Shorter Residency Work Hours?

[Law2Doc]

I wouldn't disagree with the statement that other people are working as many hours as physicians. But I would disagree with the assumption (if there was one) that this means that their 80 hours are equivalent. If I was working in business or consulting, sure, I might get told, "oh, by the way, you're working late this week." But then I'd just stay there and work late on research or number crunching. Versus the medical field, where you are randomly called at any time of day or night for any issue. Those are two different animals....

I would agree with this notion, and basically said the same thing in another thread. You do not have the flexibility or control over your day in residency the same way you do in other fields, even those where you log more hours. In law, where we worked under a billable hour scenario, you had the opportunity to budget your time as you saw fit. If you wanted to spend an extra hour out at lunch and make it up over the weekend, you could. If you wanted to take off for the weekend you could add the equivalent number of hours to the week and just stay until midnight every night. You could bring work home. Partners didn't care so long as their clients were happy and your billable hours were adequate. You didn't have a pager and people didn't feel they owned you in the same way they do in residency. So it's different than other private sector jobs, even if the hours are the same. I wasn't suggesting it's the same, I was suggesting the hours are not "inhumane". They aren't. They are very similar to hours you may work in other equivalently lucrative professional jobs. Plain and simple.

But sure, I will agree that the residency system itself does not have the same kind of flexibility of other fields which also work as hard. And that is a nuisance for sure, and maybe makes it harder, but not really more inhumane IMHO. You probably will be averaging 75 hours per week in residency and have no flexibility, but may be averaging 85 hours/week under a biglaw billable hour system, but be able to do more planning. It's really a pick your poison kind of scenario. However the ACGME proposals never look to add flexibility, they focus on duty hours. And so long as that's the analysis, then no, residency doesn't have the monopoly on long hours. Not by a long shot.

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[daru1]

As an aside, everyone seems to talk about being locked into medicine because of the debt, but I don't necessarily agree with that. At this point, you could enroll in income-based repayment and wait out the 25 years until you have your loans forgiven. Not exactly a great situation, but if you really disliked medicine, it's certainly an option.

Do you think IBR is going to be around for 25 years? How's that loan deferment in residency going for ya?

Law2Doc, you can say all you want about lawyers, but the fact is, if they screw up, lives - for the most part - aren't lost.

 

[Law2Doc]

It should be kept in mind that lawyers bill by the hour and are not above padding their hours. I'm not joking when I say this.

Padding hours is a crime. You can be disbarred, and you can go to jail for this. Only fools risk their career in this way. There are people who break the law in all fields, including medicine. If your post is somehow suggesting that criminal activity is more rampant in the legal field, I would suggest that you take a note of the fact that the number of physicians who get in trouble for fraudulent medicare and reimbursement claims far exceeds the number of allegations against lawyers for this similar kind of activity.

 

[JackADeli]

...How's that loan deferment in residency going for ya?...

Gone great

Padding hours is a crime. ...the fact that the number of physicians who get in trouble for fraudulent medicare and reimbursement claims far exceeds the number of allegations against lawyers for this similar kind of activity.

I can not speak to how many attornies commit billing fraud.

However, the comparison to insurance fraud is not an equal comparison. Lawyers are fairly much on an ~honor system as to what they actually do to bill. That type of environment/practice is very much more difficult to police. A lawyer can be out of the office and billing hours while on the phone, or in the car or at home. They can bill for their reading/research time. It is not very easy to make a paper trail to prove or disprove. Physicians being caught for billing fraud have a built in set of rules and paperwork that can be audited. The fraud ranges from claiming to spend more time with a patient then you were actually in the office to fabricating patients that don't exist. These are far easier to identify and thus prosecute.

 

[45408]

Again, please residents, get off of your entitled high horses. Stop screaming about the injustice of learning your field for 3-7 years voluntarily, and look at the BIG PICTURE. You signed up for this, you knew residency was hard (and probably harder) when you agreed to start medical school, and now you're all whining about it.

