Are we lazy?

[D5W]

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Today my attending started talking about how his generation and the one before his dedicated every second of their lives to medicine and how different our generation is. He wasn't berating me or anything like that, it just came up. One of the examples he gave was how now there are so many women in medicine, and how that used to be unusual, and that many women make family a priority so they work part time. In years past a "part time" doctor was unheard of (unless they were approaching retirement). I know this to be true, as a woman myself I am pursuing hospital medicine so that I can work part time and have kids one day. Anyway, I also know a lot of men who are entering fields admittedly based on the "lifestyle". I just can't decide if this difference is a good thing or a bad thing. I don't think it's that the new generation of doctors are lazy, we just have different priorities. Then again, that sounds like something a lazy person would say. Any thoughts?

 

[Gravi69]

Lazy is the wrong word.

Appropriate.

The field of medicine is no longer what it used to be and to keep current with the times, the attitude in medicine is undergoing a change too.

This shift in attitude is appropriate relative to the types of changes occurring in medicine.

 

[gng930]

That attitude from older generations is true in general, not just medicine. But for some reason, the average American works more hours per week than he/she did in the past. Go figure.

 

[RTrain]

I don't know if the new generation of physicians is "lazy," but they're definitely different, in a way that folks from the older generations could easily perceive as lazy. To complicate matters, I'm not sure where the line is between the youngsters and the oldsters - I definitely know that my attitude toward work and role it should play in my life feels different from that of the "new generation" who is going through med school right now, and I'm just enough older than other folks at my training level to notice. My husband, who works in another service field, has also noticed a clear difference in work ethics in the younger folk who work under him - and it's less about what they want than it is about what they expect.

Everyone wants plenty of time off to enjoy life, a great benefits package, the unconditional respect and praise of their colleagues, and continuous fulfillment and self-actualization. Of course we want that! It would be paradise in the workplace. The difficulty arises when you expect those things, or feel entitled to them, without the years of hard work and sacrifice that have traditionally preceded them.

I'm not picking on anyone here, and I'm not saying that all those wonderful things aren't great goals that we should all have, but, dear OP, I think your attending was commenting on the same thing that I and my spouse have both observed in our differing worlds. (and no, this isn't a chest-thumping post about how I'm a big stud and I don't need no stinkin' work-hours restrictions - I'm just old 😉)

 

[Top Gun]

Yeah, whatever. Your attending might not have had the 80 hour work week back in his day, but also residents during that time did not have as many patients, found time to sleep, and did not have as much paperwork. Residents today work a lot harder when they're on call than your attending did when he was a resident. Honestly, your attending sounds like my dad talking about having to walk four miles to school back in Sri Lanka and having to do chores like chopping wood when he came home.

 

[nala]

Yeah, whatever. Your attending might not have had the 80 hour work week back in his day, but also residents during that time did not have as many patients, found time to sleep, and did not have as much paperwork. Residents today work a lot harder when they're on call than your attending did when he was a resident.

I have to say I agree with this...one of my older and well-respected attendings recently made a similar comment to me - how "old school" attendings say how easy we have it now compared to them, but back in his residency days if they admitted 3 patients in a night that was a lot (and he was in NYC) and how the patients they admitted were not nearly as sick as the ones who get admitted today.

 

[swpm]

Today my attending started talking about how his generation and the one before his dedicated every second of their lives to medicine and how different our generation is.

Ask that crusty old prune how many times he, as a resident, admitted a surly smelly homeless uninsured ungrateful combative HIV+ crack addict with ESRD, pneumonia, and halitosis.

Then ask how many patients he admitted for a "routine physical exam and some lab work" ... or how many days of absolutely grueling post-op inpatient care he provided for healthy 23-year-olds who had appendectomies.

 

[U4iA]

part of it could be that people in our generation seem to base their sense of identity on more than just being in medicine.

