Humans of New York miserable MD grad

[libertyyne]

I can only think of 2-3 students in my class who had to repeat clinical rotations - both actually worked before starting school. To be fair, it's a small sample size.

Healthcare in the US is exorbitantly expensive and poorly accessible for a country of its wealth and stature, especially compared to nearly every other developed country. How is this surprising to people considering we force medical school applicants to jump through more hoops, pay exponentially more money, and finish training later versus comparable countries. And yet some want to delay this further? Seriously? I would argue that we're already past diminishing returns, and that at some point, enough is enough.

If you disagree, then I have proposal. I think we should require every medical school applicant to have at least 1 year of work experience, AND to have at least 2 years of military service with at least 6 months in a deployed unit, preferably with combat duties. That way, we can be 99.99999% sure that they will be able to handle the stresses of medical school.

healthcare costs have very little to do with physican training durations. There is conversation to be had about shorting the training pathway , but it really has nothing to do with the perception of difficulty in training like the orginial post , nor does it have anything to do with the bad culture at certain places, If anything shortening the training would be even more stressful and more hours. Your proposal would be nice, israel already does that, but now you are just going overboard. training is not a war zone. Residency and m3-4 are jobs. Maybe really ****ty jobs, but are jobs. Plus people can work full time in UG so your point about taking longer is also mooot.

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[Dagrimsta1]

Moral of the story: Medicine isn’t for snowflakes.

 

[TresselforPresident]

healthcare costs have very little to do with physican training durations. There is conversation to be had about shorting the training pathway , but it really has nothing to do with the perception of difficulty in training like the orginial post , nor does it have anything to do with the bad culture at certain places. Your proposal would be nice, israel already does that, but now you are just going overboard. training is not a war zone. Residency and m3-4 are jobs. Maybe really ****ty jobs, but are jobs. Plus people can work full time in UG so your point about taking longer is also mooot.

You don't think the burden of compounding undergrad loans + compounding medical school loans + 8 years of income loss + 3-9 years of poorly compensated apprenticeship have an affect on the specialties medical students choose? I'm sure you know as well as I do that we have a huge primary care shortage in this country.

My point is that we are well past diminishing returns - 99% of medical students at US medical schools will graduate and complete residency, and adding another barrier that will prolong training and exacerbate negative income during training is definitely not the way to go. Especially considering most other countries don't even require their medical students to complete a 4-year $200,000 fluff undergraduate degree (or will at least subsidize it), and they seem to be doing okay health-outcomes wise.

Regardless, respectfully agree to disagree going forward.

 

[libertyyne]

You don't think the burden of compounding undergrad loans + compounding medical school loans + 8 years of income loss + 3-9 years of poorly compensated apprenticeship have an affect on the specialties medical students choose? I'm sure you know as well as I do that we have a huge primary care shortage in this country.

My point is that we are well past diminishing returns - 99% of medical students at US medical schools will graduate and complete residency, and adding another barrier that will prolong training and exacerbate negative income during training is definitely not the way to go. Especially considering most other countries don't even require their medical students to complete a 4-year $200,000 fluff undergraduate degree (or will at least subsidize it), and they seem to be doing okay health-outcomes wise.

Regardless, respectfully agree to disagree going forward.

This is just straight up false. The attrition rate is is close to 5% in medical school and match rates in the mid 90's too. Coupled with residency attrition rates which vary according to specialty but may be as high as 25%. Not all students would love to go subspecialties and even with debt people go into PC. DO schools have some of the highest tuitions amongst medical schools and yet a majority of their students place in PC. If all that medicine is a paycheck or ROI you are doing it wrong because CS offers better returns. The average matriculants age is already 24 ( a lot of students are already working before school) making your point even more moot. We are not other countries physicans in america get paid more, have more liability, and pgy training is very similar to other countries. You can finish a UG degree in 2-3 years too reducing the discrepency. Health outcomes are not strictly related to training duration of physicians rather complex socioeconomic and public health factors. The pathway to training is very straight forward no one is holding a gun to anyones head to do medicine.

 

[TresselforPresident]

This is just straight up false. The attrition rate is is close to 5% in medical school and match rates in the mid 90's too. Coupled with residency attrition rates which vary according to specialty but may be as high as 25%. Not all students would love to go subspecialties and even with debt people go into PC. DO schools have some of the highest tuitions amongst medical schools and yet a majority of their students place in PC. If all that medicine is a paycheck or ROI you are doing it wrong because CS offers better returns. The average matriculants age is already 24 ( a lot of students are already working before school) making your point even more moot. We are not other countries physicans in america get paid more, have more liability, and pgy training is very similar to other countries. You can finish a UG degree in 2-3 years too reducing the discrepency. Health outcomes are not strictly related to training duration of physicians rather complex socioeconomic and public health factors. The pathway to training is very straight forward no one is holding a gun to anyones head to do medicine.

