How Being a Doctor Became the Most Miserable Profession

[WhippleWhileWeWork]

I want to address the point Whipple brought up regarding the hierarchy of medicine because I think it represents a fundamental misunderstanding of the purpose of the structure and why it's there. You're also doing nothing more than parroting stereotypes and generalities while failing to consider alternatives for why this structure exists.

I was actually addressing a specific use of the power structure, in this thread and others on SDN. That's not a stereotype. The generalities can be made because medicine is not unique in that over time, one gains more experience and the knowledge base grows. And I don't need to know everything about medicine to make that statement, I need to know about other professions to make that statement. It's also not unique in that irrational decisions can happen to anyone, no matter their knowledge base or experience level. It's the abuse of the power structure in an effort to not be criticized and/or discourage critical thinking that I'm pontificating about.

I say all this to hopefully make an argument for why the hierarchy is both necessary and relevant. You seem to be mistaking people just being dicks, hierarchy or no, with the medical hierarchy. The hierarchy exists exactly because those more senior than you have seen orders of magnitude more patients than you. Their physical exam skills, diagnostic skills, and clinical judgment are that much more developed as a result. So yes, it's absolutely ridiculous to suggest that it is even remotely appropriate for someone of lower "rank" to question the clinical judgment of someone of higher "rank." You have some real balls, ego, and/or stupidity to, as the medical student who has been on the service for all of 2 weeks, to do anything but accept on faith what the residents who have been doing this for years and attendings for decades tell you. In doing so, you would essentially be arguing that the 5 cases of X that you've seen are equal to or superior than the 800 cases (literally) of X the resident or attending has seen. I hope you can see the absurdity of that.

I read Kevin Pho's blog on a regular basis, primarily to read the comment section where mostly attendings and retired doctors exchange their ideas. One of them said this to the others, I liked it so much that I put it in my sig.
"The bigger problem is that: 1. Doctors are socialized to be very compliant with authority, and 2. Critical thinking is not our strong suit, since the way we get into med school and do well there is mostly related to how well we memorize a bunch of stuff."

The issue is more nuanced than a simple example of a MS3 challenging the resident or attending. I could easily sum up your position as "You believe in the blind following of authority", which is equally absurd. My guess is you have something more nuanced in mind, though. Either way, even the most cursory study into the irrationality of the human mind, or even a few books on the irrationality of Doctors (written by Doctors, no less), will tear this mantra to pieces.

The same principle applies to the experience of going through training. Your own post makes that abundantly clear - you don't have the perspective to even consider this as a possibility and, instead, fit your inaccurate and hyperbolic assessment of the situation to reinforce your own bias. I don't say those things to insult you. I don't think you're stupid or otherwise incompetent. It's a simple matter of experience. Much like you can't study your way to being an attending, you can't read your way to experiencing medical training. None of this is to say that senior clinicians don't mistakes. They do. This also doesn't mean that the hierarchy doesn't have negative aspects of it. It does. But I think your understanding of it is poorly founded.

We're all biased, including the way you are presenting the power structure and the way you're interpreting what I'm challenging about it. To make it clear, I'm challenging the use of the power structure to escape criticism by those on a lower rung in efforts to escape ones irrationality. Which is done routinely on this board. The idea that experience and knowledge base prevents illogical thinking is just wrong. The idea that those with less or different experiences or knowledge bases can't point out those errors in thinking, is an error in thinking itself.

I think this is such a hot-button issue because future medical students balk at the proposition that there is no way to understand or otherwise learn about something other than doing it. Unfortunately, this will only make things more difficult as you progress through training. The sooner you suppress your own ego and accept that you just might be able to learn something from people who definitively know more than you - full stop - the more you'll be able to gain during your training.

Everyone has experience being irrational, everyone can and should be able to talk about that. You've made a caricature of my position. I'm full into a career that had its own training program and power structure to work through. I have no inherent problem with it, as I'll have no inherent problem with it in medicine.

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[DermViser]

I have no idea what that is, but it's genuine sympathy. Here I am trying to discuss rationally, and this so-called doctor starts attacking me personally, which doesn't help his point in the slightest. Like I asked before, if an idiot said the sky is blue, does it suddenly change color so he's wrong?

Who cares about my credentials if my points are valid? If you destroy my points, we have something to talk about. If you're just here to name-call, WHY?!
This part is a discussion. Thank you. Can we keep doing this? I mean, I disagree that statistics have no value to an individual (I'll explain later when I have time!), but it's a discussion we can talk about!

No, he's right about Burnett's law: http://forums.studentdoctor.net/threads/sdns-godwins-law.528658/#post-6729090

Your credentials don't make you stupid. Your ideas do. Your credentials only give context to your stupid ideas.

 

[type12]

Learn about BASIC statistics on how salary is calculated. There's a reason there isn't just one source, and why some sources are more inflated (MGMA), bc salary is based on many contributing factors and practice characteristics.

I know the basic statistics. They say you are wrong through and through. Why can't you just show your work? Or at least cite ONE thing rooted in science and not conjecture?

Like I said, if you're already getting panic attacks as a premed as demonstrated by your statement in another thread:
You'll be in for even a bigger shock when you get into medical school.

Again, appreciate the following, but not going to happen. People are different: what made you cry like a baby isn't going to move me to tears. Sorry, doc, not happening. Already gave you a weapon. NUMBERS, SOURCES. Do it, I triple dare you.

They don't need your "heart". My patients appreciate what I do for them quite well.

Well, if they knew how you resort to personal attacks, they would think otherwise. Imagine if they questioned you, lol.

Your credentials don't make you stupid. Your ideas do. Your credentials only give context to your stupid ideas.

But a doctor is providing stupid evidence for his supposedly sound arguments. The context seems unrelated in your case, because your points are still wrong and absolutely unsupported.

