intern blues?

[Intern9999]

I apologize in advance for the upcoming rant; I’ve read these forums for a while without posting. I’m in a very good internal medicine program that I initially liked a lot. However, lately there has been a great deal of criticism to the point that I find it’s unprofessional, and now I’m just incredibly demoralized, angry, and disappointed. Do other places have these problems? Is this just middle-of-the-winter intern angst? What do you think:

There was an issue with intern attendance at conferences. Instead of sending out an email stating that conferences are mandatory and reminding us when they occur, they announced out of the blue that our lack of interest was unacceptable and that they are now going to call in interns for jeopardy based on how often we attend. At a class meeting where we discussed the subject, we were basically told that if we didn’t feel like there was time to go, then we're inefficient and by this time in the year we should be able to make the time. So, instead of going to conference because its interesting, furthers my education and is actually a privilage--which is how I used to think about it--I'm now being coerced into going because if I don't it means I'm inefficient and will be "punished" with more work. Feels like high school.

If we alert the medicine resident in the ED about a patient that seems sick based on passoff to make sure he/she has seen the patient, then we are “inconsiderate” for questioning their judgment, and “weak” for potentially wanting someone to go to the unit instead of the floor. On the flip side, if we do take passoff on a patient who probably should have gone elsewhere, we are responsible for that choice and hear about it from the senior or the team in the AM.

The chiefs, or most anyway, are becoming stunningly arrogant. They make backhanded comments about us at conferences such as “this is the limitation of reading an intern admit note”, and “if the intern would have been bothered to do a rectal exam…”, and “whatever intern admitted this patient didn’t seem to care whether they were orthostatic or not.” I can only guess what they say when none of us are around. Some of the juniors and seniors take on this attitude as well.

And in situations where the leadership asks for feedback and someone is brave enough to provide it, it seems to get thrown back at us... we're lazy, weak, whiney, arrogant, uninformed, etc.

On some services, I work 90-100 hrs/week. I work when I’m sick, worked on all 3 of the major holidays in the last 2 months, I’m hundreds of miles from my family. This is all fine with me if I'm a better doctor for it an the end of training, but because of the sacrifice and my own driven nature it also means a lot to me to be in a place where I’m part of something successful. Despite what people here seem to think, I really do want to do a good job and can easily change if I hear some specific constructive feedback. What I hear now from the leadership is general contempt. I just feel so terrible right now. Is anyone else running into this kind of thing?

Signed,
“whatever intern admitted this patient”

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[BigNavyPedsGuy]

Almost all of us feel like used up abused pieces of crap this time of year. I actually think it's normal.

Think of it this way: you're over halfway done. And it sounds like in your program there's a big discrepancy b/t interns and residents. In 5 short months you'll be one those residents and not an intern anymore.

Don't take this stuff personally-it's not.

 

[typeB-md]

Almost all of us feel like used up abused pieces of crap this time of year. I actually think it's normal.

Think of it this way: you're over halfway done. And it sounds like in your program there's a big discrepancy b/t interns and residents. In 5 short months you'll be one those residents and not an intern anymore.

Don't take this stuff personally-it's not.

Can someone explain to me why you guys put up with being treated like crap?

Why are physicians so spineless when it comes to overt abuse? Stand up for yourself, man. Or better yet, just document and go to the RRC and tell them about the work hour violations.

This is completely unacceptable and the fact that we allow it to perpetuate is unbelievable. We've been conditioned into thinking that sleep deprivation and depression are normal parts of training; they are not. Interns are physicians in training -- not students, not children. To ask to be treated as such is not asking too much.

 

[orientedtoself]

to the op-

as far as this year, the only thing i can say is hang in there. enjoy your days off.

you are more than halfway done with intern year. things will get better when it starts getting warmer. particularly after match day, when it becomes real that reinforcements will be coming to take over for you, and that you won't be an intern forever.

when you are an upper level resident, remember how you felt as an intern and what kind of support you would have liked to recieve, and give your interns that support. did you want more backup? then let your interns know you are accessible. want less micromanagement? let your interns have their autonomy (with backup if needed). want more teaching? prepare some talks for your interns.

 

[Tired]

And in situations where the leadership asks for feedback and someone is brave enough to provide it, it seems to get thrown back at us... we're lazy, weak, whiney, arrogant, uninformed, etc.

On some services, I work 90-100 hrs/week. I work when I’m sick, worked on all 3 of the major holidays in the last 2 months, I’m hundreds of miles from my family.

If you're going to go through all that, you might as well have done a surgical internship.

 

[Winged Scapula]

Can someone explain to me why you guys put up with being treated like crap?

Why are physicians so spineless when it comes to overt abuse? Stand up for yourself, man. Or better yet, just document and go to the RRC and tell them about the work hour violations.