Name one other field where you can work like a dog for a short time, and be guaranteed a minimum raise of 4 times your salary when its over. Then again, if whining about inhumane choices is the current status of medicine, I suppose the lottery winning of finishing residency will become a thing of the past. I can't wait for all of you to start whining about that. You're physicians - not bankers dining on $900 dinners and billing celebrity clients, not Lawyers pandering to politicians and attending fundraisers for their personal advancement. Everything you do is for your patients, and the sooner you can buck up and do your jobs without complaining about how bad it is for you, the sooner you'll realize how bad it is for your patients, and before you know it, residency will be over.

BTW - in this climate of poor economy and jobs loss, its pretty poor form for the "leaders" of our society to be complaining about having too much work, epecially in light of life after residency. We're all lucky to have jobs.

Won't someone PLEASE think of the patients?

 

[igottaquestion]

i believe the patients are our future. medicate them well and let them lead the way.

 

[michaelrack]

i believe the patients are our future. medicate them well and let them lead the way.

Are you planning on going into psychiatry?

 

[JackADeli]

Won't someone PLEASE think of the patients?

I am plenty for the patient and consider them often. I am just not for that argument being used to shackle me into something. That sort of psychology is used too often as an excuse or guilt trip power play.

Residency education is constantly put on the back burner and/or neglected "for the patient". Malpractice reform is avoided "for the patient's rights". Some individuals at the hospital establish an unprofessional environment being shieled by, "I'm a patient advocate".

It is so interesting that the supposed primary advocates for the people, all people patients and otherwise are supposed to be attornies.... do you see people demanding the same level of pay cuts and self sacrifice and risk of personal & financial injury out of attornies? The patients are human beings. You should show dignity and respect. They are not in general your friends/family (according to recommendations by AMA). They are clients of a service that we are selling/providing. So, why are we expected to give them the product for free at our own expense/family expense/etc.....

I will do my best for my patients. I will continue to risk exposure to disease that can even extend to my family and friends. I will potentially decrease my health and life expectancy because of the duration & intensity of both training and practice. But.... I expect to be compensated.... very well. I also expect my patients to take some accountability for their own actions. Patients that fail to do what they need to do will not generate a desire in anyone to go over and above. Especially in an environment when such a patient is higher risk and the attornies are waiting to then help that patient exercise their "rights".

 

[ForbiddenComma]

I am plenty for the patient and consider them often. I am just not for that argument being used to shackle me into something. That sort of psychology is used too often as an excuse or guilt trip power play.

Residency education is constantly put on the back burner and/or neglected "for the patient". Malpractice reform is avoided "for the patient's rights". Some individuals at the hospital establish an unprofessional environment being shieled by, "I'm a patient advocate".

This is part and parcel with the ACGME strategy to paint resident training coming from morning report and noon conference... and NOT from clinical duties. In their broadsides, they routinely paint clinical practice/rounds/ procedures as actually taking valuable time away from resident education.

Someone explain to me how these bureaucrats at ACGME have such vast, unchecked power over us and our programs when 1) they obviously have long forgotten what residency is like, and how we learn better from doing than from powerpoint (assuming they even went to med school... many of them did not) and 2) they would rather pursue politically driven agendas than fulfill what used to be their primary purpose: to ensure U.S. residency programs graduate the most competent doctors possible.

 

[glade]

Again, please residents, get off of your entitled high horses. Stop screaming about the injustice of learning your field for 3-7 years voluntarily, and look at the BIG PICTURE. You signed up for this, you knew residency was hard (and probably harder) when you agreed to start medical school, and now you're all whining about it.

Name one other field where you can work like a dog for a short time, and be guaranteed a minimum raise of 4 times your salary when its over. Then again, if whining about inhumane choices is the current status of medicine, I suppose the lottery winning of finishing residency will become a thing of the past. I can't wait for all of you to start whining about that. You're physicians - not bankers dining on $900 dinners and billing celebrity clients, not Lawyers pandering to politicians and attending fundraisers for their personal advancement. Everything you do is for your patients, and the sooner you can buck up and do your jobs without complaining about how bad it is for you, the sooner you'll realize how bad it is for your patients, and before you know it, residency will be over.

