At the risk of getting flamed:
Does not sound like a whimp to me. In fact that sounds like it is coming from someone who does not really care about people in general.
If this is the case, then medicine is not a great choice of careers obviously. Some fields have less patient contact -- path, rads, etc. But in general, if you're not at least somewhat a "people person", medicine is going to be a tough road.
These are hard decisions to make. In medicine, the job market does not allow one to just go find another job tomorrow or next week......can't just pick up things and move/start all over.
Many professional jobs are like this. That's what makes them professional. Most senior business exec's won't just quit their job -- they ensure that there is a transition plan. If you're a lawyer, you can't just quit and drop your cases. There are always exceptions, but in general being a professional involves a commitment. If you flip burgers, then you can quit any day you like. But the burger flipper manager, or his/her manager -- somewhere up the line -- is someone who has a professional commitment to not simply quit.
No, in fact, the archaic way residency is setup only benefits the programs, not the resident.
This is a gross overgeneralization. There are many good residency programs out there that treat their residents well, teach them, mentor them, and support them. I have personally made many sacrifices for my residents. Perhaps I am in the minority.
I mean come on....Residency only starts once per year????? What the hell, that is the most ridiculous employment ruling ever.
Residency is a (somewhat) unhappy marriage between a job and education. We have a defined curriculum -- we cover more basic topics in July/August, and then move on to more complicated topics later. We expect more of our interns after their first six months of training. All of this would be much more difficult if residents started any time they wanted.
Medical schools all graduate in May/June, so we really only have a choice of starting in July. Even if medical schools started to "stagger" it would be a mess --- what happens if your medical school graduates in December, but the program you want starts in July? Or November?
We could get into a shouting match about "the match", whether it's fair or not, etc. The fact remains that the match is a plus for the vast majority of applicants. Several of the IM fellowships did not have a match until recently, and getting spots was an absolute nightmare. A match requires that all programs start at the same time to work.
And, if you need a spot off cycle, the fact is that you can usually find one. Finding one is hard, because there is no one place that all of these positions are listed, no uniform application, etc. Interestingly, this is exactly what happens when there isn't a match -- it's a free-for-all and residents tend to lose.
England had a system like this in the recent past. You simply had to apply for "attachments" whihc could be anywhere from 6-18 months long. As there was no uniform system, it was all about connections and who you knew. If you didn't know anyone, you were screwed. England has switched to a new system which is a complete disaster, but that's another story.
The next most stupid is that you only get funding for the residency you chose in the first place...even if you don't complete it...ie, in his case like only two weeks. You are forever trapped.
What's crazy is that the federal gov't pays for this at all. I guess it's in our best national interest to have quality physicians, but I would expect that the free market could do that without the feds getting in the mix. Medicare had to limit the amount it was spending on resident training - and still it's going bankrupt. I do agree with you, though, that it would be better if the gov't funded a resident until they were BE once (instead of setting a fixed number of years based upon your first training).
Need I go on? Yes, foreign graduates can accept a prematch and US grads can't.
Be my guest and ask any IMG if they feel that this process is unfairly tilted towards them. Prematching can be a nightmare. I can't tell you how many PM's I get from IMG's, telling me that program A has said that they will rank them highly, program B offered a prematch. They want program A, but it's so hard to let a sure thing go. This is what happens when there isn't a match.
Sounds to me like program directors have waaaaaaaaaaaaayyyyy too much power.
It certainly is true that PD's have a lot of responsibility. I need to decide whether residents are ready to be promoted, how to address residents who struggle, how to balance institutional needs with residency needs, and occasionally help someone find a new path in life. The fact remains: some people who graduate from medical school will never finish a residency. The number is very small, but it is there. Either programs need to serve this function, or we let everyone through and then deal with it when patients start dying.
What EVERY PD would like, trust me, is a purely objective way of deciding whether a resident is proficient/competent. Sometimes it's very clear, but many times it's not. We all struggle with this. Personally, I don't think there will ever be any true test for competency -- it's too complex / non-linear.
Oh, and I like this one as well, if you cant get bankrupt student loans unless you are terminal.....and that is only for federal loans, cant bankrupt private loans even if you are terminal or dead. Didn't know that....???? In fact those loans can be placed upon your heirs and parents...family. Any pressure there?????
Let me see if I get this straight:
1. You borrow money from someone to get something (an education)
2. You change you mind about what you want to do / don't complete training / fail out / etc.
3. You think that the large loan you took out should simply go away. This means that someone else loses a bunch of money.
