least hierarchical field in medicine?

[dunkindona]

For those of you who have done all three of these rotations and/or are currently practicing in these fields, of radiology, neurology, and ophthalmology, which would you say is the least hierarchical?

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[Docxter]

For those of you who have done all three of these rotations and/or are currently practicing in these fields, of radiology, neurology, and ophthalmology, which would you say is the least hierarchical?

Radiology, by far. In my program there was no hierarchy.

 

[f_w]

When, in residency ?

 

[dunkindona]

as a med student, in residency, and as an attending. i am trying to avoid hierarchy.

 

[f_w]

as a med student,

Well, as a medstudent you are kind of useless in a radiology department. It is not like on the floors where you can be used to do scut, all you are is something that potentially stands between the resident and his lunch (by slowing him down to a point that he doesn't make it out). So, while most residents tend to be polite about it, don't try to be a smart-a## by asking large numbers of questions.

in residency,

There tends to be little hierarchy. Yes, you will have chief residents (third or fourth years) who make the schedules and often have first picks for vacation and holidays. But the way how rads works, you rarely have a junior resident working 'under' a senior.
Also, 2nd and 3rd year residents tend to take the majority of call. 1st years can't take call alone (up from 6mo in the past), 4th years often get relief from call so they can prepare more efficiently for the oral boards.

and as an attending.

In academia, depending on the institution, there tends to be quite a bit of hierarchy. Most departments have an elite caste of tenured 'name' academicians who don't do actual work but rather travel from conference to conferenc, investigators meeting to investigators meeting etc. Then there are the 'worker bees', often 'clinical' track faculty that is mostly employed to get the work done (and produce money so the academic types don't have to starve).
In PP there is little hierarchy. Nobody tells you HOW to do your job. Someone might be in control of what 'slots' you have to fill and you might not have much say in the business affairs of the group, but overall radiology groups value equity (a common salary structure in radiology groups is that everyone takes home the same at the end of the year, regardless of services billed and time spent at work).

i am trying to avoid hierarchy.

I wonder whether medicine as a whole is going to offer you that.

 

[driedcaribou]

as a med student, in residency, and as an attending. i am trying to avoid hierarchy.

All jobs have a hierarchy. Heck, life is a hierachy. Get used to it.

 

[dunkindona]

oh, but some fields and professions are so much worse than others about this. for example, in general, i think that science tends to be less stratified...

 

[driedcaribou]

oh, but some fields and professions are so much worse than others about this. for example, in general, i think that science tends to be less stratified...

Politcally, science is one of the roughest fields to be in.

The money isn't there like medicine and it can be difficult to obtain funding.

The hierarchy might not be as immediately obvious... but it's there.

 

[Dr. Dukes]

oh, but some fields and professions are so much worse than others about this. for example, in general, i think that science tends to be less stratified...

Nope.
In science the strata comes in several different types.
1) Where are you in your education (undergrad, MS candidate, PhD candidate, Post-Doc). As you advance up this ladder you have to put up with less stupid stuff and get to do more real stuff.
2) Where you work (Private research university, public research university, private liberal arts school). Again, where you work depends a lot on how much grant money you will get. The NIH has a section on all of its grants that asks about institutional support. Obviously, if you're at Harvard you have more institutional support (smart people around you who can help with this technique or that experiment) than you do if you're at a small school like Bates or Bowdoin.
3) What your title is (Instructor, Assistant Prof, Associate Prof, Prof, Names Prof). Your title not only controls your salary, but it controls how easy it is to get Post-Docs and grad students (who actually do your work) and therefore controls how much you publish and how you get promoted.

So yeah, science has tons of heirarchy.

 

[driedcaribou]

than you do if you're at a small school like Bates or Bowdoin.

Where?
lol

Good reply though. Couldn't have said it better myself.

dunkindona, are you worried about taking orders?

 

[dunkindona]

I understand that there is plenty of structure to how you train, funding, and tenure in science. On the other hand, I have never felt as much collegiality in medicine as I have in science. Of course, I know this really can depend on the field and on the particular lab.

What bothers me about hierarchy in medicine is that it supports a culture of exclusion/silence/resentment and does not in my opinion facilitate learning. On the other hand, perhaps hierarchy is required in a profession where someone needs to be ultimately responsible for critical decisions made about patient care. .

 

[adismo]

You're born, you take ****. You get out in the world, you take more ****. You climb a little higher, you take less ****. Till one day you're up in the rarefied atmosphere and you've forgotten what **** even looks like. Welcome to the layer cake son.


-Eddie Temple. Layer Cake.