Not going to waste anymore time arguing over the internet. So yes, healthcare quality and access is great in America, there is no projected shortage in primary care physicians, and no one uses income/age as part of their specialty-decision making process.

A/P: Things are perfect. No systemic changes needed.

 

[libertyyne]

Not going to waste anymore time arguing over the internet. So yes, healthcare quality and access is great in America, there is no projected shortage in primary care physicians, and no one uses income/age as part of their specialty-decision making process.

A/P: Things are perfect. No systemic changes needed.

lol ok. Suggesting that people who have worked before medical school have an easier time adjusting literally triggers godwins law, got it.

 

[TresselforPresident]

lol ok. Suggesting that people who have worked before medical school have an easier time adjusting literally triggers godwins law got it.

Nope. Clearly not what I was arguing. *Requiring* people to have worked for 1 year before applying to medical school was the subject.

Cheers

 

[Mad Jack]

That would be wonderful in a perfect world... but how many developed countries besides the US require (1) completion of a 4-year $200,000 undergraduate degree as requirement for entering medical school, then (2) ask $250,000 for a 4-year medical degree, and then (3) ask for a 3-9 year period of apprenticeship where you make minimum wage, before you finally make your first 'real' paycheck and can start paying off your loans/actually start your life?

That's an opportunity cost of $450,000 + yearly lost income (let's wildly underestimate with the US average of $60,000) compounded over 10-15 years

Delay this process another year? I gotta disagree. Unless we're willing to raise physicians salaries or want every medical student to become wonderful, well-read, well-rounded, highly-grounded - and a specialist.

If you spent 200k on your undergrad degree, you are foolish

 

[Mad Jack]

Not going to waste anymore time arguing over the internet. So yes, healthcare quality and access is great in America, there is no projected shortage in primary care physicians, and no one uses income/age as part of their specialty-decision making process.

A/P: Things are perfect. No systemic changes needed.

There is a maldistribution of physicians, there is no true shortage.

I can only think of 2-3 students in my class who had to repeat clinical rotations - both actually worked before starting school. To be fair, it's a small sample size.

Healthcare in the US is exorbitantly expensive and poorly accessible for a country of its wealth and stature, especially compared to nearly every other developed country. How is this surprising to people considering we force medical school applicants to jump through more hoops, pay exponentially more money, and finish training later versus comparable countries. And yet some want to delay this further? Seriously? I would argue that we're already past diminishing returns, and that at some point, enough is enough.

If you disagree, then I have proposal. I think we should require every medical school applicant to have at least 1 year of work experience, AND to have at least 2 years of military service with at least 6 months in a deployed unit, preferably with combat duties. That way, we can be 99.99999% sure that they will be able to handle the stresses of medical school.

Our training path is actually equally as long as comparable countries. We have two more years of pre-residency training, but residencies themselves are often two to five years shorter in time than comparable specialties abroad. The only country that has shorter total training time is Canada, where it's the same system we have but FM is a two year residency. Places like the UK, becoming a GP is a five year residency, and specialty paths take seven to nine years, and even once complete there is no guarantee of becoming a consultant.

 

[TresselforPresident]

There is a maldistribution of physicians, there is no true shortage.

Our training path is actually equally as long as comparable countries. We have two more years of pre-residency training, but residencies themselves are often two to five years shorter in time than comparable specialties abroad. The only country that has shorter total training time is Canada, where it's the same system we have but FM is a two year residency. Places like the UK, becoming a GP is a five year residency, and specialty paths take seven to nine years, and even once complete there is no guarantee of becoming a consultant.

My father trained in surgery in the UK. While the UK is one of a few countries with a comparable training length, they have almost completely subsidized medical education.

Again, the US is the only country where we have *both* a long training pipeline and mountains of debt to look forward to afterward.

I wager many more people would consider primary care if there was no change in training length BUT they graduated completely debt free (i.e. the UK). Or alternatively, if they incurred $50,000/year costs but only for 4-5 years, versus 8.

The way the system is set up right now, US medical students get shafted twice - except we're better 'rounded' than our European colleagues who enter medical school straight out of secondary education. Is that trade-off worth making. To me, no.

Anyways, agree to disagree.

 

[Mad Jack]

My father trained in surgery in the UK. While the UK is one of a few countries with a comparable training length, they have almost completely subsidized medical education.

Again, the US is the only country where we have *both* a long training pipeline and mountains of debt to look forward to afterward.

I wager many more people would consider primary care if there was no change in training length BUT they graduated completely debt free. Or alternatively, if they incurred $50,000/year costs but only for 4-5 years, versus 8.

