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Yeah, no. That will cause just as many problems as it is supposed to solve.
Non-trad medical students, residents and attendings, Was it worth it?
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it will cause many problems, or as bad and extensive problems as we have now? I don't think the number of problems is the issue. it's the lack of coverage for millions, too many people dying due to lack of coverage, too much paperwork, too many MBAs getting in between doctors and patients, too much out of pocket money being spent by patients, too many times doctors not getting paid, doctors spending too little time with patients,...... all the things the residents and attendings complained about.... those are the big problems we have now.
I think those are huge problems. A national program will solve many or most of them. What other problems it may cause, I think are minor in comparisson. nothing is perfect, but some things are much better than others.
QofQuimica
Seriously, dude, I think you're overreacting....
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Agree completely. Not that being a clinical med student is 100% fun and joy, but you get to have most of the pros of playing like you're a doctor while having no responsibility whatsoever. You can spend an hour talking to a patient, and no one cares that you're not being efficient. You can decide not to come in when you're sick (or if you just plain don't feel like coming in), and it doesn't inconvenience anyone else or leave your patients in the lurch because there's no one to cover for you. You get every major holiday off, including two weeks at Christmas/New Years. You get pulled in to see all the cool cases, and unless your residents are jacka**es, you get shielded from most of the BS scut. I never send my students in to see the borderline personality disorder patients who are allergic to everything except IV dilaudid, and are here yet again for their chronic back pain. When one of my seniors was being a jerk and making our student stay late every night for no good reason, I shamed him into sending the student "to the library to study" by mid-afternoon.If I could be an MS3 all over again, yeah, I'd do it. MS3 was awesome. You show up, you learn a ton, you see a bunch of cool things that most people will never see...it was great.
Being a "real doctor" took some of the fun out of things.
Once you're an intern, all of a sudden you "don't need" anyone to look out for you. It's ok to scut you out. There's no problem with having you work every single holiday in the calendar. You somehow cease to have human needs like eating lunch or using the bathroom. You have a job, and you can get fired. If that happens, you have no recourse, and your MD/DO is basically useless. Those of you who haven't done so yet should go to the Gen Res forum and read some of the threads by terminated residents. It will be a real eye-opener for you.
This I do agree with. The biggest upside of being a resident is that you *are* a doctor, and you're not just playing at being one any more. You actually do have some ability to help other people beyond sitting with them and talking for an hour.
Agree with this too.
And this.
And this.
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This reminded me of being a post-doc. You got to spend someone else's money while getting to play in the lab. Your lab wasn't counting on you to get the grants. Best time of my scientific career.
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This. Enough composure to do your job, but not be cold as stone. I just posted this quote on my facebook page actually. "Crying isn't a weakness. It's having enough strength to prove you're human." ~unknown
There was a memoir I read, called "On Call: A Doctor's Days and Nights in Residency" by Emily Transue with an excerpt that I really liked. One of the interns was talking about how she'd just been asked by a very terminal patient if she was going to make it to her wedding a few months later. She talked about how she jut made it out the door and broke into tears and someone on the team told her that if she was that thinned skinned, if she was going to let things get to her like that, she shouldn't be in medicine. She said, "If I ever stop letting things get to me, that's when I'll quit medicine." Apparently the chief psychiatry resident was sitting there listening, stood up and said, "That's the sanest thing I've heard all week." Good book btw.
I admire you guys for what you do and thanks for being honest about your experiences. I do find myself wondering how I'll fare sometimes with the BS.
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How frequently does this happen? I was told that in med school it's more dependent on one's attitude and willingness to work hard. Are you on more shakey ground as a resident? Is it much easier to slip and screw up and lose everything you've worked for? Or is it still a matter of attitude, hard work, and playing nice with your team? Thanks.
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A lot of it still is a matter of atitude and team playing. However, if you are a reckless resident and go into the residency years thinking "I know everything" and believe me there are those like that, you are setting yourself up for trouble. Any time a patient is in danger from a resident's negligence is a problem. Usually the first time the resident gets a warning and has to have all orders co-signed or checked by a higher level. There was a resident where I trained who was put on probation for almost killing a patient for giving too much potassium and was told he had to have everything co-signed for the duration. That resident didn't take the warning seriously and refused to "play by the rules". He almost killed a second patient and was fired from residency.