 

[PediBoneDoc]

to give a little perspective ... from an young old soul. every younger generation is seen by the older generation as "lazy" or not as hard working. from silent to baby boomer to gen x to gen y (mellenial), the older always has seen the younger as "lazy", slackers, etc. not just in medicine, but in all areas.

in medicine, part of the culture has always been hard work. hard work translated to many hours in the hospital. this culture of hard work became a part of what was considered "professional".

times have changed. generations have changed. technology has changed. disease patterns and understanding have changed. the face of medicine has changed (ratio men to women). the definition of being "professional" in medicine is changing but to older physicians, "dedication" to the profession is still seen as a big part of being professional.

did previous generations work harder? may be. are things easier now than in the past? probably. but like many things, medicine needed an over haul. many like to look at the changes in hours in residency as the "shot in the arm" that made medicine change.

for me, i think everyone should be well rounded. family is important and should not be neglected. that being said, time must be spent learning your craft, patients should not be put at risk because you are off shift, and don't expect me (attending) to spoon feed information when you (resident) didn't read for a case.

last year i actually did multiple posts on the generational topic

How to train the next generation of orthopaedic surgeons ...

"Everyone's special!" ... "Which is another way of saying no one is." ... How do we educate residents with todays restrictions .... (part II)

Is Andy Rooney out of touch ...

 

[Tired]

You know what I hate most about the 80hr work week?

I can work 90-100hrs/wk, I can get 2-3 days off per month, I can complete the mountains of paperwork necessary to get patients in and out of the hospital, I can run around the hospital for 36hrs on-call without a minute of sleep, I can read in my free time for the rare moments I get to the OR, and I can crush all my boards and do solid on the intraining exam.

And after all that, I still have to nod and keep my mouth shut as some attending tells me I'm lazy because I have the "benefit" of the 80hr work week.

 

[Faebinder]

Today my attending started talking about how his generation and the one before his dedicated every second of their lives to medicine and how different our generation is. He wasn't berating me or anything like that, it just came up. One of the examples he gave was how now there are so many women in medicine, and how that used to be unusual, and that many women make family a priority so they work part time. In years past a "part time" doctor was unheard of (unless they were approaching retirement). I know this to be true, as a woman myself I am pursuing hospital medicine so that I can work part time and have kids one day. Anyway, I also know a lot of men who are entering fields admittedly based on the "lifestyle". I just can't decide if this difference is a good thing or a bad thing. I don't think it's that the new generation of doctors are lazy, we just have different priorities. Then again, that sounds like something a lazy person would say. Any thoughts?

*Oh God, help me not loosen all my wrath on this topic, especially considering the OP is a potential troll!*

Did I take the wrong plane a while back and land somewhere not in the US or am I in the wrong Forum... maybe the Canadian or UK forum? They worked harder??? Define hard work? They had less to learn, less patients and less lawsuits for MORE MONEY. The service you get is in line with the price you pay.... so how much are you paying current docs now compared to the past?

I get sick to my stomach when I hear this garbage. The USMLE passing score keeps going up... hospital privelages are become harder and harder... can you even practice without being board certified in some states? Was malpractice that high back in the days? How about number of lawsuits?

How much has the resident salary gone up since 1990?

How much did they owe in loans back in those days?

You carried what back in those days? Only 10 patients all postoperative day #15??

The problem is that older attendings have been past the steep rising part of the medical learning curve ever since they finished residency and so they tend to not realize that the steep part is actually growing towards them, it's just not fast enough to catch up with them in their specialty.

__________________ So to state the final point one more time.

Are you reimburising the new attendings / residents what you were the older generation? No? Then don't expect them to sacrifice their lives for crap.


A side note.... To add to the sense of disassociation from work... you have the increasing loss of physician power+respect in the hospital. This results in the loss of pride in your profession. It's hard to be motivated to do a good job at that point. No pride and no money = It's just a job.

 

[fuzzyerin]

Tired, I so agree with you.

I happened to still be in the hospital Friday morning after my nightfloat call and our resident meeting. I ran into one of our private attendings around 9:30 am who had a strong feeling her patient in the ER was an ectopic. Knowing the two residents on the gyn service were over in ambulatory, I told the attending I'd hang out in case she needed to take the patient to the OR, which indeed she did, at around 11 am. As we were scrubbing for the case, she said to me "I want to write your program director a letter to let him know how great it was that you stayed to help me with this case."

And you know what my answer was? "Please don't. I'm not supposed to be here right now."

And a similar response was obtained from the anesthesia attending, who knew I wasn't supposed to be there. I told him that "I was just hanging out, and Dr. So-and-so needed a hand." He told me, jokingly, that "some might call it a work hour violation."

 

[Mariah246]

Are you reimburising the new attendings / residents what you were the older generation? No? Then don't expect them to sacrifice their lives for crap.


