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Are some specialties really just about money?

Prncssbuttercup

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    I know enough people who went into finance and other jobs for $$$, no other reason. They put in their time and will retire early with large amounts of cash. It's their choice. I have suffered through 10+ years in the biotech industry and have hated it every single day. Am I going into medicine for those reasons, yes, my likely choice of family practice clearly shows I'm in it just for the money, as they are such a high paying specialty :/ So, here's the thing, you (Law2Doc) say no one goes into it for the money, but other people have disagreed with you. Clearly you are a lawyer because you take 10x more words to say anything. Either way, people go into many jobs in many fields (law, engineering, nursing, etc) for the money ALL the time! Why shoud I assume that medicine is so pure and innocent and that no one would ever (by your assertion) be so stupid to go into it for the $$$?? You feel that every doctor goes into medicine for the 'right' reason, but there is no way that's true. You also assume that saying "all jobs have cons" is a copout, REALLY??? So, medicine has no cons? Even if you love your job, regardless of what it is, they have downfalls. NO job is 100% perfect; they may have downsides we can live with, but that doesn't mean they don't exist. Did you "unearth" something in me, nothing other than the realization you're pompous and in the pre-med forum instead of where you belong... If you want to start doling out helpful information instead of trying to attack me for asking if it's possible that people go into a specialty for the money, great, if not why are you here?
     

    QofQuimica

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      Hey, easy there, everyone. First, you're more or less in agreement here, but you're talking past one another. Yes, as SBB pointed out, some people do go into medicine (and every other career you can think of) primarily for the money. I don't think anyone disputes that fact. But as L2D pointed out, it's not a great plan to do that because of the time and expense required to become a doc. Going into a medical specialty you hate can make you especially miserable because you have so much less free time away from work than you do in many other non-physician jobs.

      Second, this forum is *not* only for premeds, in spite of the forum being located in the premed section of the forum list. Any person of any age and at any level of training, including med students, physicians, and other allied health folks (pharmacists, dentists, etc.), is welcome to participate in our dicussions of topics relevant to nontraditional students/health care practitioners. And if anything, we want to encourage our nontrads who are further along in their training to participate *more* in this forum, not less. No one appreciates the bumps in the road you nontrad premeds are on better than someone who's traveled a few miles ahead of you on it. :)
       

      BPlaysItCool

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        Hey, easy there, everyone. First, you're more or less in agreement here, but you're talking past one another. Yes, as SBB pointed out, some people do go into medicine (and every other career you can think of) primarily for the money. I don't think anyone disputes that fact. But as L2D pointed out, it's not a great plan to do that because of the time and expense required to become a doc. Going into a medical specialty you hate can make you especially miserable because you have so much less free time away from work than you do in many other non-physician jobs.

        Second, this forum is *not* only for premeds, in spite of the forum being located in the premed section of the forum list. Any person of any age and at any level of training, including med students, physicians, and other allied health folks (pharmacists, dentists, etc.), is welcome to participate in our dicussions of topics relevant to nontraditional students/health care practitioners. And if anything, we want to encourage our nontrads who are further along in their training to participate *more* in this forum, not less. No one appreciates the bumps in the road you nontrad premeds are on better than someone who's traveled a few miles ahead of you on it. :)

        In the spirit of this. I politely disagree with the certainty of L2D's argument.

        Namely that there are a whole range of limiting factors. Not just what one likes to do. So that the decision science is a myriad of grays, not just. I like derm. Therefore I will be a dermatolgist. I'm sure L2D would not disagree.

        But there are many such limitations than just scores--although that one is huge. That would be worth at least thinking about at the premed stage. One should consider whether they would still think it would be worth it in the sense that L2D describes if they couldn't do this or that thing.

        And also. Let's not forget in our bubble. That medicine is one sure thing of a living in an increasingly hostile badland for the middle class. Is doing it for the money such a crime against humanity. Must we obtain monastic purity.

        And yes. Some specialties are clearly a money draw. We cannot all possibly really have dreamt about doing some of these hot specialties since we were young. And of course there is the nature of race horses when the gates open that might just be inertia if anything else. Everybody wants what everybody wants.
         
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        penguin24

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          I agree. I spend way too much time in pre-allo!



          Well then I'm gonna hope and pray that I fall in love with one of the ROAD fields :xf:

          I gotta love what I do. I know what it feels like waking up dreading work and I don't think any amount of money could make up for the life it sucks out of me.

