M4's are mean

[nightowl]

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So, I was studying today, the second to last day of my test week, I'm drained, I'm tired, and in walks an M4. She is chatting with another M4 whose sitting toward the front of the room, and they're discussing what they're specializing in. She's doing internal medicine. So going against my hesitance, I ask her when she knew that was what she wanted to do? She says she originally thought OB, hated it, thought about med/peds, hated it, and then she ended up loving medicine as an M3. Then she asks me what I'm thinking? I say I don't know, I'm undecided, but that I know I'd like to do something that allows me to have a life outside of work. I was thinking in terms of like, as a woman, I'd like to have some kids and know what they look like. I want to be able to work hard and love what I do, but that not be ALL I do. So, she replies, well you need to do radiology or anesthesia. Well, that's not what I meant, I didn't say I wanted a LIFESTYLE specialty- I don't mind working more than 40 hours a week- I just meant you know, not neurosurgery or something. So, I reply, well I know I'd like to work with patients, I was thinking maybe primary care. And she snaps back, well primary care you are working your tail off. And then looks at me like I'm too lazy to want to actually work at my job.

well, thanks. I think people forget what it's like to go through this or something. I just wanted to have a pleasant conversation with someone whose actually past the first two years and doing primary care. Ah well.

 

[SoCuteMD]

Oh, chica. Just wait until day 3 of your first rotation on the floor. You'll see what the "mean" M4 meant.

- Cranky M3

 

[ranmyaku]

Sounded like a reasonable response to me.

 

[smq123]

So, I was studying today, the second to last day of my test week, I'm drained, I'm tired, and in walks an M4. She is chatting with another M4 whose sitting toward the front of the room, and they're discussing what they're specializing in. She's doing internal medicine. So going against my hesitance, I ask her when she knew that was what she wanted to do? She says she originally thought OB, hated it, thought about med/peds, hated it, and then she ended up loving medicine as an M3. Then she asks me what I'm thinking? I say I don't know, I'm undecided, but that I know I'd like to do something that allows me to have a life outside of work. I was thinking in terms of like, as a woman, I'd like to have some kids and know what they look like. I want to be able to work hard and love what I do, but that not be ALL I do. So, she replies, well you need to do radiology or anesthesia. Well, that's not what I meant, I didn't say I wanted a LIFESTYLE specialty- I don't mind working more than 40 hours a week- I just meant you know, not neurosurgery or something. So, I reply, well I know I'd like to work with patients, I was thinking maybe primary care. And she snaps back, well primary care you are working your tail off. And then looks at me like I'm too lazy to want to actually work at my job.

well, thanks. I think people forget what it's like to go through this or something. I just wanted to have a pleasant conversation with someone whose actually past the first two years and doing primary care. Ah well.

A better way to phrase the question would probably have been to ask, "What specialties do you think are family-friendly?" By phrasing it the way that you did, you may have made it seem like you were asking for lifestyle specialties.

She probably snapped at you because she felt that YOU were making mean insinuations about HER career choice. One of the things that I hate about 3rd year is that everyone who is NOT in a lifestyle specialty gives you a hard time if you want to go into one. Everyone who IS in a lifestyle specialty will tease you mercilessly if you want to go into surgery or OB. It's annoying, so whenever anyone asks about lifestyle specialties, I also get unnecessarily cranky - much like the MS4 that you talked to. I'd rather just avoid that whole conversation all together.

Sorry that the MS4 snapped at you. To look on the bright side, now you won't be so taken aback the first time your resident snaps at you/curses at you/snaps his fingers in your face/kicks your shin to get you to move.

If you're interested in primary care, PM me. I was really involved with primary care interest groups during my first 2 years of med school.

 

[LuckyBambooGirl]

Med school in general makes you mean. Just wait until you've gone through a few more semesters and you'll see what I'm talking about....

 

[Law2Doc]

I didn't say I wanted a LIFESTYLE specialty- I don't mind working more than 40 hours a week- I just meant you know, not neurosurgery or something.

