Aug 26, 2015
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I was once a prolific SDNer nearly 10 years ago. I retired when most people started talking on FB instead, taking many of my SDN friends with me.

I am taking some time to reflect on much of the discourse that used to be commonplace.

What follows is based on med school, residency, fellowship, and practice in a competitive specialty.

1. Where you go to medical school is not nearly as important as people on SDN seem to think it is. I forgot 90% of what I needed to get through med school years ago. I have been in residency and fellowship with people from all over, and we were not that different from each other.

2. Caveat to #1--I have bumped into many who have had a rougher road with licensing boards and moonlighting privileges because they went to medical schools that were not accredited by the AAMC. I don't want to spread any hate or spark some debate. I am just reporting what I saw. After you are completely done with training, this doesn't matter a whole lot after you are settled.

3. Most medical schools do not need your tuition, and what they charge is absolute robbery for what you get in return.

4. Don't depend on any "public service" loan forgiveness program you read about to necessarily apply to you down the road. Very few things that politicians are responsible for have affected my life, but student loan policy is one of them.

5. If it is really about "helping people," you can do that as a mid-level. Salary is no longer a good reason to go into medicine. The reason to become a doctor is that you want to be called doctor and not much else. I admit that being called doctor is still pretty cool. Whether it is worth the pricetag is another story.

6. Training, for a tough specialty, takes a LONG time. You will lose time with your children. You will burn away your healthiest years. You will miss out on important things. I look at my friends who I went to college with, and many have great jobs, happy families, paid off student loans, and enough cash to be happy. I am nearly 40 and still have never had much of a "real job."

7. Not every doctor gets to work where he or she wants, and you may be forced to sign a non-compete agreement that will keep you in a bad practice. Almost no other profession stands for BS like this.

Feel free to comment if you would like. If SDN is how it used to be, I am sure a lively discussion is possible. I'm just too old to enjoy the banter I used to get into here anymore.
 
Jan 13, 2013
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Does the title of the thread imply you feel like medicine was a mistake? If so, I hope it's a temporary sentiment.
 
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StudyLater

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1. Where you go to medical school is not nearly as important as people on SDN seem to think it is. I forgot 90% of what I needed to get through med school years ago. I have been in residency and fellowship with people from all over, and we were not that different from each other.
We know.

2. Caveat to #1--I have bumped into many who have had a rougher road with licensing boards and moonlighting privileges because they went to medical schools that were not accredited by the AAMC. I don't want to spread any hate or spark some debate. I am just reporting what I saw. After you are completely done with training, this doesn't matter a whole lot after you are settled.
I think this is pretty much a given. I didn't even know one could get licensed at all ever without going to an accredited school. Could you possibly expand on this? Maybe an anecdote you can share?

3. Most medical schools do not need your tuition, and what they charge is absolute robbery for what you get in return.
Oh I know. And I hope my peers are intelligent enough to realize that as well. Though it's kind of like, when you're in love....the dollars and cents, what do they matter?

They matter when you snap out of it ;)

4. Don't depend on any "public service" loan forgiveness program you read about to necessarily apply to you down the road. Very few things that politicians are responsible for have affected my life, but student loan policy is one of them.
I didn't. I'll expect to pay the full amount + interest of what I take out. How manageable have you found the loans to be? Did you intend to wipe them out quick or are you doing the 20-year thing for 6 figures out of pocket?

5. If it is really about "helping people," you can do that as a mid-level. Salary is no longer a good reason to go into medicine. The reason to become a doctor is that you want to be called doctor and not much else. I admit that being called doctor is still pretty cool. Whether it is worth the pricetag is another story.
Very much agreed on this point. But wouldn't you say the level of impact the doc has can be much greater? Aren't you the brains behind their whole recovery? I agree that midlevels are a big part of making that recovery happen, but if you don't give the right order the whole ship goes down. I've just always seen the doc as being in a much more pivotal role than any other midlevel -- much more in control of the outcome, and therefore he/she has a much greater propensity for actually saving a life that is in his/her control. Is this an incorrect train of thought?