          How do so many pre-meds choose a specialty before they get into med school?

          This reminds me of the saying, "Don't marry for money, instead hang around rich people and marry for love". One of my mentors told me, don't pick a specialty based on how much you like doing the actual work; instead pick the type of lifestyle you want to live & then find a specialty that will provide that lifestyle.
           

          EdLongshanks

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            The other day I was one of the staff who organized a health care seminar celebrating the 90th anniversary of our local public-supported community health center. For the whole weekend everyone there talked about how we need to increase the number of PCP's. I even wrote one of the speeches for one of the doctors.

            But, every one of the guest speakers was a specialist!

            It would have been impolite to sit there and shake my head, but I felt like it. Almost every medical student aspires to be anything BUT a PCP. Since being a PCP is the least desirable field, increasing the numbers of PCP's is easy - you just reduce the numbers of residencies in specialties and increase the PCP residencies. The specialty residencies fill up and everyone else gets to be a PCP, whether they like it or not.

            This doesn't take comprehensive health reform. It doesn't take an act of Congress. It doesn't even take an executive order of the president. The NIH can do this, pretty much, all by themselves.

            But I think that health care policy people would rather moan about the difficulty of reform.
             

            BPlaysItCool

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              This reminds me of the saying, "Don't marry for money, instead hang around rich people and marry for love". One of my mentors told me, don't pick a specialty based on how much you like doing the actual work; instead pick the type of lifestyle you want to live & then find a specialty that will provide that lifestyle.


              That's funny. It makes sense to me too. I like working with my hands. but that doesn't mean I want to get pulverized in surgery training.

              An FP salary is plenty to pay back loans and things. So what's next is what does the work feel like day to day. And I don't subscribe to the notion of perpetually putting off feeling good today. Or good enough. Or. better than poor SOB/surgery intern at least. Training is 3-5 years after medical school. So a friendlier, more benign training regimen is a key factor for me. One that will allow me to stay fit. And not arrive in my mid 40's a total slob.

              So lifestyle really is a composit picture not just money. I'm just going to use thrid year to rule things I couldn't make a long run at from this subset criteria.


              Ed. Your event was ironic and unfortunately the norm. I am not quite sure myself why exactly a narrow, highly specialized training is viewed so highly. And is so sought after. Many of these things seem emininetly boring to me. Road schmoad.

              But I don't see any solution besides redistributing residency spots. And with medical culture being what it is. There would be uproar.
               

              Prncssbuttercup

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                Wasn't there an uproar because they changed the hours for first-year residents to 60 instead of 80? There's always an uproar for any change, then people calm down after a while, especially if it's the right thing to do.... I am going to be primary care because it's what I want to do, I can pick pretty much whatever lifestyle (general hospitalist, clinician, whatever) and make a good living doing what I want to do everyday... I think that sounds pretty good to me... As I said, there's ups/downs to everything, but it's whether the ups outweigh the downs, and for me, I know they will...
                 

                QofQuimica

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                  Wasn't there an uproar because they changed the hours for first-year residents to 60 instead of 80? There's always an uproar for any change, then people calm down after a while, especially if it's the right thing to do....
                  The problem here is that we don't know for sure that it's the "right" thing to do. There are no rigorous studies showing that even an 80 hour work week decreases medical errors. Of course, by common sense, it seems that it should. We do know that being sleep-deprived affects you almost like being drunk does if you're tired enough. However, this may be offset by the fact that a greater number of patient handoffs also is known to increase medical errors, probably in large part because the receiving physician does not know the patient as well as the original physician does. Some people also believe that forcing residents to hand off patients in the middle of the patient's workup adversely affects learning since the resident is not following that patient from start to finish and is not being involved in every aspect of their care. Surgeons in particular tend to feel this way.

                  Just for the record, the 80 hour work week rule is still in effect. What's going to be different about the work hours for my class is that interns are no longer allowed to take 30 hour call. (The new max is 16 hours on with eight hours off.) People are up in arms because some specialties (again, surgery being a big one) may have trouble covering their services. A related problem is that the scheduling logistics will likely require that programs switch to a night float system in many cases. Some people believe that a night float type of system interferes with residents' circadian rhythm and makes it harder for them to recover when they switch shifts back and forth between nights and days. Also, again, some people believe that a 16 hour limit interferes with patient care and resident learning for the reasons I listed above.