BTW - in this climate of poor economy and jobs loss, its pretty poor form for the "leaders" of our society to be complaining about having too much work, epecially in light of life after residency. We're all lucky to have jobs.

Hey, Barney Frank just called and told me that your post is so gay he wants to marry it.

Nobody wants to hear your self-righteous bullcrap about how physicians aren't allowed to complain AND on top of that are supposed to embrace crappiness like *****ic martyrs. I barely do anything for my patients and, unless you're working for five figures in some slum at a free clinic, you aren't either, poser. And if you WERE doing that, I'd still laugh because you'd be the biggest loser of physicians ever.

This whole notion of "doing it all for my patients" was nice when I got some respect and I wasn't being treated like the bag boy at a supermarket. Now some idiot patient can just sit around and refuse to leave the hospital until THEY'RE satisfied, thanks to the fact that they aren't paying for anything. Oh, and heaven forbid they are dissatisfied with anything, you have to kiss their extremely morbidly obese asses in terror that they'll start looking up lawyers in phone books even though you saved their life. Too bad it's apparently a crime for some patient to actually thank you or appreciate anything any more.

How many people took call this Fourth of July? The hospital was dead quiet, probably. Know why? Because all the ****** patients were out at parties. Guess what happens right around July 6th? Right, all of them suddenly realized "how sick" they are and will flock to the hospitals. Expect a high pay? YOU DAMN RIGHT I DO. I wouldn't do this job for less than $200K and you can take that to the bank, tool.

 

[J-Rad]

All feel free to continue an interesting conversation, however, can the seventh-grade trash talk.

 

[glade]

a) Isn't calling it "seventh-grade trash talk" also trash talk? Except that in that instance it's from the fifth-grade?

b) I'll can the seventh-grade trash talk if he'll can the second-grade bleeding heart B.S.

 

[Cerberus]

Also; nobody's going to sue the pants off of an investment banker for misplacing some paperwork after his seventieth hour of work. If I drop a lung placing an IJ because I'm exhausted and tremulous from hypoglycemia... well...

I was talking to a few MS-3s the other day that were all bright-eyed and bushy-tailed. One of them asked me the - "if I had to do it all over again, would I" question, or the related - "what would it take for you to walk away" question. The answer was: pay my debt and let me go. There are better ways to make good honest money without the risk of frivolous lawsuits, dirty needlesticks, eighty-hour workweeks, and the resultant loss of my soul after sacrificing so much to serve my fellow man only to watch him crucify me in one way or another.

I wouldn't complain so much if we MD/DOs were appreciated. Whenever a patient gets upset over ridiculous detail x or doesn't think that he needs y... I think to myself - "Do you have a better idea/solution? G'head... go fix yourself. Did you go to medical school? No? Hmm...I did. Now shut up and take your medicine. It'll save your life."

Instead of appreciation, we get litigation. I have half a mind to let the public just up and suffer/die until they figure out that they have no idea what they're doing.

If you drop a lung doing an IJ, you've probably been working longer than 70 hours. Either that or you accidentally grabbed the "ACME Central Line" kit.

 

[Cerberus]

In regards to the "all other professionals work 80 hours a week" argument, I'd just point out that numerous studies have showed that people tend to grossly inflate the number of hours they work in a week. While this could include physicians, our numbers are probably more accurate considering even while logging our work hours, many residents are either hitting 80 hours or going over. Other professionals though, well, I'd trust the hours per week figure of a lawyer about as much as I'd trust anything else that came out of his mouth...

http://online.wsj.com/article/SB124355233998464405.html

The numbers are equally striking with work. Back in the 1990s, using 1985 data, researchers John Robinson and his colleagues compared people's estimated workweeks with time-diary hours. They found that, on average, people claiming to work 40 to 44 hours per week were working 36.2 hours -- not far off. But then, as estimated work hours rose, reality and perception diverged more sharply. You can guess in which direction. Those claiming to work 60- to 64-hour weeks actually averaged 44.2 hours. Those claiming 65- to 74-hour workweeks logged 52.8 hours, and those claiming workweeks of 75 hours or more worked, on average, 54.9 hours. I contacted Prof. Robinson recently to ask for an update. His 2006-07 comparisons were tighter -- but, still, people claiming to work 60 to 69 hours per week clocked, on average, 52.6 hours, while those claiming 70-, 80-hour or greater weeks logged 58.8. As Mr. Robinson and co-author Geoffrey Godbey wrote in their 1997 book "Time for Life," "only rare individuals put in more than a 55-60 hour workweek."

