luck to everyone who is dedicated and informed about his/her decision. For real!

Gfliptastic, I have no doubt your intensions are meant to be balancing, and I certainly appreciate that. I say good! I am glad to hear your RL perspective.

No debate from me. Just sharing perspectives, as you and others are as well. Resiliency, no doubt this is completely true.

People resist that notion that certain nurses do have some insight into the iceberg. Do you guys thing that we don't work closely and make friends with residents and fellows and see and hear about their plight of woes? In my area of nursing, we definitely do. Doesn't mean we know the whole iceberg. It just means that some of us have a better bird's eye view that the average student or pre-med, especially after working in it for the length of time that we have. I have no illusions and no rose-colored glasses. I also am quite aware of politics and bureaucracy, especially after working in highly specialized areas such cardiothoracic adults and peds. Geez more than half of the hospital staff limits exposure to these areas b/c of the politics--just ask folks that work in radiology or some other specialities. It is extremely political and extremely "know it all" and "vying for top-dog" oriented. Documentation is a huge issue for all of us. I will give residents and fellows are killing themselves and swimming in tons of it. At the same time, many of us RNs are not paid anymore to stay late to be on top of documentation--even exceptional documentation--codes and such. If we are, we have to get utter hell for it from someone. But I try not to leave until all my t's are crossed and i's are dotted, and it can be a major pain in the ass--especially when you are rotating through long shifts and have to travel at least an hour coming or going.

One thing that is common in healthcare on all levels--and that is the level of bitching and moaning; and truth be told. It doesn't really help--not even in the sense of venting; b/c people birds can carrying that venting and cause trouble--and it just makes people more miserable to BP & M. Plus it becomes contagious, and has a detrimental effect on morale.

Thank you for your perspectives. There are those of us that do respect and appreciate them.

 

[Crayola227]

Right, and when I talk about resiliency at 44 I really mostly mean physical.

At 26 with no health issues it seemed totally worth it.

Now that I'm a resident with 300K in debt, with a load of physical ailments that aren't going anywhere specifically from being ground under the heel of med school that didn't give a f*ck when I said "Uncle", now I'm unwillingly crushing patients under the heel of the business of medicine.

The system broke me physically, forces me to torture patients to some degree, and has left me a pauper with debt and threatens to spit me out before I get to BE/BC because of the ailments it caused me.

I've gone to HRs and short of suing for ADA that's the way the cookie crumbles.

So at 30, I'm questioning if it was worth the destruction. Keep in mind that even if you get to the attending level a good deal of burn out isn't the hours, the documentation, the bureacracy, but the ways that hurts patient care that you can't change.

15 min office visits for my poor, disadvantaged, low health literacy patients with multiple comorbidities, it is spirit crushing for reals to anyone that cares and finds themselves disturbed by the half-assed care that provides.

I can't adequately address ongoing chest pain, poorly controlled diabetes, smoking, weight loss, AND suicidal ideation in that visit. Or even with 20 min office visits every other week for the foreseeable future, even if this patient could come see someone in the office that often, which they can't. You're told to just have them do follow up or book for longer appts, but as I've said in practice neither happens satisfactorily.

The treat'em and street'em mentality gets you down because the business of medicine has you going through more motions than what is actually helpful.

Spending 5 min tops in AM chart stalking, 5 min in the room with the patient, and spending almost zero minutes teaching the patient or providing empathy, times 10 or 20 depending on census, and then worrying about getting notes done and doing all you can to avoid a family conference so you can be within work hours (or go home as an attending so you can eat dinner with family, maybe help with some homework?) When I'd love to go talk to the family I think it would do a lot to advance care, but oh no, notes always come before patient care (do not aske to quote who said that to me).

Basically you're working for Dr. Kelso or Cox (at least Cox cared about his patients)

Say you were in the army, that was your dream. You don't mind the hours. You don't mind marching your feet off. You don't even mind being shot at. But now you have to bomb a village, you're trying to get the terrorists shooting at you, but you're pretty sure there's a school of school children nearby. Does that get you down? Now maybe you're wondering if there was a job that would help your country some other way.

That's my analogy, because I want to emphasize that the job will call on you to act a certain way, and there's no getting around it.

If you go to war, you've signed up to be called on to shoot people. That's part of the job description. You might get through your service without seeing battle, but have no illusions that you've opened yourself up for the possibility of deployment.

If you go to med school, while all of the harms may not befall you as I've described, know that you will have a hand in harming patients. And even past residency, as an attending, *you will find it hard to feel you are doing right by your patients* no matter what you do. You can't fight City Hall no matter what you think.

That's the problem. People think they will somehow outsmart the system and be the doc they want to be.

As long as you accept you will be going through the motions, and the good you do being the doctor you want to be and know your patients need, will be despite the system, and not the rule.

But I know people who drink the Kool Aid that the care they provide is great and "efficient" and they cling to the "Thank you" cards from the patients, and ignore just how ridiculous the system is.

I felt the ICU and nurses at my hospital were doing 10x the job I was. At the end of the day, they get the orders done. They see to it the patients are in bed, clean, fed, medicated, comforted, as best they can.

My job, on the other hand, shouldn't mostly be writing those orders and notes. Doctor means teacher in Latin. I should be doing more of that with patients, but there isn't time.

If you want patient care, be a midlevel and spend time with your patients.

If you want all the legal liability, debt, notes, and write all the orders while shrugging patient concerns off, go to med school.

The average doc spends only 30 seconds talking about a new drug they prescribe. 5-7 min facetime with patient. I thought those numbers were absurd and somehow I would see to it to be the exception not the rule. Like somehow those docs had lost sight of good care.

What I didn't know is how we've become the finger puppets of bean counters. And funny how you cant move about freely with a finger in your ass.

If you do go MD, either stay out of patient care (radiology/path), do stuff where patient contact is when they're sleeping (surg/anesthesia), or go into a small group practice or hang out a shingle if y'all can even make that financially feasible.

I worked in a group practice doing neurology. They seemed like they had enough time for people. I've worked in a few other environments where patients weren't mill grist, usually specialty which is why so many end up there (not just $ signs).

This isn't about me bitching about how hard I work.