Just FYI, most of those lifestyle specialties still work well over 40 hours per week (both radiology and anesthesiology average in the 60 hour per week range), so that 40 hour number shouldn't even be in your mind. 40 hours a week is not a figure that relates to professions -- that is for 9 to 5ers.

These days primary care tends to mean longer hours at lower pay, thanks to the way reimbursements work, so I could see someone getting hostile at a suggestion that they are somehow doing a less intense path. That may not be what you meant to say, but might have been how it was taken.

 

[Tired]

Well, that's not what I meant, I didn't say I wanted a LIFESTYLE specialty- I don't mind working more than 40 hours a week- I just meant you know, not neurosurgery or something. So, I reply, well I know I'd like to work with patients, I was thinking maybe primary care. And she snaps back, well primary care you are working your tail off. And then looks at me like I'm too lazy to want to actually work at my job.

The problem wasn't that she was mean, the problem was that you inadvertently insulted her chosen specialty by implying that it was "easy" or that you don't have to work that hard in it. Understand that she probably endures endless comments from her surgically-oriented colleagues about how she's taking the "easy way out". Your comments, while intended to be innocuous, were probably taken by her as offensive.

 

[45408]

Just FYI, most of those lifestyle specialties still work well over 40 hours per week (both radiology and anesthesiology average in the 60 hour per week range), so that 40 hour number shouldn't even be in your mind. 40 hours a week is not a figure that relates to professions -- that is for 9 to 5ers.

As always, I'd say it depends on your goals, location, and desired income. Move away from the big city, and your practice may become more or less busy, depending what it is that you do. The anesthesiologist I know who is in a big city works a lot - he starts at 60 hours and hopes it doesn't go up from there. Then I know another one who is in a rural area and making money hand over fist as he works a max of 40 hours a week.

Go into emergency medicine, and you won't have to worry about working any more than what you're scheduled for. A senior attending I know works maybe 3-4 shifts a week (none are 3rd shift, and none over 8 hours), but she does administrative things as well.

 

[WiscDoc]

I shadowed an orthopedist who said he only works three and a half days a week and had the rest off. He mainly does minimally invasive surgeries (among other "general ortho stuff"), and works in private practice with partners. He graduated med school in 1999, so he's not nearly old enough to be retiring. His work days are 8-5ish. "little call," as he described it. Thoughts? Is he just making less money in return for the comfier life, or what is the deal?

 

[Long Dong]

She snapped back at you because she is so tired and hasn't had much sleep, probaby doing sub-I now and working her butt off to impress people. People get that way when they've had 4hours of sleep a night for the past couple of months and some nights no sleep at all. I'm a little snappy now to my S.O. cause of that same reason now that I'm on ICU. Man I can't wait until internship is over.

 

[Law2Doc]

I shadowed an orthopedist who said he only works three and a half days a week and had the rest off. He mainly does minimally invasive surgeries (among other "general ortho stuff"), and works in private practice with partners. He graduated med school in 1999, so he's not nearly old enough to be retiring. His work days are 8-5ish. "little call," as he described it. Thoughts? Is he just making less money in return for the comfier life, or what is the deal?

The orthopods I know are all working closer to 70 hours a week. Few surgical fields start at 8 am so most likely you'll find such folks with 5 to 5ish hours, not 8 to 5. Because of the way physicians are paid these days (through insurance reimbursements), if you see fewer patients, you generate less income for the partnership and they are likely to want to pay you less. So if you cut a deal to work fewer hours, it is usually going to be at a lot less salary.

 

[SalseraDoctora]

Sounds as though we have all chosen a career path designed specifically to suck all of the idealism and goodwill toward mankind out of us. What could the solution be? More doctors so our shifts can all be shorter? Would we all get paid half as much though?

I am already feeling pissed off and I am just in month two of my first year. I love all my non-trad education and all the skills I accumulated outside of science as a non-science major, but man I am feeling bitter at the moment and pretty envious of my classmates who all majored in immunology and neuroscience. How easy must med school be when you are learning this all for the second time?