 

[AllAboutSara]

glade wrote: How many people took call this Fourth of July? The hospital was dead quiet, probably. Know why? Because all the ****** patients were out at parties.

It’s so sad that you categorize your patients this way. I would ask, why do you continue? Perhaps the lack of respect that you receive from your patients is a direct result of how you treat your patients….with no respect. You get what you give.

On topic,

forbiddencomma wrote: Someone explain to me how these bureaucrats at ACGME have such vast, unchecked power over us and our programs when 1) they obviously have long forgotten what residency is like, and how we learn better from doing than from powerpoint (assuming they even went to med school...

Other than Dr. Nasca, do we know who is on the Board of ACGME? Physicians, non-physicians?? I’ve researched Dr. Nasca and he appears to be quite the medical educator and researcher (program director, dean, etc.) I don’t know much about the others that are listed on the ACGME website. Any one have any insight?

 

[glade]

Perhaps the lack of respect that you receive from your patients is a direct result of how you treat your patients….with no respect. You get what you give.

That's quite a stupid statement that attempts to sound philosophical. You act as if all of your patients -- that is, if you're even an attending -- act responsible and respectful. And if you ACTUALLY think that, then you're so blind that you shouldn't be taking care of anyone. All you do is absorb their crap in a Pollyannaish fashion and tell yourself that it's OK, which is fine if you don't mind it. I don't mind if you want to act like patients are all these great people, but if you think that makes you better than anyone else you'd be quite wrong. Although I can see where you'd have to tell yourself that in order to get through the day.

 

[RustedFox]

I did mean 'subclavian', I had just finished logging all of my IJ lines when I wrote that reply... and we here at University of Looney Tunes Emergency Medicine Residency stock ONLY "ACME Central Line" kits.

I have been overworked/sleep deprived lately. There's a few other posts somewhere on here where I made some noticable spelling/grammar errors... which is usually something that I'm rather vigilant about.

 

[glade]

Just to be clear, it is still possible and a known complication to create a pneumothorax with an IJ approach. I'm not sure why you guys are are saying it's only a complication with subclavians.

 

[Cerberus]

Just to be clear, it is still possible and a known complication to create a pneumothorax with an IJ approach. I'm not sure why you guys are are saying it's only a complication with subclavians.

Yeah, it's possible, it's just much harder to do - especially since most IJs are done with US guidance these days.

 

[glade]

If something is harder to do, I just try harder.

 

[AllAboutSara]

to glade:
so sad, so sad.

 

[glade]

To AllAboutSara:
I hope you look hot, for your sake.

 

[UserNameNeeded]

It should be kept in mind that lawyers bill by the hour and are not above padding their hours. I'm not joking when I say this.

Why don't doctors move to a model like this? That's more sane, compensating for the time worked, instead of it being tilted towards payments for procedures.

Even in procedural specialties, like general surgery, I remember the surgeons complaining about getting paid the same for a surgery that takes 30 minutes or 3 hours.

 

[Law2Doc]

...
However, the comparison to insurance fraud is not an equal comparison. Lawyers are fairly much on an ~honor system as to what they actually do to bill. That type of environment/practice is very much more difficult to police. A lawyer can be out of the office and billing hours while on the phone, or in the car or at home. They can bill for their reading/research time. It is not very easy to make a paper trail to prove or disprove. Physicians being caught for billing fraud have a built in set of rules and paperwork that can be audited. The fraud ranges from claiming to spend more time with a patient then you were actually in the office to fabricating patients that don't exist. These are far easier to identify and thus prosecute.