Most people that have made it through the process would rather do anything but primary care regardless of the money. I thought I would be big on it, and I even enjoyed my rotation, but it's just the least enjoyable of the things I was interested in. Most people tend to be in the same "it's okay I guess but there are so many other things I would like to do" boat. And it really doesn't matter because EVERY SINGLE PRIMARY CARE SPOT FILLS. IMGs fill them. No amount of making training cheaper will make there be more primary care doctors because, let me say it again for the people in the back, international medical graduates fill every training spot US graduates don't want and cheaper training doesn't magically create more residency positions. It isn't like if more US students want to go into primary care training spots will just materialize from the ether for them to fill.

 

[TresselforPresident]

If you spent 200k on your undergrad degree, you are foolish

Personally, I was fortunate that I didn't have to spend a dime on my undergrad degree. If you spent anything on your undergrad degree, you are foolish.


Jokes aside, many don't know they want to become a physician until they enter undergrad. Sure, if you enter knowing you're going MD then going to the cheapest school makes sense. If you're considering banking or finance, or other specialized industries where training is best offered by certain institutions, sometimes you pay more to go to a bigger name school with more opportunities. That's another conversation.

The fact is, many US medical students will graduate with boatloads of debt and that is certainly a factor that keeps them from entering primary care. If we disagree on that, we probably won't agree on much.

Cheers

 

[Matthew9Thirtyfive]

Most people that have made it through the process would rather do anything but primary care regardless of the money. I thought I would be big on it, and I even enjoyed my rotation, but it's just the least enjoyable of the things I was interested in. Most people tend to be in the same "it's okay I guess but there are so many other things I would like to do" boat. And it really doesn't matter because EVERY SINGLE PRIMARY CARE SPOT FILLS. IMGs fill them. No amount of making training cheaper will make there be more primary care doctors because, let me say it again for the people in the back, international medical graduates fill every training spot US graduates don't want and cheaper training doesn't magically create more residency positions. It isn't like if more US students want to go into primary care training spots will just materialize from the ether for them to fill.

Yeah, we need them to go to the places no one wants to practice. Not make more of them.

 

[libertyyne]

Personally, I was fortunate that I didn't have to spend a dime on my undergrad degree. If you spent anything on your undergrad degree, you are foolish.


Jokes aside, many don't know they want to become a physician until they enter undergrad. Sure, if you enter knowing you're going MD then going to the cheapest school makes sense. If you're considering banking or finance, or other specialized industries where training is best offered by certain institutions, sometimes you pay more to go to a bigger name school with more opportunities. That's another conversation.

The fact is, many US medical students will graduate with boatloads of debt and that is certainly a factor that keeps them from entering primary care. If we disagree on that, we probably won't agree on much.

Cheers

By your logic NYU's tuition free class is bound to go into primary care in droves. I wouldnt hold my breath tho.

 

[Matthew9Thirtyfive]

Personally, I was fortunate that I didn't have to spend a dime on my undergrad degree. If you spent anything on your undergrad degree, you are foolish.


Jokes aside, many don't know they want to become a physician until they enter undergrad. Sure, if you enter knowing you're going MD then going to the cheapest school makes sense. If you're considering banking or finance, or other specialized industries where training is best offered by certain institutions, sometimes you pay more to go to a bigger name school with more opportunities. That's another conversation.

The fact is, many US medical students will graduate with boatloads of debt and that is certainly a factor that keeps them from entering primary care. If we disagree on that, we probably won't agree on much.

Cheers

I guess we'll find out in a few years when the first class of NYU students who are tuition free matches. In all seriousness, that's a super skewed bunch, since I imagine many of them are interested in other fields not just because of the debt:income ratio.

 

[Matthew9Thirtyfive]

By your logic NYU's tuition free class is bound to go into primary care in droves. I wouldnt hold my breath tho.

Great minds think alike, lol. I do think that the NYU class isn't super representative though, since it's a top institution with likely many people who were interested in research and competitive specialties regardless of how much debt they have. But if the debt issue is a major cause, then you'd expect to see at least a modest shift towards primary care in their match list.

 

[TresselforPresident]

By your logic NYU's tuition free class is bound to go into primary care in droves. I wouldnt hold my breath tho.

Unlikely. Highly selective sample. I'm talking nation-level, systemic change.

Reducing educational debt across the entire system IMO would without a doubt lead to more medical students entering primary care.

 

[Mad Jack]

Yeah, we need them to go to the places no one wants to practice. Not make more of them.