A side note.... To add to the sense of disassociation from work... you have the increasing loss of physician power+respect in the hospital. This results in the loss of pride in your profession. It's hard to be motivated to do a good job at that point. No pride and no money = It's just a job.

Well said.

 

[buckley]

Now, I am an advocate of "you shall honor thy mentors"...but i have to admit sometimes they can be very unfair when they compare their times and our times.
My favorite is an old orthopedic surgeon who looked down on me because i admitted i have never done a below the knee amputation on my own. He said during his time it was unheard of for a medical doctor not to be able to do a BKA. Well...those were the times when antibiotics was scarce and he was an intern during world war II! My co-intern, who was chided because he did not know his anatomy, told me---of course they had all the time in the world to master anatomy! That was all they had to learn! DNA wasn't even discovered then! (We laughed our heads off on this one)
Come to think of it, it's so hard to be a doctor at this time because people still have the idea that a doctor should be a know-it-all (can deliver babies, can treat adults and pedia, can do appendectomies, can prescribe any meds) but the explosion of medical science is just growing at such a huge rate, specialization is really becoming the only option. I mean even specialties of "breadth" such as family medicine would be hard pressed to not refer patients every so often.
I'm not saying being a doctor then was easy. I for one have no intention to fall flat on the operating field because a bullet hit my left carotid. BUT I think we have a different set of challenges nowadays, and maybe that's why we seem to be lax on the "essentials" of their time which they would rightfully perceive as our laziness, and lack of drive.

 

[PediBoneDoc]

let us all take a breath and gain perspective. let's look back at the people who are in your position 5 years ago. what would you say about them? are they hard workers, slackers? are they like you? will you give the the "when i was a ___ speech?

tell me who was a better running back jim brown, gale sayers, walter payton, barry sanders, or ladanian tomlinson? difficult to say, it was a different time and the game was different. you can argue that the game today is faster and more sophisticated or in the past they played less games with less rules. but the comparison is difficult because it was a different time.

when i was a resident, we worked hard. searches for xrays, doing manual calculations for A-a gradients, long hours. they said we were lazy and didn't read enough because we didn't know the classic 1970s article on wear debris in total hips. yada yada yada, i would say i was just trying to keep my head above water.

today's residents don't spend as much time in the hospital, is that equated with being lazy? working as a resident today is made easier in a number of ways (PACS, order sets, lab access from any computer, computer ordering). on the other hand, the amount of information need to be learned is immense. there is more paperwork etc.

yes it is different. the most important thing is that was all learn from each other. forget the past and you are destined to repeat it.

 

[PeepshowJohnny]

I guarantee the attendings who complain about this generation had attendings who train them complain about their generation. The current generation will be complaining about the future generation they'll be training, regardless of how much or little that generation works. It's all cyclical.

We laugh when the crusty old doctors don't know what PCR is or how to use the computerized charting. A future generation will laugh at us for not knowing their advancements and techologies.​

 

[D5W]

We laugh when the crusty old doctors don't know what PCR is or how to use the computerized charting.

So true!

 

[medicinesux]

your attending needs to get a life🙄

 

[johankriek]

Today my attending started talking about how his generation and the one before his dedicated every second of their lives to medicine and how different our generation is. He wasn't berating me or anything like that, it just came up. One of the examples he gave was how now there are so many women in medicine, and how that used to be unusual, and that many women make family a priority so they work part time. In years past a "part time" doctor was unheard of (unless they were approaching retirement). I know this to be true, as a woman myself I am pursuing hospital medicine so that I can work part time and have kids one day. Anyway, I also know a lot of men who are entering fields admittedly based on the "lifestyle". I just can't decide if this difference is a good thing or a bad thing. I don't think it's that the new generation of doctors are lazy, we just have different priorities. Then again, that sounds like something a lazy person would say. Any thoughts?

dude medicine is as hard as it ever has been The patients are dog dog sick.. they have more and more complications becuase more elaborate procedures are being done. Have you been to a busy ICU lately? the amount of medical problems there is astounding. and they come to the Operating room frequently.

The older generation ****ed the field of medicine up royally. they sold it out. that is why we are in the mess that we are in now. the hmos, malpractice premiums skyrocketing, the decreasing reimbbursement the ever increasing workload, i mean what the **** is this guy talking about. talk to a general surgeon of today. and one 25 years ago and compare salaries and work schedule and types of patients.. not even close.

