Primary care attendings and their ego trips

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gshocke

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Why do 90% of primary care docs have an ego trip on med students, especially med students that are specializing? Is it that academia is their opportunity to exert their power on others (i.e. Med students)? Or are they just naturally annoying.
Despite the stigma of surgery being known for breeding a-holes, I think my primary care rotations have been worse when it comes to treating students differently if they are not going into primary care. I’ve noticed that surgeons don’t care if you are going into their specialty, they don’t care if you don’t find it interesting, and they could care less if you’d rather spend your life treating uncontrolled DM and HTN rather than to become a surgeon or specialist. Ive noticed that they praise merit and hardwork regardless of your speciality. I’ve noticed similar with ppl in ROADs specialities. They don’t care. They are (usually) very happy with their specialty choice and do not get offended by another’s choice. I had one rotation where the attendings were “reprimanded” after the rotation for incessantly inquiring about our specialty interests which resulted in a student being told that they wouldn’t honor b/c of their specialty choice.
The peds, family, IM etc. ppl seem to get offended at my school.
Maybe it’s a concealed form of buyers remorse? maybe it’s just my school? Thoughts?
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Merely said:
Thoughts are you sound like a tool
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Not a tool. This is serious question. There are numerous posts about surgeons being mean a-holes, and it’s widely accepted to speak of them like that. But God forbid, I call out a pattern that many other students have also observed but won’t say, because it’s just “not the norm”.
 
gshocke said:
Why do 90% of primary care docs have an ego trip on med students, especially med students that are specializing? Is it that academia is their opportunity to exert their power on others (i.e. Med students)? Or are they just naturally annoying.
Despite the stigma of surgery being known for breeding a-holes, I think my primary care rotations have been worse when it comes to treating students differently if they are not going into primary care. I’ve noticed that surgeons don’t care if you are going into their specialty, they don’t care if you don’t find it interesting, and they could care less if you’d rather spend your life treating uncontrolled DM and HTN rather than to become a surgeon or specialist. Ive noticed that they praise merit and hardwork regardless of your speciality. I’ve noticed similar with ppl in ROADs specialities. They don’t care. They are (usually) very happy with their specialty choice and do not get offended by another’s choice. I had one rotation where the attendings were “reprimanded” after the rotation for incessantly inquiring about our specialty interests which resulted in a student being told that they wouldn’t honor b/c of their specialty choice.
The peds, family, IM etc. ppl seem to get offended at my school.
Maybe it’s a concealed form of buyers remorse? maybe it’s just my school? Thoughts?
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Overall I had the exact opposite experience. PC attendings where I’m at have always been very accepting of anyone regardless of their speciality choice. One lady used to say “every doctor is a primary care doctor sometimes” - meaning that everyone deals with the classic issues to some degree...that always stuck with me for some reason.

One exception. If you tell an attending you’re going into a surgical subspeciality from day one (Ortho, NSG, derm, etc) they’ll sort of laugh at you. May try to impress on you the importance of primary care. But to me it just sounds like you have some crappy professors.

Also, god bless the people that do primary care. Every time I had to counsel a patient with no medical literacy on diabetes management a little bit of me died inside. But we sure as hell need someone to do it.
 
The Knife & Gun Club said:
Overall I had the exact opposite experience. PC attendings where I’m at have always been very accepting of anyone regardless of their speciality choice. One lady used to say “every doctor is a primary care doctor sometimes” - meaning that everyone deals with the classic issues to some degree...that always stuck with me for some reason.

One exception. If you tell an attending you’re going into a surgical subspeciality from day one (Ortho, NSG, derm, etc) they’ll sort of laugh at you. May try to impress on you the importance of primary care. But to me it just sounds like you have some crappy professors.

Also, god bless the people that do primary care. Every time I had to counsel a patient with no medical literacy on diabetes management a little bit of me died inside. But we sure as hell need someone to do it.
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Thanks for sharing your experience, I truly wanted insight on others experience. However, why laugh off someone saying they want to do ortho, derm, etc but not laugh off someone doing peds? And why do I need to be impressed with primary care? who said that individuals specializing don't understand the importance of primary care? Individuals going into primary care are praised but those who've dreamt of being surgeons their whole life - have to be impressed with the importance of primary care?
 
I have never had an experience that even remotely resembled this. PC doctors were among the nicest attendings in 3rd year. Additionally, maybe I just go to a good school but I've never really had anyone crap on what specialty I told them I was going in to (EM). Ultimately I thought telling people I was going into EM (when I decided) made 3rd year better because they would try to teach things that were relevant to me and not make me do a bunch of stuff I wouldn't want to do.