Getting through residency isn't that hard but ultimately you are learning on an attending's patient who is ultimately responsible for that individual. If the resident does anything that would jeopardize that patient or potentially cause grief/harm to the attending they will definitely be in front of the discipline committee pronto. If the committee feels you are a danger to the patients, they can and will dismiss you from the program.
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Ok then, sounds like it's still mostly within my own control. Thanks for the reassurance!
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Q, it's interesting that our positions have switched; when we were in med school, I was the one saying I wouldn't do it over, whereas now, in residency, while that's still true, I'm much more content, and you're posting in the non-trad forums saying you don't feel it's worth it.
Anyway, I like you, but I'm going to have to do a line-by-line...
The best part of all is that after next year, I'll be able to start moonlighting, and thus getting paid they way doctors should be paid... by the amount of work they do.
Anyway, I like you, but I'm going to have to do a line-by-line...
Disagree completely.
Not that being a resident is 100% fun and joy, but you're actually getting paid for doing real work that needs to be done, instead of getting endlessly pimped on topics you couldn't care less about, never being sure what your role is, switching to a new rotation as soon as you start to get the hang of how things work on the current one, feeling like an idiot as your resident sends you off on some task to deal with other hospital staff and you know they're thinking "oh, great, they only sent the medical student... can we get someone who actually knows what's going on?"
You have a legitimate excuse to cut off patients who'd talk indefinitely, because you've got work to do.
Cue Law2Doc coming in here to say that your school must have been a rarity, and you shouldn't go into medical school counting on any of the above being true, at most hospitals a medical student will catch hell for calling out sick, you'll be working most major holidays and not having 2 weeks at Christmas/New Years off, you'll be doing scut because you're the low man on the totem pole and "that's just the culture" in 3... 2... 1...
Welcome to psych residency.
But again, you're doing important work that needs to be done and getting paid, and you can just do your work and GFTO, rather than being expected to show up bright-eyed and bushy-tailed, kissing butt and asking displaying your knowledge and asking insightful questions about something you don't have the least bit of interest in.
Screw that. I'm no longer a medical student who has to suppress my stomach grumbles and clench my sphincters extra-tight all day in the hopes of making a good impression and getting that coveted honors. I'm there to work, and I'm eating my damn lunch and using the damn bathroom. What are they going to do, fire me? These academic hospitals are staffed by lazy attendings, and residents do all the work. They need us. They fire us, they have a gaping hole in their staffing, and that's a prospect too terrible for them to contemplate.
Haven't been over there in a while, but I recall stories of people getting fired for endangering patients, not for eating and using the bathroom.
The best part of all is that after next year, I'll be able to start moonlighting, and thus getting paid they way doctors should be paid... by the amount of work they do.
QofQuimica
Seriously, dude, I think you're overreacting....
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I don't think I ever said that I don't feel it's worth it, nor that other people shouldn't do it. I said that *I* wouldn't do it again if I had it to do over. And I wouldn't. I would have gone to pharmacy school instead.
Here's my reply, but in paragraphs.
Yes, you get paid for the work, but a lot of that filling out forms and making phone calls could be done by someone with a high school education. Also, for the number of hours worked, the pay sucks. At least in my program, interns do still get pimped. And being an intern doesn't shield you from getting an eye roll when you deal with other people, because you really don't know much of anything, especially when you're starting out. You still have to do off-service rotations and try to adjust to a new system for most months of your intern year, so that's not an improvement over med school either.
Ok, did you seriously ever "catch hell" for calling in sick as a med student? We had three automatic sick days off per rotation. We had vacation every Christmas/New Years. Our school specifically did not allow us to be scutted out.
What I find ironic is that you're in psych, a specialty that basically hangs up the stethoscope entirely and places a lot more focus on talking to patients, while the more clinical specialties are the exact opposite. People who don't like talking to patients don't generally choose psych as a specialty! And seeing as many clinical rotations do not realistically have a way to schedule time for lunch, sometimes I don't get lunch. Or it's at 3 PM even though I got there at 7 AM.