 

[Blade28]

Exactly. Though I respect the opinions and experience of the older attendings, patients 30 years ago didn't live through some of the illnesses that are survivable these days (albeit sometimes only temporarily). ICUs, meds, vents, technology and procedures can keep very ill patients alive these days - patients that 30 years ago would have died long ago.

 

[supercut]

Also, remember that not so long ago, when the work world in general was dominated by men and women stayed home...the culture dictated that to be a good husband/father meant providing as much income as possible. It was acceptable to be a workaholic and to not spend much time with one's family. Men didn't have any housework/child care duties, save for yardwork. Many of the attendings who refer to us as "lazy" are using this cultural idea as a comparison.

Few people today aspire to this model. Most men and women want to spend quality time with their family. If that makes us lazy, so be it.

 

[Faebinder]

Also, remember that not so long ago, when the work world in general was dominated by men and women stayed home...the culture dictated that to be a good husband/father meant providing as much income as possible. It was acceptable to be a workaholic and to not spend much time with one's family. Men didn't have any housework/child care duties, save for yardwork. Many of the attendings who refer to us as "lazy" are using this cultural idea as a comparison.

Few people today aspire to this model. Most men and women want to spend quality time with their family. If that makes us lazy, so be it.

👍 Never thought of it that way.

 

[SparkleMD]

Also, remember that not so long ago, when the work world in general was dominated by men and women stayed home...the culture dictated that to be a good husband/father meant providing as much income as possible. It was acceptable to be a workaholic and to not spend much time with one's family. Men didn't have any housework/child care duties, save for yardwork. Many of the attendings who refer to us as "lazy" are using this cultural idea as a comparison.

Few people today aspire to this model. Most men and women want to spend quality time with their family. If that makes us lazy, so be it.

Amen. As I finish my fourth year of medical school, I am excited to begin residency and excited to start caring for patients on my own. I realize how important it is for doctors to put the care of their patients first and foremost, however, it has always been important to me to put the care of my family first and foremost as well. I intend to try my best to do both throughout my career and life. I don't think this makes me lazy - I think it will make me a good doctor and a good wife.

 

[Drawing Dead]

Also, remember that not so long ago, when the work world in general was dominated by men and women stayed home...the culture dictated that to be a good husband/father meant providing as much income as possible. It was acceptable to be a workaholic and to not spend much time with one's family. Men didn't have any housework/child care duties, save for yardwork. Many of the attendings who refer to us as "lazy" are using this cultural idea as a comparison.

Few people today aspire to this model. Most men and women want to spend quality time with their family. If that makes us lazy, so be it.

I agree completely. I've already had the lazy tag placed on me because I wanted to go into a field that doesn't require me to bust my ***. And in 5 years, when I complete my residency, and have my choice of either EM or FP, I don't care who calls me lazy. I want to keep my marriage, and I want my kids to know who they're daddy is and what he looks like. I don't want to be the parent who has their kid raised by their nanny or nursery school, and then turn them into a spoiled brat because I'm throwing my money at them, trying to buy their love. So, maybe I'm the lazy man, but I'll be the lazy man with a family to go home to.

 

[Tired]

I've already had the lazy tag placed on me because I wanted to go into a field that doesn't require me to bust my ***.

I think you're confused about what this thread is about.

The general argument of the majority of younger posters here is that we do work just as hard, or harder, than our older attendings did as residents.

Your argument is that you shouldn't be called lazy for wanting to work less.

Those are two different things.

 

[Drawing Dead]

Anyway, I also know a lot of men who are entering fields admittedly based on the "lifestyle". I just can't decide if this difference is a good thing or a bad thing. I don't think it's that the new generation of doctors are lazy, we just have different priorities. Then again, that sounds like something a lazy person would say. Any thoughts?

This is from the OP, with lifestyle in quotes. Lifestyle was one of the biggest factors in my choice of specialty, in order to have more family time. So, the confused one is you.

And I never said I shouldn't be called lazy. What I'm saying is I don't care when people do, because I have my own priorities, and my family takes precedent over my career. Don't put words in my mouth.

 

[PediBoneDoc]

one of the perceptions by many residents and medical students is that many "older" and even younger attendings what residents and medical students to work all hours of the night drawing labs and carting patients around. as a general rule, most that refer to "lazy" resident, it is not because they left the hospital at 5-6pm after the work was done on a non-call day. it is the leaving at 3-4pm and all of the work is not done.

i am going to give a little insider information into an attending conversation i had yesterday.