Many docs, myself included, are genuinely concerned for the PATIENTS.

I'm only bitter about paying the price I have for the practice on the other side.

People think anything is worth the MD and getting that will make everything OK.

Imagine, like the soldier above, you mowed down a village and found out you had taken out a big terrorist base and prevented a nuke from hitting New York. Losing a leg for that? Great. Finding out it was all bull**** and you just leveled a school? Now it seems for nothing.

Just some views. Have fun in school. Come back 10 years from now and let me know how you fared, and how you ended up with a practice you enjoy, and found a balance that made y'all feel like it was worth it. I would really appreciate the insight.

 

[TheTao]

Ji Lin, I'll definitely be in touch with you, and to Crayola thanks a bunch for your perspectives!!

 

[jl lin]

Right, and when I talk about resiliency at 44 I really mostly mean physical.

At 26 with no health issues it seemed totally worth it.

Now that I'm a resident with 300K in debt, with a load of physical ailments that aren't going anywhere specifically from being ground under the heel of med school that didn't give a f*ck when I said "Uncle", now I'm unwillingly crushing patients under the heel of the business of medicine.

The system broke me physically, forces me to torture patients to some degree, and has left me a pauper with debt and threatens to spit me out before I get to BE/BC because of the ailments it caused me.

I've gone to HRs and short of suing for ADA that's the way the cookie crumbles.

So at 30, I'm questioning if it was worth the destruction. Keep in mind that even if you get to the attending level a good deal of burn out isn't the hours, the documentation, the bureacracy, but the ways that hurts patient care that you can't change.

15 min office visits for my poor, disadvantaged, low health literacy patients with multiple comorbidities, it is spirit crushing for reals to anyone that cares and finds themselves disturbed by the half-assed care that provides.

I can't adequately address ongoing chest pain, poorly controlled diabetes, smoking, weight loss, AND suicidal ideation in that visit. Or even with 20 min office visits every other week for the foreseeable future, even if this patient could come see someone in the office that often, which they can't. You're told to just have them do follow up or book for longer appts, but as I've said in practice neither happens satisfactorily.

The treat'em and street'em mentality gets you down because the business of medicine has you going through more motions than what is actually helpful.

Spending 5 min tops in AM chart stalking, 5 min in the room with the patient, and spending almost zero minutes teaching the patient or providing empathy, times 10 or 20 depending on census, and then worrying about getting notes done and doing all you can to avoid a family conference so you can be within work hours (or go home as an attending so you can eat dinner with family, maybe help with some homework?) When I'd love to go talk to the family I think it would do a lot to advance care, but oh no, notes always come before patient care (do not aske to quote who said that to me).

Basically you're working for Dr. Kelso or Cox (at least Cox cared about his patients)

Say you were in the army, that was your dream. You don't mind the hours. You don't mind marching your feet off. You don't even mind being shot at. But now you have to bomb a village, you're trying to get the terrorists shooting at you, but you're pretty sure there's a school of school children nearby. Does that get you down? Now maybe you're wondering if there was a job that would help your country some other way.

That's my analogy, because I want to emphasize that the job will call on you to act a certain way, and there's no getting around it.

If you go to war, you've signed up to be called on to shoot people. That's part of the job description. You might get through your service without seeing battle, but have no illusions that you've opened yourself up for the possibility of deployment.

If you go to med school, while all of the harms may not befall you as I've described, know that you will have a hand in harming patients. And even past residency, as an attending, *you will find it hard to feel you are doing right by your patients* no matter what you do. You can't fight City Hall no matter what you think.

That's the problem. People think they will somehow outsmart the system and be the doc they want to be.

As long as you accept you will be going through the motions, and the good you do being the doctor you want to be and know your patients need, will be despite the system, and not the rule.

But I know people who drink the Kool Aid that the care they provide is great and "efficient" and they cling to the "Thank you" cards from the patients, and ignore just how ridiculous the system is.

I felt the ICU and nurses at my hospital were doing 10x the job I was. At the end of the day, they get the orders done. They see to it the patients are in bed, clean, fed, medicated, comforted, as best they can.

My job, on the other hand, shouldn't mostly be writing those orders and notes. Doctor means teacher in Latin. I should be doing more of that with patients, but there isn't time.

If you want patient care, be a midlevel and spend time with your patients.

If you want all the legal liability, debt, notes, and write all the orders while shrugging patient concerns off, go to med school.

The average doc spends only 30 seconds talking about a new drug they prescribe. 5-7 min facetime with patient. I thought those numbers were absurd and somehow I would see to it to be the exception not the rule. Like somehow those docs had lost sight of good care.

What I didn't know is how we've become the finger puppets of bean counters. And funny how you cant move about freely with a finger in your ass.

If you do go MD, either stay out of patient care (radiology/path), do stuff where patient contact is when they're sleeping (surg/anesthesia), or go into a small group practice or hang out a shingle if y'all can even make that financially feasible.

I worked in a group practice doing neurology. They seemed like they had enough time for people. I've worked in a few other environments where patients weren't mill grist, usually specialty which is why so many end up there (not just $ signs).

This isn't about me bitching about how hard I work.

Many docs, myself included, are genuinely concerned for the PATIENTS.

I'm only bitter about paying the price I have for the practice on the other side.

People think anything is worth the MD and getting that will make everything OK.

Imagine, like the soldier above, you mowed down a village and found out you had taken out a big terrorist base and prevented a nuke from hitting New York. Losing a leg for that? Great. Finding out it was all bull**** and you just leveled a school? Now it seems for nothing.

Just some views. Have fun in school. Come back 10 years from now and let me know how you fared, and how you ended up with a practice you enjoy, and found a balance that made y'all feel like it was worth it. I would really appreciate the insight.

Crayola, you have done a great job at helping to paint the picture. Concern for patients is totally legit. I don't like this aspect of current medical practice, and I fear that with current reimbursement changes, it is only going to get worse. For the kiddies, well, often a good % of those I care for are medicaid, and that can suck. And if they get the care their need by way of approval from say UHCCP, then the other problem is some of the parents don't get what their part has to be--yes, the extreme entitlement--the kind that say, " I shouldn't have to contribute in the care of my own child" kind of BS. This gets very frustrating at times.