Don't worry, I won't call you hitler. Can you try to attack my points rather than me personally? Are you really that afraid of them? I'm sorry to say, you will not find me a weak target, so you are better off going for the discussion.

 

[DermViser]

I know the basic statistics. They say you are wrong through and through. Why can't you just show your work? Or at least cite ONE thing rooted in science and not conjecture?

Again, appreciate the following, but not going to happen. People are different: what made you cry like a baby isn't going to move me to tears. Sorry, doc, not happening. Already gave you a weapon. NUMBERS, SOURCES. Do it, I triple dare you.

Well, if they knew how you resort to personal attacks, they would think otherwise. Imagine if they questioned you, lol.
But a doctor is providing stupid evidence for his supposedly sound arguments. The context seems unrelated in your case, because your points are still wrong and absolutely unsupported.

Don't worry, I won't call you hitler. Can you try to attack my points rather than me personally? Are you really that afraid of them? I'm sorry to say, you will not find me a weak target, so you are better off going for the discussion.

Actually no you don't. You said, "why is AAMC's own site "OFF" in regards to salary?" If you can't answer this question of why average salaries can be inaccurate, that tells me you have no idea what actually affects and what contributes to a salary.

Like I said, if premed is giving you panic attacks/anxiety, then use common sense. Is medical school harder or easier than premed? I'll give you a hint, it isn't easier, and you have much greater risk, sacrifice (both financially and time) in medical school compared to as an undergraduate.

Just because you're wrong, doesn't mean it's a personal attack. It just means you're wrong. My patients ask me questions all the time. I answer them to the best of my ability and they like that. But please continue to enlighten us, oh illustrious premed. Or invoke Burnett's law again.

 

[NickNaylor]

I was actually addressing a specific use of the power structure, in this thread and others on SDN. That's not a stereotype. The generalities can be made because medicine is not unique in that over time, one gains more experience and the knowledge base grows. And I don't need to know everything about medicine to make that statement, I need to know about other professions to make that statement. It's also not unique in that irrational decisions can happen to anyone, no matter their knowledge base or experience level. It's the abuse of the power structure in an effort to not be criticized and/or discourage critical thinking that I'm pontificating about.



I read Kevin Pho's blog on a regular basis, primarily to read the comment section where mostly attendings and retired doctors exchange their ideas. One of them said this to the others, I liked it so much that I put it in my sig.
"The bigger problem is that: 1. Doctors are socialized to be very compliant with authority, and 2. Critical thinking is not our strong suit, since the way we get into med school and do well there is mostly related to how well we memorize a bunch of stuff."

The issue is more nuanced than a simple example of a MS3 challenging the resident or attending. I could easily sum up your position as "You believe in the blind following of authority", which is equally absurd. My guess is you have something more nuanced in mind, though. Either way, even the most cursory study into the irrationality of the human mind, or even a few books on the irrationality of Doctors (written by Doctors, no less), will tear this mantra to pieces.



We're all biased, including the way you are presenting the power structure and the way you're interpreting what I'm challenging about it. To make it clear, I'm challenging the use of the power structure to escape criticism by those on a lower rung in efforts to escape ones irrationality. Which is done routinely on this board. The idea that experience and knowledge base prevents illogical thinking is just wrong. The idea that those with less or different experiences or knowledge bases can't point out those errors in thinking, is an error in thinking itself.



Everyone has experience being irrational, everyone can and should be able to talk about that. You've made a caricature of my position. I'm full into a career that had its own training program and power structure to work through. I have no inherent problem with it, as I'll have no inherent problem with it in medicine.

I didn't make a caricature of your position any more than you made a caricature of mine. Perhaps we can agree that using ridiculous examples to argue against is a bad tactic.

Interestingly, your entire post and argument is itself based on an appeal to authority ("I've had a full professional career"). Your argument is no more valid than mine. The difference is that I've actually engaged in part of the medical training process. You haven't made your background clear, but I'm assuming you're either applying or about to matriculate. In this case, I think it's not unreasonable to pull rank and say "yeah, you have no idea what you're talking about." Reading blogs does not an expert make. That was the whole point of my post. You're claiming that you know and understand something to an equal or greater degree - with what I'm guessing/assuming is zero experience, but please correct me if I'm wrong - than those that have been in medicine from anywhere from 1-10 years, all of which are more than yourself. I don't think I'm making an absurd claim here.

You're illustrating perfectly the fallacy and why there is an almost perfect dichotomy between those who are in training vs. those who are not.

Your argument also fails to take into account the fact that, at least in my case, similar feelings are widely shared even among non-traditional students. You aren't the first to switch careers into medicine.


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[DermViser]

I read Kevin Pho's blog on a regular basis, primarily to read the comment section where mostly attendings and retired doctors exchange their ideas. One of them said this to the others, I liked it so much that I put it in my sig.
"The bigger problem is that: 1. Doctors are socialized to be very compliant with authority, and 2. Critical thinking is not our strong suit, since the way we get into med school and do well there is mostly related to how well we memorize a bunch of stuff."

Wow, if you think that doing well/success in medical school is based on how well you memorize a bunch of stuff, you are in for a HUGE shock.

 

[type12]

Actually no you don't. You said, "why is AAMC's own site "OFF" in regards to salary?" If you can't answer this question of why average salaries can be inaccurate, that tells me you have no idea what actually affects and what contributes to a salary.

Can YOU answer the question? You're the one disagreeing with a reputable source. You're asking me if I understand

Like I said, if premed is giving you panic attacks/anxiety, then use common sense. Is medical school harder or easier than premed? I'll give you a hint, it isn't easier, and you have much greater risk, sacrifice (both financially and time) in medical school compared to as an undergraduate.

Let me get this straight: you saw a post of mine on a forum, and you think you understand what gives me a panic attack/anxiety? Do you even know what aspect of premed makes me so? Hint: it's not the difficulty, lol. So, again, even if the difficulty of medical school made you cower in the corner inconsolably, that's on you, not me. Premed is not difficult, at least not to me, and difficulty has never given me any worry.