This is completely unacceptable and the fact that we allow it to perpetuate is unbelievable. We've been conditioned into thinking that sleep deprivation and depression are normal parts of training; they are not. Interns are physicians in training -- not students, not children. To ask to be treated as such is not asking too much.

Uh...because their program might be put on probation and closed, leaving them without a spot? Or because they will be known as a complainer, "difficult" resident who will not be asked back for the following year by their program?

Residencies have physicians by the balls, and they know it.

 

[Intern9999]

Thanks for the encouragement... I'm going to make a point NOT to treat the new interns this way next year.

TypeB-md-- Winged Scapula has it right, there is no way I would bring up these concerns in public. It wouldn't do any good -- just another whiney, lazy intern trying to get out of work-- and it would mark me as a complainer. As much as I hate this, I don't want to enter the match again and risk repeating intern year to get out of it. I can barely hold my wits together as it is (the other morning I left the house with 2 different socks on and didn't notice till 4 PM), and can't imagine taking on a project like finding a new program or fighting the work hours. As an example, I filled out the work hours the other day and lied about it again, becuase it's better than what I imagine might ensue if I recorded them accurately:

Me: "Hello Dr. Chief. So what's this meeting about?"
Evil chief: "you're over your work hours again."
Me: "oh really? Maybe that's because I've had exactly 4 days off in the last 2 1/2 months"
Evil chief: "no, I think it's because you're inefficient. No one else goes over their work hours. I think you should be on probation until you learn to manage your time."

See, it's not a tough choice. Like winged scapula said, they have us by the nads and they know it. It's like indentured servitide, only we admit patients instead of pick crops.

 

[Annette]

Almost all of us feel like used up abused pieces of crap this time of year. I actually think it's normal.

It is normal, because you are being abused like a piece of crap. And winged scapula is right, they have interns/residents by the short and curlies. There is nothing you can do to fight this (yeah, you can report hour violation and invite closure of your residency). If you stick your head up to complain, they will chop it off, and you will have no recourse. Your career, (student loans and literal blood sweat and tears) will be all for nought. Residency is indentured servitude with blessings from the government.

Hang in there. Once you are done, you will be free of the petty tirany of residency and on to the petty tirany (which you can actually fight) of the insurance companies.

 

[GoodMonkey]

Almost all of us feel like used up abused pieces of crap this time of year. I actually think it's normal.

Think of it this way: you're over halfway done. And it sounds like in your program there's a big discrepancy b/t interns and residents. In 5 short months you'll be one those residents and not an intern anymore.

Don't take this stuff personally-it's not.

and, the important thing, as mentioned abouve, is that when you are the resident and no longer the intern, remember what it was like to feel so stepped-upon and abused. and then try your hardest not to do that in turn to your interns.

 

[Blade28]

Can someone explain to me why you guys put up with being treated like crap?

Why are physicians so spineless when it comes to overt abuse? Stand up for yourself, man. Or better yet, just document and go to the RRC and tell them about the work hour violations.

You'll find that in residency, complaining when something is amiss sounds a lot easier than it really is.

Besides the possibility of putting your program on probation (because you were trying to effect change that would end workweek hour violations, etc.) - and thus jeopardizing your residency training - there's the very distinct possibility of getting blacklisted or labelled as a "whistleblower."

Don't think that there's a way to do all this anonymously.

 

[DrDawg]

Only advice I could add is to lookout for your fellow interns. Your in it together. Socialize with them outside of the hospital, and bitch about your chiefs over beer. Sending funny text pages to each other can occasionally make the day go by. And remember that "whatever intern wrote this note didn't bother to ..." generally comes across as they didn't do this, but I didn't do anything.

 

[Doowai]

I feel for ya. I decided to take a prematch offer - the location is far from my favorite, and the program does not seem to support the residents too much. My first choice was a program in a location I loved, where I already knew alot of people, and all the residents and a former classmate spoke so highly of how much the program director took care of the residents. Like the others one can bit the bullet and just get through the damn thing, and then look back and feel better about it.

 

[swpm]

Aren't you glad it's a leap year, and you get an extra whole day of internship?

 

[GoodMonkey]

Aren't you glad it's a leap year, and you get an extra whole day of internship?

BALLS! you just ruined my night.

 

[sunlioness]

BALLS! you just ruined my night.

*laugh* I think maybe the highlight of my intern year (also in internal medicine) was being on call the night the clocks "sprung forward". An hour less of call was the most beautiful gift imaginable.

 

[DrDawg]

Thought of another way to win you chiefs over...
Some in medicine argue that there is no free lunch. I'm sure you heard the expression. Next time you see your senior in the cafe buy him lunch he will feel so indebted to you he'll be sending you home early, and decrease your call load. Or the next time he or she needs a pen you can give him one, and he/she can think pleasant thoughts about how super you are while he plays soduko. Then on round he will be signing your praises, while you secretely call him your b****. Works best if you get pens with your name on them though.