Also, we all talk about how important patient-doctor relationships are and how vital to the patients' health good communication and trust are, but you don't see too many awards being given out for "Nicest Doctor in America" or "Most Well-Rounded Surgeon." The medical field doesn't seem to give a rat's ***, when the chips are down, about how much your patients love you, and lord knows that doesn't translate into better grades or more prestigious careers either. Or if it does it is only because you are a genius Harvard/Hopkins MD/PhD AND you happen to be nice to people also.

I like people, and I try to be nice to people both because it makes me happy and because I genuinely think it does translate into better health. But for that competitive side of me that is getting beaten up pretty badly in med school I guess what I am saying is that if karma really exists then I want a tangible display of it, dammit. 😡

 

[Tired]

Sounds as though we have all chosen a career path designed specifically to suck all of the idealism and goodwill toward mankind out of us. What could the solution be? More doctors so our shifts can all be shorter? Would we all get paid half as much though?

What's a "shift"?

Seriously, if you want great hours, a career filled with compassion and idealism, and decent pay, you should have gone to nursing school.

Medicine is a hard-nosed business because ultimately we bear all responsibility for what happens to our patients. After training, you are where the buck stops, you have to make the hard choices, you have to explain all the bad things that can and do happen, and when **** goes down it's your name in the papers and on the lawsuit.

We get pushed in training for the same reasons the Marines do in boot camp: the harder you train, the better prepared you are for the real thing.

 

[SalseraDoctora]

I bet there are a zillion nurses who would disagree with this assessment.

And I am not whining for the sake of whining (okay maybe I am a little). But a much more serious point is that the grind really does affect our ability to provide the best care to our patients, and I don't think that can be disputed. Also everything about your post (your screen name, your attitude about compassion, etc.) confirms what I was saying earlier. THIS IS NOT A CRITICISM OF YOU. It is just a criticism of the system.

 

[ZagDoc]

What's a "shift"?

Seriously, if you want great hours, a career filled with compassion and idealism, and decent pay, you should have gone to nursing school.

Medicine is a hard-nosed business because ultimately we bear all responsibility for what happens to our patients. After training, you are where the buck stops, you have to make the hard choices, you have to explain all the bad things that can and do happen, and when **** goes down it's your name in the papers and on the lawsuit.

We get pushed in training for the same reasons the Marines do in boot camp: the harder you train, the better prepared you are for the real thing.

I agree with the assessment.

It's the nature of the beast. It's that way going in, it's that way coming out. With the burden of the baby boomers coming on and the climate of this nation's health insurance, things aren't going to change. Changes will come but nothing that will drastically change the demands on physicians.

 

[CycleCA]

Seriously, if you want great hours, a career filled with compassion and idealism, and decent pay, you should have gone to nursing school.

Hahahaha, yeah right

👎

 

[Northerner]

There's a whole new level of "tired" med school forces you to appreciate. I like to think Tired's name is derived from that.

 

[45408]

There's a whole new level of "tired" med school forces you to appreciate. I like to think Tired's name is derived from that.

That reminds me, I should go to bed now...

 

[deleted77919]

More doctors so our shifts can all be shorter? Would we all get paid half as much though?

For some fields the limiting factor to the number of qualified physicians is the training fodder. Take neurosurgery for example, there aren't enough procedures to go around to double the number of neurosurgeons we have (unless we cut our standards in half). Thus for every one trained society needs to maximize the work that we get out of him/her. Further once in practice it's important to keep those skills up. Again, how many craniotomies is enough? I'm not certain, but some people with a lot more training than I decided to set a pretty high standard. Would you really want neurosurgeons to have more family time and right before removing a barely operable tumor from your brainstem say "Well, I've never done this myself, but I saw someone do something similar on a training simulator way back in residency. But at least I'm home by 5 every night."

Admittedly this is not the case for all fields, but for some it's definitely true.

 

[sendwich]

Med school in general makes you mean. Just wait until you've gone through a few more semesters and you'll see what I'm talking about....

i'm an M1, and i'm already there 🙁

does this mean i'll get even meaner?