                  For anyone who is interested, here is a good basic article that explains the work hour changes, discusses pros and cons, and gives some links to relevant articles. There was also an excellent thread discussing this issue in the Gen Residency forum a few months ago.
                   

                  jl lin

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                    I appreciate this thread. It's totally irrelevantless.


                    :laugh: :thumbup:




                    (Sorry, but I have to agree that irregardless is superfluous and idiotic.)
                    Regardless of people's sustaining motivations, which obviously have to be about A LOT more than money, we have to get real about something.

                    Even nonprofit hospitals are about making a profit somewhere. "Not for profit" DOES NOT MEAN without making a profit. Yes, I am talking beyond merely NOT being in the red. I learned this reality many moons ago.

                    No one is running anything without trying to make money on it.

                    Now if you differ on whether or not this should be because of philosophical reasons and such, that is fine. But reality is reality. This is hard for some folks, but I have learned that in just about everything in life, you get what you pay for. *Ooops. I ended the sentence with a preposition. OUCH!*

                    It is one thing to help out truly needy people. It's another thing to devalue what is supposed to be important to people. I am talking about health and wellness. People show their level of concern and commitment by way of what and how they invest time and money. It's a funny thing how that works.

                    If any of this is simply all about the money for some people, then time will definitely reveal this in the lives of these people. I, however, think that, to some degree, money should be a factor.

                    Listen, I have the opportunity to do certain things that are more interesting and more financially rewarding than what I am doing now. But the bottom line is I need to make a reasonable income while keeping a good GPA and preparing for the future, all while living the life I'm committed to now. Sometimes you have to drop back and punt in order to focus on higher priority things.

                    Of course people have to be balanced in thinking when they decide on this path. So obviously money is a huge part of that when considering this path. You always have to count the cost or you are being foolish.
                     
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                    RFHawks

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                      The problem here is that we don't know for sure that it's the "right" thing to do. There are no rigorous studies showing that even an 80 hour work week decreases medical errors. Of course, by common sense, it seems that it should. We do know that being sleep-deprived affects you almost like being drunk does if you're tired enough. However, this may be offset by the fact that a greater number of patient handoffs also is known to increase medical errors, probably in large part because the receiving physician does not know the patient as well as the original physician does. Some people also believe that forcing residents to hand off patients in the middle of the patient's workup adversely affects learning since the resident is not following that patient from start to finish and is not being involved in every aspect of their care. Surgeons in particular tend to feel this way.

                      Just for the record, the 80 hour work week rule is still in effect. What's going to be different about the work hours for my class is that interns are no longer allowed to take 30 hour call. (The new max is 16 hours on with eight hours off.) People are up in arms because some specialties (again, surgery being a big one) may have trouble covering their services. A related problem is that the scheduling logistics will likely require that programs switch to a night float system in many cases. Some people believe that a night float type of system interferes with residents' circadian rhythm and makes it harder for them to recover when they switch shifts back and forth between nights and days. Also, again, some people believe that a 16 hour limit interferes with patient care and resident learning for the reasons I listed above.

                      For anyone who is interested, here is a good basic article that explains the work hour changes, discusses pros and cons, and gives some links to relevant articles. There was also an excellent thread discussing this issue in the Gen Residency forum a few months ago.

                      Yes the literature does not say conclusively that the reduction from 120 to 80 hour work weeks has reduced medical error. The night float system seems to have it's own downsides (besides messing with circadians) by placing patient care in the hands of largely unsupervised interns overnight - hence the July phenomenon, and switching interns and residents in the middle of patients care. Personally, I think that the night float system is not the correct answer for the reasons Q listed above. The main point is that the literature is inconclusive and we likely need a different approach. If more research funds were allocated to patient care practices we could get at least a better idea of what we're dealing with, but for some reason ($?) these funds are allocated to basic science and clinical research, with little going towards studying what we could do to improve patient care practices.
                       

                      BPlaysItCool

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                        Yes the literature does not say conclusively that the reduction from 120 to 80 hour work weeks has reduced medical error. The night float system seems to have it's own downsides (besides messing with circadians) by placing patient care in the hands of largely unsupervised interns overnight - hence the July phenomenon, and switching interns and residents in the middle of patients care. Personally, I think that the night float system is not the correct answer for the reasons Q listed above. The main point is that the literature is inconclusive and we likely need a different approach. If more research funds were allocated to patient care practices we could get at least a better idea of what we're dealing with, but for some reason ($?) these funds are allocated to basic science and clinical research, with little going towards studying what we could do to improve patient care practices.