FWIW, it's not true that you're irreplaceable. If you disappeared tomorrow; if your entire intern class disappeared, you'd simply be replaced by people who failed to match somewhere this year. Most of the Gen Res descriptions of firings are because of the resident having interpersonal conflicts with attendings and faculty, not because they're endangering patients or eating/using the bathrooms. I know one terminated resident IRL, and that is the exact reason why this person was terminated. (However, knowing this individual, I can't say that their termination wasn't warranted.)
Finally, I will never moonlight. My time means more to me than getting additional money, and I would like to work fewer hours, not more.
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and working as a pharmacist is all painless? http://www.theangrypharmacist.com/
That's what matters the most to me. As long as the process is not arbitrary and I have control over my own performance, I think there is still hope for making the most of it and being happy.
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I definitely didn't get the impression that she thinks it's all painless. I also suspect she'd do something a bit different with a pharmd than work in retail pharmacy...
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There have been a number of stories in the gen res forum where it seems to be about miscommunication and misunderstanding, getting off on the wrong foot with a supervising resident/physician, and never getting back on track, so your evals are always subpar and then, well...
I can see how that would easily happen, but who knows for sure exactly what happened in each of those stories.
It really depends on the culture at the program. At some programs, with some attendings, there IS a fair degree of "arbitrariness" to the process, and it's not completely in your control. It's hard to tell which programs are like this, and which are not. So there's a fair degree of luck in that, too.
QofQuimica
Seriously, dude, I think you're overreacting....
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Correct. I have no desire to be a retail pharmacist, any more than I have a desire to be a community physician. However, there is a lot more that can be done with a PharmD than work in retail. Academic pharmacists often do residencies and specialize, analogous to what academic physicians do. For example, it is possible for a pharmacist to specialize in cards drugs, or GI drugs, and work in those departments. Likewise, they can work in critical care areas of the hospital such as ICUs or the ED. At my current hospital, we have pharmacists rounding with us in the ICUs, and coordinating the drug administration during codes. The ER even has specialized emergency pharmacists who work solely in that capacity to advise the ER physicians.
There are other academic roles for pharmacists as well. One is that they can participate in or coordinate drug-related research projects. My best friend from grad school, who is a PharmD/PhD, does this. They can also teach health students, including medical students. Many of my med school pharmacology class sessions were taught by academic pharmacists, and unsurprisingly, their knowledge of drugs in their area of specialty far surpassed that of most physicians who specialize in that area.
I'd argue that it's basically akin to how third year of medical school is graded: you have the objective part (exam grades), and you have the subjective part (evaluations). The objective part is easy to evaluate. No one can argue over whether a resident scored well enough on, say, an in-service exam, or whether or not they passed Step 3 if that is required for eligibility to continue their training. (It is for us.)
The subjective part is where people who have interpersonal conflicts may get into trouble. For the premeds, residents get evaluated based on competencies, such as professionalism or medical knowledge. Some of the criteria for these competencies are relatively objective. For example, few would argue that it violates professionalism standards to show up for work drunk, or to not show up for work when you are scheduled for a shift or clinic day.
Evaluating interpersonal conflicts starts moving toward the more subjective end of the spectrum. Is it unprofessional to go home right at the end of your shift and leave half-completed tasks for the next resident to deal with? There is no clear professional standard requiring that residents spend an extra hour to tie up loose ends at the end of their shift, even if doing so would improve relations within the department and be better for patient care. Whether people stay the extra time is entirely dependent on program culture and on each person's own sense of professionalism. In a program where most people do stay, even one person who decides to buck that expectation causes a lot of angst and resentment in the department since other people have to take up the slack. However, assuming they do a good job during their assigned work hours, should a resident who is not perceived as a "team player" because they won't stay the extra time be fired because their peers and superiors don't like them? There's no clearly objective answer to that question.
As another example, faculty evals are often subjective and ill-thought out to the point of being useless. At my program, we are scored on a scale of 1-10 on various subjective criteria, such as "shows compassion toward patients," or "effectively teaches junior residents/students." I had one attending tell me, "well, you're an intern, so I'll give you all 7's." Another attending automatically gives everyone all 10's. While I appreciate the ego boost of getting an eval with straight 10's more than I appreciate having one with straight 7's, neither of these evals was helpful in terms of telling me what I did well, nor what I should do to improve.
