Is this all worth it? Really.

[LadyWolverine]

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I don't understand how all of the M1s can realistically chime in about how it's "worth it" - even the non-trads. Having a year or 2 (or 5, like me) of "real life experience doesn't qualify you to comment on how much better being a doctor is than your old job. You haven't really experienced clinical medicine yet.

Wait until you get to 3rd and 4th year - you will begin to understand how medicine/surgery is truly practiced in this country. You will start to see how much futile, pointless care is delivered. You will realize how insignificant a lot of what you do from day-to-day really is. You will start to resent the people who abuse the system - there are a lot of them. You will get frustrated with how much oversight and encroachment and paperwork there is. And it will eventually dawn on you how memorization of patterns, algorithms, and protocols has become the practice of modern medicine, and not the critical thinking and basic science skills that you developed in medical school. If you have a soul, it will be sucked away piece by piece by the people who refuse to take any part in their care or responsibility for themselves and waste your skills and valuable resources. This is true of every single specialty that has direct patient care (which is most of them).

This is what most people mean when they tell you it's not "worth it." Listen to those who have been there, and heed their words, no matter how starry-eyed you get during your qweekly clinical skills course.

And to the person who commented about 4th year being a cakewalk - it's not. When you're not on sub-internships, away rotations, time-consuming electives on consult services, or out in the middle of nowhere doing your required rural medicine rotations, you're filling out your ERAS application, interviewing at programs, and studying for Step 2 CK and CS. I bought into the "4th year is a vacation" mentality early on in med school, and now I'm realizing that it just ain't true. If anything, you'll have *more* responsibility on your rotations, because now you actually know how the process works.

 

[Trismegistus4]

It sure is worth it. I spent years working in offices, in IT, in landscaping, and other jobs - and being a medical student is far more enjoyable in all respects.

Well, de gustibus non est disputandum. To anyone for whom the primary reason you're going into medicine is simply that you really like medicine, I say: more power to you. My warnings are intended for those who (no matter what they may be telling themselves or others) deep down are doing it primarily for some secondary benefit.

Also, for one med. student here in particular, it seems you need to find some serious play time. You need to just spend some time being a kid again. You seem older (in the sense of being miserable rather than an issue of mere age) than some 70 and 80 year olds I know.

I don't know why one wouldn't direct one's statements to their intended subject by name, especially on an anonymous message board, but if you're talking to me, I know what you're saying, but it's easier said than done when you have the travails of medical school constantly hanging over your head. Of course, since I'm taking Step I this week, I've been doubly unhappy recently.

Wait until you get to 3rd and 4th year - you will begin to understand how medicine/surgery is truly practiced in this country. You will start to see how much futile, pointless care is delivered. You will realize how insignificant a lot of what you do from day-to-day really is. You will start to resent the people who abuse the system - there are a lot of them. You will get frustrated with how much oversight and encroachment and paperwork there is. And it will eventually dawn on you how memorization of patterns, algorithms, and protocols has become the practice of modern medicine, and not the critical thinking and basic science skills that you developed in medical school. If you have a soul, it will be sucked away piece by piece by the people who refuse to take any part in their care or responsibility for themselves and waste your skills and valuable resources. This is true of every single specialty that has direct patient care (which is most of them).

This is what most people mean when they tell you it's not "worth it." Listen to those who have been there, and heed their words, no matter how starry-eyed you get during your qweekly clinical skills course.

I don't understand the point of this argument. You're basically saying "if you have not experienced clinical medicine yet, you can't say it's not worth it, because once you experience clinical medicine you will encounter even more reasons why it's not worth it." That may be true, but if those reasons are only going to confirm their view that it's not worth it, this doesn't negate their current view that it's not worth it. Besides, there are other reasons to dislike medicine besides the typical "your starry-eyed idealism gets shattered when you realize you don't really get to help people all that much" trope. Some of us never had that starry-eyed idealism in the first place but thought we were going to like medicine for other reasons, and have still been disappointed.

 

[oldbearprofessor]

And it will eventually dawn on you how memorization of patterns, algorithms, and protocols has become the practice of modern medicine, and not the critical thinking and basic science skills that you developed in medical school. If you have a soul, it will be sucked away piece by piece by the people who refuse to take any part in their care or responsibility for themselves and waste your skills and valuable resources. This is true of every single specialty that has direct patient care (which is most of them).

With all due respect, I strongly disagree that this is true of neonatal intensive care, which is my specialty.