 

[45408]

Would you really want neurosurgeons to have more family time and right before removing a barely operable tumor from your brainstem say "Well, I've never done this myself, but I saw someone do something similar on a training simulator way back in residency. But at least I'm home by 5 every night.".

🙄 No, but I wouldn't mind if my neurosurgeon hadn't just been up all night working on a pt with a GSW to the head, right before he got to my brain tumor.

 

[erin682]

How about not generalizing all M4's by one negative encounter you had with one M4 who may well have just been having a bad day.

 

[urgentcase]

So, I was studying today, the second to last day of my test week, I'm drained, I'm tired, and in walks an M4. She is chatting with another M4 whose sitting toward the front of the room, and they're discussing what they're specializing in. She's doing internal medicine. So going against my hesitance, I ask her when she knew that was what she wanted to do? She says she originally thought OB, hated it, thought about med/peds, hated it, and then she ended up loving medicine as an M3. Then she asks me what I'm thinking? I say I don't know, I'm undecided, but that I know I'd like to do something that allows me to have a life outside of work. I was thinking in terms of like, as a woman, I'd like to have some kids and know what they look like. I want to be able to work hard and love what I do, but that not be ALL I do. So, she replies, well you need to do radiology or anesthesia. Well, that's not what I meant, I didn't say I wanted a LIFESTYLE specialty- I don't mind working more than 40 hours a week- I just meant you know, not neurosurgery or something. So, I reply, well I know I'd like to work with patients, I was thinking maybe primary care. And she snaps back, well primary care you are working your tail off. And then looks at me like I'm too lazy to want to actually work at my job.

well, thanks. I think people forget what it's like to go through this or something. I just wanted to have a pleasant conversation with someone whose actually past the first two years and doing primary care. Ah well.

you can still go into primary care and have a 9-5 job if you work in the clinic. However your pay will be that of an executive office worker. Some people like myself don't care b/c I am not doing this for the money, but many medical students get this "entitlement" syndrome that just b/c we put in an extra 4 years we are entitled to a 6 figure income. If you ask me this is just another profession nothing that special. People do this for the same reasons that they become engineers and programmers and scientists. However if you want to make a buck you will work your tuxus off no matter what field you go into, b/c having your own business in the US means long hours and unlimited compensation potential whether you own a fast food restaurant a grocery store or a medical office.

 

[PeepshowJohnny]

you can still go into primary care and have a 9-5 job if you work in the clinic. However your pay will be that of an executive office worker. Some people like myself don't care b/c I am not doing this for the money, but many medical students get this "entitlement" syndrome that just b/c we put in an extra 4 years we are entitled to a 6 figure income. If you ask me this is just another profession nothing that special. People do this for the same reasons that they become engineers and programmers and scientists. However if you want to make a buck you will work your tuxus off no matter what field you go into, b/c having your own business in the US means long hours and unlimited compensation potential whether you own a fast food restaurant a grocery store or a medical office.

Extra four years? I don't expect to be paid more.
Extra four years of mentally taxing work? I expect my pay to be a bit higher.
Extra for years of mentally taxing work with a quarter of a million dollars in the debt at the end? I expect to get paid far out the ass.

 

[Northerner]

you can still go into primary care and have a 9-5 job if you work in the clinic. However your pay will be that of an executive office worker. Some people like myself don't care b/c I am not doing this for the money, but many medical students get this "entitlement" syndrome that just b/c we put in an extra 4 years we are entitled to a 6 figure income. If you ask me this is just another profession nothing that special. People do this for the same reasons that they become engineers and programmers and scientists. However if you want to make a buck you will work your tuxus off no matter what field you go into, b/c having your own business in the US means long hours and unlimited compensation potential whether you own a fast food restaurant a grocery store or a medical office.

The smart money says you won't be going into medicine at all.

It's priceless, by the way, that you're calling medical students bearing $1/4 million in educational debt looking forward to minimum wage residency salary upon graduation "entitlement" syndrome for wanting to eventually make a comfortable living when most of your posts blame your medical school for trying to screw you over at every turn and that it's your God-given right to practice medicine regardless of their evaluation of your competency & professionalism....