And that is actually done better by having IMGs fill positions because IMGs have a service requirement that keeps them in underserved areas. US graduates have no such requirement and tend to flee for the cities regardless of where they train. Without the Visa programs, my hospital would be short 90% of its attendings, most of whom were initially trying to serve out their fees years but stayed because they put down roots. So I guess that is to say, I don't care if US graduates physicians are going into primary care, because they are probably the worst option to address the rural distribution issues our country faces

 

[libertyyne]

Great minds think alike, lol. I do think that the NYU class isn't super representative though, since it's a top institution with likely many people who were interested in research and competitive specialties regardless of how much debt they have. But if the debt issue is a major cause, then you'd expect to see at least a modest shift towards primary care in their match list.

The debt issue forgets the other part of the equation. The income issue. If non primary care fields pay more, by the same logic where people maximize income , people will not have any less incentive to go into non primary care fields.

 

[Matthew9Thirtyfive]

The debt issue forgets the other part of the equation. The income issue. If non primary care fields pay more, by the same logic where people maximize income , people will not have any less incentive to go into non primary care fields.

Yep.

 

[TresselforPresident]

The debt issue forgets the other part of the equation. The income issue. If non primary care fields pay more, by the same logic where people maximize income , people will not have any less incentive to go into non primary care fields.

You're assuming income is the only factor. Decisions are made on the margin. Perhaps you like Family Med the most, with your second choice being something like Emergency Medicine. The average FP makes 160K and the average ED doc makes 300K. Both are 3 year residencies. You have 300K+ in combined undergrad/med school debt, which is compounding.

The majority of people will go EM. I can name several classmates who faced similar decisions and made that choice.

If their debt level was 150K (or $0 a la Europe), FM becomes more appealing.

 

[Instatewaiter]

A few random thoughts
Someone posted about there has been a rise in physician suicides. This isn't because medicine has become inhospitable. Medicine, unquestionably, has become a kinder, gentler version of itself. It is much more lifestyle friendly. The hours are shorter. You get breaks. While it does tend to draw people who are type A and will be at risk, There is no reason for the uptick in suicides to be found in medicine itself.

 

[Mad Jack]

A few random thoughts
Someone posted about there has been a rise in physician suicides. This isn't because medicine has become inhospitable. Medicine, unquestionably, has become a kinder, gentler version of itself. It is much more lifestyle friendly. The hours are shorter. You get breaks. While it does tend to draw people who are type A and will be at risk, There is no reason for the uptick in suicides to be found in medicine itself.

Lower autonomy, increased bureaucracy, increased productivity retirements, and decreased value of physicians by insurers, hospitals, and society are probably more to do with it than anything. The stressors are very different than they were 20 years ago

 

[Mad Jack]

Unlikely. Highly selective sample. I'm talking nation-level, systemic change.

Reducing educational debt across the entire system IMO would without a doubt lead to more medical students entering primary care.

How will that change the number of primary care residents when every spot already fills? And how will filling primary care spots with US graduates that have no service requirement prove more helpful than filling those spots with IMGs that have an undeserved service requirement and far fewer existing geographic ties in the US than students coming out of US schools? Basically, how does your proposal in any way result in a net increase of providers, or a net increase of providers going to underserved areas?

 

[Instatewaiter]

Lower autonomy, increased bureaucracy, increased productivity retirements, and decreased value of physicians by insurers, hospitals, and society are probably more to do with it than anything. The stressors are very different than they were 20 years ago

While I agree those things contribute to those out of training, it is more than that. If these were the only things, you wouldn't see more suicides in med students and residents when their lives have gotten ostensibly easier than it was 20 years ago.

 

[TresselforPresident]

How will that change the number of primary care residents when every spot already fills? And how will filling primary care spots with US graduates that have no service requirement prove more helpful than filling those spots with IMGs that have an undeserved service requirement and far fewer existing geographic ties in the US than students coming out of US schools? Basically, how does your proposal in any way result in a net increase of providers, or a net increase of providers going to underserved areas?

I'm not proposing anything. I'm proposing NOT doing something - specifically, NOT mandating a period of employment prior to applying to medical school.

A user stated she wanted a 1 year period of employment to be a requirement to apply to medical school. I disagreed with that, as I believe the time cost and economic cost of becoming a physician is already very significant (easily more than every other comparable country, with worse health outcomes to show for it).

Adding additional requirements will only exacerbate the time, debt and economic cost of becoming a physician, and consequently will drive fewer individuals to choose primary care.

Given the current primary care shortage, and the fact that 99% (sorry - 95%) of medical students graduate without a problem and complete residency, I believe this additional requirement is overkill and not needed.

That is when a different user shifted the topic into how economics/debt burden do not impact specialty choice - which I disagree with. Here we are now.

 

[Matthew9Thirtyfive]

You're assuming income is the only factor. Decisions are made on the margin. Perhaps you like Family Med the most, with your second choice being something like Emergency Medicine. The average FP makes 160K and the average ED doc makes 300K. Both are 3 year residencies. You have 300K+ in combined undergrad/med school debt, which is compounding.