Even among attendings who spend the time to fill out each item individually, the scores run the gamut based on attending preferences. Another criterion that we get evaluated on is "presents patients in an organized fashion." One person may think I present patients very well and give me a 10. But the next attending may want presentations done a different way and therefore give me a 4. So who is right, the first person or the second? Or should I be considered a 7 overall since that's the average of 4 and 10? What happens if I work three weeks or shifts with the first person but only one with the second, and therefore wind up with three 10s and only one 4? Am I now an 8.5 overall? As these examples show, overlying faculty evaluations of subjective criteria with the veneer of a 1-10 scale does nothing to make the evals any more objective.
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so if you're a clinical or academic pharmacist, won't you get evaluated and judged by the corresponding faculty, program directors, and department chairs? if you're an assistant professor, don't you have to "publish or perish"? What if you rub the department chair the wrong way, or you don't bring in enough grant money, and you don't get tenure? what if you work for a pharmaceutical company, and your boss gives you a "doses not meet expectations" rating cause she doesn't like you? not only that, you don't get to do research on what you want, but on what the company wants.
same things you describe in medicine can happen in any field or on any job. that's part of being a working adult, isn't it? to have to navigate the mine fields of work, and survive under conditions where it's not just your objectively measurable skills which determine your success.
also, I don't think that residency PD's and attendings are "out to get" the residents. if they were, they would have a reputation for it, which you should've been able to find out about and not chosen to go there.
same things you describe in medicine can happen in any field or on any job. that's part of being a working adult, isn't it? to have to navigate the mine fields of work, and survive under conditions where it's not just your objectively measurable skills which determine your success.
also, I don't think that residency PD's and attendings are "out to get" the residents. if they were, they would have a reputation for it, which you should've been able to find out about and not chosen to go there.
QofQuimica
Seriously, dude, I think you're overreacting....
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The difference is that in most industries, you can still get some LORs from people who do like you and use them to get a job somewhere else. It's not generally possible for a resident to join another program without their PD's blessing. The consequence of not being able to finish a residency program is that you cannot practice medicine. Or, if you have at least finished your intern year and gotten a full license, the consequence is that your clinical job options are severely limited, as most jobs and hospitals require you to be board-eligible at minimum. (You cannot be BE in any specialty without completing an entire residency in that specialty.)
I suppose you must have married the very first person you ever dated after only going out once or twice. I mean, no one ever puts on a good show for your benefit the first time you meet them, right?
Extending that metaphor a little further, the match is like an arranged marriage. You do get some say into who you marry by how you rank your programs, but ultimately you don't get to make the final decision of who you end up with. And as with marriage, some people are less desirable in the match process than others, either for certain specialties or at certain programs. People with fewer options can and do choose to rank "malignant" programs in specialties they might not especially like if their other option is to go unmatched/scramble. See what I said above about effectively not being able to work in medicine without being at least BE.
As for people being "out to get residents," medicine is no different than any other hierarchical power structure. You have some faculty and PDs who are great mentors/leaders, a vast middle who are good but not great at training residents, some who are indifferent to the grooming of trainees because it's not their priority, and some who are sadists and wield their power accordingly. Hopefully your PD won't be in the last category; I'm happy to say that mine is not. But things could be very different if he were.
FWIW, thank you for discussing this in a rational manner rather than continuing to insist that following zen buddhism can conquer all pain. I find proselytism to be extremely off-putting.
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thanks Q, I don't mean to be antagonizing you or to be proselytizing. that was just something that came to my mind. It wasn't targeted to you. I put in a disclaimer, remember?
I still think it's more than 50% up to the individual to succeed. The rest of it is luck or whatever, and that's not too different from anything else in life.
the things you mention maybe need to be looked at in any healthcare "reform" effort, cause surely we can't have a good healthcare system if most of the doctors are disgruntled and disillusioned with their training process and careers. the high cost of medical training, the debt, the stress, the high risk of failure, are too unfair and too high of a burden on the aspiring physicians. Thanks again.
I still think it's more than 50% up to the individual to succeed. The rest of it is luck or whatever, and that's not too different from anything else in life.
the things you mention maybe need to be looked at in any healthcare "reform" effort, cause surely we can't have a good healthcare system if most of the doctors are disgruntled and disillusioned with their training process and careers. the high cost of medical training, the debt, the stress, the high risk of failure, are too unfair and too high of a burden on the aspiring physicians. Thanks again.