Just because you're wrong, doesn't mean it's a personal attack. It just means you're wrong. My patients ask me questions all the time. I answer them to the best of my ability and they like that. But please continue to enlighten us, oh illustrious premed. Or invoke Burnett's law again.

Okay, so you SAY I'm wrong, but just because you say I'm wrong doesn't make it so. For the umpteenth time, give me a WHY. Provide something tangible. Why is this so difficult for a doctor who supposedly answers questions? Do explanations for those answers not count? Is this how you treat your patients? When they ask you why you are giving them a prescription, or touching them? If so, I have reason to sympathize with them. Very bad insight, based on your attempt to read me from a post, lol.

 

[DermViser]

Can YOU answer the question? You're the one disagreeing with a reputable source.

Let me get this straight: you saw a post of mine on a forum, and you think you understand what gives me a panic attack/anxiety? Do you even know what aspect of premed makes me so? Hint: it's not the difficulty, lol. So, again, even if the difficulty of medical school make you cower in the corner inconsolably, that's on you, not me. Premed is not difficult, at least not to me, and difficulty has never given me any worry.

Okay, so you SAY I'm wrong, but just because you say I'm wrong doesn't make it so. For the umpteenth time, give me a WHY. Provide something tangible. Why is this so difficult for a doctor who supposedly answers questions? Do explanations for those answers not count? Is this how you treat your patients? When they ask you why you are giving them a prescription, or touching them? If so, I have reason to sympathize with them.

The AAMC doesn't come up with the salaries. They quote sources (MGMA) who do statistics on salary data. MGMA attending salaries are hugely inflated, and this is known by all attendings as the average is based on people who return their surveys.

Do you think medical school's difficulty is just bc the knowledge? Wow, you so don't know why medical school is hard and stressful for students. Medical school didn't make me cower, like I said, I'm a resident (meaning I've FINISHED medical school) - now in derm. Thank you for invoking Burnett's Law again.

 

[WhippleWhileWeWork]

I didn't make a caricature of your position any more than you made a caricature of mine. Perhaps we can agree that using ridiculous examples to argue against is a bad tactic.

I thought I made it clear that I was intentionally making a caricature of yours. That was the point of saying that...to show why that's not helpful when I do it, so it's equally unhelpful when you do it.

Interestingly, your entire post and argument is itself based on an appeal to authority ("I've had a full professional career"). Your argument is no more valid than mine.

I really have no idea how you could connect me bringing up my professional experience in the context of , "The sooner you suppress your own ego and accept that you just might be able to learn something from people who definitively know more than you - full stop - the more you'll be able to gain during your training." and claim that this was the basis for my entire argument. I suspect you're not reading my argument, at all. I was actually agreeing with your point there, having gone through a training program with power structure in place.

The difference is that I've actually engaged in part of the medical training process. You haven't made your background clear, but I'm assuming you're either applying or about to matriculate. In this case, I think it's not unreasonable to pull rank and say "yeah, you have no idea what you're talking about." Reading blogs does not an expert make. That was the whole point of my post. You're claiming that you know and understand something to an equal or greater degree - with what I'm guessing/assuming is zero experience, but please correct me if I'm wrong - than those that have been in medicine from anywhere from 1-10 years, all of which are more than yourself. I don't think I'm making an absurd claim here.

Again, you're not reading my position. Your bias seems to be so strong that you can't even fathom that I'm actually making no claims to know much of anything about the practice of medicine. It's almost as if you wish I were, so that you could pull rank and win this thing.
You're presenting a side of the power structure that I am not arguing against. I've made my point of contention very specific, and your trying to caricature it as something else. This is a dead end.

You're illustrating perfectly the fallacy and why there is an almost perfect dichotomy between those who are in training vs. those who are not.

Your argument also fails to take into account the fact that, at least in my case, similar feelings are widely shared even among non-traditional students. You aren't the first to switch careers into medicine.

Ok, I can see we aren't going to get anywhere.

 

[WhippleWhileWeWork]

Wow, if you think that doing well/success in medical school is based on how well you memorize a bunch of stuff, you are in for a HUGE shock.

I'm convinced you guys just troll for the fun of it, now. It's like there's a bank of standard responses that you pull from for each board on SDN.

 

[type12]

The AAMC doesn't come up with the salaries. They quote sources (MGMA) who do statistics on salary data. MGMA attending salaries are hugely inflated, and this is known by all attendings as the average is based on people who return their surveys.

Anecdotal evidence is the worst kind of evidence:
http://en.wikipedia.org/wiki/Anecdotal_evidence#Scientific_context
Do you have a source you can provide that shows MGMA inflates the numbers? Thanks! And what numbers would you use? Or, better yet, can you actually show me your numbers and calculations?

Do you think medical school's difficulty is just bc the knowledge? Wow, you so don't know why medical school is hard and stressful for students. Medical school didn't make me cower, like I said, I'm a resident (meaning I've FINISHED medical school) - now in derm. Thank you for invoking Burnett's Law again.

Straw man fallacy. I never spoke about the content of the difficulty (what makes med school "difficult"). I just said the difficulty doesn't worry me. In fact, everything you said would not give me a panic attack, even if it USED to make you cry.

 

[DermViser]

I'm convinced you guys just troll for the fun of it, now. It's like there's a bank of standard responses that you pull from for each board on SDN.

You said: I read Kevin Pho's blog on a regular basis, primarily to read the comment section where mostly attendings and retired doctors exchange their ideas. One of them said this to the others, I liked it so much that I put it in my sig.
"The bigger problem is that: 1. Doctors are socialized to be very compliant with authority, and 2. Critical thinking is not our strong suit, since the way we get into med school and do well there is mostly related to how well we memorize a bunch of stuff."