I pray your health improves, you get a long, needed break, and that overall, things turn around for you. You have invested so much at this point, and you seem to care about your patients. It would be a shame if things didn't improve for you. Somehow, you have to get more balance in life.

You seem like a strong person. My guess is that you will change the things that you can and be better off for it. Even if your patients don't always tell you this, trust me. Many of them are grateful you are there. But medicine must become better in teaching and allowing it's practitioners the importance of self-care. If a physician cannot take decent care of herself/himself, how in the hell can he/she be expected to do so for others. The hypocrisy in healthcare astounds me. Hell, this should be a special course weaved throughout all of med school and residency.

 

[Crayola227]

Thanks Jl lin.

On one hand, I see people signing up and I'm like "save yourselves!!!" but on the other hand I am still appreciative that we still have highly qualified, motivated, resilient and otherwise talented folks still naive enough to sign up and make a difference. I'm worried some will end up as cannon fodder, but if anyone's going to change the tide of this war on ****ty healthcare, it will be the people brave enough to sign up and soldier on.

The only way for this to change is for people to keep signing up, infiltrating, to change it from the inside out. I think. That's what they tell me anyway. The profession must go on, that's for sure.

And to be fair, my favorite colleagues are the non-trads, the "older folk," with kids and past careers and the lot. They seem more tired and miserable than my younger gunner colleagues, but I also think they're the best docs and the ones most likely to change the profession for the better.

 

[TheTao]

Ideally, I'd just like to win the lottery and work as a Doc for free! And yeah, I'd still go to med school if I hit the lottery, LOL!!!

<SLAP!!>

A person can dream, can't they?

 

[Ad2b]

@Crayola - the only people who can change this are the ones that see how the @#$ty healthcare reform impacts the patients and the physicians who serve them.

as a former finance director in healthcare at a very large conglomerate of clinics and hospitals, I know how we "forced" physicians to treat every 15mins or else... we budgeted that way, held metrics for the physicians, punished them (lower bonuses) for NOT achieving the expected KPIs of the finance department (led by no MD or DO) ... that was in 1995.

I can only imagine how bad it has gotten ... my head hangs in shame for having been a part of it and can only hope that if I'm granted some fancy initials, I can help be the change healthcare needs. From the inside, not from the finance department.

 

[jl lin]

Thanks Jl lin.

On one hand, I see people signing up and I'm like "save yourselves!!!" but on the other hand I am still appreciative that we still have highly qualified, motivated, resilient and otherwise talented folks still naive enough to sign up and make a difference. I'm worried some will end up as cannon fodder, but if anyone's going to change the tide of this war on ****ty healthcare, it will be the people brave enough to sign up and soldier on.

The only way for this to change is for people to keep signing up, infiltrating, to change it from the inside out. I think. That's what they tell me anyway. The profession must go on, that's for sure.

And to be fair, my favorite colleagues are the non-trads, the "older folk," with kids and past careers and the lot. They seem more tired and miserable than my younger gunner colleagues, but I also think they're the best docs and the ones most likely to change the profession for the better.

Thanks. Seriously, it's like there is no time to be a gunner. We are just happy if there are clean towels and underwear. LOL

 

[jl lin]

Ideally, I'd just like to win the lottery and work as a Doc for free! And yeah, I'd still go to med school if I hit the lottery, LOL!!!

<SLAP!!>

A person can dream, can't they?

I was thinking of hitting up Donald Trump for some help with MS. LOL But, well, he's gonna see if he can bust another of his billions and then he is going to have to reach for outside funders. Seriously that dude still owes people money. It's just a shame it's not me. LOL

 

[Gfliptastic]

Hey, call me weird but I include nurses in my gripe-fest all the time. Maybe because I'm from a family of mostly nurses. But to me, y'all know a bit about what it's like to be "bamboozled" and be held to some applied metrics that sometimes are unrelated to useful effective medical care. We (new doctors) can "smell our own", and there's a palpable generalized air at the nurses stations at most hospitals that feels a lot like: "I went to nursing school for THIS?!" Join the club!!! Medicine, is NOT what I think anyone thought it would be back in our "innocent" days before we started school for this crap. (I've ALWAYS gotten along w/ my nurses!)

TheTao, spoken like someone who has great intentions but doesn't really know a thing! Cuz God/Allah/Buddha knows that every time I put $2-3 on a Powerball ticket I said the exact same thing! Till the day I started residency! The whole new dealio is, even w/ enough $$ to build 5-6 hospitals, to practice medicine, in these United States, you need to at least be BE/BC. MAYBE the FSMB is corrupt enough, however, even your patients might ask you, "Where'd you do your residency?" RESIDENCY! Still gotta do that, buddy! $100-aire or $1,000,000,000-aire. Granted, if you were ridiculously rich, you'd have the means to maximize your idle time away from hospital duties. (i.e. - "What I have 24-hrs of post-call, I'm going to take a jet to Rio and back!") *sigh* Hell, if a rich-ass intern offered me $500 to take one of their shifts, I'd probably do it.

In this crazy world I've flip-flopped quite often of "Go Fund Me" to beg people to help me chip away at my loans. Promising that I will be less surly when they keep their 95 year old demented grandmother w/ 6 co-morbidities a FULL-code. I'll vow to think fondly of my decreased med school debt as I crush this poor old lady's ribcage for 4 minutes, 2 smashes/second. And as I wipe sweat off my brow, I won't glare at them while thinking: "We have this thing called DNR and this other thing called 'comfort measures' for the next grandparent you want me to physically abuse for the sake of life-saving manual perfusion."

Where do I post my link???

 

[TheTao]

TheTao, spoken like someone who has great intentions but doesn't really know a thing! Cuz God/Allah/Buddha knows that every time I put $2-3 on a Powerball ticket I said the exact same thing! Till the day I started residency!