The majority of people will go EM. I can name several classmates who faced similar decisions and made that choice.

If their debt level was 150K (or $0 a la Europe), FM becomes more appealing.

What? He literally said that the debt argument ignores the other side of the equation. He literally said there are two sides to the equation.

 

[TresselforPresident]

What? He literally said that the debt argument ignores the other side of the equation. He literally said there are two sides to the equation.

He said the two sides are debt and income. Reduce debt and you address one half - but income is still higher in other specialties.

My reply is that specialty preference also has a subjective component - people may *prefer* to do FM over other specialties. No one chooses a specialty purely on economics. However, if two specialties are very close *subjectively* *e.g. FM > EM by a tad), then debt burden can play a role. Seen this happen for several of my classmates. They all picked EM.

 

[NicMouse64]

Sure, and I had a full ride. But I'm guessing for 80% of people, even their state school probably costs at least 30K/year.

This is veering off-topic, but I personally disagree with adding new hurdles and costs to what is already an incredibly expensive route to becoming a physician given the underperforming US healthcare system relative to our international peers, the primary care physician shortage, and the continued lack of access to healthcare for many.

We uniquely require an undergraduate degree because we want our doctors to be 'well-rounded' - interesting, then, that we are outperformed in many metrics by countries that have no such requirement. Of course, that's another matter and many of those metrics are flawed... but my point remains - if we want more accessible healthcare, making it more difficult and costly to become a doctor is not the way to go.

Undergraduate degrees aren't what's causing the doctor "shortage". It's maldistribution in rural areas. Adding more physicians to the system isn't necessarily the answer. Also we suck at healthcare for a multitude of reasons, including our crap culture and health choices. We still have very advanced care in comparison to even those with the best metrics, but our care is not distributed evenly among the population like it is in other countries.

 

[libertyyne]

I'm not proposing anything. I'm proposing NOT doing something - specifically, NOT mandating a period of employment prior to applying to medical school.

A user stated she wanted a 1 year period of employment to be a requirement to apply to medical school. I disagreed with that, as I believe the time cost and economic cost of becoming a physician is already very significant (easily more than every other comparable country, with worse health outcomes to show for it).

Adding additional requirements will only exacerbate the time, debt and economic cost of becoming a physician, and consequently will drive fewer individuals to choose primary care.

Given the current primary care shortage, and the fact that 99% (sorry - 95%) of medical students graduate without a problem and complete residency, I believe this additional requirement is overkill and not needed.

That is when a different user shifted the topic into how economics/debt burden do not impact specialty choice - which I disagree with. Here we are now.

You are claiming that incorporating work experience as an important aspect of medical school applications will lead to an exacerbation of the primary care shortage and increased costs of medical care.
Multiple users have made points which you have not even addressed.
1. There is very little to no correlation between length of training and cost of medical care
2. There is not a shortage in PCP rather a maldistribution .
3. All the primary care spots are filled currently by IMGs with more incentive to stay in the rural communities.
4.Reducing training does not lead to more PCP
5. There are more aspects than just debt that lead to the decision to avoid primary care by american grads but point 2,and 3 make it a moot point.
6. Specialty choice is a complex decision and is multifaceted, but pay , hours, work environment and lifestyle are factors and having more debt doesnt necessarily stop people from choosing FM . see DO schools.
7. The age of the average matriculant is already 24+ , many already have a year or three of experience in the work place.
8. No one is forcing people to go into medicine, and if ROI was the main concern CS seems like a better deal with better hours.

 

[TresselforPresident]

You are claiming that incorporating work experience as an important aspect of medical school applications will lead to an exacerbation of the primary care shortage and increased costs of medical care.
Multiple users have made points which you have not even addressed.
1. There is very little to no correlation between length of training and cost of medical care
2. There is not a shortage in PCP rather a maldistribution .
3. All the primary care spots are filled currently by IMGs with more incentive to stay in the rural communities.
4.Reducing training does not lead to more PCP
5. There are more aspects than just debt that lead to the decision to avoid primary care by american grads but point 2,and 3 make it a moot point.
6. Specialty choice is a complex decision and is multifaceted, but pay , hours, work environment and lifestyle are factors and having more debt doesnt necessarily stop people from choosing FM . see DO schools.
7. The age of the average matriculant is already 24+ , many already have a year or three of experience in the work place.
8. No one is forcing people to go into medicine, and if ROI was the main concern CS seems like a better deal with better hours.

1) You're telling me that systemically, the fact that every doctor in this country has to pay back another 50K-200K in loan debt vs. comparable countries, has 0 effect on the systemic cost of healthcare? I thought our salaries are higher because we have to pay back our loans? Less loan burden, lower salaries, less healthcare expenditure. Yes, it's not a huge contributor - but it is one.