The main premise of that quote is WRONG.

 

[WhippleWhileWeWork]

You said: I read Kevin Pho's blog on a regular basis, primarily to read the comment section where mostly attendings and retired doctors exchange their ideas. One of them said this to the others, I liked it so much that I put it in my sig.
"The bigger problem is that: 1. Doctors are socialized to be very compliant with authority, and 2. Critical thinking is not our strong suit, since the way we get into med school and do well there is mostly related to how well we memorize a bunch of stuff."

The main premise of that quote is WRONG.

Then take it up with the attending who said it? It's called a difference of opinion, you're disagreeing with him. It's ok.

 

[Lucca]

Can YOU answer the question? You're the one disagreeing with a reputable source. You're asking me if I understand

Let me get this straight: you saw a post of mine on a forum, and you think you understand what gives me a panic attack/anxiety? Do you even know what aspect of premed makes me so? Hint: it's not the difficulty, lol. So, again, even if the difficulty of medical school made you cower in the corner inconsolably, that's on you, not me. Premed is not difficult, at least not to me, and difficulty has never given me any worry.

Okay, so you SAY I'm wrong, but just because you say I'm wrong doesn't make it so. For the umpteenth time, give me a WHY. Provide something tangible. Why is this so difficult for a doctor who supposedly answers questions? Do explanations for those answers not count? Is this how you treat your patients? When they ask you why you are giving them a prescription, or touching them? If so, I have reason to sympathize with them. Very bad insight, based on your attempt to read me from a post, lol.

Let's say there are two people. I am most familiar with costs in the state of Texas so, for the sake of argument, let's say they are residents of this fair state.

Let's assume both come from lower middle class families and had to service the majority of their education with loans. One person has 200k debt from medical school and the other has 40k from undergrad (average 4 yr COA for undergrad in TX is 80k so their family could afford to pay some of it).

They both graduate, one with a BBA and the other with the MD. They are both "hired" following graduation.

BBA works 40 hours a week for 55k/year at an entry level position in a Texas Business firm. Remember, Texas is fairly cheap to live in so 55k a year is definitely a very respectable salary here (I think it's the equivalent of being paid 70 in NYC/SF, maybe 80 these days):

MD works 80 hours/week being paid 50k at his IM residency in Houston.

DISCONNECT NUMBER ONE: MD works 2x the hours for the same pay as a resident.

BBA buys a house in a Houston suburb since he has time to commute and wants to raise a family there. 170k mortgage, 25k car debt. Monthly mortgage payment ~2000$, car payment about 400$. Middle class savings scheme = low savings, about 500$ go to loan payments and the rest goes to living expenses, leisure expenses.

MD rents an appartment near the TMC to minimize commute time and be ready to respond to call as quickly as possible. Rent is about 2000$, car debt is 25k so payment is about 400$. Loan repayment 500$ a month and the rest goes to living expenses leisure expenses.


The rest is left to the reader as an exercise is noticing that some numbers are bigger than other numbers.

 

[DermViser]

Anecdotal evidence is the worst kind of evidence:
http://en.wikipedia.org/wiki/Anecdotal_evidence#Scientific_context
Do you have a source you can provide that shows MGMA inflates the numbers? Thanks! And what numbers would you use? Or, better yet, can you actually show me your numbers and calculations?

Straw man fallacy. I never spoke about the content of the difficulty (what makes med school "difficult"). I just said the difficulty doesn't worry me. In fact, everything you said would not give me a panic attack, even if it USED to make you cry.

I'm not as weak as you. Your defense mechanism of displacement on me, doesn't fool anyone.

I didn't say MGMA "inflates" the numbers. I said the numbers are inflated relative to actual salaries based on the # of surveys they get back. This isn't based on anecdotes. Your salary as a physician is dependent on more than just what your specialty is.

In the New England Journal of Medicine (you know that "throwaway" journal of medicine): http://www.nejmcareercenter.org/article/understanding-physician-compensation-components/

Other minor marketplace trends — even short-lived or region-specific ones — can influence physician compensation components’ structures and relative weights, Ms. Meyer notes. “We are seeing elevated compensation numbers in the physician salary surveys because of the merger and acquisition mode in the industry right now, and that’s inflating starting salaries relative to what physicians can expect to bring in,” she said, in revenues or collections.

Precisely because of such short-term trends, Dreyer Medical Clinic takes a longer view when it sets physician compensation in the context of survey findings, Ms. Meyer explains. Rather than using a single survey or only current-year data to set base compensation, the group’s methodology incorporates data from both the AMGA and MGMA surveys, and over two consecutive years. “That way we have four data points when we set compensation,” she said. “If you only use one survey, and only for one year, things can get fuzzy because the [survey] numbers sometimes lag behind what’s going on in the market.”

 

[Mad Jack]

Of course there will be misery when you have a field filled with the brightest, most driven, and often most talented members of society forced to live by rules and reimbursement structures crafted by foolish politicians, bean counters, nurse administrators, patients (patient satisfaction), and bureaucrats. Physicians operate in the uniquely awful circumstance of having the way in which they practice largely dictated by people who have never themselves practiced medicine.

 

[DermViser]

Then take it up with the attending who said it? It's called a difference of opinion, you're disagreeing with him. It's ok.

Yeah, I've only completed medical school, that's all. If you actually believe that memorization is the key to success in medical school. I can't wait till you enter your MS-3 year.

 

[WhippleWhileWeWork]

Of course there will be misery when you have a field filled with the brightest, most driven, and often most talented members of society forced to live by rules and reimbursement structures crafted by foolish politicians, bean counters, nurse administrators, patients (patient satisfaction), and bureaucrats. Physicians operate in the uniquely awful circumstance of having the way in which they practice is largely dictated by people who have never themselves practiced medicine.

Oh you're gonna get it.

 

[studentp0x]

I'd rather be a retired billionaire who just travels and spends time at home.