This is somewhat dangerous thinking. Someone loaned you their money. Why should they lose their money because you changed your mind?
More importantly, it has serious downstream consequences. If you only had to pay back your loans if you actually finish your training, then the loan originators would be forced to decide "how likely" you were to succeed. Less "academically talented" (however we want to define that) candidates for medical school might find that they can't get loans at all. People who make loans do so to make money, and they won't take bad risks. neither should the gov't -- it's going bankrupt itself as we speak.
I was unaware that heirs / parents would be liable for your loans, unless your parents cosign your loan agreements, at which point they are of course just as liable as you are.
To be fair, the problem here is our bankruptcy system. It has been abused badly in the past, and successful lobbying has now adjusted it to make it much more difficult to file. There were multiple cases of residents filing for bankruptcy because their residency salary couldn't pay their loans, only to then go out and make $300K+ in a few years. One of my patients came to me a few years ago (before the laws were tightened) and told me that she was in the process of getting as many credit cards as possible, charging them all up on a big vacation, and then filing for bankruptcy. To make things better, a friend of hers was doing it with her.
I mean the creditors don't care if you can't find work for a year. They don't care you can't touch patients without a license. Don't care that your chances of residency decrease because of perceptions program directors have on someone switching residency. Don't care that you may have children to feed, parents to watch, need to pay that 200K+ loan back.
And this is different from other jobs in what way? Creditors in general do not care if you can't find a job -- in fact, that makes them more desperate, as they worry that you'll never pay them. And, many of us take out loans well beyond our means, such that if anything happens so that we can't pay, and interest accrues unabated, that we can never pay it back.
Many people across the US are losing their houses because they have large loans, lost their job, and can't pay. There is no free ride here, and you just can;t make your loans disappear, just like you can't make your other responsibilities disappear (family, kids, food, heat, etc)
No resident should feel like they are stuck in their field....
I completely agree with this statement. And, if the jist of your post was that it is inherently difficult to change training fields in medicine, I agree with that too. Still, many, many people do it every year. It takes work, and it's not easy, but it can be done. Again, I expect this is similar to other porfessional fields -- if you have been working as a corporate lawyer for awhile and wake up one day and want to do trial work, I doubt it will be as easy as walking into your boss's office and telling them you've changed your mind.
Program director positions need to be scaled back to "Teaching" and coordinating teaching. Major overhaul is need, and I think the only way it is going to happen is either in the courts (they seem to legislate these days) or the federal government....Since the public is paying taxes, which are then sent to government, which pays the salaries of program directors and residents.....Program directors working for the public...do they see it that way???
This is a very simplistic view of the world. Somebody has to administer the program -- if it's not the PD then whom? The government? Personally I would love to do just teaching. Then I wouldn;t need to read those 1000 applications carefully. I wouldn't need to help a resident who wasn't doing well get back on track. I wouldn't need to negotiate with Cardiology/ICU/Heme-Onc for better rotations. Forget about worrying about lunches for conferences, getting laptops/handhelds for my residents, helping my residents get fellowships and negotiate the "first job" process, oversee all of the subspecialty fellowship directors, keep abreast of the national changes coming down the pike, address duty hours and try to improve our performance, prepare the 300+ page report required for ACGME visits -- one for my program and one for each of our 11 fellowships. Yes, now that I think of it, it would be great to just focus on teaching.
Being a program director is a thankless job. Faculty complain and push for more resident work. Admin pushes for more resident scut. Residents are the highlight of my day -- they are usually upbeat and energetic, although I certainly get many complaints / concerns from them also. The average "lifespan" of an IM PD is 2-3 years, and it doesn't surprise me at all.
A very small part of my salary comes indirectly from tax dollars. I and most of my colleagues work very hard, and get paid a lot less than we could make in the private sector. None of us is doing this for the money, or because it's an easy job.
I do work for the public good. "Public" is everybody, not just your needs. My job is to help train new physicians and to stop people who are not comepetent in this field from injuring patients. That is my public commitement. If you come to my program, I promose you I will work my hardest to help you be the best IM physician you can be. If you change your mind during your training program, I will certainly not get in your way of changing. In fact, I will help point you in the right direction. However, finding a new training program is your responsibility. I doubt that any of your old bosses, if you told them you were unhappy, would help you find another job.