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And I, in keeping with my long-standing theme of having gone to med school to score a babe, would have learned to play the guitar.
I shoulda learned to play the guitar
I shoulda learned to play them drums
Look at that mama, she got it stickin' in the camera
Man, we could have some fun[/Dire Straits]
Yeah, but contrasted with being a medical student, when someone rolls their eyes at you, you can just punch them in the face. OK, not really, but you don't have to care. Maybe our experiences are different because you cared less as a medical student, or care more now. But after the gut-wrenching torture that was the clinical years of medical school, I find it almost exhilarating that, on off-service rotations, all I have to do is survive (and not harm patients, of course.) Yeah, I got pimped a little on medicine, but I just did the best I could, and rested easy in the knowledge that it would all be over soon. I know, I was probably fortunate to have pretty non-malignant attendings and seniors. Actually, the worst attending I have encountered so far was an ER attending during my ED month--awkward, poor social skills, a curt, abrasive personality and sardonic, condescending tone; everybody in the hospital disliked her, and yeah, she gave me a hard time, but I still felt that as a resident I just didn't have to care as much as I did as a medical student, and taht made all the difference.
No, I agree with you, I just thought I'd channel Law2Doc for fun.
I like talking to patients in general, but manic patients need to be cut off or they would never stop, and with psychotic patients with bizarre delusions, you don't get anything useful out of them after the first 5 or so minutes.
I suppose the lesson is, do your homework during interviews, and if you're a laid-back person, go into a laid-back field. I have sympathy for people in malignant programs, but not for jackasses who can't get along with others.
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by the way, there are fields in medicine which have much less patient contact, if any, and so for those who don't want to deal with the fear of "killing someone", there's always options like preventive/occupational med etc. for preventive you just have to do a 1 year internship/transition year, so you just have to survive that. and you're not likely to get fired for almost killing anyone cause as an intern you don't have as much independence as a resident. then after that you get your mph and then you can work in public health. so starting out as a pre-med or 1st year med student, you don't have to be so scared of not ever having a job in medicine. I'm not quite sure though why you'd want to do the extra 5 years of med school + internship and then get the MPH and work in public health. what's the added benefit vs just getting a MPH without the MD? seems like a waste of time to go to med school if you're never gonna touch patients. maybe someone can explain that to me....
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I'm not sure on the answer, but I keep in touch with an MPH friend who wishes he had gone to med school to supplement his career in global health. (I told him it's never too late, of course; he's younger than me.
) He does firmly believe all physicians should have background coursework in public health. Probably not a bad idea considering PH policy directly affects doctors' jobs. More informed workers = more effective lobbying for what is best for everyone.
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QofQuimica
Seriously, dude, I think you're overreacting....
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I like patient contact. That's the main thing that makes medicine worth doing, IMO. Like you pointed out, I could have done public health with an MPH. That being said, having an MD does give you a perspective that those with grad school only experience do not have. It's all well and good to discuss pharmaceuticals as a chemist (i.e., theoretically), but real practice often doesn't follow theory. To the point that, when applicants tell me that they're applying to med school because they "love science," I tell them that if they *really* love science (like, actually doing science), they won't love medicine. The way we make decisions at the bedside would never fly at the bench.
There is a big push afoot for "evidence-based medicine" these days, but the reality is that much of our practice is what I call "evidence-less medicine." (Somewhere along the way, I heard someone else call it "evidence-laced medicine," so I'm obviously not the only person thinking along these lines.) What this means is that doctors often make treatment decisions based on personal experience, subjective beliefs, or so-called expert opinion that is also based on personal experience and subjective beliefs. Then when studies are actually done, it sometimes turns out that these expert opinions are completely backwards. The use of beta blockers in congestive heart failure is probably one of the best examples of this phenomenon. Not giving a CHF patient a beta blocker would constitute malpractice today, but a few decades ago, giving a CHF patient a beta blocker would have just about been considered like signing that patient's death certificate.
Tri, I didn't find medical school rotations to be torture, and that's probably the biggest difference in our perspectives. (There was one exception, which was OB, but then, I don't know all that many people who really loved their OB rotation.) I don't find residency rotations to be torture either; that's a pretty strong word. I just don't like that my reason for existence has come in large part to be doing ridiculous amounts of paperwork. We have forms here that need to be filled out to get more forms. It's ridiculous.Trismegistus4 said:
As for channeling L2D, he's still around. What you need is a bat-signal, not a medium.
