Does the hierarchy exist after residency?

[laserbeam]

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Right now I feel like a slave for seniors. I do whatever they ask me to do. Sometimes I feel they overly panic and ask me do unnecessary and irrational things. When these things happen, I wish I did not have any seniors above me. A lot of times, seniors treat juniors rudely. I wonder, isn't that we are all going to be colleagues after graduation? Why do they act like they are the bosses?

 

[Arcan57]

Right now I feel like a slave for seniors. I do whatever they ask me to do. Sometimes I feel they overly panic and ask me do unnecessary and irrational things. When these things happen, I wish I did not have any seniors above me. A lot of times, seniors treat juniors rudely. I wonder, isn't that we are all going to be colleagues after graduation? Why do they act like they are the bosses?

Because they are your boss (during the rotation). A boss is someone that is responsible for the work of other people. If you screw up, they take the fall as well because they should have been supervising you more closely. If you were ready for independent practice, then you'd be an attending. Until then (and depending on practice location possibly for some time afterwards) you're not at the top of the totem pole. It's a good thing that it chafes a little to be under someone, but it's usually a destructive illusion to think you don't need the support.

 

[Law2Doc]

Right now I feel like a slave for seniors. I do whatever they ask me to do. Sometimes I feel they overly panic and ask me do unnecessary and irrational things. When these things happen, I wish I did not have any seniors above me. A lot of times, seniors treat juniors rudely. I wonder, isn't that we are all going to be colleagues after graduation? Why do they act like they are the bosses?

Yes. Most people leave residencies and join practices, where they will be the low man on the totem pole. Or they become hospitalists here they certainly have many layers of administration to answer to. Very few people don't have bosses, so that dynamic tends to continue until late in your career, until you are the boss. Some fields, eg psych are more amenable to hanging up a shingle and opening your own shop than others but then you need to deal with the non medical business aspects.

 

[mercaptovizadeh]

Right now I feel like a slave for seniors. I do whatever they ask me to do. Sometimes I feel they overly panic and ask me do unnecessary and irrational things. When these things happen, I wish I did not have any seniors above me. A lot of times, seniors treat juniors rudely. I wonder, isn't that we are all going to be colleagues after graduation? Why do they act like they are the bosses?

My MD/PhD mentor is a pathologist and full professor and he, too, has several bosses to account to: the head of his division within the department, the head of the department of pathology, the chief scientific officer and dean, etc. Even heads of institutions are often accountable to boards of trustees and such.

Where did you get the idea that hierarchies are all bad? Bad hierarchy is when it misses the point: hierarchy for the sake of glory, honor, self-promotion, etc. Or, when hierarchy places glaringly less qualified people ahead of more qualified people. But hierarchy has a purpose: it puts better qualified, organized, and experienced individuals in a position of management over those who are less qualified, organized, and experienced, and thus promotes better function of the system overall.

 

[Goneril]

There will always be someone to piss on you. Sad fact.

 

[deleted87716]

Like they say in the Iditarod, unless you're the lead dog, the view never changes. 😉

 

[Dejavu]

As an attending, even a new one, you have mucho more status than a junior resident.

That being said, I have been an attending for 15 yrs and I have a Division Head, an Anesth Department Chairman, and I don't know how many bosses in the administrative building.

A fact of life, I guess. Just read some Dilbert, and go with it. A guy doesn't have much chance of changing it.

 

[rachmoninov3]

Right now I feel like a slave for seniors. I do whatever they ask me to do. Sometimes I feel they overly panic and ask me do unnecessary and irrational things. When these things happen, I wish I did not have any seniors above me. A lot of times, seniors treat juniors rudely. I wonder, isn't that we are all going to be colleagues after graduation? Why do they act like they are the bosses?

It sounds like you have the false idea that many of us had as interns that your MD actually stands for something. Consider it a Make-believe Degree for right now. You have much knowledge, and a lot of what your uppers are doing is indeed overkill. However, you are in a position that for the majority of people you don't know what you don't know. As stated previously your uppers know this and are equally scared themselves having to manage you. This does not mean that your uppers need to start zosyn for a UTI on a patient who you've had numerous family meetings about, extubated and transferred to comfort care on an ativan and fentanyl drip...but stuff like that still happens. Next year it will be you who are the boss, or at least higher up on the totem pole. Remember what this year was like and do your best to help your younger residents rather than micromanage them.