The money is excellent, but of course as far as just attaining a solid, consistent general happiness, no one needs doctor money to get that. Hopefully that is obvious enough to everyone here.

6. Training, for a tough specialty, takes a LONG time. You will lose time with your children. You will burn away your healthiest years. You will miss out on important things. I look at my friends who I went to college with, and many have great jobs, happy families, paid off student loans, and enough cash to be happy. I am nearly 40 and still have never had much of a "real job."
That's the idea. Sacrificial lamb. I'm sure, having gone through it all, you get the idea that some of us just really don't give a ****. Use me up if it helps out. I'm not really doing anyone, including myself, much good not being helpful to others. I assume this life will go quickly regardless, and I'm not expecting some big f*cking shebang or special treatment because "I'm me and I deserve it." To those that value themselves over others, however, I pretty much agree that it's a line of work that doesn't make much sense (and could be considered idiotic/masochistic, even).

7. Not every doctor gets to work where he or she wants, and you may be forced to sign a non-compete agreement that will keep you in a bad practice. Almost no other profession stands for BS like this.
Law, and I'd bet financial firms as well. But sure the deal could totally vary based on the shop. No surprises there.

Feel free to comment if you would like. If SDN is how it used to be, I am sure a lively discussion is possible. I'm just too sober to enjoy the banter I used to get into here anymore.
Fixed that for you.
 

StudyLater

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Does the title of the thread imply you feel like medicine was a mistake? If so, I hope it's a temporary sentiment.
Rough day at the office, maybe. Or second/third divorce. Or diagnosed with a metastasized tumor.

Jesus if I finished this whole thing and had the last one happen I'd want a f*cking life refund.
 
Feb 6, 2013
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Art is long, life short, judgment difficult, opportunity transient. To act is easy, to think is hard; to act according to our thought is troublesome. Every beginning is cheerful; the threshold is the place of expectation. The boy stands astonished, his impressions guide him; he learns sportfully, seriousness comes on him by surprise. Imitation is born with us; what should be imitated is not easy to discover. The excellent is rarely found, more rarely valued. The height charms us, the steps to it do not: with the summit in our eye, we love to walk along the plain. It is but a part of art that can be taught; the artist needs it all. Who knows it half, speaks much, and is always wrong; who knows it wholly, inclines to act, and speaks seldom or late. The former have no secrets and no force: the instruction they can give is like baked bread, savoury and satisfying for a single day; but flour cannot be sown and seed-corn ought not to be ground. Words are good, but they are not the best. The best is not to be explained by words. The spirit in which we act is the highest matter. Action can be understood and again represented by the spirit alone. No one knows what he is doing, while he acts aright; but of what is wrong we are always conscious. Whoever works with symbols only, is a pedant, a hypocrite, or a bungler. There are many such, and they like to be together. Their babbling detains the scholar: their obstinate mediocrity vexes even the best. The instruction which the true artist gives us, opens the mind; for where words fail him, deeds speak. The true scholar learns from the known to unfold the unknown, and approaches more and more to being a master.
 
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JustintheDoctor

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Art is long, life short, judgment difficult, opportunity transient. To act is easy, to think is hard; to act according to our thought is troublesome. Every beginning is cheerful; the threshold is the place of expectation. The boy stands astonished, his impressions guide him; he learns sportfully, seriousness comes on him by surprise. Imitation is born with us; what should be imitated is not easy to discover. The excellent is rarely found, more rarely valued. The height charms us, the steps to it do not: with the summit in our eye, we love to walk along the plain. It is but a part of art that can be taught; the artist needs it all. Who knows it half, speaks much, and is always wrong; who knows it wholly, inclines to act, and speaks seldom or late. The former have no secrets and no force: the instruction they can give is like baked bread, savoury and satisfying for a single day; but flour cannot be sown and seed-corn ought not to be ground. Words are good, but they are not the best. The best is not to be explained by words. The spirit in which we act is the highest matter. Action can be understood and again represented by the spirit alone. No one knows what he is doing, while he acts aright; but of what is wrong we are always conscious. Whoever works with symbols only, is a pedant, a hypocrite, or a bungler. There are many such, and they like to be together. Their babbling detains the scholar: their obstinate mediocrity vexes even the best. The instruction which the true artist gives us, opens the mind; for where words fail him, deeds speak. The true scholar learns from the known to unfold the unknown, and approaches more and more to being a master.
what
 

steelersfan1243

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May 9, 2013
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I was once a prolific SDNer nearly 10 years ago. I retired when most people started talking on FB instead, taking many of my SDN friends with me.