                        I don't even understand the notion of thinking "the literature" could tackle such a question. That would be massive. And highly theoretical. What. Your gonna have two groups of similar residents, n = several hundred, practicing in very similar systems with very similar patient populations with very similar working cultures and very similar support staff. One working under the 80 hour rule one working under the traditional live in the hospital situation. And then carry out the study over 30 years to analyze the rates of alcoholism, drug abuse, broken homes, depression, suicide, and acquired antisocial disorders, and then meta analyze the effect on work flow and errror rates of the staff under both supervising physician groups.

                        And then compare the error rates.

                        Aint ever gonna happen. And as it happens now--in the almighty literature--the studies are more sensitive to selection bias and who's asking the questions than the answers themselves.

                        Or you could come to your own conclusion. n = 1. That a consistent 80 hours of anything sucks. And you will suck. And your loved ones will be around a sucky person. And your patients will have a person in a state of psychic disrepair to deal with.

                        I can do it for a year or so. After that 60 to 70 is a limit. There's not enough money in the world. To make some attempt at relevance to the OP.
                         

                        Prncssbuttercup

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                          I don't even understand the notion of thinking "the literature" could tackle such a question. That would be massive. And highly theoretical. What. Your gonna have two groups of similar residents, n = several hundred, practicing in very similar systems with very similar patient populations with very similar working cultures and very similar support staff. One working under the 80 hour rule one working under the traditional live in the hospital situation. And then carry out the study over 30 years to analyze the rates of alcoholism, drug abuse, broken homes, depression, suicide, and acquired antisocial disorders, and then meta analyze the effect on work flow and errror rates of the staff under both supervising physician groups.

                          And then compare the error rates.

                          Aint ever gonna happen. And as it happens now--in the almighty literature--the studies are more sensitive to selection bias and who's asking the questions than the answers themselves.

                          Or you could come to your own conclusion. n = 1. That a consistent 80 hours of anything sucks. And you will suck. And your loved ones will be around a sucky person. And your patients will have a person in a state of psychic disrepair to deal with.

                          I can do it for a year or so. After that 60 to 70 is a limit. There's not enough money in the world. To make some attempt at relevance to the OP.

                          My friend who is finishing her residency this year told me that there is a surgical residency on the East coast that prides itself on having a 100% divorce rate... NICE.... Apparently that's a good thing??? WTH?
                           

                          RFHawks

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                            I don't even understand the notion of thinking "the literature" could tackle such a question. That would be massive. And highly theoretical. What. Your gonna have two groups of similar residents, n = several hundred, practicing in very similar systems with very similar patient populations with very similar working cultures and very similar support staff. One working under the 80 hour rule one working under the traditional live in the hospital situation. And then carry out the study over 30 years to analyze the rates of alcoholism, drug abuse, broken homes, depression, suicide, and acquired antisocial disorders, and then meta analyze the effect on work flow and errror rates of the staff under both supervising physician groups.

                            And then compare the error rates.

                            Aint ever gonna happen. And as it happens now--in the almighty literature--the studies are more sensitive to selection bias and who's asking the questions than the answers themselves.

                            Or you could come to your own conclusion. n = 1. That a consistent 80 hours of anything sucks. And you will suck. And your loved ones will be around a sucky person. And your patients will have a person in a state of psychic disrepair to deal with.

                            I can do it for a year or so. After that 60 to 70 is a limit. There's not enough money in the world. To make some attempt at relevance to the OP.

                            I agree that it will never happen. I love this bolded statement. "And you will suck." :laugh: This is the truth. It's very poetic.
                             
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                            RFHawks

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                              My friend who is finishing her residency this year told me that there is a surgical residency on the East coast that prides itself on having a 100% divorce rate... NICE.... Apparently that's a good thing??? WTH?

                              Transplant? Or Cardio-Thoracic? Transplant is supposed to have the crappiest lifestyle of all medical specialties. As far as the pride is concerned, I honestly can't wait until all the stuffy old schoolers retire. IMHO there is no room in medicine for people that think doctors shouldn't have a family life.