Ultimately this has next to nothing to do with whatever specialty someone is in and just the personality of whatever person you have issue with.
 
gshocke said:
Thanks for sharing your experience, I truly wanted insight on others experience. However, why laugh off someone saying they want to do ortho, derm, etc but not laugh off someone doing peds? And why do I need to be impressed with primary care? who said that individuals specializing don't understand the importance of primary care? Individuals going into primary care are praised but those who've dreamt of being surgeons their whole life - have to be impressed with the importance of primary care?
Click to expand...
Have you considered that it might be your attitude in the primary care rotations that’s making the attendings not particularly appreciate your presence ? Versus that they care so much about your future specialty.
 
gshocke said:
Why do 90% of primary care docs have an ego trip on med students, especially med students that are specializing? Is it that academia is their opportunity to exert their power on others (i.e. Med students)? Or are they just naturally annoying.
Despite the stigma of surgery being known for breeding a-holes, I think my primary care rotations have been worse when it comes to treating students differently if they are not going into primary care. I’ve noticed that surgeons don’t care if you are going into their specialty, they don’t care if you don’t find it interesting, and they could care less if you’d rather spend your life treating uncontrolled DM and HTN rather than to become a surgeon or specialist. Ive noticed that they praise merit and hardwork regardless of your speciality. I’ve noticed similar with ppl in ROADs specialities. They don’t care. They are (usually) very happy with their specialty choice and do not get offended by another’s choice. I had one rotation where the attendings were “reprimanded” after the rotation for incessantly inquiring about our specialty interests which resulted in a student being told that they wouldn’t honor b/c of their specialty choice.
The peds, family, IM etc. ppl seem to get offended at my school.
Maybe it’s a concealed form of buyers remorse? maybe it’s just my school? Thoughts?
Click to expand...

Any chance you come off as arrogant or even too confident for your level of training? This would be sufficient for many (insecure) attendings to be offended. Perception is reality, and whether you intend it or not doesn’t matter. It’s how the other perceive you... just wait until residency and you’ll understand what I mean.
 
MerYangBey said:
Have you considered that it might be your attitude in the primary care rotations that’s making the attendings not particularly appreciate your presence ? Versus that they care so much about your future specialty.
Click to expand...
I don't think its about concern for my future specialty, but more of my lack of concern for their's. I guess I can use the comparison of some nurse practioners. Some their attitudes towards physicians aren't necessarily b/c they envy our profession, but more that they know that we are indifferent about their's, so they go out of their way to make it so evident that their skills and profession is vital to the medical community.


ACSurgeon said:
Any chance you come off as arrogant or even too confident for your level of training? This would be sufficient for many (insecure) attendings to be offended. Perception is reality, and whether you intend it or not doesn’t matter. It’s how the other perceive you... just wait until residency and you’ll understand what I mean.
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Actually, no to both remarks. In fact, a common trend through my evals have been that I am "very quiet, humble, soft spoken". Ive been told that I am too timid and need to be more aggressive. I know it probably sounds contradictory given my post, however my post is more out of built up frustration rather than my resting attitude towards the profession. I almost took the NHSC scholarship prior to med school, because I was 100% positive that I was going into primary care and spent many years prior to med school working in those fields. But things change. I don't want to give too many identifiers, but I am one of those classmates that you look at and "just know" that they are going into primary care.

Do not get me wrong, these attendings are not rude or mean, however what gets to me is that their biases are very evident. If my post was about surgeons, no one would be calling me arrogant.
 
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I also ran into douchey primary care doctors when I was a student. I think they exist in every specialty, but there is a general “trend” to think of surgeons as a-holes because we are more outspoken/aggressive/abrasive. In reality I think every specialty has their bad seeds—maybe you are just unlucky and came across a few more than usual in primary care.


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Dr. Brightside said:
IMO there's nothing admirable about having wanted to be a surgeon your whole life. Not sure why so many med students act like it (not saying you are, but it's an attitude out there)
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Agree—I think having tunnel vision of any kind (for surgical or any other specialty) is a bad thing for a student.


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Dr. Brightside said:
IMO there's nothing admirable about having wanted to be a surgeon your whole life. Not sure why so many med students act like it (not saying you are, but it's an attitude out there)
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Why is it not admirable? To have an interest that you’ve spent essentially your whole life working towards.
Yet, wanting to be a family med doc in rural Kansas IS admirable? (Apparently it is because that’s what half of the personal statements for Med school are about).

Why the double standard
 
gshocke said:
Why is it not admirable? To have an interest that you’ve spent essentially your whole life working towards.
Yet, wanting to be a family med doc in rural Kansas IS admirable? (Apparently it is because that’s what half of the personal statements for Med school are about).

Why the double standard
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Because a lot of these people are perceived as "prestige chasers", regardless of accuracy.
 