I am taking some time to reflect on much of the discourse that used to be commonplace.

What follows is based on med school, residency, fellowship, and practice in a competitive specialty.

1. Where you go to medical school is not nearly as important as people on SDN seem to think it is. I forgot 90% of what I needed to get through med school years ago. I have been in residency and fellowship with people from all over, and we were not that different from each other.

2. Caveat to #1--I have bumped into many who have had a rougher road with licensing boards and moonlighting privileges because they went to medical schools that were not accredited by the AAMC. I don't want to spread any hate or spark some debate. I am just reporting what I saw. After you are completely done with training, this doesn't matter a whole lot after you are settled.

3. Most medical schools do not need your tuition, and what they charge is absolute robbery for what you get in return.

4. Don't depend on any "public service" loan forgiveness program you read about to necessarily apply to you down the road. Very few things that politicians are responsible for have affected my life, but student loan policy is one of them.

5. If it is really about "helping people," you can do that as a mid-level. Salary is no longer a good reason to go into medicine. The reason to become a doctor is that you want to be called doctor and not much else. I admit that being called doctor is still pretty cool. Whether it is worth the pricetag is another story.

6. Training, for a tough specialty, takes a LONG time. You will lose time with your children. You will burn away your healthiest years. You will miss out on important things. I look at my friends who I went to college with, and many have great jobs, happy families, paid off student loans, and enough cash to be happy. I am nearly 40 and still have never had much of a "real job."

7. Not every doctor gets to work where he or she wants, and you may be forced to sign a non-compete agreement that will keep you in a bad practice. Almost no other profession stands for BS like this.

Feel free to comment if you would like. If SDN is how it used to be, I am sure a lively discussion is possible. I'm just too old to enjoy the banter I used to get into here anymore.
Art is long, life short, judgment difficult, opportunity transient. To act is easy, to think is hard; to act according to our thought is troublesome. Every beginning is cheerful; the threshold is the place of expectation. The boy stands astonished, his impressions guide him; he learns sportfully, seriousness comes on him by surprise. Imitation is born with us; what should be imitated is not easy to discover. The excellent is rarely found, more rarely valued. The height charms us, the steps to it do not: with the summit in our eye, we love to walk along the plain. It is but a part of art that can be taught; the artist needs it all. Who knows it half, speaks much, and is always wrong; who knows it wholly, inclines to act, and speaks seldom or late. The former have no secrets and no force: the instruction they can give is like baked bread, savoury and satisfying for a single day; but flour cannot be sown and seed-corn ought not to be ground. Words are good, but they are not the best. The best is not to be explained by words. The spirit in which we act is the highest matter. Action can be understood and again represented by the spirit alone. No one knows what he is doing, while he acts aright; but of what is wrong we are always conscious. Whoever works with symbols only, is a pedant, a hypocrite, or a bungler. There are many such, and they like to be together. Their babbling detains the scholar: their obstinate mediocrity vexes even the best. The instruction which the true artist gives us, opens the mind; for where words fail him, deeds speak. The true scholar learns from the known to unfold the unknown, and approaches more and more to being a master.
Is today secretly 4/20 or something? What is up with these posts?
 