                              One of the hypocrisies in medicine. I read an interview with an old schooler complaining that today's young physicians think about lifestyle when choosing a specialty and compensation, saying that they feel like the public owes them something for all the time and work they sacrifice. He said medical training shouldn't be martyrdom. According to him, medical training should entail giving up your family, personal life, hobbies, etc. This sound like martyrdom to me. Old schoolers need to wise up and see that times change and people aren't always willing to give these things up without some kind of compensation. I bet this dude graduated medical school with 25K in debt in the 70s. :thumbdown:
                               

                              BPlaysItCool

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                                Transplant? Or Cardio-Thoracic? Transplant is supposed to have the crappiest lifestyle of all medical specialties. As far as the pride is concerned, I honestly can't wait until all the stuffy old schoolers retire. IMHO there is no room in medicine for people that think doctors shouldn't have a family life.

                                One of the hypocrisies in medicine. I read an interview with an old schooler complaining that today's young physicians think about lifestyle when choosing a specialty and compensation, saying that they feel like the public owes them something for all the time and work they sacrifice. He said medical training shouldn't be martyrdom. According to him, medical training should entail giving up your family, personal life, hobbies, etc. This sound like martyrdom to me. Old schoolers need to wise up and see that times change and people aren't always willing to give these things up without some kind of compensation. I bet this dude graduated medical school with 25K in debt in the 70s. :thumbdown:

                                Yeah man. This is the discussion that I'm interested in.

                                (though I missed Q's point. She was saying given the 80 hours rule, what is the efficacy of the recent modifications to the intern call schedule. A slightly more studiable question. though unanswered.)

                                There's definitely a virulent strain of this is medicine. It may have taken a disgruntled step back. But it's still dug in. I can tell you as someone who has squired for many physicians that the behavior we are trained to exhibit. And by this I mean the bad behavior we are never dicouraged from exhiniting. Combined with the inense psychic dysfunction we go through spells all sorts of bad patient care scenarios.

                                That question. Never gets asked at it's fundamental core. There's absolutely no responsibility for it taken by our overseers. Psychic destruction is seen as absolutely normal. And necessary for succesful training.

                                You're a lazy, wimpish loser for evening thinking about it. And for considering it in your selection of a career your definitely a latte-sipping socialist. Unsavory. Someone to be avoided and weeded out.
                                 
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                                Lazarus

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                                  Yeah man. This is the discussion that I'm interested in.

                                  (though I missed Q's point. She was saying given the 80 hours rule, what is the efficacy of the recent modifications to the intern call schedule. A slightly more studiable question. though unanswered.)

                                  There's definitely a virulent strain of this is medicine. It may have taken a disgruntled step back. But it's still dug in. I can tell you as someone who has squired for many physicians that the behavior we are trained to exhibit. And by this I mean the bad behavior we are never dicouraged from exhiniting. Combined with the inense psychic dysfunction we go through spells all sorts of bad patient care scenarios.

                                  That question. Never gets asked at it's fundamental core. There's absolutely no responsibility for it taken by our overseers. Psychic destruction is seen as absolutely normal. And necessary for succesful training.

                                  You're a lazy, wimpish loser for evening thinking about it. And for considering it in your selection of a career your definitely a latte-sipping socialist. Unsavory. Someone to be avoided and weeded out.


                                  Dear Sir,

                                  How dare you have the gall to hijack this thread! I am shocked and appalled by your audacity. I was enjoying an entertaining flame war when you go and ruing things by making the conversation about something quasi serious.

                                  With Disapproval,
                                  -Lazarus
                                   

                                  Pons Asinorum

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                                    Transplant? Or Cardio-Thoracic? Transplant is supposed to have the crappiest lifestyle of all medical specialties.