I am at the head of the bed in the with my anesthesiologist talking about residents (as we do 😀) ... actually we talking about the economy ... any who ... he mentioned that he noticed that the residents seemed a little lazy. i asked why he said that. he mentioned a number of things a long the lines of residents skipping out on procedures or wanting to leave early. yada yada yada .... i informed him that i have noticed it but in my specialty it is not as common.

why do i bring it up? it seemed like a benign discussion that most attendings have about lazy residents. i bring it up because many who answer this forum believe that it is the grey haired academic hard a** physicians. not so fast batman. the anesthesiologist i was talking to was a younger (late 30's) private attending who was back brushing up on peds anesthesia. anesthesia is also a "lifestyle" specialty.

imjussayin

what frustrates me with residents and medical students today is the lack desire to seek out learning. when people don't come to lecture or a procedure prepared. when work ups of patients are not completed and procedures followed through. on my service, we generally get done by 5-6pm and no weekends unless on call. we are well within the hour limits. many approach residency as a job and it is to an extent. it is also training and as a resident/med student, you must also put time into the education side of things as well. it is the lack of a quest for knowledge frustrates me.

(i know i am going to take a beating for having this opinion ... ok ... i am ready ... thank you sir may i have another 🙂)

 

[Faebinder]

one of the perceptions by many residents and medical students is that many "older" and even younger attendings what residents and medical students to work all hours of the night drawing labs and carting patients around. as a general rule, most that refer to "lazy" resident, it is not because they left the hospital at 5-6pm after the work was done on a non-call day. it is the leaving at 3-4pm and all of the work is not done.

i am going to give a little insider information into an attending conversation i had yesterday.

I am at the head of the bed in the with my anesthesiologist talking about residents (as we do 😀) ... actually we talking about the economy ... any who ... he mentioned that he noticed that the residents seemed a little lazy. i asked why he said that. he mentioned a number of things a long the lines of residents skipping out on procedures or wanting to leave early. yada yada yada .... i informed him that i have noticed it but in my specialty it is not as common.

why do i bring it up? it seemed like a benign discussion that most attendings have about lazy residents. i bring it up because many who answer this forum believe that it is the grey haired academic hard a** physicians. not so fast batman. the anesthesiologist i was talking to was a younger (late 30's) private attending who was back brushing up on peds anesthesia. anesthesia is also a "lifestyle" specialty.


what frustrates me with residents and medical students today is the lack desire to seek out learning. when people don't come to lecture or a procedure prepared. when work ups of patients are not completed and procedures followed through. on my service, we generally get done by 5-6pm and no weekends unless on call. we are well within the hour limits. many approach residency as a job and it is to an extent. it is also training and as a resident/med student, you must also put time into the education side of things as well. it is the lack of a quest for knowledge frustrates me.

I hate to disagree with two attendings but if you both think Anesthesia is a life style specialty, then you are both sunk too deep to realize what life style is. Anesthesia: Stays late for cases like surgery (heck you might not need the resident around but still need the anesthesiologist and if the oncall guy/gal started a case, then you are it), they get called for intubation stat over head, take oncall OB cases and those can be at 5:00 am Sunday morning.. and the bane of anesthesia is inpatient Pain Medicine calls.

My point is, anesthesia is far from lifestyle specialty. It's a good paying specialty and less BS work than surgery, but no one says they work an 8-5 shift with a great lifestyle. Maybe the lucky ones who go into private practice for plastic surgery. (The CRNAs on the other hand have great lifestyle).

(i know i am going to take a beating for having this opinion ... ok ... i am ready ... thank you sir may i have another 🙂)

No beating here, just adjustment of prespective of what is considered lifestyle specialty. When you are stuck in the OR for two hours cause the oncall anesthesiologist is doing an oncall case.... you are not going home on time.

------> Side note: I noted that it is common to get a senior resident not interested in a subspecialty. So you know you are going to spine and yet here you are stuck doing pediatric orthopedics as an elective. Or you know are going to minimally invasive surgery but you are stuck doing vascular surgery in your last year. At that point, it translates to a 8-5 job mentality.