Cotterpin

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Jun 18, 2015
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That's the idea. Sacrificial lamb. I'm sure, having gone through it all, you get the idea that some of us just really don't give a ****. Use me up if it helps out. I'm not really doing anyone, including myself, much good not being helpful to others. I assume this life will go quickly regardless, and I'm not expecting some big f*cking shebang or special treatment because "I'm me and I deserve it." To those that value themselves over others, however, I pretty much agree that it's a line of work that doesn't make much sense (and could be considered idiotic/masochistic, even).
I think about this aspect of it all the time. Being nontraditional, I've already spent my twenties doing only the things that seemed like fun and made me happy. And then I looked back and felt like **** about it. Now I just want to be a useful person and I think my particular personality and strengths will be best suited to medicine. Being with patients brings me joy. And if that means that I have to sacrifice everything else to spend my life practicing medicine, then I'm ready. Because I already know what it feels like to live only for yourself and I don't want to do that anymore.
 
Jul 21, 2015
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Art is long, life short, judgment difficult, opportunity transient. To act is easy, to think is hard; to act according to our thought is troublesome. Every beginning is cheerful; the threshold is the place of expectation. The boy stands astonished, his impressions guide him; he learns sportfully, seriousness comes on him by surprise. Imitation is born with us; what should be imitated is not easy to discover. The excellent is rarely found, more rarely valued. The height charms us, the steps to it do not: with the summit in our eye, we love to walk along the plain. It is but a part of art that can be taught; the artist needs it all. Who knows it half, speaks much, and is always wrong; who knows it wholly, inclines to act, and speaks seldom or late. The former have no secrets and no force: the instruction they can give is like baked bread, savoury and satisfying for a single day; but flour cannot be sown and seed-corn ought not to be ground. Words are good, but they are not the best. The best is not to be explained by words. The spirit in which we act is the highest matter. Action can be understood and again represented by the spirit alone. No one knows what he is doing, while he acts aright; but of what is wrong we are always conscious. Whoever works with symbols only, is a pedant, a hypocrite, or a bungler. There are many such, and they like to be together. Their babbling detains the scholar: their obstinate mediocrity vexes even the best. The instruction which the true artist gives us, opens the mind; for where words fail him, deeds speak. The true scholar learns from the known to unfold the unknown, and approaches more and more to being a master.
That's what I'm trying to say.
 

StudyLater

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Art is long, life short, judgment difficult, opportunity transient. To act is easy, to think is hard; to act according to our thought is troublesome. Every beginning is cheerful; the threshold is the place of expectation. The boy stands astonished, his impressions guide him; he learns sportfully, seriousness comes on him by surprise. Imitation is born with us; what should be imitated is not easy to discover. The excellent is rarely found, more rarely valued. The height charms us, the steps to it do not: with the summit in our eye, we love to walk along the plain. It is but a part of art that can be taught; the artist needs it all. Who knows it half, speaks much, and is always wrong; who knows it wholly, inclines to act, and speaks seldom or late. The former have no secrets and no force: the instruction they can give is like baked bread, savoury and satisfying for a single day; but flour cannot be sown and seed-corn ought not to be ground. Words are good, but they are not the best. The best is not to be explained by words. The spirit in which we act is the highest matter. Action can be understood and again represented by the spirit alone. No one knows what he is doing, while he acts aright; but of what is wrong we are always conscious. Whoever works with symbols only, is a pedant, a hypocrite, or a bungler. There are many such, and they like to be together. Their babbling detains the scholar: their obstinate mediocrity vexes even the best. The instruction which the true artist gives us, opens the mind; for where words fail him, deeds speak. The true scholar learns from the known to unfold the unknown, and approaches more and more to being a master.
It looks like you just smooshed a bunch of people's lame FB posts together and made a post out of them.
 
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Aug 31, 2015
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I actually value this post. All of us pre-meds are very optimistic about what medicine holds for us, but the truth is most of us will probably end up unhappy in the profession. The only problem is, we can't look into the future. Right now, this is what we feel like we should be doing with our lives. People change. When we finally do succeed and become physicians, there is always going to be the "grass is greener" outlook. It is human nature to want more.

Truthfully, I'm frightened at the aspect of being rejected completely, but I'm also frightened of being accepted. Being accepted means this is it: Medicine will be my life for the next 50-60 years. While exciting, it certainly is scary to wonder about all of the things that could and will change in that time.

But right now, I want to be a physician. And right now is the only thing I can control.
 