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As for channeling L2D, he's still around. What you need is a bat-signal, not a medium.
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I'm sure that was tongue in cheek, but I run into enough people who have a skewed view of pathology so I can't resist. With few exceptions like forensics and autopsy, the bulk of a pathologists work is diagnostics and stuff on living patients where they definitely can kill people. (I think I've seen estimates that say outside of being a medical examiner, less than 5% of the work a pathologist does is only deceased pts.)
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Of course it was!!!
My point was you can be in medicine and be a doctor and not have to touch a live patient unless you are one of the few who performs bone marrow biopsies.
My point was you can be in medicine and be a doctor and not have to touch a live patient unless you are one of the few who performs bone marrow biopsies.
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What are "laid-back fields"?? I'm looking at FM, I *hope* it's laid-back!!!! Am I basically going to have to be a kiss-ass for 5yrs (med school + residency) so that I am always perceived as "getting along"?? I can do that, I think... I'm generally well-liked, but as with any person I'm sure there will be people who don't like me, as I am strong-willed, how do you deal with that?
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Med school (4) + FP residency (3) = 7 years
As far as being strong willed, know that as a student and resident there is always someone who knows more than you and who has power over you. Just know that you will always be wrong even if your right in the eyes of some people. Many have a power trip and will do their best to make your life miserable because their's is. Just know when not to talk and do your best not to be argumentative.
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I was thinking 3rd/4th year + residency, not years 1 & 2....
When do you cross the line from "stand your ground/idea" to "argumentative"?? Or is it basically, if they say jump you do it regardless of your thoughts?
When do you cross the line from "stand your ground/idea" to "argumentative"?? Or is it basically, if they say jump you do it regardless of your thoughts?
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Depends on the attending. Have to feel them out. Many like the students to throw out ideas and are very active in teaching. Many are not. You just have to see. Just remember as an intern you really don't know much and you get more leeway as the years progress. You will know who trusts you and who doesn't.
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I just started reading this. cure for med student and resident disillusionment.
http://www.amazon.com/Routine-Mirac...=sr_1_3?s=books&ie=UTF8&qid=1335143534&sr=1-3
http://www.amazon.com/Routine-Mirac...=sr_1_3?s=books&ie=UTF8&qid=1335143534&sr=1-3
QofQuimica
Seriously, dude, I think you're overreacting....
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Read it two years ago. Huge fan of Dr. Fischer. (For those of you who are preclinical med students, Conrad Fischer is to Step 2 what Goljan is to Step 1, only funnier and much less pompous.) Great book. Not a cure for the disillusioned trainee, I'm afraid, but well worth reading anyway. Did I mention that I'm a huge fan of his??
Read it two years ago. Huge fan of Dr. Fischer. (For those of you who are preclinical med students, Conrad Fischer is to Step 2 what Goljan is to Step 1, only funnier and much less pompous.) Great book. Not a cure for the disillusioned trainee, I'm afraid, but well worth reading anyway. Did I mention that I'm a huge fan of his??
I'm a Conrad fan myself. But i just watched the interview series on youtube.
Who the f@ck has time to read a book. I watch stuff. While I'm eating. Or listen to it while I'm studying. Books...are like some old school ****...like, horses and buggies.
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i'm reading it on the ipad. that makes me feel 21st century. I'll have to keep up with my millenial classmates
Cabinbuilder, what an inspiration you are! The only dissimilarity is that my children are a lot older, maturer and independent, and I'm starting pretty late in the game. Medicine has always been my passion for as long as I can remember. With the love and support of my husband and children, I have come to the decision that "here and now" is the time to make my dreams of being a doctor come true. I know it won't be easy, but doing what you love be nothing but extremely well worth it!!
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1) all expectations were exceeded - including cost and difficulty, but also happiness
2) if you're asking how it's worse than what I thought it would be, my answer would be the toll the stress takes on you. But you learn to manage and it's growth...
3) my significant other had an adjustment period but now basically accepts that i can't spend as much time as I want with her. I don't think this would work with most other women, so be careful.
4) yes. there's nothing I'd rather do.
FYI, I'm still only in my first year.