2/3)
[A] Great. Seems like we should no longer concern ourselves about the cost of training for our graduates - we can simply drain developing countries of their physicians to meet our needs.
Why not require military service before applying? Require a PhD to show research productivity? The whole point of my original post, which you seem to be missing entirely, is that I don't think we need to add yet another hurdle (employment requirement) to the medical school application process when 95% of medical students graduate without a problem.

4-6) I have no interest in debating specialty choice anymore considering that neither of us will change the others mind and that the PCP discussion was a trangent to my main point. Also, DO students choose primary care because they often don't have a choice.

7) Great - so even less reason to require a mandatory employment year, since many students are doing that anyway.

8) Again not what I was arguing. But sure, I'll bite. No one is forcing anybody into medicine, but given the systemic issues in medicine, it seems rather short-sighted to wave our hands and say "nobody forced you to choose medicine, so suck it up". I agree - CS and banking and engineering are MUCH better deals than medicine. However, that doesn't mean we shouldn't try and improve the flaws in medicine. Including the substantial debt burden and length of training.

----
Tl;dr Don't foist yet another requirement on pre-meds.


That will be all from me folks. Cheers

 

[libertyyne]

1) You're telling me that systemically, the fact that every doctor in this country has to pay back another 50K-200K in loan debt vs. comparable countries, has 0 effect on the systemic cost of healthcare? I thought our salaries are higher because we have to pay back our loans? Less loan burden, lower salaries, less healthcare expenditure. Yes, it's not a huge contributor - but it is one.

2/3) [A] Great. Seems like we should no longer concern ourselves about the cost of training for our graduates - we can simply drain developing countries of their physicians to meet our needs.
Why not require military service before applying? Require a PhD to show research productivity? The whole point of my original post, which you seem to be missing entirely, is that I don't think we need to add yet another hurdle (employment requirement) to the medical school application process when 95% of medical students graduate without a problem.

4-6) I have no interest in debating specialty choice anymore considering that neither of us will change the others mind and that the PCP discussion was a trangent to my main point. Also, DO students choose primary care because they often don't have a choice.

7) Great - so even less reason to require a mandatory employment year, since many students are doing that anyway.

8) Again not what I was arguing. But sure, I'll bite. No one is forcing anybody into medicine, but given the systemic issues in medicine, it seems rather short-sighted to wave our hands and say "nobody forced you to choose medicine, so suck it up". I agree - CS and banking and engineering are MUCH better deals than medicine. However, that doesn't mean we shouldn't try and improve the flaws in medicine. Including the substantial debt burden and length of training.

----
That will be all from me folks. Cheers

Doctor salaries are a small, and less than ~20% of costs. SO yes i am telling you that.
A) Slippery slopes make for bad arguments and logically dont hold any water. This constitutes a large number IMGs, also FMGs are free to make their decisions to immigrate or not, no one is holding a gun to their heads to move to the US. If not to be doctors they would come to be taxi drivers.
95% of the graduates do not graduate without any problem match rates of 95% mean that ~90% realistically graduate within 5 years of matriculation , so that is 10% attrition or failure to match. Plus how many have issues with professionalism etc? How many fail out of residency because they cant adapt appropriately to a work place ?
4-6) Yes DO students may not have a choice, but it just goes to show people with large debt will also take primary care. It is a maldistribution problem rural areas wont magically become more appealing to young professionals , there is already a high premium being paid for primary care doctors in rural areas yet many graduate would rather settle in major metropolitan areas and take a large pay cut.
7) My point exactly no need to go ballistic at the suggestion that work experience is a good thing. I have never said mandatory, and you can work during UG FT. But even you with a mandatory year it is unlikely that the average age would change to such a degree.
8. The point was that people dont select medicine just for the pay. So even with debt , even with training , even with everything you are saying there are many more applicants than there are positions in medical school.

Whats even weirder is you dont see that I agree with you that training could be streamlined, but somehow selecting students with work experience is going to break the camels back in your mind. And shortening the training is only going to make the training more brutal, which the OP is complaining about.

 

[Goro]

A few random thoughts
Someone posted about there has been a rise in physician suicides. This isn't because medicine has become inhospitable. Medicine, unquestionably, has become a kinder, gentler version of itself. It is much more lifestyle friendly. The hours are shorter. You get breaks. While it does tend to draw people who are type A and will be at risk, There is no reason for the uptick in suicides to be found in medicine itself.

I submit that some of these may be due to people who are so driven for perfection that once they start to struggle academically, it destroys their very being. Add into this mix people who were driven into the profession due to family and/or cultural pressure. These are individuals who not likely to handle the pressure of clinical training very well.