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StudyLater

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I think about this aspect of it all the time. Being nontraditional, I've already spent my twenties doing only the things that seemed like fun and made me happy. And then I looked back and felt like **** about it. Now I just want to be a useful person and I think my particular personality and strengths will be best suited to medicine. Being with patients brings me joy. And if that means that I have to sacrifice everything else to spend my life practicing medicine, then I'm ready. Because I already know what it feels like to live only for yourself and I don't want to do that anymore.
Then I think you did and are doing the right things for yourself. I can't really successfully argue (without a commonly held standard or goal between myself and the person I'm arguing with) that helping others is a superior route to being 100% selfish or even to causing the suffering of others for personal gain. This is just what I'd rather do, right now. It's where I see myself being most satisfied, but I can easily see the grind wearing me down. F*cking 8-10 years is a while for anyone -- you're not gonna go every day and night of that perfectly happy. It's better to have realistic expectations going in. And as a lot of the attendings have said, the training part is kind of a separate thing....I don't know if we should be basing how our lives as attendings will be on how brutal our training is.

@Ready 4 Med how far out are you at this point? 1st/2nd year?
 

StudyLater

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I actually value this post. All of us pre-meds are very optimistic about what medicine holds for us, but the truth is most of us will probably end up unhappy in the profession.
And you wonder why we're given ridiculously large loans. That'll function as our de facto cage to prevent us from leaving when we really really f*cking want to.

The only problem is, we can't look into the future. Right now, this is what we feel like we should be doing with our lives. People change. When we finally do succeed and become physicians, there is always going to be the "grass is greener" outlook. It is human nature to want more.
Sure. I really love how, despite the class structure we've got within the working class, everyone feels that same entrapment from time to time. Strapping down people who yearn for complete freedom will do that. Then when you get complete freedom, you don't know what to do with yourself so you strap yourself back down into something because you know of no other way to live. It's really great.

Truthfully, I'm frightened at the aspect of being rejected completely, but I'm also frightened of being accepted. Being accepted means this is it: Medicine will be my life for the next 50-60 years. While exciting, it certainly is scary to wonder about all of the things that could and will change in that time.
Agreed on the bolded. With that said, 50-60 is an overstatement. It doesn't have to be. You could practice a few years, get your loans out of the way, save up a bit, and then go do something else if you really wanted to.
 
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Jan 22, 2015
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6. Training, for a tough specialty, takes a LONG time. You will lose time with your children. You will burn away your healthiest years. You will miss out on important things. I look at my friends who I went to college with, and many have great jobs, happy families, paid off student loans, and enough cash to be happy. I am nearly 40 and still have never had much of a "real job."
what do you mean not having a "real job."
 

StudyLater

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what do you mean not having a "real job."
Didn't get this either. If residency isn't a "real job" I don't know what the f*ck is.

But I'd assume he's talking about working a job for which you are fully trained and completely competent. I would describe some PGY4s I've seen this way, though. Some have complete autonomy in the OR.
 

Mr Magpie

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It looks like you just smooshed a bunch of people's lame FB posts together and made a post out of them.
He's actually quoting a segment from 18th century influential German writer Johann Wolfgang Goethe. Reducing some of the eloquent prose, the passage is basically saying it is easier to start something than to finish it.

The novel the segment comes from,Wilhelm Meister's Apprenticeship, is considered a literary masterpiece (think Don Quixote).

I suppose I can see the relevance regarding this thread.
 
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OP
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Aug 26, 2015
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You don't need to attend a medical school accredited by the AAMC to get into residency, but you often do have to complete a year or more of an ACGME residency before they will give you a license.

By "real" job, I mean a job that you have an expectation of having indefinitely until you are fired or quit. In residency, your paychecks cease when your contract ends. If there is no job for you, you are left moving again.

I don't regret my decision, and going through the training was by far not the hardest thing I've done in life. It was just unnecessarily time-consuming. Medicine has just become too much of a business to be as intrinsically satisfying as it used to be.