I love being a doctor. I say pursue medicine if you understand the sacrifices and want to proceed anyway. I just think people should really understand the sacrifices and see how it can personally affect you. When you're a 20 year old girl you might not care too much if you're 30 and single and won't possibly have kids until you're 35... but when you're 30 and single and your biological clock is ticking, it's going to really suck. You might wonder why you did this to yourself, because there's no going back and undoing it. You may have missed your chance to have kids for good, and $300,000/year might not bring you that happiness in life.

I think sometimes people focus on the career and forget about their life. You'll progress through undergrad, med school, residency, etc and that will all go well. But you also need to live life, and medicine can be very disruptive to that goal. It's about priorities, I guess.

FWIW my wife is a professor and her job is pretty awesome. I mean it's high stress because productivity is so important, but her hours are very lax, she gets paid well, and she had no debt. Her PhD is more computer sciencey, so obviously different from a hard science.

edit: this is also where all of those "If you could see yourself doing anything else, don't go in to medicine.." comments come from

I think you're misunderstanding the article. And that's ok, I would have misunderstood it as a resident, too.

The lack of free time, missing out on family moments, etc. - meh. Yes, it sucks, but (to an extent) you get used to it. And you would miss out on a lot of family moments no matter what kind of job you worked. That's certainly not unique to medicine.

The work hours are also a meh. That gets better (usually) once you're done residency. The money does, too.

The hardest transition for me, from med student to attending, was realizing just how little you matter, even as a physician, particularly if you work for a large corporation, or if you work in a non-physician owned practice. They value you for the income you generate, but any MD with the same credentials and similar work ethic would generate the same amount of income. You, as an individual, do not matter. What that means is that the second you become a liability (a VIP complains about you, because you didn't kiss their ass enough, a bad patient outcome that you couldn't avoid happens), they'll drop you like a hot rock. I know a lot of physicians who have been told, to their faces, by hospital administration, that they are expendible and easily replaceable.

The insurance companies don't care who you are as a physician either. Your clinical experience means nothing to them - you're another faceless MD/DO who ordered another expensive test for another faceless patient that this insurance company does not want to pay for.

Finally, a lot of the patients don't care either. You could be Dr. Armybound, Dr. Navybound, Dr. Whatever-bound. They value you for what you do for them, and many patients will only see you as a vending machine - tell it what you want, and out it comes. When you balk, they will get angry. Not all patients are like this, of course, but there are quite a few who do not care who you are as a person. I was taken aback by how many patients got angry that I had the audacity to *gasp* go on vacation, because it "inconvenienced them." Because I was gone, they couldn't get their disability forms, or their meds as fast as usual, or their lab results, and they took it as a personal affront that I took some time off.

Maybe I was too idealistic for too long? I don't know. I still think that the article exaggerates a lot, and I'm not miserable in my job. But, I would encourage people to go to med school only if they understood what kind of conditions they should look for in a job once they finish their training.



I might be happier, actually. Because at least I'd know that it was a useless job, and there wouldn't be this pretense that you, as a person, matter - when you actually don't. Plus, I could leave AT FIVE, instead of having 1-2 hours of paperwork to finish up that has to be done.

There's more to life than job satisfaction. If you're just a corporate slave and basically an average man, you won't be happy with what you do if you are the same person as now (ambitious).
Income does matter, the people leaving at 5 aren't making good money (most of them).

 

[WhippleWhileWeWork]

Yeah, I've only completed medical school, that's all. If you actually believe that memorization is the key to success in medical school. I can't wait till you enter your MS-3 year.

Haha, I don't know what to say. You seem to have only one setting here, "I've done more than you, you're wrong".

I hope everyone else reading this exercise in futility knows the difference between quoting someone's claim, and making a claim yourself.

I give up, I can't even tell who or what is trolling anymore.

 

[ninjaman22]

 

[DermViser]

Haha, I don't know what to say. You seem one setting here, "I've done more than you, you're wrong".

I hope everyone else reading this exercise in futility knows the difference between quoting someone's claim, and making a claim yourself.

Like I said, if you believe one-step thinking (memorization) is the key to being successful in medical school, let me know once you've finished your MS-3 year. That is no longer the case now, esp. on MS-3 rotations when you're evaluated by residents/attendings, not just your ability to fill in multiple choice bubbles. I didn't say you made the claim, which you "liked it so much that I put it in my sig."

 

[WhippleWhileWeWork]

Like I said, if you believe one-step thinking (memorization) is the key to being successful in medical school, let me know once you've finished your MS-3 year. That is no longer the case now, esp. on MS-3 rotations when you're evaluated by residents/attendings, not just your ability to fill in multiple choice bubbles. I didn't say you made the claim, which you "liked it so much that I put it in my sig."

Like I said, if you believe that puppy **** doesn't stink just wait until you're on your 5th day of 95+F temps, 100% humidity and you walk outside to bring the little jerk some water and get that week old green slimy stuff between your toes and under your toe nails and can't wash it off enough. I didn't say you made this claim, but what the hell.

 

[Muffinho]

Naturopaths must love reading threads like this.

 

[Lucca]

I don't even know what you people are arguing about anymore.

 

[type12]

Lucca, this is exactly what I wanted. I wish I could converse with you about this hypothetical example which is PERFECT, but I'm having too much fun at the moment. Sorry. :-/

I'm not as weak as you. Your defense mechanism of displacement on me, doesn't fool anyone.

Oh my. Do you say that to all your patients too? No one's displacing anything, and I don't want to fool anyone. I'm not like you and scared of challenges. I welcome them. Did I strike a nerve? Me thinks someone protests too much.

I didn't say MGMA "inflates" the numbers. I said the numbers are inflated relative to actual salaries based on the # of surveys they get back. This isn't based on anecdotes. Your salary as a physician is dependent on more than just what your specialty is.