Actually, the larger clients all have auditors who audit their bills in great detail. It's probably not much harder for a doctor to overbill an insurance company as it is for a lawyer to overbill a client. Both are illegal, and neither is significantly more common. In my experience, lawyers are more attuned to what the repercussions are, and as a result, are less likely to stray. Lawyers also do a significant amount of intra-professional policing of things that are unethical (even where they are not illegal), so there are lots of consequences within the profession, let alone with law enforcement. Again, there are crooks in every profession, but truthfully it has not been my experience that lawyers are any worse than doctors in this kind of thing.

As for lawyers being able to bill out of the office, for phone calls, and for research/reading time, the answer is yes, if it's well documented. You absolutely do this in law, and you are expected to, and there's nothing wrong with it. Lawyers bill for their time, frequently in 5 minute blocks. If I spend 20 minutes talking to a client about something substantive, then I bill the client for 20 minutes. If I spend an hour at home researching a treatise to figure out how to do a deal most advantageously for the client, then I bill the hour. There is nothing dishonest about that, and the bill is very detailed in itemizing what time was spent doing what. Most frequently, lawyers put together a long itemized list of what work was done for the client daily, itemized by 5 minute increments, and then simply cut some percentage off the top, to give the client a better deal. For instance the firm may dutifully keep tabs of all the time everybody spent on a client's matter, and have the total end up, say, $12,000, and simply tell the client he's getting the "good customer discount" and so the bill sent is for $10,000. The client, in turn, will have their auditors go through the bill in detail and say, can we make it $8000. That's how billing works in law these days. So there isn't a great incentive for a firm to misstate hours anyhow, since they are going to negotiate the ultimate fee -- the hours only provide the starting point of negotiations; the larger clients with leverage rarely pay that amount.

As for associates padding their hours, most are smart enough not to jeopardize their careers, and most dutifully log their hours and the details of how they were spent. But, when you are junior, you tend to spend way too much time spinning your wheels on matters anyhow, so you will honestly say it took you 4 hours to research a topic and your boss will say "that's too much" and chop it down to 2. So plenty of associates will make themselves look better and only report 2 out of the 4 hours they spent the next time they do a similar project for that partner. So padding, though not that widespread, cuts both ways. I have to admit that you will hear of far more residents adjusting their duty hour cards to comply with the 80 hour rules than you do people playing fast and loose with billable hours in law. So I'd say a lot of physicians are living in glass houses here. Sorry to ramble.

 

[badasshairday]

So is this a for sure? ~60hr work week coming? Or is it possible that it will stay around 75-80hrs?

 

[PharmaTope]

Actually, the larger clients all have auditors who audit their bills in great detail. It's probably not much harder for a doctor to overbill an insurance company as it is for a lawyer to overbill a client. Both are illegal, and neither is significantly more common. In my experience, lawyers are more attuned to what the repercussions are, and as a result, are less likely to stray. Lawyers also do a significant amount of intra-professional policing of things that are unethical (even where they are not illegal), so there are lots of consequences within the profession, let alone with law enforcement. Again, there are crooks in every profession, but truthfully it has not been my experience that lawyers are any worse than doctors in this kind of thing.

As for lawyers being able to bill out of the office, for phone calls, and for research/reading time, the answer is yes, if it's well documented. You absolutely do this in law, and you are expected to, and there's nothing wrong with it. Lawyers bill for their time, frequently in 5 minute blocks. If I spend 20 minutes talking to a client about something substantive, then I bill the client for 20 minutes. If I spend an hour at home researching a treatise to figure out how to do a deal most advantageously for the client, then I bill the hour. There is nothing dishonest about that, and the bill is very detailed in itemizing what time was spent doing what. Most frequently, lawyers put together a long itemized list of what work was done for the client daily, itemized by 5 minute increments, and then simply cut some percentage off the top, to give the client a better deal. For instance the firm may dutifully keep tabs of all the time everybody spent on a client's matter, and have the total end up, say, $12,000, and simply tell the client he's getting the "good customer discount" and so the bill sent is for $10,000. The client, in turn, will have their auditors go through the bill in detail and say, can we make it $8000. That's how billing works in law these days. So there isn't a great incentive for a firm to misstate hours anyhow, since they are going to negotiate the ultimate fee -- the hours only provide the starting point of negotiations; the larger clients with leverage rarely pay that amount.