I just want people to understand the trends--tuition rising exponentially, the ACGME slashing training hours and forcing unnecessary patient hand-offs (probably creating a greater safety hazard than the risk of sleep deprivation entails), pushing us to see more and more patients to feed the hospitals, quality-based performance metrics that are obscure, evaluating us based on patient satisfaction, the onslaught of excess imaging because nobody is confident in a physical exam anymore, etc.

The healthcare machine is becoming a protocol-driven robot that is designed to simply everything into treatment algorithms that result in the most profit while minimizing liability, and it will only get worse.

Mid-levels cannot do my job, but if administrators had their way, all non-emergent and non-surgical medicine would be managed by mid-level providers. All the while, there is every incentive to open an off-shore medical school, charge $80K a year, tell the students to go find their own clinical rotations, and make a killing on the revenue.
 
Jan 22, 2015
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to get better context on your perspective and if you are comfortable answering: what is your specialty, your age range when you started medical school, and total debt range after you graduated medical school?
 
OP
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One of the ROAD specialties, started med school near age 30 after giving up a $75K/year job, debt range $250K (but PSLF is still in play as of now with a few years to go).

Lost income during training only amounts to a net loss of about a quarter mil, so I still only sacrificed less than a million in money but will hopefully recover those losses within a few years.

It's not about the money so much as it is about WHEN you need(ed) the money. If your kids go from being little to graduating high school during training, you probaby needed the money more during their childhood. I can vacation or whatever for the next 20 years, but buying a bigger home is no longer of value short of giving me the privilege of higher electricity bills.
 

StudyLater

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By "real" job, I mean a job that you have an expectation of having indefinitely until you are fired or quit. In residency, your paychecks cease when your contract ends. If there is no job for you, you are left moving again.
Again, I thought this was assumed. I've never been told by any residents I've shadowed that they expect to have a job at the same institution when they get out.

I don't regret my decision, and going through the training was by far not the hardest thing I've done in life. It was just unnecessarily time-consuming. Medicine has just become too much of a business to be as intrinsically satisfying as it used to be.
When was medicine ever not a business? I can't remember hearing of the profession on the whole being totally free of charge in any civilization ever throughout history (except for some individual instances, of course).

I just want people to understand the trends--tuition rising exponentially, the ACGME slashing training hours and forcing unnecessary patient hand-offs (probably creating a greater safety hazard than the risk of sleep deprivation entails), pushing us to see more and more patients to feed the hospitals, quality-based performance metrics that are obscure, evaluating us based on patient satisfaction, the onslaught of excess imaging because nobody is confident in a physical exam anymore, etc.
That last one, I'm assuming, goes back to the business thing. Bigger patient bill + smaller provider liability. Win-lose, unless you truly do find that excessive imaging is really saving someone's skin -- I've been told by physicians that it actually does, albeit on rare occasions (I was quoted about 20/yr in a 20k ED).

The rest of it sucks. I also find it kind of funny you want more hours, given your complaints. Do you think keeping <80hrs for residents is "unnecessary?" You talk about training itself being unnecessarily time consuming, unless you meant med school.

The healthcare machine is becoming a protocol-driven robot that is designed to simplify everything into treatment algorithms that result in the most profit while minimizing liability, and it will only get worse.

Mid-levels cannot do my job, but if administrators had their way, all non-emergent and non-surgical medicine would be managed by mid-level providers. All the while, there is every incentive to open an off-shore medical school, charge $80K a year, tell the students to go find their own clinical rotations, and make a killing on the revenue.
Truth.

One of the ROAD specialties, started med school near age 30 after giving up a $75K/year job, debt range $250K (but PSLF is still in play as of now with a few years to go).

Lost income during training only amounts to a net loss of about a quarter mil, so I still only sacrificed less than a million in money but will hopefully recover those losses within a few years.

It's not about the money so much as it is about WHEN you need(ed) the money. If your kids go from being little to graduating high school during training, you probaby needed the money more during their childhood. I can vacation or whatever for the next 20 years, but buying a bigger home is no longer of value short of giving me the privilege of higher electricity bills.
I don't know. Worst case scenario your kids are pissed at you for....providing for them selflessly, even though you couldn't give them excess luxury??