 

[smq123]

Sounds as though we have all chosen a career path designed specifically to suck all of the idealism and goodwill toward mankind out of us. What could the solution be?

Find med students who had already gotten a good dose of realism, and didn't have such an idealistic view of medicine to begin with.

Honestly, most doctors and med students are really nice. Just don't look like you're trying to question (or mentally smirking at) their career choices - I know that you weren't; just be careful that you don't give them the wrong impression that you are. They get enough of it from everyone else, they don't need it from you too.

 

[SalseraDoctora]

This thread makes me go like this 🙄

I think we are all misunderstanding each other and unintentionally offending each other, and it is clear that we are all just stressed out and I am sure in the real world, with enough sleep, we would all get along just fine.

You are right, I wasn't questioning anybody's choice, including mine, and I appreciate your niceness in mentioning the way my comments could be misconstrued and giving me the benefit of the doubt. Speaking of niceness, it seems unnecessarily mean for some people to be telling other posters that they shouldn't go into medicine based on three sentences they wrote on this forum. Why go for the jugular like that? It seems pretty nasty to me.

This will be my last posting on the subject, but ultimately my point is just that I don't think medicine should have to be a contest about who can sleep the least, work the most, have the most atrophied personal life, and be the biggest martyr, and I hope I can find a way to be an excellent physician without losing the rest of my identity and happiness in the process.

The End.

 

[IHeartNerds]

I think most MS4s, like most MDs, have gotten past sugar-coating the truth and just tell everything like it is. Sadly, this is interpreted as rudeness in our happy-lovey American culture.

Me, I'm out for a lifestyle specialty like neurosurgery. Different lifestyle than derm, but a distinct lifestyle specialty nonetheless....

 

[medhacker]

Forget all the previous psychoanalysis

It is quite simple actually

She is wrong for snapping back

You are wrong for taking it so personal.


Certified! 😎



BTW if you think MIVs are mean, wait 'till you see some residents/fellows...

 

[smq123]

Me, I'm out for a lifestyle specialty like neurosurgery. Different lifestyle than derm, but a distinct lifestyle specialty nonetheless....

😕

 

[deleted77919]

😕

A neurosurgeon does have a lifestyle. The lifestyle happens to be working all the time, but it is indeed a lifestyle.

 

[IHeartNerds]

A neurosurgeon does have a lifestyle. The lifestyle happens to be working all the time, but it is indeed a lifestyle.

👍👍 So it is.

It just bothers me when people say "lifestyle" and correlate that to fewest-hours-possible. What if the lifestyle you want involves becoming a real-life Dr Cox with fewer alcohol problems and an OR?

 

[MrBurns10]

However if you want to make a buck you will work your tuxus off no matter what field you go into

I think you're totally right and a lot of med students forget this. Obviously we have to go to school longer than I think just about anyone (I'm including residency in this), but not all of medicine is 80 or even 60 hour work weeks and not all of the "outside world" is 40 hour work weeks. I know PLENTY of doctors who work 45 hours a week and make well into six-figures. It's all about choices and being wise businesspeople. If you want to work 80 hours a week and make $500,000 that's great...become a specialized surgeon. If you'd rather work 45 hours a week and make $250,000 that's great too, and completely possible if you choose the right field and make the right choices within said field. Not a whole lot of business owners/engineers/lawyers, etc. can say the same if they only work 40 hours a week...certainly not the majority.

 

[smq123]

A neurosurgeon does have a lifestyle. The lifestyle happens to be working all the time, but it is indeed a lifestyle.

👍👍 So it is.

It just bothers me when people say "lifestyle" and correlate that to fewest-hours-possible. What if the lifestyle you want involves becoming a real-life Dr Cox with fewer alcohol problems and an OR?

Ok. Point taken.

Just know that on the wards, your residents are explicitly talking about "fewest-hours-possible" when they're talking about "lifestyle specialties." If you stick to your own definition, your residents will either be horribly confused, or think that you're insane. (Probably both.)