                                    There are a bunch of neurosurg residents and attendings who are most likely offended by that comment. I would say many, if not most, would say they have the crappiest residency and post-residency lifestyle. Something like a point of pride.
                                     

                                    QofQuimica

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                                      I don't even understand the notion of thinking "the literature" could tackle such a question. That would be massive. And highly theoretical. What. Your gonna have two groups of similar residents, n = several hundred, practicing in very similar systems with very similar patient populations with very similar working cultures and very similar support staff. One working under the 80 hour rule one working under the traditional live in the hospital situation. And then carry out the study over 30 years to analyze the rates of alcoholism, drug abuse, broken homes, depression, suicide, and acquired antisocial disorders, and then meta analyze the effect on work flow and errror rates of the staff under both supervising physician groups.
                                      You're right that there's no way we can do a 30 year prospective trial. The most realistic way that comes to mind to study these kinds of questions is using historical controls. The original 80 hour work week rules went into effect in 2003, and now these new rules are being implemented in 2011. So you could compare outcomes from years before and after the change, assuming you could adequately adjust for confounding factors like changes in medical practice over that period of time, changes in the composition of the medical workforce, etc. But FWIW, I think you are probably right that getting meaningful results would be very difficult. Database data quality varies considerably, and results would depend heavily on how we defined our poor outcomes. Plus, these kinds of retrospective studies can only show whether there is an association between variable and outcome, not a causation.

                                      There's definitely a virulent strain of this is medicine. It may have taken a disgruntled step back. But it's still dug in. I can tell you as someone who has squired for many physicians that the behavior we are trained to exhibit. And by this I mean the bad behavior we are never dicouraged from exhiniting. Combined with the inense psychic dysfunction we go through spells all sorts of bad patient care scenarios.
                                      Agreed.

                                      I got asked at one of my residency interviews to tell about a time when I had a disagreement with a resident or attending, and how I handled it. I described a time when an attending (and not just any attending--it was the rotation director, the person who was giving me my final grade!) was trying to get a patient sample and couldn't get it. The patient, who was demented and didn't really understand what was happening, was screaming and begging the attending to stop. I was the only other person in the room. Of course I was extremely uncomfortable, but as a third year med student, I was not in a very good position to protest! Finally, I suggested that I call a specialist, just for backup in case we needed it. Fortunately, the attending gave me permission to do this. The specialty resident came and got the sample on the first try.

                                      When I think about this situation, the biggest regret I have is that I didn't speak up sooner. But I wasn't sure what to do. It's not like I could have ordered the attending to stop even though I felt very strongly that what was happening was wrong. I had been told once that you try two or three times max, and then if you still can't get something, you let someone else more experienced give a try. Unfortunately, sometimes health care providers get caught up in thinking along the lines of, "well, I know I'll get it this time. Just one more try...."

                                      It also impressed upon me how important it is to model professional behavior when I'm the team leader, and to not let my ego get in the way of doing what's right for my subordinates and patients. Not only in serious cases like this where I felt like the patient was being unnecessarily tortured, but even in little things like making sure my team members get lunch, have a chance to use the bathroom, etc. In other words, treating both patients and trainees as human beings. That's not always an easy thing to do when it requires inconveniencing yourself for the sake of other people, especially when you can easily use your position of power to make life easier for yourself at the expense of your subordinates. It also doesn't help that the culture you're working in encourages you to do exactly that.
                                       

                                      Torr

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                                        This reminds me of the saying, "Don't marry for money, instead hang around rich people and marry for love". One of my mentors told me, don't pick a specialty based on how much you like doing the actual work; instead pick the type of lifestyle you want to live & then find a specialty that will provide that lifestyle.

                                        There's a lot of wisdom in this.

                                        I've never had any interest in any of the ROAD specialties and for a long time I felt like choosing one based on lifestyle/money would be a cop out. As I get older I don't feel as bad choosing based on lifestyle though.

                                        At this point I'm mostly worried I'll fall in love with surgery.
                                         

                                        Pons Asinorum

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                                          At this point I'm mostly worried I'll fall in love with surgery.

                                          My wife and I are worried about the same thing. I'm drawn to the work of surgery, particularly CT and neuro. We're also utterly repulsed by the lifestyle both in residency and afterwards. We'll just have to see I guess.
                                           

                                          BPlaysItCool

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                                            You're right that there's no way we can do a 30 year prospective trial. The most realistic way that comes to mind to study these kinds of questions is using historical controls. The original 80 hour work week rules went into effect in 2003, and now these new rules are being implemented in 2011. So you could compare outcomes from years before and after the change, assuming you could adequately adjust for confounding factors like changes in medical practice over that period of time, changes in the composition of the medical workforce, etc. But FWIW, I think you are probably right that getting meaningful results would be very difficult. Database data quality varies considerably, and results would depend heavily on how we defined our poor outcomes. Plus, these kinds of retrospective studies can only show whether there is an association between variable and outcome, not a causation.


                                            Agreed.