Until you've walked ONE DAY in the shoes of MY life, don't pretend to know what I know and don't know. I also think some reading comprehension of ALL my comments in this thread would be quite helpful as well as a sense of humor and sarcasm too. Quite frankly, I'd never reveal the details of what I know about the medical profession OR how I know it. Not around here anyway. What I've learned working in the medical profession in one capacity of another since you were probably an embryo, is that "The Blue Wall" ain't got $hit on the medical profession when it comes to "circling the wagons". And they don't take too kindly to people who "talk too much" about the down sides of it.

Finally, I've have an entire career (20+ years) of serving the under served in one capacity of another. Unless you can say the same (which I'm certain you can't), you can't say who knows what because YOU don't know. OTOH, do I need to BE a Surgeon to know that it's hard as f**k? Probably not.

This idea that everyone desiring to attend medical school is "green" to the realities of medical school and the medical profession is just plain stupid. Just because YOU were green as chlorophyll, don't assume everyone else is too, especially nontraditional students with experience in/with the medical profession.

 

[Crayola227]

I think (I hope) the point is that there's a greenness to just how bad things are in practice until you are both the target and responsible.for its evils, experiencing them, and dishing them out.

This doesn't happen to shadowees, but once you actually start training, and as long as you are in training, you will shocked and amazed the level of psychological abuse you will be under, or how it could hurt that bad, and why there's so much kick the dog going on. As you get your MD, you will be fully educated on what will make patients well, and you will see that continually shat on almost minute by minute and be powerless to make it better. You will have the knowledge, not the tools or even the time. The times when you know maybe 15 minutes more conversation with each patient you treat could have made so so much difference, but you don't have that x20 each day. Ignorance is bliss. The more you know the more you can imagine a better way, the more you can grieve it. I don't know if you've seen the last Batman movie, the prison with the escape hole that you can almost climb out of but can't, you can see freedom but never obtain it.

Read what ad2b said. I'm not sure change from MDs within will do it, not while busy treating patients. MDs and the public will have to lobby, MDs will have to take time from clinical work to work against admin, I don't know how, but that's what it would take. Laws and money that aren't working in the doctor/patient therapeutic alliance benefit.

The naysayers that popping in here are basically further along and saying definitively, "Entering school at 44?" "Bad idea, a lot can go wrong, even if it doesn't, you'll probably be miserable for a myriad of reasons." And most of the dissent with that opinion is coming from people who are at best, still in med school (although one student's latest blog on their first rotation was illuminating) and another is someone with ICU nurse experience.

There are docs that like what they do. They like it despite the problems us "naysayers" are throwing out there, because it's not a question of whether or not the unsavory realities are true; no one denies them. The issue is really how *much* they get individual docs down. It's a question of degrees.

You must be OK witnessing/experiencing constant physical and mental abuse, AND being forced to dish it out, for dimishing monetary and personal reward. You will trade happiness, integrity, health, and time with family, financial and overall wellbeing (I arguably listed the most important things in life) for...
helping patients? If only that were the trade off. You will swim against the current to minimize how much they get shortchanged.

It isn't as bad as all that. What I'm saying is true to differring degrees, and there's so many factors. It's a minefield at best.

Tread carefully.

 

[Gfliptastic]

Okee dokee! W/ that attitude I'm sure you'll find medicine is EXACTLY as you know it from whatever experience that ISN'T actually going through medical school or residency affords you. Everything and anything is so comparable to the entire process I'll stay quiet. As a resident, practicing medicine...as a (supervised) doctor, my opinion is far less than a 40-something pre-med who had wonderful shadowing experiences. It will always be like that shadowing experience.

Thanks for knowing everything about me w/o me saying it also. I know you knew I went into this change of career to chase my life-long dream w/o sharing a similar hope and passion to almost quote what you previously posted: "I would be a doctor for free." I absolutely am NOT still passionate about being a physician and it's not like I could have just posted all tongue-in-cheek. It's not really at all that seeing medicine for what it is in residency doesn't try it's best to crush this passion that made me leave my career. I really just wake up and work 70 hrs/week in the "trenches" for a measly paycheck.

 

[TheTao]

You must be OK witnessing/experiencing constant physical and mental abuse, AND being forced to dish it out, for dimishing monetary and personal reward. You will trade happiness, integrity, health, and time with family, financial and overall wellbeing (I arguably listed the most important things in life) for...helping patients?

How many minorities and/or women do you know? I'm assuming VERY few especially in STEM careers, since if you talk to a few you'll find that BOTH experience varying degrees of mental abuse throughout their careers especially in STEM, and yeah sometimes physical abuse too (Female military officer, anyone??). In other words, the reason there are so few women in many STEM fields like Computer Science doesn't have jack **** to do with talent or skill.

My point, medicine ain't the ONLY tough career out here. And if you're coming into medicine as a minority and/or female especially from a STEM career in your 30' and 40's you're already used to be being shat on, on a regular basis. Medicine will just be the same **** with a different shovel.

As for "wonderful shadowing experiences", I'd hardly call considering shadowing (and working) in a hospital for indigent non English speakers, a "wonderful shadowing experience". Some folks just have the "backbone for" and don't mind the "streets" of the medical profession. And in the words of Cookie Lyon, "The streets (or medical practice in these settings) ain't made for everybody, that's why they made sidewalks (and residencies in Dermatology)".

 

[Crayola227]

This becomes a righteous indignation debate about street cred. Street cred or experience in other fields has nothing to do with why I think med school at 44 is a mistake.

I've known plenty of people from plenty of fields, and people who have crossed fields.

I won't get into my own personal experiences.

I'm not saying anyone can't hack it based on anything shared in these threads. I'm saying it's miserable under the best of circumstances, and it's not hard to find yourself in an untenable situation in medicine.

Talking about the military is great.
Some people came back from 'Nam without PTSD. None of them had a good time. Some may have thought it was worth it, most didn't. That's my point.

Like they say, war is war, and war sucks. No one wants to hear that about medicine, because whole goal ostensibly is to ease suffering, which is why no one outside of it can believe it is so twisted, and why people who get inside of it are not happy.

I've heard from more than one person in military AND medicine how much more viscious medicine is.

Medicine is not like the other STEM fields. It really is unique.

I never made this about gender, BTW. I am a woman, BTW. Being a woman in medicine only sucks more as a woman than a man if your uterus or mammary glands get in the way.