In the New England Journal of Medicine (you know that "throwaway" journal of medicine): http://www.nejmcareercenter.org/article/understanding-physician-compensation-components/

Other minor marketplace trends — even short-lived or region-specific ones — can influence physician compensation components’ structures and relative weights, Ms. Meyer notes. “We are seeing elevated compensation numbers in the physician salary surveys because of the merger and acquisition mode in the industry right now, and that’s inflating starting salaries relative to what physicians can expect to bring in,” she said, in revenues or collections.

Precisely because of such short-term trends, Dreyer Medical Clinic takes a longer view when it sets physician compensation in the context of survey findings, Ms. Meyer explains. Rather than using a single survey or only current-year data to set base compensation, the group’s methodology incorporates data from both the AMGA and MGMA surveys, and over two consecutive years. “That way we have four data points when we set compensation,” she said. “If you only use one survey, and only for one year, things can get fuzzy because the [survey] numbers sometimes lag behind what’s going on in the market.”

I read the whole thing. I didn't know IRS actually played a role! But this reads like a "Hey, is this your first job?" 101 post.

There's a number of problems here, unfortunately. The problem is this article is dated Dec 2013, so it's possible the aforementioned mergers and acq. probably did not affect the 2013 data I linked to. Even if it did, the 2012 data on AAMC looks oddly similar, as does the 2011 one. By that, I don't mean the numbers, but that the trend is upward, not downward.

So, the data doesn't reflect the merger and acq.'s, especially if it's two years' spread. So there's still an upward trend, but it's not as high as before. If you are arguing there's a downward trend, then that's fine. Regardless, all three data points (2011-2013) have do not invalidate my 40-60 RANGE. It does, however, make the 60 upper arguable, which I agree is too high now after reading it. However, 45-50k is still a realistic hypothetical number we can start off with and discuss.

 

[type12]

I don't even know what you people are arguing about anymore.

I'm not sure either. DermViser started insulting me personally when I asked him to show me math (basically what you did), so I need something to pass the time during this very anxious waiting period.

 

[Lucca]

I'm not sure either. DermViser started insulting me personally when I asked him to show me math (basically what you did), so I need something to pass the time during this very anxious waiting period.

@DermViser is a resident and I'm sure he has better things to do than to work out some straightforward calculations simply to convince a premed that 200k is larger than 40k. I, on the other hand, am just eating a croissant before my noon class.

 

[type12]

@DermViser is a resident and I'm sure he has better things to do than to work out some straightforward calculations simply to convince a premed that 200k is larger than 40k. I, on the other hand, am just eating a croissant before my noon class.

No one is arguing 200k is larger than 40k. I just posited that the 2% difference on that 200k loan (6.7%) and a 200k mortgage (4.7%) on a house is not sufficient a difference to say the debt is impossible for a 50k resident, but manageable for a 50k salaryman. And this is even before the tax breaks and benefits.

 

[DermViser]

Lucca, this is exactly what I wanted. I wish I could converse with you about this hypothetical example which is PERFECT, but I'm having too much fun at the moment. Sorry. :-/
Oh my. Do you say that to all your patients too? No one's displacing anything, and I don't want to fool anyone. I'm not like you and scared of challenges. I welcome them. Did I strike a nerve? Me thinks someone protests too much.
I read the whole thing. I didn't know IRS actually played a role! But this reads like a "Hey, is this your first job?" 101 post.

There's a number of problems here, unfortunately. The problem is this article is dated Dec 2013, so it's possible the aforementioned mergers and acq. probably did not affect the 2013 data I linked to. Even if it did, the 2012 data on AAMC looks oddly similar, as does the 2011 one. By that, I don't mean the numbers, but that the trend is upward, not downward.

So, the data doesn't reflect the merger and acq.'s, especially if it's two years' spread. So there's still an upward trend, but it's not as high as before. If you are arguing there's a downward trend, then that's fine. Regardless, all three data points (2011-2013) have do not invalidate my 40-60 RANGE. It does, however, make the 60 upper arguable, which I agree is too high now after reading it. However, 45-50k is still a realistic hypothetical number we can start off with and discuss.

I'm talking about what contributes to ATTENDING salaries. I'm not talking about resident salaries, genius. If after all this, you think I was talking about resident salaries, then you're not worth talking to. If you can't understand the different factors that contribute to attending salaries then I can't help you, esp. if you think 50K salary people buy 200K houses. If you can't understand sample bias of those practices that take the time to fill out a lengthy survey, I can't help you.

We get it. Invoking Burnett's Law is what you have to do, to keep you from going into panic attacks and anxiety while you're anxiously waiting for an acceptance. I'll let you have the last word, so make it good. And be sure to invoke Burnett's law and put down anything that goes against your worldview. Make it good.

 

[type12]

I'm talking about what contributes to ATTENDING salaries. I'm not talking about resident salaries, genius. If after all this, you think I was talking about resident salaries, then you're not worth talking to. If you can't understand the different factors that contribute to attending salaries then I can't help you. If you can't understand sample bias of those practices that take the time to fill out a lengthy survey, I can't help you.

We get it. Invoking Burnett's Law is what you have to do, to keep you from going into panic attacks and anxiety while you're anxiously waiting for an acceptance. I'll let you have the last word, so make it good. And be sure to invoke Burnett's law and put down anything that goes against your worldview. Make it good.

Thanks! But aren't attending salaries higher? So doesn't your argument fall apart there all the same? What number would you like to start with then? Let's start with some good numbers, as long as they are within reason. C'mon, this is what I've been asking from you since you started your unwarranted personal attacks.

Aren't you invoking Burnett's Law? I haven't done anything but just used your own logic against you. You seem to hate that a liiiiiitttttllle too much. Did reading about panic attacks really make you recall traumatic memories of med school or something? Is that why you think I must invariably have panic attacks in med school? Because you did? Remember, doc, not everyone is like you.