CherryRedDracul said:
Because a lot of these people are perceived as "prestige chasers", regardless of accuracy.
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Thank you for proving my point.
A person who dreamt of attending Harvard their whole life will not look at someone who has similar feelings at Princeton as “prestige chasing”. Yet a person who wants to go to their state college will. Why?

We criticize outsiders for doing this exact thing to us. Lay people love to say that Docs are money chasing a-holes, and we combat it by saying “well we wouldnt give up X years of our lives and go into X amount of debt” if we didn’t love the field.
So same thing applies to specialties like surgery. As if, I won’t be giving atleast 7-10 more years of residency, research years, fellowship, and lack of attending salary in order to fulfill that goal.
 
There are a-holes in every single specialty. This is medicine where every single specialty has an ego and reason why their specialty is cooler. What you're doing right now to Primary Care in this post is exactly what they are doing and you probably will end up being one of "those" attendings.
 
I think there is a difference between ego trip and being an expert and knowing you’re an expert.

As you all know, docs spend a lot of time and effort learning to do what they do. They are the experts in their fields and you shouldn’t discredit or disregard their expertise, they have accomplished much more than you and you’re getting an opportunity to learn from them.

If you want to be liked on rotations, show respect for a person’s expertise and management. Even if you don’t like that person necessarily. Or like that field of medicine. There’s always something you can learn.

There’s nothing worse than some a-hole student who thinks they know everything about a speciality because they decided they wanted to do something else.

Never think or have the attitude that you know more than your attending. You’re not. A FM attending probably knows a lot more about ortho than you do (right now). If you think you’re smarter than them it will show in your behavior and they will pick it up and you’ll just end up looking like an a-hole.


Just general words of advice from what I gathered from third year.

In regards to different attitudes and personalities, I’ve noticed that residents are usually more rude/pompous than attendings.

In my personal experience it’s been (from meanest to nicest).

Surgery = obgyn (a-hole residents, not even all of them)

Medicine = neuro (very nice, not normal)
Psych = Peds (very nice, very well adjusted)


The speciality wars in medicine have to end. Respect other people’s skills and people will respect yours. You shouldn’t be passionate about your field because of how much the other fields suck.

To even suggest that the FM/IM people have “buyer’s remorse” is both insulting and reveals your concealed idea that there is somehow a hierarchy and that somehow specialists (future you) are at the top.


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gshocke said:
Why do 90% of primary care docs have an ego trip on med students, especially med students that are specializing? Is it that academia is their opportunity to exert their power on others (i.e. Med students)? Or are they just naturally annoying.
Despite the stigma of surgery being known for breeding a-holes, I think my primary care rotations have been worse when it comes to treating students differently if they are not going into primary care. I’ve noticed that surgeons don’t care if you are going into their specialty, they don’t care if you don’t find it interesting, and they could care less if you’d rather spend your life treating uncontrolled DM and HTN rather than to become a surgeon or specialist. Ive noticed that they praise merit and hardwork regardless of your speciality. I’ve noticed similar with ppl in ROADs specialities. They don’t care. They are (usually) very happy with their specialty choice and do not get offended by another’s choice. I had one rotation where the attendings were “reprimanded” after the rotation for incessantly inquiring about our specialty interests which resulted in a student being told that they wouldn’t honor b/c of their specialty choice.
The peds, family, IM etc. ppl seem to get offended at my school.
Maybe it’s a concealed form of buyers remorse? maybe it’s just my school? Thoughts?
Click to expand...
Must be just your school. This sounds foreign to me.
Gorne said:
Always tell residents and attending's you are undecided MS3 unless it is the field of your choice. People have sensitive ego's, whether they want to admit it or not.
Click to expand...
I disagree. I was always upfront about my interests and that led to residents and attendings funneling the cases in their specialties that overlapped with my interests my way or trying to highlight things about the specialty I might not have considered given what my interests were. I'm not talking about answering the question with "well certainly not this specialty" but just being honest about where my interests lay. Frankly, if two students are working equally hard and one has made it clear their interests lie elsewhere, I'd probably be more appreciative of that student than the one who is interested in my specialty or even undecided.
 
gshocke said:
Why do 90% of primary care docs have an ego trip on med students, especially med students that are specializing? Is it that academia is their opportunity to exert their power on others (i.e. Med students)? Or are they just naturally annoying.
Despite the stigma of surgery being known for breeding a-holes, I think my primary care rotations have been worse when it comes to treating students differently if they are not going into primary care. I’ve noticed that surgeons don’t care if you are going into their specialty, they don’t care if you don’t find it interesting, and they could care less if you’d rather spend your life treating uncontrolled DM and HTN rather than to become a surgeon or specialist. Ive noticed that they praise merit and hardwork regardless of your speciality. I’ve noticed similar with ppl in ROADs specialities. They don’t care. They are (usually) very happy with their specialty choice and do not get offended by another’s choice. I had one rotation where the attendings were “reprimanded” after the rotation for incessantly inquiring about our specialty interests which resulted in a student being told that they wouldn’t honor b/c of their specialty choice.
The peds, family, IM etc. ppl seem to get offended at my school.
Maybe it’s a concealed form of buyers remorse? maybe it’s just my school? Thoughts?
Click to expand...