I'm not going to get into the gender politics part of practicing medicine because that was never my point.

Projection. Maybe you have something to prove regarding age or womanpower.

You're not willing to hear what getting an MD will actually be like.

So instead you assert you have greater street toughs and make an analogy to medicine.

You quoted me but most of your points seem to me to be directed at the other poster.

I object because you quote me and question my depth of experience as a disadvantaged woman in a science field to discredit experience I have as an MD that you do not, but like to think you have approximated enough to think you won't find that the spade I told was you was a spade is a spade when you get into the toolbox.

I only object to anyone questioning my experiences as a disadvantaged woman.

Otherwise, I don't care anymore if any premeds believe me or @Gfliptastic anymore, because like with any patient, we can offer you prognosis and you can think whatever.

I win either way, either things will be better for you (that always makes me glad, I would rather you be all right and I be wrong although unlikely) or as I suspect, I will be right, you will be miserable, but you'll be a step ahead because it won't be a surprise at least.

 

[TheTao]

And herin lies the problem with quoting message from other users, they take EVERYTHING you say in your response as being directed and them, le sigh..................................

Crayola, after reading that last post of yours, you sound bitter with your choice to pursue medicine. And I totally get that because I've felt the same way at times about being a Scientist. (My bad, that career does't "count", does it?) I agreed with and liked some of your posts, and likes connotes "agreement". But not everything I posted above was in response to you. However that last post of yours, I lack the time or motivation to respond to very minute detail of it because unlike you, I don't feel I have anything to prove. Especially around here.

There are about 20 or so Physicians in varying fields, that I know personally (for reasons I don't need to list here) that give me PLENTY of reality checks about medicine, so I don't need an online resource for that. I also don't need either support OR encouragement (from online of all places) that what I want to do at this point of my life is crazy as hell. Common sense tells me that already. I know what I'm bringing to the table and after weighing pros and cons based on MY life, I've decided to move ahead.

I will however comment on your declaration that I'll be miserable. What I've learned after decades of being on this planet is that people are real good about projecting their feelings/thoughts/emotions on others based on how they're feeling. But luckily I'm MANY years past my 20's/30's, where I've learned by middle age how to deflect other's people personal baggage. You've allowed "misery" space in YOUR head, and that's very unfortunate. Hopefully after a few or many more B'days, you'll realize what a waste of time thinking that way is.

So to the OP God willing, you're going to be in your 50's one day. Decide if you want you be in your 50's as a Doctor, or as I person wishing they had tried to become one.

Good luck in whatever you decide!

 

[jl lin]

I think (I hope) the point is that there's a greenness to just how bad things are in practice until you are both the target and responsible.for its evils, experiencing them, and dishing them out.

This doesn't happen to shadowees, but once you actually start training, and as long as you are in training, you will shocked and amazed the level of psychological abuse you will be under, or how it could hurt that bad, and why there's so much kick the dog going on. As you get your MD, you will be fully educated on what will make patients well, and you will see that continually shat on almost minute by minute and be powerless to make it better. You will have the knowledge, not the tools or even the time. The times when you know maybe 15 minutes more conversation with each patient you treat could have made so so much difference, but you don't have that x20 each day. Ignorance is bliss. The more you know the more you can imagine a better way, the more you can grieve it. I don't know if you've seen the last Batman movie, the prison with the escape hole that you can almost climb out of but can't, you can see freedom but never obtain it.

Read what ad2b said. I'm not sure change from MDs within will do it, not while busy treating patients. MDs and the public will have to lobby, MDs will have to take time from clinical work to work against admin, I don't know how, but that's what it would take. Laws and money that aren't working in the doctor/patient therapeutic alliance benefit.

The naysayers that popping in here are basically further along and saying definitively, "Entering school at 44?" "Bad idea, a lot can go wrong, even if it doesn't, you'll probably be miserable for a myriad of reasons." And most of the dissent with that opinion is coming from people who are at best, still in med school (although one student's latest blog on their first rotation was illuminating) and another is someone with ICU nurse experience.

There are docs that like what they do. They like it despite the problems us "naysayers" are throwing out there, because it's not a question of whether or not the unsavory realities are true; no one denies them. The issue is really how *much* they get individual docs down. It's a question of degrees.

You must be OK witnessing/experiencing constant physical and mental abuse, AND being forced to dish it out, for dimishing monetary and personal reward. You will trade happiness, integrity, health, and time with family, financial and overall wellbeing (I arguably listed the most important things in life) for...
helping patients? If only that were the trade off. You will swim against the current to minimize how much they get shortchanged.

It isn't as bad as all that. What I'm saying is true to differring degrees, and there's so many factors. It's a minefield at best.

Tread carefully.

IDK, I think Tao is just trying to say that there are those of us that have worked deeply enough in healthcare, etc, that it's well beyond shadowing. We were doing, and in our doing, we had to do so with medicine on a continuous basis. Does it mean we know of the WHOLE experience? Of course not. What it means is that we have a better understanding as compared to the average applicant that has not worked in the same capacities that we have. It's not a pissing contest. It's just the way it is.

My belief is that the more direct, clinical exposure, with actual accountability, and working with medicine/surgery, and their residents, so much the better re: insight into the stress, annoyances, loss of personal life experiences, etc.

I think so many folks that go into medicine, regardless of age, have no idea what they are getting into, and as such are beyond chagrin--especially in the first 2 or so years of residency. During that time, it can be so hard to see any light beyond the tunnel. At the same time, the sad part is that people go into this believing it will be one thing, sacrifice so much time, money, endure a lot of stress, and then they realize, "God this is not what I want to do, but now, b/c of all the investment of time and money, there is no way out for me." That's why I think mere shadowing is a cute start; but it just doesn't cut the muster.

That's why I argued a while back for getting way more than 200 hours in direct, clinical experience--in a busy, medicaid-receiving, university-based medical center. People poo poo'd me. No one is doing themselves any favors in busting their ass to get that "magic yes" to medical school, if they have not spent a large amount of time seeing, feeling, working, being around the demands of direct, healthcare--and having some level of patient care/safety responsibility. Applicants are doing themselves no favors if they can't get up close and see what the residents are going through in having to deal with this. I've had a ton of responsibility as a critical care nurse; but when I read about being a resident and getting sign-out on 200 patients, I was blown away. Of course working in critical care, many of our residents/fellows were not responsible for those that did not fall under critical care and progressive kind of care plus any ED patient being evaluated for needing critical or progressive/step-down care--or critical patient transfers to our facility or even direct, critical care admissions--yes they do happen.