 

[Law2Doc]

Just know that on the wards, your residents are explicitly talking about "fewest-hours-possible" when they're talking about "lifestyle specialties." If you stick to your own definition, your residents will either be horribly confused, or think that you're insane. (Probably both.)

Agreed. The phase "lifestyle" job/field/specialty, in all professions, not just medicine, is currently the pc way of saying a job that allows you to have a life outside of work. In law we had the big law firms, where you worked a ton, and the "lifestyle" friendly firms, where you could go home at 6 every day and not work weekends. So too in medicine the lifestyle fields tend to be those where you are working 60 hours/week with less call, as opposed to certain surgical fields where on bad weeks you can sometimes hit double that.
You have to go with the current lingo.

 

[TexasTriathlete]

To the OP: her response has nothing to do with the fact that she's an M4, and everything to do with the fact that she's a woman.

 

[smq123]

To the OP: her response has nothing to do with the fact that she's an M4, and everything to do with the fact that she's a woman.

Isn't the OP also a woman?

Your attempt at consoling the OP might not work out so well...

 

[TexasTriathlete]

I'm not consoling anyone. Just being right.

 

[Taciturngosamer]

That my friend is bull $#!t. No offense but comments like the above are not only outdated but completely juvenile.

And male M4s can be just as big of post call monsters as their female counterparts.

Finally, to the OP: the previously mentioned points are all good. Don't forget that as you progress through Med school you loose all that shiny optimism that made the selection committee pick you. As an M4 you are a completely different person than you were as an M1. Just consider it a pre exposure to the third year of medical school. Is that fair? Is that right? Nope, but it is reality and as you will hear throughout the next few years "Deal".

Plus you'd be cranky too if
a) you'd not been home in 36 hours
b) your interview applications are due
c)you've been yelled at for the third time this week because one of your M3s keeps forgetting to put a physical exam section in their progress notes (happens folks, it happens)
d) you are actually buying more underwear because you don't have time to do laundry
e) and a shower seems like your perfect definition of nirvana

 

[Lion-O]

one of your M3s

Your M3s?

Get. Over. Your. Self.

 

[sendwich]

That my friend is bull $#!t. No offense but comments like the above are not only outdated but completely juvenile.

And male M4s can be just as big of post call monsters as their female counterparts.

Finally, to the OP: the previously mentioned points are all good. Don't forget that as you progress through Med school you loose all that shiny optimism that made the selection committee pick you. As an M4 you are a completely different person than you were as an M1. Just consider it a pre exposure to the third year of medical school. Is that fair? Is that right? Nope, but it is reality and as you will hear throughout the next few years "Deal".

Plus you'd be cranky too if
a) you'd not been home in 36 hours
b) your interview applications are due
c)you've been yelled at for the third time this week because one of your M3s keeps forgetting to put a physical exam section in their progress notes (happens folks, it happens)
d) you are actually buying more underwear because you don't have time to do laundry
e) and a shower seems like your perfect definition of nirvana

i can't wait!
/sarcasm

 

[colbgw02]

c)you've been yelled at for the third time this week because one of your M3s keeps forgetting to put a physical exam section in their progress notes (happens folks, it happens)

Your M3s?

Get. Over. Your. Self.

Reminds of when I was an MS3 on Ob/Gyn. The sub-I thought that she was God's gift to the MS3s. Kept giving us advice like we gave a rat's ass. I think she ended up matching in East Timor, or something like that.

I eventually got fed up and told the nurses that the MS4 would prefer that she be addressed as "acting intern" Last Name. She had a pretty rough rotation after that.

 

[Taciturngosamer]

Your M3s?

Get. Over. Your. Self.

When I get b!tched at for every little thing someone else does and was held accountable for every freaking little mistake someone else did, I feel fine with the above pronoun. For the record I did not consider myself their tutor or their nanny. And furthermore, I never wanted it to be that way. It was just expected. So: Get. Over. It.

 

[Medikit]

At least she cares about your life. That's far more than I expect now days.