As for associates padding their hours, most are smart enough not to jeopardize their careers, and most dutifully log their hours and the details of how they were spent. But, when you are junior, you tend to spend way too much time spinning your wheels on matters anyhow, so you will honestly say it took you 4 hours to research a topic and your boss will say "that's too much" and chop it down to 2. So plenty of associates will make themselves look better and only report 2 out of the 4 hours they spent the next time they do a similar project for that partner. So padding, though not that widespread, cuts both ways. I have to admit that you will hear of far more residents adjusting their duty hour cards to comply with the 80 hour rules than you do people playing fast and loose with billable hours in law. So I'd say a lot of physicians are living in glass houses here. Sorry to ramble.

i got a friend did 113 hours last week. avgs between 110-130 hours a week (yes averages). his program basically sat there while he filled out paperwork about this..

cant do anything about it.

 

[45408]

I have to admit that you will hear of far more residents adjusting their duty hour cards to comply with the 80 hour rules than you do people playing fast and loose with billable hours in law. So I'd say a lot of physicians are living in glass houses here. Sorry to ramble.

Do law firms penalize junior associates for working too many hours?

 

[akinetopsia]

Padding hours is a crime. You can be disbarred, and you can go to jail for this. Only fools risk their career in this way. There are people who break the law in all fields, including medicine. If your post is somehow suggesting that criminal activity is more rampant in the legal field, I would suggest that you take a note of the fact that the number of physicians who get in trouble for fraudulent medicare and reimbursement claims far exceeds the number of allegations against lawyers for this similar kind of activity.

If anything, billable hours are underreported in some firms. What would happen in my firm is an associate shows the debit note to the partner that oversees that particular client, and he/she is told to lower the cost.

(not a lawyer, but worked in formalities for an IP law firm for several years)

 

[Law2Doc]

Do law firms penalize junior associates for working too many hours?

Not penalized, but if they spend too much time on a matter that a partner feels should take X hours (and that he plans to bill the client for X hours), it won't make the partner happy -- you are spinning your wheels and the time you spent could have been better spent on something they could actually bill for. But there is really no ceiling as to how many hours you might work -- that is my point. Residents are penalized for submitting duty hour sheets exceeding the rules. An associate in law who logs a ton of hours is given a pat on the back. So there is nothing really uncommon or inhumane about resident hours, at least now insofar as they are capped at 80. That's pretty common for the junior folks in high paying professional fields.

 

[MJB]

I'm going to go ahead and assume that the young lawyer makes a lot more per year than your average resident.

 

[ladyintern]

Thank you MJB. What an incredibly stupid argument. Everyone knows there is no comparison between lawyers starting out and residents. If you're going to argue that the hours are similar (which they may in fact be at some of the big law firms), that's fine. But

a) the work is nowhere near as important or stressful - ever spent 30 hours working in a NICU?
b) you haven't been working your ass off since freshman year of college on courses like orgo to get to residency.
c) you are making LOADS more money. I would love to see which lawyer working 80 hours a week is making 45K for 3-7 YEARS.
d) you can opt out anytime and head to a more relaxed career path - I have had a number of lawyer friends do that very thing because they hated the big law firm lifestyle. Unfortunately, as a resident, you are trapped until you're board certified, which is attainable ONLY at the end of a residency.

 

[Law2Doc]

Thank you MJB. What an incredibly stupid argument. Everyone knows there is no comparison between lawyers starting out and residents. If you're going to argue that the hours are similar (which they may in fact be at some of the big law firms), that's fine. But

a) the work is nowhere near as important or stressful - ever spent 30 hours working in a NICU?
b) you haven't been working your ass off since freshman year of college on courses like orgo to get to residency.
c) you are making LOADS more money. I would love to see which lawyer working 80 hours a week is making 45K for 3-7 YEARS.
d) you can opt out anytime and head to a more relaxed career path - I have had a number of lawyer friends do that very thing because they hated the big law firm lifestyle. Unfortunately, as a resident, you are trapped until you're board certified, which is attainable ONLY at the end of a residency.