 

[AmoryBlaine]

I have to say I agree with this...one of my older and well-respected attendings recently made a similar comment to me - how "old school" attendings say how easy we have it now compared to them, but back in his residency days if they admitted 3 patients in a night that was a lot (and he was in NYC) and how the patients they admitted were not nearly as sick as the ones who get admitted today.

Two quick points before I dash off...

1. Totally agree with above. One of my surgery attendings started laughing when a resident was berating students about how tough it was back in the old days. The attending (a pretty old dude) said something like, "yeah it was pretty brutal to cross-cover 40 20 year old dudes who where POD#1 from hernia/appy."

2. If medicine were more like it was "back then" there would probably be much less emphasis on our lifestyle. Medicine is no longer a sure-fire ticket to independant wealth and prestige like it once was.

 

[Tired]

i informed him that i have noticed it but in my specialty it is not as common.

That's because Ortho interns/residents are superior people.

A hard-working anesthesia resident would likely be considered a lazy Ortho resident. 😉

 

[sirus_virus]

Today my attending started talking about how his generation and the one before his dedicated every second of their lives to medicine...

He forgot to mention how much more they got paid back then, and how much his ex-wife took when she bailed with the poolboy.

 

[tr]

what frustrates me with residents and medical students today is the lack desire to seek out learning. when people don't come to lecture or a procedure prepared. when work ups of patients are not completed and procedures followed through. on my service, we generally get done by 5-6pm and no weekends unless on call. we are well within the hour limits. many approach residency as a job and it is to an extent. it is also training and as a resident/med student, you must also put time into the education side of things as well. it is the lack of a quest for knowledge frustrates me.

One notices these things more as the instructor than as a pupil.

When you're one of the class you're mostly aware of your own attitude towards learning. It really doesn't affect you deeply if your peers are on a quest for education or not.

It's much more bothersome to spread your pearls of wisdom before people who don't appreciate them as dearly as you would wish, and the ones who are less hardworking or less interested are likely to draw your attention much more than they did when you were their peer.

I'd bet the difference is not in the residents, but in your own perspective.

I don't care who calls me lazy. I want to keep my marriage, and I want my kids to know who their daddy is and what he looks like.

I totally agree. I couldn't care less whether someone wants to slap a 'lazy' label on me or not. I'm lucky in that the field I loved just happened to be one that doesn't have this insane culture of overwork.

 

[PediBoneDoc]

I hate to disagree with two attendings but if you both think Anesthesia is a life style specialty, then you are both sunk too deep to realize what life style is. Anesthesia: Stays late for cases like surgery (heck you might not need the resident around but still need the anesthesiologist and if the oncall guy/gal started a case, then you are it), they get called for intubation stat over head, take oncall OB cases and those can be at 5:00 am Sunday morning.. and the bane of anesthesia is inpatient Pain Medicine calls.

My point is, anesthesia is far from lifestyle specialty. It's a good paying specialty and less BS work than surgery, but no one says they work an 8-5 shift with a great lifestyle. Maybe the lucky ones who go into private practice for plastic surgery. (The CRNAs on the other hand have great lifestyle).

Although, Faebinder would like to disagree with me on anesthesia being a life style specialty, it has always been considered on of the ROADs. i.e. specialties with good lifestyle and good income (Radiology, Opthalmology, Anesthesiology, and Dermatology). i didn't label it as a lifestyle specialty others have.

Side note: I noted that it is common to get a senior resident not interested in a subspecialty. So you know you are going to spine and yet here you are stuck doing pediatric orthopedics as an elective. Or you know are going to minimally invasive surgery but you are stuck doing vascular surgery in your last year. At that point, it translates to a 8-5 job mentality.

being a subspecialist, i realize this more than most. i am a bold print teacher. all i ask is that you understand the bold print or bullet points. just understand the basics of what they are doing. i try to make my teaching relevant to what their future plans are and to the exams that they will be taking. (btw i do pediatric spine, so those going into spine have quite a good time 😉 )

One notices these things more as the instructor than as a pupil.

When you're one of the class you're mostly aware of your own attitude towards learning. It really doesn't affect you deeply if your peers are on a quest for education or not.

It's much more bothersome to spread your pearls of wisdom before people who don't appreciate them as dearly as you would wish, and the ones who are less hardworking or less interested are likely to draw your attention much more than they did when you were their peer.

I'd bet the difference is not in the residents, but in your own perspective.