The discussion about debt driving people into specialties, rather than PC where we need bodies in the right places, has been an issue as long as I've been teaching. The new three-year curricula at UCD, Duke, and now NYU-Long Island seems ot be a response to that. But this discussion is also far from the OP.

 

[LAIsTheBestPlaceEver]

Honestly, when I read this I was like why is he complaining while I worked 24 hours a week while taking 4 classes and still be involved in research, volunteer, and student orgs just so I can get into med school....

 

[NotASerialKiller]

Honestly, when I read this I was like why is he complaining while I worked 24 hours a week while taking 4 classes and still be involved in research, volunteer, and student orgs just so I can get into med school....

WARNING: trouble ahead

 

[LAIsTheBestPlaceEver]

WARNING: trouble ahead

I am a little confused..?

 

[Mr.S]

A few random thoughts
Someone posted about there has been a rise in physician suicides. This isn't because medicine has become inhospitable. Medicine, unquestionably, has become a kinder, gentler version of itself. It is much more lifestyle friendly. The hours are shorter. You get breaks. While it does tend to draw people who are type A and will be at risk, There is no reason for the uptick in suicides to be found in medicine itself.

Kinder, gentler? What are you talking about? We have ZERO control over ANYthing. The primary care docs cant even choose their medical assistants anymore. The nurses are givng them the middle finger saying "we are better".

Docs cant even take a day off without checking with several administrators.

If every minute of everyday is not filled with patient appointments you will be terminated and called unproductive.
Back in the day the rewards of primary care were great. Now they have turned it into a job at 7-11.

I think my explanation is closer to the truth than your kinder gentler one.

 

[OrthoTraumaMD]

There are no gender specific pronouns describing the speaker. The photo does not show gender specific clothing or the person's face. How did you determine the person was female?

Someone said it was a female in the prior posts, that’s what I’m going by


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[OrthoTraumaMD]

I’m curious, is there a good reason for this or is it low key hazing? Why can’t people learn in a less grueling environment and take a little more time to spread out the work? I know finishing fast is important given how long the whole process takes, but is it THAT important that you must compensate by working 16-hr days with no days off for a month at a time? I mean there are plenty of 5-yr dual degree MD programs, and people take gap years like nothing in order to get into medical school. But all of sudden once your in, time is so critically important that it justifies a grueling work day that probably isn’t even conducive to the best memory consolidation in terms of learning.

Because attendings don’t have the luxury of work hour restrictions.
Also it is well documented that too many hand-offs lead to the ball being dropped.




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[Angus Avagadro]

Moral of the story: Medicine isn’t for snowflakes.

Someone finally said it. It only took 58 posts

 

[Matthew9Thirtyfive]

Someone finally said it. It only took 58 posts

Surprised it took that long, actually.

 

[freedoctor17]

I feel like from reading this thread we can all agree that bullying should have no place in medicine and that people should be able to take criticism without getting offended at every little thing.

 

[Angus Avagadro]

Incorrect - the article phrases it poorly, but if you read the lawsuit, the ATTENDING shaved and marked the wrong side of the head prior to surgery. The resident pointed this out to the attending.

The attending then yelled at the resident for not pointing it out sooner.

Page 14, point 78.

This is most certainly an outlier, the overwhelming majority of programs are not like this. This program should have a rep for this treatment and the resident should have been aware of the culture before he applied. There are always 2 sides to a story, it would be interesting to know the other side
However, this is why we have lawyers and lawsuits to deal with these kinds of situations. 50 mil is a little outrageous, but obviously the resident wants to get their attention. If all is accurate, he should prevail.

 

[Master Thinker]

No matter which job, there will always be people who are unhappy. You should not be discouraged from a whole profession just because someone had a bad experience.

 

[Carbon_Martian]

Thank you for the through responses cregg - I just wanted to elaborate on a few of my remarks

I don't think anybody goes into medicine anticipating that they will be one of the people who struggle. It's not that easy. And once you're in it and realize you're struggling...you're 50-100k in debt with no easy way to pay it off if you drop out."

I can fully sympathize with the situation you're describing - it's unfortunate and it's why I think adcoms really need to look at their admission standards more carefully. Ideally, you wouldn't want this sort of thing to happen at all - if someone is accepted into medical school they should be more than capable of getting through it. Though I won't get into that topic here. Still, the sentiment of not anticipating a struggle baffles me. I can't for the life of me understand why people think they'll be the exception to cold hard statistics. If 50% of doctors at the time these surveys are taken suffer from some form of mental weathering - it's not too big of a leap to assume that upwards of 80% of them have suffered from these conditions at one point or another. People should go into med school with the mindset that they WILL struggle, because it's overwhelmingly likely that they will.

- For the pre-meds reading this: I think one of the best things you can do in your undergrad career is at least attempt to emulate a med-school workload.