If you really don't want to have a civil conversation, that's fine. But don't go pretending like your argument makes sense.

I think you may have accidentally discredited yourself with that "people with 50k salaries don't buy 200k houses." You should edit that out before someone sees! You would look like you don't know anything about finances.

I'm glad you couldn't make it as a surgeon. You can't finish what you started.

 

[Lucca]

No one is arguing 200k is larger than 40k. I just posited that the 2% difference on that 200k loan (6.7%) and a 200k mortgage (4.7%) on a house is not sufficient a difference to say the debt is impossible for a 50k resident, but manageable for a 50k salaryman. And this is even before the tax breaks and benefits.

Sure, if that was their only debt. The 200k debt resident also has the equivalent of a 200k mortgage to pay off. Thats 400k total compared to a 240k salaryman with 40k ugrad debt. Also, you have to factor in that most residents will train in urban areas as they are the most desired and that means caregorically higher living costs.

 

[type12]

Sure, if that was their only debt. The 200k debt resident also has the equivalent of a 200k mortgage to pay off. Thats 400k total compared to a 240k salaryman with 40k ugrad debt. Also, you have to factor in that most residents will train in urban areas as they are the most desired and that means caregorically higher living costs.

That's cool, but do residents buy houses if they are already financially burdened? Wouldn't they rent?

 

[Muffinho]

As a serious question: How much of the discontent of physicians comes from billing practices/insurance and how much of it is from other factors? Billing/Insurance is different in Canada, and I'd like an idea of how it compares to Canadian health care.

 

[Lucca]

That's cool, but do residents buy houses if they are already financially burdened? Wouldn't they rent?

If you are paying 2k a month either way it doesnt matter. There's opportunity cost involved and personal preference on the residents behalf. Remember that residents are also starting families ar that age so having a stable home and not a rented appartment could be very important. There's too much variance to pin down all pf the specifics but it doesnt change the fact that they will have 200k+ more debt (not factoring interest) in any scenario.

 

[ECkayak]

Here are a couple numbers for you type12, since you're really into those calculations:

200k debt with 6.7% interest = 13400 in interest per year, which equals 1117 PER MONTH

Resident salary of 50k (pre taxes mind you) gets you 4167 per month (in reality, lower after taxes)

That means that you only have 3050 left per month for EVERY OTHER EXPENSE, which is 36,6000 (again, in reality, this number is much lower after taxes).

This is based on 200k debt (I have nearly 100k more) and only paying back interest on the loans, nevermind the actual loans themselves.

 

[Frazier]

That's cool, but do residents buy houses if they are already financially burdened? Wouldn't they rent?

The decision to buy or rent is a complex one that is dependent upon a wide range of factors.

For example, it was cheaper for me to buy a home than rent...During med school.

That likely sounds outrageous, but numbers are numbers and in our scenario -- purchasing was the clear winner.

 

[mehc012]

I feel ya. Challenge still stands. Quote me and show me, or can you not do it? Harmless request, lol. But seems like it can't be done because I'm right.

*drops the mic, walks away*

EDIT: Oh, have to point this out: your talking to the wall reply = ad hominem! The more you know!

Look, I honestly have no skin in this game, not having been involved thus far, but please stop speaking like some sort of talk show caricature. It's painful.
Finally, neither mcloaf's statement nor my own here qualifies as an ad hominem. While they do insult you, there is no element of "and therefore I am correct and type12 is wrong", which is necessary in order for a statement to be a debate/logical fallacy. To quote everyone's favorite source, "Equating someone's character with the soundness of their argument is a logical fallacy. Mere verbal abuse in the absence of an argument, however, is not ad hominem nor any kind of logical fallacy."

If you're going to sit there trying to sound cocky and condescending, at least get your damn facts straight to begin with.

 

[type12]

Hey guys, this was the conversation I was hoping for, but didn't get until now!

I don't have anymore time today to have fun. I just wanted to teach DermViser a lesson. Now that I have, I'm going to peace out until later!

@mehc012 My challenge to him was about his straw man fallacy, not his ad hominems, which I didn't quote there. So, in short, I agree with you there. What is so bad about asking him to quote me on something he was arguing about?

I have no beef with you or anyone. I just don't appreciate people resorting to insults. *hesitantly drops the mic*

 

[mehc012]

Hey guys, this was the conversation I was hoping for, but didn't get until now!

I don't have anymore time today to have fun. I just wanted to teach DermViser a lesson. Now that I have, I'm going to peace out until later!

@mehc012 My challenge to him was about his straw man fallacy, not his ad hominems, which I didn't quote there. So, in short, I agree with you there. What is so bad about asking him to quote me on something he was arguing about?

I have no beef with you or anyone. I just don't appreciate people resorting to insults. *hesitantly drops the mic*

You specifically stated "ad hominem". If you meant "straw man" that's one hell of a typo.
You did later also throw "straw man" into the mix.

 

[Frazier]

The decision to buy or rent is a complex one that is dependent upon a wide range of factors.

For example, it was cheaper for me to buy a home than rent...During med school.

That likely sounds outrageous, but numbers are numbers and in our scenario -- purchasing was the clear winner.

I forgot to stress for readers and general lurkers (and this is just about as "on topic" as the recent squabbling):

Not many pre-meds consider this option, but it could end up saving you a decent chunk of money. For example, I am set to save ~$30,000 over the course of med school via this decision. If I stay for a 4 year residency, those savings will balloon closer to 65k total.

Look into it to see if it is the correct choice for you.

 

[type12]

Mostly the fact that type12 has taken a logic class and is very proud of their ability to remember the logical fallacies, even if they're not so good at actually applying them or saying anything of merit beyond the debate equivalent of chest thumping and "come at me, bruh".

What's your problem? I'm not sure what the issue is. I wanted to stop the squabbling, and I did it with a very direct method of, "Hey, you're saying I said this, so show me where I said this." He tiptoed away instead of providing the solution I requested. I don't see the problem with this.