                                            I got asked at one of my residency interviews to tell about a time when I had a disagreement with a resident or attending, and how I handled it. I described a time when an attending (and not just any attending--it was the rotation director, the person who was giving me my final grade!) was trying to get a patient sample and couldn't get it. The patient, who was demented and didn't really understand what was happening, was screaming and begging the attending to stop. I was the only other person in the room. Of course I was extremely uncomfortable, but as a third year med student, I was not in a very good position to protest! Finally, I suggested that I call a specialist, just for backup in case we needed it. Fortunately, the attending gave me permission to do this. The specialty resident came and got the sample on the first try.

                                            When I think about this situation, the biggest regret I have is that I didn't speak up sooner. But I wasn't sure what to do. It's not like I could have ordered the attending to stop even though I felt very strongly that what was happening was wrong. I had been told once that you try two or three times max, and then if you still can't get something, you let someone else more experienced give a try. Unfortunately, sometimes health care providers get caught up in thinking along the lines of, "well, I know I'll get it this time. Just one more try...."

                                            It also impressed upon me how important it is to model professional behavior when I'm the team leader, and to not let my ego get in the way of doing what's right for my subordinates and patients. Not only in serious cases like this where I felt like the patient was being unnecessarily tortured, but even in little things like making sure my team members get lunch, have a chance to use the bathroom, etc. In other words, treating both patients and trainees as human beings. That's not always an easy thing to do when it requires inconveniencing yourself for the sake of other people, especially when you can easily use your position of power to make life easier for yourself at the expense of your subordinates. It also doesn't help that the culture you're working in encourages you to do exactly that.


                                            Right. You had to swim up stream to do something compassionate. It's a dangerous game. The whole being human thing. A perfect cyborg can snatch every medal in this game and all your deans of this and that would be front and center with applause. Teary-eyed.


                                            Sorry. Lazurus. I'm sulking in the library. Waiting for the four horseman of the appocalypse to make all this go away.

                                            I just botched an interview for a summer program. Can somebody edit out my lines for simple questions like what are your weaknesses. And what do you think of medical school so far? And then go live with it. Cause I'm not getting so far. With this whole honesty thing.
                                             

                                            Prncssbuttercup

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                                              Bah Lazarus! I can hijack my own thread if I feel like it! ;)

                                              I am not sure what the surgical specialty was, and to me, it doesn't matter. The fact that a residency prides itself on being so awful as to dissolve a family is atrocious to me. Granted, the docs in it chose it for a reason, probably made fully aware of the situation. Since it's surgery, I'm assuming there are some egos involved with the people chosen... (I stand by my joke of what's the difference between God and a surgeon? God doesn't think he's a surgeon.... clearly no offense intended for those going into that specialty) I agree that some of the 'old school' attitudes can leave with the people who hold them, it is sad to me that it is perpetuated that doctors aren't mere mortals they are somehow not supposed to have a home life, or companions, etc... I don't get it... It is a strong factor for why I will likely choose family med or IM versus some incredibly intense field, as I would like to enjoy my family!
                                               

                                              Law2Doc

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                                                I don't even understand the notion of thinking "the literature" could tackle such a question. That would be massive. And highly theoretical. What. Your gonna have two groups of similar residents, n = several hundred, practicing in very similar systems with very similar patient populations with very similar working cultures and very similar support staff. One working under the 80 hour rule one working under the traditional live in the hospital situation. And then carry out the study over 30 years to analyze the rates of alcoholism, drug abuse, broken homes, depression, suicide, and acquired antisocial disorders, and then meta analyze the effect on work flow and errror rates of the staff under both supervising physician groups.

                                                And then compare the error rates.

                                                Aint ever gonna happen. And as it happens now--in the almighty literature--the studies are more sensitive to selection bias and who's asking the questions than the answers themselves.

                                                Or you could come to your own conclusion. n = 1. That a consistent 80 hours of anything sucks. And you will suck. And your loved ones will be around a sucky person. And your patients will have a person in a state of psychic disrepair to deal with.

                                                I can do it for a year or so. After that 60 to 70 is a limit. There's not enough money in the world. To make some attempt at relevance to the OP.