 

[lowbudget]

The issue here is knowing your place and knowing your role, because at the end of the day, it comes down to responsibility, accountability, and liability. What you consider to be excessive and unnecessary may be important to others; and what you consider to be important may be nothing to someone else. It all depends on your perspective. The problem in medical training is that there's an element that the doctor doesn't know what he/she doesn't know. That's why we create so many processes and protocols and systems, and tier out your responsibilities that increase as you progress. I think you'll understand this as you progress. Some days, there's enough pieces of evidence that allows you to laser in on the patient's problems like textbook, but after a while, you'll realize that textbook doesn't always happen. There may be enough variations that confuse the clinical picture and although you can probably make a good call, you may choose to hedge in this particular patient case because there is sufficient uncertainty and unpredictability. Someone will call you out on your OCD and unnecessary work, be it a peer, a specialist, the patient, their family, or an insurance company.

But this is the life we choose to lead, and you have to recognize that even though we are doctors, we are also human and what makes medicine such a rewarding field is that no one at no time knows everything down to 100% certainty. Science and medicine advance and we are always learning new things. So, just because someone sees the world in a different way doesn't make them a slave driver. It may be a difference in the facts, but it may also be a difference of opinions. Keep an open mind, and maybe you'll learn something.

Just remember at the end of the day a decision has to be made. You may not be the ultimate decision maker right now, but at some point you will. And at that point, you may find it as liberating to take action unencumbered on one hand but equally burdensome on the other to bear the weight of such awesome responsibility.

 

[Perrotfish]

Yes. Most people leave residencies and join practices, where they will be the low man on the totem pole. Or they become hospitalists here they certainly have many layers of administration to answer to. Very few people don't have bosses, so that dynamic tends to continue until late in your career, until you are the boss. Some fields, eg psych are more amenable to hanging up a shingle and opening your own shop than others but then you need to deal with the non medical business aspects.

I don't think you need to hang up a shingle to have a relatiely independent practice. In many civilian practices I've seen, particularly very large ones attached to major hopsital systems, the 'boss' of the attendings is often a comittee executives that you never actually see unless you either have a serious liability issue or a problem meeting their various well publicized metrics. Now I admit that's not the same as hanging up a shingle and being your own boss, but that's certainly not the same as having a suprior who is physically in the room with you, rewriting your notes, second guessing your management, and helpfully saying 'a little to the left' during your procedures.

I also do agree with the OP that the dynamic between junior and senior residents is wierd. Attendings are clearly bosses: they maintain a professional distance, their licenses are on the line for your work, they always evaluate you at the end of the rotation, and they're usually pretty danged old. On the other hand I feel like senior resients have a hard time deciding if they want to take on the role of 'boss', evaluating and judging me, or 'more experienced employee', dispensing cynical advice with dark humor. How you're expected to relate to senior residents can change abruptly with a new resident, a new rotation, or even if the resent is in a different mood that day. The easiest decison is on a ward or ICU rotation where the seniors don't see patients independently of the juniors and are very clearly in a bosses role. It's more difficult for seniors on subspecialty or clinic rotations, where juniors report directly to the attending and the seniors need to make more of a judgement call about how responsible they are for your work. By far the most obnoxiuos are the residents who don't seem to understand that they need to chose one role or the other, at least for the duration of a given rotation. We can have a long discussion about how my sense of humor (in a resdients only enviornment) is unprofessional. Or we can have a beer together after work. But not both.

 

[FutureInternist]

Goes on till you die

 

[NotAProgDirector]

Perhaps I'm a bit naive. Or delusional. But I'd like to think that not all fields / programs are as dysfunctional as the OP is suggesting.

 

[Law2Doc]

Perhaps I'm a bit naive. Or delusional. But I'd like to think that not all fields / programs are as dysfunctional as the OP is suggesting.

I think the bird picture above sums it up. In general the "dysfunction" is more of a reflection of what the seniors see coming downstream. Crap flows downhill. It's actually a very military approach. when a junior screws up, he may get scolded by the attending but his senior is the one who really takes the hit. The senior is the responsible party in the attendings eyes, and gets reamed accordingly.. So the senior in turn deals with his underlings accordingly, like the army sergeant deals with his grunts after the officer deals with the sergeant. What the juniors find "unnecessary and irrational" for patient care may be what the senior knows is necessary to keep a particular attending happy. Much of the time what you do to be considered a well regarded senior resident isn't treat the patient so much as cater to the idiosyncrasies of your bosses. The senior knows these, the junior doesn't. So juniors may feel like they are jumping through unnecessary hoops, but really thy are just doing what is needed to make the seniors happy so they can keep the attendings happy and everybody is happy.

 

[bhop]

Right now I feel like a slave for seniors. I do whatever they ask me to do. Sometimes I feel they overly panic and ask me do unnecessary and irrational things. When these things happen, I wish I did not have any seniors above me. A lot of times, seniors treat juniors rudely. I wonder, isn't that we are all going to be colleagues after graduation? Why do they act like they are the bosses?

welcome to residency! and once you are a senior resident, you will be "slave" to the attendings and take it on the poor innocent interns below you.