I have been with Peds, FM, Med/Ped, IM, GS, Ortho, OBGYN attendings. Almost all of them like me and give me raving reviews, with the exception of this spineless FM oldie who gives me crap and calls me for knowledge deficiency for not knowing the #9 or #10 MC side effect of this one drug, when I know the top five MC SEs that make up 99% of the pt population really well. That guy wasn't my grader, so screw him. If I had FM with that dude, my life would be very miserable. One time, I tried to be approachable to that dude over a luncheon one time and ask him for his name after a handshake. For some reason, he decided to give me a fake name. Whenever I saw that dude down the hallway, I always greeted him and smiled, but yet he was always rude and awkward. Whatever to that dude. Have zero interest in FM, so dgaf.
 
Black Coffee 24/7 said:
I have been with Peds, FM, Med/Ped, IM, GS, Ortho, OBGYN attendings. Almost all of them like me and give me raving reviews, with the exception of this spineless FM oldie who gives me crap and calls me for knowledge deficiency for not knowing the #9 or #10 MC side effect of this one drug, when I know the top five MC SEs that make up 99% of the pt population really well. That guy wasn't my grader, so screw him. If I had FM with that dude, my life would be very miserable. One time, I tried to be approachable to that dude over a luncheon one time and ask him for his name after a handshake. For some reason, he decided to give me a fake name. Whenever I saw that dude down the hallway, I always greeted him and smiled, but yet he was always rude and awkward. Whatever to that dude. Have zero interest in FM, so dgaf.
Click to expand...

Wow. I can’t believe he gave a fake name. LOL. That’s wild.
 
gshocke said:
I’ve noticed that surgeons don’t care if you are going into their specialty, they don’t care if you don’t find it interesting, and they could care less if you’d rather spend your life treating uncontrolled DM and HTN rather than to become a surgeon or specialist.
Click to expand...

How much less could they care? I’m trying to decide if surgeons have the same problem you accuse PC guys of having. I mean they obviously care some 😉

I don’t know man, maybe they treat you like that because you come off as deserving of it? Or maybe 90% of primary care docs are able to see how much of of your education you seem uninterested in since you’re tunnel-visioning on surgery; I know that doesn’t make for a good, well rounded student in my eyes.

More likely your obviously poor attitude toward primary care oozes out in all your interactions. This poor attitude is painfully obvious to me even just reading your written words. That you surmise that your PC attendings may have some form of buyers remorse, and that they are doing nothing more than “spending their lives treating uncontrolled DM and HTN” tells me an awful lot about you. And it tells me you basically know nothing (willfully or not) about the real nature of primary care. You probably can’t see it yourself, but I’ll bet your not the most pleasant student to teach.
 
MSTPlease said:
Must be just your school. This sounds foreign to me.

I disagree. I was always upfront about my interests and that led to residents and attendings funneling the cases in their specialties that overlapped with my interests my way or trying to highlight things about the specialty I might not have considered given what my interests were. I'm not talking about answering the question with "well certainly not this specialty" but just being honest about where my interests lay. Frankly, if two students are working equally hard and one has made it clear their interests lie elsewhere, I'd probably be more appreciative of that student than the one who is interested in my specialty or even undecided.
Click to expand...

I'd hope that's always the case. You just never know and saying "undecided" is playing it safe. You don't want that one resident that wished they could have gone derm if they had the scores to be your resident when you show up on day one of 3rd year and say you're a derm hopeful. It's just human nature to feel resentment.
 
Gorne said:
I'd hope that's always the case. You just never know and saying "undecided" is playing it safe. You don't want that one resident that wished they could have gone derm if they had the scores to be your resident when you show up on day one of 3rd year and say you're a derm hopeful. It's just human nature to feel resentment.
Click to expand...

Meh, I had plenty of students interested in and applying for the ultra competitive specialties. One in particular stands out, he was interested in Neurosurg, wasn’t ashamed to talk about it. But you know what, he was engaged, helpful, and very competent during the continuity clinic sessions he worked with me on; and I liked working with him a lot. He got a glowing evaluation, and I think he’s in neurosurgery residency somewhere in Maryland now. It didn’t bother me at all that he was interested in Neurosurg, because he cared about learning, was actively engaged and trying to become a better future physician, and he didn’t slow me down or get in the way.
 
Last edited:
The pcp faculty at my school might fit this. But none out in clinicals so far are egotistical
 
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