                                                I think you overthinking this. You have an error rate pre-80 hour limit, and an error rate post-80 hour limit. Every other independent factor is a wash. Thus far the data suggests error rates haven't gone down. In a few more years we will be able to say that with more confidence. The most likely reason? Because you are replacing sleep deprivation errors with handoff and other systemic errors. In prior years, it was rough to be a resident, and you were exhausted, but at least you knew your patients and every little detail about their care. Now you have a long list of folks you never heard about before sign out, and are quick to tell every person who pages you "hey, I don't know, I'm only cross covering". That's not really better.
                                                 
                                                May 24, 2010
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                                                  My wife and I are worried about the same thing. I'm drawn to the work of surgery, particularly CT and neuro. We're also utterly repulsed by the lifestyle both in residency and afterwards. We'll just have to see I guess.

                                                  Pons and Torr, I'm in the same place.

                                                  Like surgery the most but don't like the idea of 100 hr work weeks!

                                                  I've heard some surgeons can make it work post-residency, so just because you pick one field doesn't mean you have to work crazy hours.

                                                  Except maybe Neuro, sorry.

                                                  Anyway, I think a GS or Ortho spot could somehow find a sub-60 hour week post residency. CT seems interesting but I heard it's a dying specialty, or at least hard to find work in.
                                                   
                                                  May 24, 2010
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                                                    Right. You had to swim up stream to do something compassionate. It's a dangerous game. The whole being human thing. A perfect cyborg can snatch every medal in this game and all your deans of this and that would be front and center with applause. Teary-eyed.


                                                    Sorry. Lazurus. I'm sulking in the library. Waiting for the four horseman of the appocalypse to make all this go away.

                                                    I just botched an interview for a summer program. Can somebody edit out my lines for simple questions like what are your weaknesses. And what do you think of medical school so far? And then go live with it. Cause I'm not getting so far. With this whole honesty thing.

                                                    Are you that one poster from a while ago, Nasrudin? Such a unique way of. writing.

                                                    Anywho. There. Are. so many. periods. in your. sentences. dude. bro.

                                                    Edit: Actually, I decided you must be Nasrudin. No one talks like that.
                                                     

                                                    BPlaysItCool

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                                                      I think you overthinking this. You have an error rate pre-80 hour limit, and an error rate post-80 hour limit. Every other independent factor is a wash. Thus far the data suggests error rates haven't gone down. In a few more years we will be able to say that with more confidence. The most likely reason? Because you are replacing sleep deprivation errors with handoff and other systemic errors. In prior years, it was rough to be a resident, and you were exhausted, but at least you knew your patients and every little detail about their care. Now you have a long list of folks you never heard about before sign out, and are quick to tell every person who pages you "hey, I don't know, I'm only cross covering". That's not really better.

                                                      Rather. Most are underthinking it.

                                                      But I can't argue your assertion. If your only consdieration is cotinuity of care with one doc. Then yes. Move in with you patients.

                                                      I'll keep preferring the sanctity of some semblance of a private life.
                                                       
                                                      May 24, 2010
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                                                        I think you overthinking this. You have an error rate pre-80 hour limit, and an error rate post-80 hour limit. Every other independent factor is a wash. Thus far the data suggests error rates haven't gone down. In a few more years we will be able to say that with more confidence. The most likely reason? Because you are replacing sleep deprivation errors with handoff and other systemic errors. In prior years, it was rough to be a resident, and you were exhausted, but at least you knew your patients and every little detail about their care. Now you have a long list of folks you never heard about before sign out, and are quick to tell every person who pages you "hey, I don't know, I'm only cross covering". That's not really better.

                                                        If this is true, then all we have to do is figure out how to reduce handoff errors. Done and done.

                                                        Sleep deprivation errors = hard to fix

                                                        Handoff errors = easier to fix
                                                         

                                                        EdLongshanks

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                                                          Are you that one poster from a while ago, Nasrudin? Such a unique way of. writing.

                                                          Anywho. There. Are. so many. periods. in your. sentences. dude. bro.

                                                          Edit: Actually, I decided you must be Nasrudin. No one talks like that.

                                                          We already discussed that possibility. BPlays is much more rhythmic than Nasrudin and also occasionally makes sense.
                                                           

                                                          Pons Asinorum

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                                                            We already discussed that possibility. BPlays is much more rhythmic than Nasrudin and also occasionally makes sense.

                                                            This. It's the cadence, the pacing that makes them different. They both lose me; at least while I'm getting lost with BPlays, I've got a little skip in my step.
                                                             
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