There are clearly things we don't directly know, experientially speaking. But some of us have somewhat of an advantage and have worked in the area of healthcare for ~20 years and have tasted the stress of it. You can't say this to your typical MS or PGY-1 in July. We are aware of many of the sucky issues within healthcare and dealing with patients, bureaucracy, and endless mounds of paperwork, plus stupid healthcare/hospital politics. Knowing this, we may be less likely to be chagrin when getting our asses kicked during residency or even in our earlier years of PG practice.

 

[jl lin]

This becomes a righteous indignation debate about street cred. Street cred or experience in other fields has nothing to do with why I think med school at 44 is a mistake.

I've known plenty of people from plenty of fields, and people who have crossed fields.

I won't get into my own personal experiences.

I'm not saying anyone can't hack it based on anything shared in these threads. I'm saying it's miserable under the best of circumstances, and it's not hard to find yourself in an untenable situation in medicine.

Talking about the military is great.
Some people came back from 'Nam without PTSD. None of them had a good time. Some may have thought it was worth it, most didn't. That's my point.

Like they say, war is war, and war sucks. No one wants to hear that about medicine, because whole goal ostensibly is to ease suffering, which is why no one outside of it can believe it is so twisted, and why people who get inside of it are not happy.

I've heard from more than one person in military AND medicine how much more viscious medicine is.

Medicine is not like the other STEM fields. It really is unique.

I never made this about gender, BTW. I am a woman, BTW. Being a woman in medicine only sucks more as a woman than a man if your uterus or mammary glands get in the way.

I'm not going to get into the gender politics part of practicing medicine because that was never my point.

Projection. Maybe you have something to prove regarding age or womanpower.

You're not willing to hear what getting an MD will actually be like.

So instead you assert you have greater street toughs and make an analogy to medicine.

You quoted me but most of your points seem to me to be directed at the other poster.

I object because you quote me and question my depth of experience as a disadvantaged woman in a science field to discredit experience I have as an MD that you do not, but like to think you have approximated enough to think you won't find that the spade I told was you was a spade is a spade when you get into the toolbox.

I only object to anyone questioning my experiences as a disadvantaged woman.
th
Otherwise, I don't care anymore if any premeds believe me or @Gfliptastic anymore, because like with any patient, we can offer you prognosis and you can think whatever.

I win either way, either things will be better for you (that always makes me glad, I would rather you be all right and I be wrong although unlikely) or as I suspect, I will be right, you will be miserable, but you'll be a step ahead because it won't be a surprise at least.

But you are missing the point that there are plenty of people 40 or> that don't feel as you do--especially since you are not yet in that age-range. There are many here >40 and they do not regret their choices re: medicine. There are plenty at Old Pre-meds that feel the same.

How you feel given where you are in your life and your life experiences are yours--and that is totally fine. Same thing for Gflip. You are entitled to feel what you feel. It is, however, unfair, and without substance to assume that every person, regardless of age, gender, relational statuses, religion, or the like will feel the same as you or Gflip.

I respect what you and Gflip have shared. But you are sharing from your experiences and not coming from our perspectives.

None of us should have the, well, hubris, to KNOW how someone sees thinks, feels, or will feel. It's just not possible. Each person walks in their own shoes, on their own path. Experiences and even some feelings may be shared, but each person's responses and perceptions will vary on an individual basis. People like group commiseration. And misery, even meant as venting, likes company. But not everyone sees some misery as the totality of all misery for their lives and the life of others. To do so means engaging in projection.

 

[TheTao]

That's why I argue a while back for getting way more than 200 hours in direct, clinical experience--in a busy, medicaid-receiving, university-based medical center. People poo poo'd me. No one is doing themselves any favors in busting their ass to get that "magic yes" to medical school, if they have not spend a large amount of time seeing, feeling, working, being around the demands of direct, healthcare--and having some level of patient care/safety responsibility.

I agree 1000%!!

In fact, I think there ought to be a minimum age for matriculation into med school of 27 and a life experience requirement of having worked at least 2 years on a |real "job" for reasons far too numerous to list here (not that I would waste my time given the predicted reactions). There's a minimum age to be President of the US as there should be. IMHO, med school should be the same.

BTW, a huge thanks Jl Lin for "getting" what I was trying to say.

 

[jl lin]

I agree 1000%!!

In fact, I think there ought to be a minimum age for matriculation into med school of 27 and a life experience requirement of having worked at least 2 years on a |real "job" for reasons far too numerous to list here (not that I would waste my time given the predicted reactions). There's a minimum age to be President of the US as there should be. IMHO, med school should be the same.

BTW, a huge thanks Jl Lin for "getting" what I was trying to say.

You are welcome. Your idea seems nice but realistically that will affect the whole game, which is largely based in schools making money. It's not merely about the long-term work of the accepted MS applicant, which is what some adcoms will use as a rationale for shutting out older applicants. I mean, it is, but it also isn't.

What I mean is that there is a distinct business advantage to keeping the cycles flowing, and that means you want as many young folks applying as possible. The industry of specialized, graduate school education depends upon it.

Heck, there may even be the fear of accepting older, more life-experienced and healthcare-career-relevant applicants; b/c they may be deemed as "Not as moldable." Kind of a BS thing. Interpretation: they may be less willing to put up with BS and be intimidated.

Of course seasoned applicants may well get how the game works and play along, b/c it's something they feel that they will hopefully be good at doing or feel called to it--and we've learned there is a level of balanced necessity in doing so after working in sociopolitical organizations for years.

Of course these are arguable points, but that doesn't mean they are not, in some way, part of reality.