Knowing the effects of sleep deprivation doesn't make your work day any shorter, or improve your exam grades with no studying, or stop you from needing to go to the grocery store or go to your kid's baseball game or eat and shower or exercise regularly or....there are some days in med school, residency, and as an attending where there are truly just not enough hours in the day. If you're working a 16 hour day, which happens not infrequently, especially for residents, you have 8 hours to drive home (and back to work), eat a meal, shower, at a minimum - you're not getting 8 hours of sleep. You can get 7+ hours >80% of the time if you're smart and manage your time well, but there are times when you can't "simply sleep after getting home."

I don't disagree with you on any of this. I'm just saying that from a purely scientific standpoint you're far better off sleeping when you can instead of studying. No one is going to argue that there are days where you can't get home and just to sleep because of your other responsibilities. But I can make a very good argument for sleep being a better "academic" choice after getting home from a 16 hour work day - you're going to retain little to none of what you study so you essentially accomplish nothing.

 

[getdown]

Kinder, gentler? What are you talking about? We have ZERO control over ANYthing. The primary care docs cant even choose their medical assistants anymore. The nurses are givng them the middle finger saying "we are better".

Docs cant even take a day off without checking with several administrators.

If every minute of everyday is not filled with patient appointments you will be terminated and called unproductive.
Back in the day the rewards of primary care were great. Now they have turned it into a job at 7-11.

I think my explanation is closer to the truth than your kinder gentler one.

He's talking about medical student education in the wards as well as, to a lesser extent, in residency. Not physician autonomy.

 

[Dagrimsta1]

I guess we'll find out in a few years when the first class of NYU students who are tuition free matches. In all seriousness, that's a super skewed bunch, since I imagine many of them are interested in other fields not just because of the debt:income ratio.

I think all NYU ended up doing is make their program even more competitive by making it free.

In terms of which specialty students choose; Yeah it's feasible that students actually passionate about primary care can feel better about going into a lower paid specialty not having that 300k-500k debt on their shoulders. In practice, it's probably not gonna work until more schools take their "free" approach.

Definitely a step in the right direction though. Graduate school tuition is legal robbery at the moment and the way it's going, the government won't keep up.

Yup.

This is why I want a year of employment experience to be a requirement for admission to med school.

I was once called a piece of **** by my boss for coming late to work by 25 minutes. I was also railed by him for the following week about my work ethic. That being said, when I quit, he spent the following 3 months trying to increase my salary to get me to come back. Real life experience > books.

People who say that it doesn't make sense spending a year working to obtain a career that already takes 8+ years to get are full of ****. I worked throughout my last 2 years of high school and the entirety of college to pay off my tuition and expenses. That's at least 4 years of being employed and that's without my gap year of employment.

Don't make ****ty excuses people! See what the real world is like before it hits you like a truck.

 

[deleted804295]

Recently saw this Humans of New York post about a recent med school grad who sounds like they had a horrible experience in med school and seems super disillusioned/pessimistic about being a doctor. Just wondering - is this really a common experience?? Are the work hours really like the way this person describes?? It seems like there’s a lot of people in the comment section of the post who relate as well, but I was under the impression that it wasn’t this bad anymore due to new regulations and stuff

edit: here’s the link the post, not sure if the previous link worked!

You can make every experience as miserable or as entertaining as you want. I personally will be working part time as an attending for a couple of years- if I become a doctor- just so that I have had a period of relaxation and then increase or decrease the amount of work from there.

If someone's burnt out why not take some time off! After you get your license you can work as much or as little as you want.

 

[deleted804295]

I often hear stories of residents hating life and working long hours.

How likely is it for residents to get fired?

I imagine if they were sleep deprived they would just sleep a full amount, take care of the kids, and then go a bit late to work whether that be 30 minutes to an hour.

Would you truly get fired over this? I don't see students failing for coming a bit late to class. I imagine residents would be paid less but fired, really? In the US, there are a shortage of doctors. The hospitals rely on doctors not the other way around.

It seems as if residents have a lot of bargain power but they just don't use it.

 

[libertyyne]

I often hear stories of residents hating life and working long hours.

How likely is it for residents to get fired?

I imagine if they were sleep deprived they would just sleep a full amount, take care of the kids, and then go a bit late to work whether that be 30 minutes to an hour.

Would you truly get fired over this? I don't see students failing for coming a bit late to class. I imagine residents would be paid less but fired, really? In the US, there are a shortage of doctors. The hospitals rely on doctors not the other way around.

It seems as if residents have a lot of bargain power but they just don't use it.

imo, yes you would be fired for this if you made a habit of showing up half an hour late. Patient care does not stop because you have stuff going on outside of the hospital, and the team depends on you to show up on time.