I'm not sure why you're attacking me with insults, but I have no qualms with you.

 

[type12]

You specifically stated "ad hominem". If you meant "straw man" that's one hell of a typo.
You did later also throw "straw man" into the mix.

Oh, you're talking about my EDIT part. Sounded like you were talking about the "come at me brah" part, lol. My mistake. Thanks for the clarification then.

 

[chenzt]

I forgot to stress for readers and general lurkers (and this is just about as "on topic" as the recent squabbling):

Not many pre-meds consider this option, but it could end up saving you a decent chunk of money. For example, I am set to save ~$30,000 over the course of med school via this decision. If I stay for a 4 year residency, those savings will balloon closer to 65k total.

Look into it to see if it is the correct choice for you.

30k over 4 years? Even with interest on a mortgage (I assume?), homeowner insurance, upkeep, and property tax?

 

[Frazier]

30k over 4 years? Even with interest on a mortgage (I assume?), homeowner insurance, upkeep, and property tax?

Yeah 30k in savings over 4 years.

Remember, I tried to stress earlier how it depends on the individual's situations... painting with broad strokes:

I'm a nontrad (closer to 30 than 20)
Very (VERY) cheap housing market where my school is located
This led to me being able to pay for the house in cash -- no mortgage.

These calculations factor in a broad range of factors from the price of apartment we would have rented given our needs, to lost investment income due to paying for the home, to county tax, to school tax, to utilities, to cable and internet, to home warranty, to maintenance expenses, to repair expenses, to assumed flat appreciation rates, etc., etc.

So, yeah, those numbers included it all.

Really, almost as important as the cost savings is the qualitative value....freedom of being able to leave the dark stressful halls of the med school in the heart of the city, drive home to my quiet little suburb, wave at the kids playing in their yards, sit on the deck and have a cookout with my SO or have family come over. I cannot imagine ever going back to apartment life (did it for 8+ years).

Plus at 3BR, dining room, office, garage, etc there is plenty of room for me to put my stuff.

 

[Frazier]

Yeah 30k in savings over 4 years.

Remember, I tried to stress earlier how it depends on the individual's situations... painting with broad strokes:

I'm a nontrad (closer to 30 than 20)
Very (VERY) cheap housing market where my school is located
This led to me being able to pay for the house in cash -- no mortgage.

These calculations factor in a broad range of factors from the price of apartment we would have rented given our needs, to lost investment income due to paying for the home, to county tax, to school tax, to utilities, to cable and internet, to home warranty, to maintenance expenses, to repair expenses, to assumed flat appreciation rates, etc., etc.

So, yeah, those numbers included it all.

Really, almost as important as the cost savings is the qualitative value....freedom of being able to leave the dark stressful halls of the med school in the heart of the city, drive home to my quiet little suburb, wave at the kids playing in their yards, sit on the deck and have a cookout with my SO or have family come over. I cannot imagine ever going back to apartment life (did it for 8+ years).

Plus at 3BR, dining room, office, garage, etc there is plenty of room for me to put my stuff.

Also, since the school I go to has very strong residency programs, I am certainly for staying for residency/fellowship. Unfortunately, since well regarded, there is cooresponding competitiveness to these positions. We are fortunate that the rival health system in town also has residencies in most the specialties that I am currently interested in...so between those 2, the option should be viable to stay local if we want. Collect additional $35k in savings.

If I end up matching somewhere else in the country, there are 2 exit strategies, since the house is already paid for I can either have it sold (which can take awhile and those costs come out of my prior profit's bottom line), or turn it into a rental and have a management company take it over (big market for rentals in the local suburbs here).

Just gotta be sure to plan everything out.

 

[BillrothI]

Sorry, but this is no longer a valid statement. Just ask the significant number of those who went unmatched.

There may be a relatively significant number of folks who didn't match, but that number pales in comparison to the percentage of college graduates who end up unemployed or working entry-level jobs. And even those who don't match can take a transitional year and recover the following cycle. I think the match rate at most schools - including DO programs - is over 90% (correct me if I'm wrong). Compare that to the ~70% of college graduates who don't find work related to their field of study.

-Bill

 

[DermViser]

Hey guys, this was the conversation I was hoping for, but didn't get until now!

I don't have anymore time today to have fun. I just wanted to teach DermViser a lesson. Now that I have, I'm going to peace out until later!

@mehc012 My challenge to him was about his straw man fallacy, not his ad hominems, which I didn't quote there. So, in short, I agree with you there. What is so bad about asking him to quote me on something he was arguing about?

I have no beef with you or anyone. I just don't appreciate people resorting to insults. *hesitantly drops the mic*

Actually, you didn't "teach" me any "lesson". I'm letting the stupidity of your comments speak for itself, no to mention your posts read like a cartoon caricature. Also, I had no desire whatsoever to do General Surgery. If you can't realize there are expenses you'll have at that age, than just student loan payments, I can't help you.

 

[type12]

Actually, you didn't "teach" me any "lesson". I'm letting the stupidity of your comments speak for itself, no to mention your posts read like a cartoon caricature. Also, I had no desire whatsoever to do General Surgery.

I thought you were going to let me have the last word? In regards to General Surgery, sure, whatever you'd like to believe. Why aren't you letting the stupidity of my comments speak for itself? By posting, aren't you doing the opposite? And isn't that stupid? To post to explain the stupidity speaking for itself?

 

[DermViser]

I thought you were going to let me have the last word? In regards to General Surgery, sure, whatever you'd like to believe. Why aren't you letting the stupidity of my comments speak for itself? By posting, aren't you doing the opposite? And isn't that stupid?

You are truly nuts, if you think I have ever said that I was in General Surgery. If you believe that, you might want to add hallucinations and delusions to your panic attack disorder.