I know about new grad nurses getting positions before more well-seasoned, experienced nurses, b/c 1. They can pay them less. 2. They can jerk their schedules all over the place, and the fear of being young and new keeps them quiet. 3. They feel like they have nothing to un-teach them; which is an idiotic perspective, b/c we all grow and learn cumulatively on a continuum. And simply b/c a person has learned to do some things in one way, doesn't necessarily mean they will not adapt to another way or incorporate the new learning into their overall tool kit, insights, and experiences. My experiences have proven this.

Mostly, young or old, you have to know when to speak and when to shut up. If you speak too much or at the wrong time, or without enough solid information, you could be crushed. If you don't speak enough, you may appear as not bright or engaged enough. Tricky how people make all kinds of perceptions and conclusions about other people. Mostly, you have to know who you are what you are about, while being adaptable and even tolerant. Not always an easy thing to do--at any age. But when you get to be 40 and up, if you have worked long enough, you should have been at enough poker games to know when to hold em and know when to fold em.

I don't necessarily take a severe position on age from one end or another; b/c I have seen the exceptional 20 year olds that have the insight and maturity that many 40 year olds should have. I can't build people into boxes re: age anymore than I could re: their gender or any other such piece of demographics about them.

Someone on SDN, I think it was an attending, told me that people are NOT complex. I disagree and think that he/she has an overly simplistic view of human beings and their natures--the totality of what makes them who they are and guides them as to what they do. Sure, there are a whole lot of phlegmatic kinds of people--I think someone has shared that in general they make up the bulk of people--and most of them make up those that are referred to as sheep, primarily b/c of their strongly phlegmatic personalities. They tend to go more with the flow, one way or another. And of course this is still all so overly simplistic, b/c no one person is solely phlegmatic, choleric, melancholy, or sanguine.

But those that tend to make more of a dynamic difference are those that are anything but primarily phlegmatic. Those that are mostly phlegmatic are afraid to rock the boat. Cholerics are not; but even those change agents--those dynamic cholerics--have to be tempered with qualities from the other types. You get too aggressive, and you will be showed the way out the door and/or slapped into the cement.

And this is just looking at the very basics of personality types and not the nuances of how the qualities can vary and overlap or even how nurture affects what they can produce in a person. Um, yea. People are complicated. Some may seem easier to read and manipulate than others; but IMO, people tend to underestimate the uniqueness of the individual--their whole enchilada so to speak. It's not that simple, and we like everything to be simple.

 

[TheTao]

Nice but that will affect the whole game, which is largely based in schools making money. .

Well GREED is the reason it will NEVER happen.

Of course, I think greed is ruining this country everyday as we speak, but that's a different topic altogether.

 

[jl lin]

Well GREED is the reason it will NEVER happen.

Of course, I think greed is ruining this country everyday as we speak, but that's a different topic altogether.

I am not against free enterprise system or capitalism. It ends up being unfortunate or imbalanced at times; but no where nearly as problematic as socialism IMO.

 

[Crayola227]

Thanks for the responses guys.

I guess my own view lies in some of the wonderful people crushed by the current culture of medicine.

No one likes how things are done, but people find career satisfaction.

I'm a pretty conservative person when it comes to taking risks.
You'd never find me climbing a rockface high enough that the fall might seriously cripple me.

I am projecting. I hope you don't get chewed up and spit out. I now fear for anyone in the field.

I think of the person who shared a story on this board who developed rheumatoid arthritis, took time off, came back slower, and the pack of hyenas descended and ousted them. I don't know if they had a PGY1 under their belt or got another position, but that is a scary world to be in. I won't go into other stories. That doesn't mean life is **** or it will happen to you or that you won't sweat and toil and think it was all worth it.

Thanks for reading my long posts and never making snide comments about length

Seriously, good luck to you guys.

I just hope we can change the way things are done and the culture.

PS - I liked the thought of min age 27 for med school! Probably not fair so I'm not behind it 100%, but I get the spirit of what you mean. I wish we had more of a spirit of mature collaboration, less petty competition, more sight of patient care not dollars. If we raised the age to 27 I think that could lead to some other changes, more work/life balance for families and stuff.

 

[Esquire]

"Medicine is a cruel and jealous mistress"

I agree 100% with the residents except for that part. It's a misquote of Justice Joseph Story ("The law is a jealous mistress and requires a long and constant courtship. It is not to be won by trifling favors, but by lavish homage."). Medicine, however, is a lovely fiancée that turns into a vindictive bitch you can't afford to divorce the moment you say, "I do."

LOL at premeds who say they'd work for free in medicine. Don't be silly. Hospitals will pay med school graduates $50,000/yr to regularly crush little old ladies' ribs and shove tubes up all of their orifices at the behest of adult children trying to keep grandma's Social Security checks coming. If you can set aside common notions of decency or just don't care for a handful of years, you win. You get the keys to attending-dom and life is great again.

 

[Esquire]

I am projecting. I hope you don't get chewed up and spit out. I now fear for anyone in the field.

I think of the person who shared a story on this board who developed rheumatoid arthritis, took time off, came back slower, and the pack of hyenas descended and ousted them. I don't know if they had a PGY1 under their belt or got another position, but that is a scary world to be in.

This is probably program dependent. I know 2 people who became seriously ill and had to leave their residency. Both ended up getting into different programs at their respective hospitals, but one program pulled strings for their former resident while the other didn't do much.

 

[jl lin]

Thanks for the responses guys.

I guess my own view lies in some of the wonderful people crushed by the current culture of medicine.

No one likes how things are done, but people find career satisfaction.

I'm a pretty conservative person when it comes to taking risks.
You'd never find me climbing a rockface high enough that the fall might seriously cripple me.

I am projecting. I hope you don't get chewed up and spit out. I now fear for anyone in the field.

I think of the person who shared a story on this board who developed rheumatoid arthritis, took time off, came back slower, and the pack of hyenas descended and ousted them. I don't know if they had a PGY1 under their belt or got another position, but that is a scary world to be in. I won't go into other stories. That doesn't mean life is **** or it will happen to you or that you won't sweat and toil and think it was all worth it.

Thanks for reading my long posts and never making snide comments about length

Seriously, good luck to you guys.

I just hope we can change the way things are done and the culture.