TR, good point. fact is i can care less that they want to go into my specialty. i do care that they understand what they are doing. although we would all like to think that our way is the best and our pearls are dogma, i realize it is not the case. i learn almost as much from my residents as they learn from me.

on my service, it is a "team" approach. the less hard working residents are dealt with on a resident level. you know those who are not pulling their weight. in our residency, the laziness label usually come from seniors speaking of juniors.

issues that are more of a concern to me are lack of preparedness for procedures (i.e. knowing anatomy), understanding simple disease processes or treatments. when i refer to a change in mentality, i am referring to people who expect to do no reading and expect to be spoon feed information, or taken through a procedure without even reading about it. this is what drives me crazy.

 

[8744]

Hey, I'm lazy. I love to be done with my shift and I resent mightily every hour I spend in the department past the end of my shift when I should be home. When I'm done with three-in-a-row 12-hour (but more like 14-hour) shifts and I get to go home for a three days off I am hilariously happy...and when I have to go back to the grind, especially after a vacation, I am sad and not a little depressed.

In other words, being a resident blows and my hours aren't even that bad anymore.

Do I care about how hard my elderly attendings had it? Not really. The ones who were residents in the seventies and before may have worked more hours but, as has been pointed out, there was not that much that could be done for most patients. Those were the days when a patient with a heart attack spent three weeks in the hospital routinely, doing nothing in particular with nothing in particular being done to them. My older attendings have confided to me that, while they definitely spent more time in-house, their census of patients was much more stable, basically a bunch of long-term boarders, most of whom wouldn't even be sick enough to be admitted today, with the occasional admission.

When one of my ICU attending was an intern, there were only three ventilators in town. Today, between the two big hospitals we have about 250 critical care beds, all of which are full most of the time.

Emergency Departments were sleepy little shadows of what they are today. Additionally, up until the seventies you could go into private practice with only an intern year. Lots of doctors hung out their shingle with no more training than that. It's one thing to endure one year of hell if you know it's going to be over soon. Even the shortest residency programs are three years now.

But is was nothing like the patient processing, goat-rodeo-cum-sausage-plant that hospitals have become today. I did two medicine rotations last year with Q3 call for three weeks per month (a week of night float with no call so the hours worked out in the end) and admitted between 12 and 18 patients per call night.

It is true that the old-school guys weren't paid as much, even in inflation adjusted money, and that they were always at the hospital but they were all also geeky, single white guys with no outside responsibilities. I have four kids. I'd like to see the typical I-Had-It-Harder-In-My-Day attending make his way through medical school and residency with a family and see how he liked them apples.

Now, those guys in the eighties and nineties were really screwed. That was when the technology and the explosion of medical knowledge started putting a strain on a system that was designed for a more sedate, contemplative pace.

 

[Jeff05]

why are modern physicians looking for something else outside of medicine (vs older...)

1. work environment. physicians used to be masters of the hospital. now we are 10th in line. administration, nurse managers, case managers, dude sweeping the floor, etc...
respect now must be earned, before it was extended.

2. compensation. it's not only how much you make. it's how much you make relative to other members of society. salaries are DOWN and heading further down. in the 70s, if you made 200k/yr you were WELL OFF. now, you make 1% of what that business guy down the street made as his bonus. and he did not create anything for society's benefit. this is very obvious in metro areas (ny).

3. the law. i'm sorry, but they did not get sued 40 years ago. now, EVERY decision one makes is qualified by "can i defend this in court"

4. prestige. intelligent people still realize exactly what it takes to become a physician. really smart people understand what it takes to be a good physician. most people are not that insightful.

5. rise of super chronic dz/longer life. we are taking care of older and sicker patients than EVER before in history of humanity AND the expectations are higher than ever. keep that 80 year old with multiple organ failure ALIVE anything else is a failure.

6. work load. as an intern i would admit 5 new patients through RD. receive another 2 transfers from ICUs. and cross cover for 10, yes 10 other interns (80-120 patients).

so we may work fewer hours, but the intensity of the work, the satisfaction, positive feedback, compensation, prestige, status in society, are also way down. so we look for positives in addition to work - family, friends, hobbies. which, is the way, i think, it should be anyway.

i KNOW that i can provide better care for my patients - listen to them, be more empathetic, pay attention to the smallest details when i'm well rested and fulfilled outside of the hospital.