 

[typeB-md]

Thanks for the encouragement... I'm going to make a point NOT to treat the new interns this way next year.

TypeB-md-- Winged Scapula has it right, there is no way I would bring up these concerns in public. It wouldn't do any good -- just another whiney, lazy intern trying to get out of work-- and it would mark me as a complainer. As much as I hate this, I don't want to enter the match again and risk repeating intern year to get out of it. I can barely hold my wits together as it is (the other morning I left the house with 2 different socks on and didn't notice till 4 PM), and can't imagine taking on a project like finding a new program or fighting the work hours. As an example, I filled out the work hours the other day and lied about it again, becuase it's better than what I imagine might ensue if I recorded them accurately:

Me: "Hello Dr. Chief. So what's this meeting about?"
Evil chief: "you're over your work hours again."
Me: "oh really? Maybe that's because I've had exactly 4 days off in the last 2 1/2 months"
Evil chief: "no, I think it's because you're inefficient. No one else goes over their work hours. I think you should be on probation until you learn to manage your time."

See, it's not a tough choice. Like winged scapula said, they have us by the nads and they know it. It's like indentured servitide, only we admit patients instead of pick crops.

As I said, it's a matter of being timid and afraid. We allow it to continue because we fear the consequences more than the mistreatment.

And I find it hilarious how anyone who questions "the man" is automatically called a whistleblower et al. George Orwell anybody?

Now if you all would please excuse me, I have to get back to working for the Ministry of Enlightenment.

 

[Annette]

As I said, it's a matter of being timid and afraid. We allow it to continue because we fear the consequences more than the mistreatment.

Damn right! Think about it- college and medical school, $$$$$ in debt (and the only hope of paying it off is getting an appropriately paying job), plus alot of personal and family time lost. Are you going to throw it all away because you complain about mistreatment for 1-7 years of your life? And you will be throwing away your career by whilstle blowing, make no doubt about that. For most of us, the price is too high.

Hmmm. You don't seem too threatened. Where are you in your training?

 

[typeB-md]

Damn right! Think about it- college and medical school, $$$$$ in debt (and the only hope of paying it off is getting an appropriately paying job), plus alot of personal and family time lost. Are you going to throw it all away because you complain about mistreatment for 1-7 years of your life? And you will be throwing away your career by whilstle blowing, make no doubt about that. For most of us, the price is too high.

Hmmm. You don't seem too threatened. Where are you in your training?

MS4... and i'm going for psychiatry. We tend to be a more sedate bunch.

And it's not only the practice of mistreatment, it's that nobody can really justify its necessity. On the other hand, there is no shortage of education literature to support that sufficient sleep is necessary for effective learning.

 

[Sweet Tea]

All I know is that I'm very, very tired.

 

[Hoo\/er]

I feel for ya man. It's the crap that you described that led me to ditch medicine right after I finished medical school. I saw it during my third year rotations and knew immediately that medicine could kiss my white ass.

I think this shirt spells it out rather nicely:

 

[xanthines]

I'm pretty sure this guywould tell you to just suck it up rather than risk losing your job. What the article glosses over is just how close he came to not finding a residency after blowing the whistle. He was pretty lucky to have some good friends in the right places willing to take him in. The abuse sucks but it's only temporary and not worth finishing a residency. You're just too vunlerable and powerless, which is probably why the abuse occurs.

Oh yeah, I'm pretty sure pysch still requires that intern year too, so watch your back.

-X

As I said, it's a matter of being timid and afraid. We allow it to continue because we fear the consequences more than the mistreatment.

And I find it hilarious how anyone who questions "the man" is automatically called a whistleblower et al. George Orwell anybody?

Now if you all would please excuse me, I have to get back to working for the Ministry of Enlightenment.

 

[sunlioness]

Oh yeah, I'm pretty sure pysch still requires that intern year too, so watch your back.

-X

Psych doesn't require a prelim year anymore. You match directly to psych these days. Unless you're like me and thought you actually wanted to do medicine first before seeing the light.

 

[xanthines]

I stand corrected. Awesome!

-X

Psych doesn't require a prelim year anymore. You match directly to psych these days. Unless you're like me and thought you actually wanted to do medicine first before seeing the light.

 

[Annette]

And it's not only the practice of mistreatment, it's that nobody can really justify its necessity. On the other hand, there is no shortage of education literature to support that sufficient sleep is necessary for effective learning.

You are talking about what is right, not what is reality.

I got into alot of trouble because I was a whistle blower- I pointed out to the CEO of the hospital that the staffing in the ICU wasn't safe. Part of my "punishment" was to give a presentation on "Professional" behavior. I turned it around and looked at what residents face. The program director only yawned.