PS - I liked the thought of min age 27 for med school! Probably not fair so I'm not behind it 100%, but I get the spirit of what you mean. I wish we had more of a spirit of mature collaboration, less petty competition, more sight of patient care not dollars. If we raised the age to 27 I think that could lead to some other changes, more work/life balance for families and stuff.

LOL. I am not crushing on medicine. Don't mistake me for that person. It's a tough job, and someone has to do it.

P.S. If a person has a legitimate disorder, for which they needed time off, then it will be a rough road for them; but it's not an impossible one. They may have to limit their type of practice. Yes they have to get through the BS of residency--especially if the program wasn't very understanding re: their RA. But listen, if you have a tough disease like that, you can still get through a tough, hypocritical, uncaring PD and such, and get through the program--the person could have enlisted legal help with this if he or she had to do so. OTOH maybe he/she would need to get into a different kind of residency program. I mean surgery is harsh; especially if you have a disease like RA or Crohn's Disease. But then again, I've seen where IMs in residency didn't have it too sweet either. People don't realize how grueling IM residencies can be. I hope the person with RA got into a good, reasonable program that works well for them.

And though it's not residency, my job can be a demanding job--varies from place/area to place/area; but nursing isn't a picnic either. There is ALSO hypocrisy in nursing regarding lack of self-care as well. It's very wrong.

As an open heart ICU recovery RN, I was expected to come in sicker than a dog, coughing up God knows what, and changing my gown, mask and visor q 15 minutes to protect the patient that was at risk, and so I could see to draw gases and shoot hemodynamics for the fresh post-op heart: (Goggles and visors get would repeatedly get fogged up->-my burning temp and pumping metabolic while being near the OR--where most open heart or direct surgical recovery areas are)--as well as ensuring that I could keep an eye on the patient, monitors, chest-tube drainage, all the lines and drips, the ventilator, and the Intraaortic Ballon Pump, as well as with checking and hanging the numerous blood products I would have to give--and that doesn't count the numerous ABGS or CBGs, other IV meds, dysrhthymias, calling docs, while also dealing with open retractors in the chest wall and other wound issues--while trying to write numbers and such down on flow sheets with tiny space areas every 5/15/or 60 minutes. They did not care. One OHS unit was excellent and would say, "Don't come in and bring crap in to our patients or be subpar for practice. We will just send you home." Another was not so great and said, "Too bad. Unless you are unconscious, you had better be here." Now how is that fair to the fresh open heart adult or child that is still cold and just off pump from the OR?

Now, do this kind of work as well when you have little ones that can tend to get every freaking RSV or virus that comes down the pike--from the days they are in day care, mind you, with other kids that are brought into day care by parents that were either forced to bring them there or lose their job or didn't care. When my kids were spiking temps and sick, NO, I generally did not sent them to day care. And I worked a lot of 12 hour nights and WEs to limit their exposure there. But God forbid you tell your hospital/unit manager that you can't come in b/c your kid has a 104 fever that is hard pressed to break with pushing fluids and Tylenol, or who is susceptible to dehydration from severe vomiting and diarrhea--or major upper respiratory congestion. That was always a point of utter frustration in many places. And sometimes I had to take a lot of grief for staying home and caring for my child/children when my husband couldn't and there was no one else in the family that could care for them. What a bunch of utter crap. **** happens to people. **** happens to everyone else in the world. But somehow, for the healthcare worker or physician, **** does not happen. It's amazing. I have never seen any medical degrees that came with a letter of guarantee that **** would not happen to them as physicians during residency or otherwise. Never got any such thing after I jumped through all the hoops and got my nursing license. So, someone please tell me exactly how this works. Other people need care and treatment; BUT apparent docs, nurses, and others in healthcare do not need care and treatment???? So, they are invincible after graduating? Really?

It's an abusive, hypocritical healthcare system we work in that says, "The patient comes first, advocate for excellency in care and standards of care, and always employ "best practices," but then refuses to teach and allow the very caregivers themselves the importance of taking care of themselves and their own family when necessary.

But then look how quickly they will move to dump a medicaid patient--somehow those ideals of practice are secondary to $$$$ the bottom line with those pts. It's only when the hospital is afraid it's brand will be smeared, or when the insurer will not reimburse for a too early bounce back to hospital--well that is when they may then attempt to return to those ideals. Yes. The hypocrisy is massive. You don't have one argument about that from me. I have worked, seen it, lived it.

Also, I try not to get too caught up in the whole issue about GME limiting residency hours, b/c I can genuinely understand both points of view.. People want to be able to stand on their own when it's their time of release from their program. I get that. At the same time, although there aren't a ton of studies on working >80hrs and making errors, there are studies about errors that come as a result of shift work--and that is usually when, like most humans, professionals are trying to live in both worlds--the night world and the day world. Eventually you never catch up, and at some point it leads to diminishing returns. My answer is to put more physician staff on coverage to limit excessive shifting of overnights going back to days. Then the reply will be; but this is more costly.

So, I don't see how anyone is ever going to strike a fair balance and win this war--until maybe they develop a machine that quickly and inexpensively evaluates residents on a day by day basis to see how alert, quick, free and fluid their thinking and reaction skills are.

Standardizing things has it's positives. It also has it's negatives; b/c what is optimal for some folks may not be for others--and those others may have successfully jumped through all the hoops for MS and beyond.

Medicine and healthcare have to remember that it's a crucial, health service that cares for human people directly by human people; hence those human people are subject to the same physiological and psychosocial demands the patients are.

Yes, you have to give of yourself; but you can't squeeze water from a stone; and an empty or contaminated well cannot meet the needs of sustaining or refreshing others. This is a human-based line of work, and all the humans involved have to be given fair consideration.

 

[TheTao]

LOL at premeds who say they'd work for free in medicine. Don't be silly.

What's silly is the notion that once you enter med school/residency (in case they missed you), everyone gets a wad stuffed up their rears. Except that it seems true.

Geez, must everything be taken so literally around here? Context is everything and winning the lottery (which is what it would take for me to truly work for free as a Physician) changes the context of what it means to work for free.

And since we're all in "wad in the a$$ mode", why can't medicine be a fiance' instead of a fiancee'? If medicine is a b*tch it's that way because of men NOT women, making it transgendered!