1. My patients are not responsible for their disease. For the most part, neither were their parents. However, even in the small number of cases where some might blame the parents, the child is not at fault.

2. I just finished working all night. I took care of multiple patients with inborn errors of metabolism which I won't list for patient confidentiality reasons. I spent time with several services going over basic metabolic pathways. This happens regularly.

3. Although when I rounded I used protocols to manage some patients, most of the patients had unique issues requiring me to evaluate how to fit them within or outside of the protocol. The decision to stick to protocols or deviate was entirely mine. Difficult and complex decision making is standard in my business. Actually, the use of protocols in neonatal intensive care has been proven to improve certain outcomes. I even write some of these protocols.

4. I believe I have a soul and 20 years as an attending has not sucked out any of it.

Of course, you may understand me and my specialty better than I do. After all, I'm silly enough to love my job despite working all-night shifts for my entire career.

 

[devilpup]

Me too, and what's so frustrating is that back when I was deciding to go to medical school and people said this kind of thing, my reponse was "no, you don't understand, I have that job, but it's soooooooooooo stressful, my boss doesn't like me and thinks I'm a slacker, I could get fired anytime; medicine is MUCH better because there I'll at least make $250k/year, have 100% job stability, and all the chicks will dig me."

Well sir, you have come a long way. Otherwise, you'd still be a tool.

 

[LadyWolverine]

I believe I have a soul and 20 years as an attending has not sucked out any of it.

obp, I humbly defer to your vastly more significant experience and I only hope that, in 20 years, I feel the same way that you do now. You have clearly picked the right specialty to match your personality. My observation over the past couple of years has been that it is diificult to feel like you are truly making a difference in many specialties, and that eventually wears on you. I did not feel this way about pediatrics, which I probably should have qualified when I posted my original statement. I was speaking mainly about adult medicine. That said, I'm sure that there are still many physicians in other specialties who would also disagree with me. Unfortunately, I think that a significant portion of my outlook can be attributed to the location of my clinical training sites, and by the fact that I sometimes become very frustated by the preventable problems and patient attitutdes that I encounter. Thank you for the concrete examples - especially #2 and 3. It gives me hope.

 

[oldbearprofessor]

obp, I humbly defer to your vastly more significant experience and I only hope that, in 20 years, I feel the same way that you do now. You have clearly picked the right specialty to match your personality. My observation over the past couple of years has been that it is diificult to feel like you are truly making a difference in many specialties, and that eventually wears on you. I did not feel this way about pediatrics, which I probably should have qualified when I posted my original statement. I was speaking mainly about adult medicine. That said, I'm sure that there are still many physicians in other specialties who would also disagree with me. Unfortunately, I think that a significant portion of my outlook can be attributed to the location of my clinical training sites, and by the fact that I sometimes become very frustated by the preventable problems and patient attitutdes that I encounter. Thank you for the concrete examples - especially #2 and 3. It gives me hope.

Thank you for a nice post in response. One of my pet peeves is med students and even residents complaining that they are forced into clinical protocols. I understand the complaint and there is absolutely no doubt that sometimes these protocols can be overwhelming and excessively restrictive. However, in recent years, having been involved in many local, national and global training programs in my field, I've come to understand protocols/care pathways a bit differently.

When properly written, they are very helpful and do not limit you excessively. Let me give you a specific example from neonatology. We have protocols in place for the management of common problems and even very complex problems such as diaphragmatic hernias. Why would you want a protocol for something like a diaphragmatic hernia? Well, if everyone approaches the ventilation and delivery room management the same, the chances that a timely decision on ECMO vs non-ECMO can be rationally made is much better. Before the use of protocols, every doc and every shift would change vent settings, fluids and have a different standard for ECMO. Using the literature to set a protocol has vastly improved the flow of care.

Now, for sure some babies don't follow that protocol. Some babies don't fit into an easily defined ECMO/no-ECMO box. The protocol hardly has kept us from being up all night deciding how to handle blood gasses, electrolytes, etc. But it has given us a basic direction and led to confidence that what we decide today will not be reversed tomorrow (well, usually...). This is much better for families too.

I'm not sure if this makes sense, but hopefully it does in some way. It becomes clearer as training progresses. Interestingly, it is those attendings who deviate the most from care pathways that frustrate the residents and fellows. In my experience, those who persistently find excuses to avoid doing what is part of the usual approach are not brilliant docs with unique insights.....Maybe I should watch more TV docs?

Hope this helps.