While I don't disagree with parts b & c of your post, I think the other two (a&d) fall into the "incredibly stupid argument" category that you just attacked the other poster for.

First, as for (a), I think you are being a bit myopic and self important there. The young lawyer who works to close the deal that builds the NICU is hardly doing something less important than the doctor who works in the NICU. Some would argue that the former actually does something more important, because without his efforts, far more infants are impacted. Don't kid yourself that doctor's work is more important than everyone elses. It may have the MOST DIRECT impact because you are actually working with the patient, but not usually the greatest. Every time you drive on a road, go into a building, turn on a diagnostic machine, prescribe a medication, the work of hundreds of young lawyers and business personnel makes this actually happen.

As for (d), some people's notion of "optional" on this thread don't take the reality of the situation into account. You can always opt out of residency and do something else, just like you can opt out of a big law firm and do something else. You would be killing your career, just like most people at big firms who bail while still a young associate kill their career. There is a direct comparison. If you think someone still an associate, ie at the "training" level of lawyerdom in the first 3-5 years (ie akin to residency) can actually jump to a relaxed lifestyle and not destroy their career, I think you aren't very plugged into the legal field. You could certainly do this many years down the road. But if you do it from a big firm early on, it's over. You won't be earning a six digit salary, your career progression will be nil. This is very much a one way jump, and you go from very marketable, to poorly marketable. There are really two realistic options, (1) stick with the big law firm until you actually have valuable skills and portable clients, which happens quite a few years down the road for most, or (2) until you make partner, junior partner, non-equity partner etc. (whatever term various firms put on folks who they deem worthy of keeping/valuable). Only then can you jump to a smaller firm, a corporate, or a government job and not really have committed career suicide. So it's really the same as a resident -- if you bail before completing residency, you are kind of SOL. If you complete residency, more options exist. I would say it's naive to say that folks at big firms who want to maintain the professional income have a ton of options other than to work hard. They don't. It's up or out, just like residency.

 

[Nellyakgo]

Again, it's not optional. It's only optional if you don't care for your job - just like in residency. If you don't care to remain as a resident, then you, too, can pick and choose how many hours you work. Saying that other professionals can remain somewhere in the financial or law industry is just semantics, since obviously, you can still remain in the "health care" industry if you drop residency for nursing.

Sorry, I disagree. And this is based on my 15 years experience in Fortune top 50 companies, both for myself and close friends.

 

[Nellyakgo]

This is part and parcel with the ACGME strategy to paint resident training coming from morning report and noon conference... and NOT from clinical duties. In their broadsides, they routinely paint clinical practice/rounds/ procedures as actually taking valuable time away from resident education.

Someone explain to me how these bureaucrats at ACGME have such vast, unchecked power over us and our programs when 1) they obviously have long forgotten what residency is like, and how we learn better from doing than from powerpoint (assuming they even went to med school... many of them did not) and 2) they would rather pursue politically driven agendas than fulfill what used to be their primary purpose: to ensure U.S. residency programs graduate the most competent doctors possible.

Hear hear!

 

[bronx43]

Sorry, I disagree. And this is based on my 15 years experience in Fortune top 50 companies, both for myself and close friends.

Which part do you disagree with? That hard work isn't optional in high-income professions?

And corporate is corporate. Fortune 50, 100, or 300 means nothing. It's 2-3 steps below the likes of high finance, corporate law, consulting, or lucrative specialties in medicine - unless you somehow manage to get into upper management and actually acquire equity within the company. But, the likelihood of that is slim to none, especially within Fortune 100.

 

[Nellyakgo]

Hard work is not optional, it is a must. But (1)hard work is not measured by the number of hours. (2)Actually, people who can "deliver" but don't have to stay in the office after 6-7pm everyday to do so, are seen as the better performers are are more likely to rise in the ranks.

The part I don't agree with is that putting in 80+ hrs a week is a MUST in other corporate professions in order to stay in them. It's optional. You CAN stay in those professions and you CAN have a high profile AND get promoted and you CAN be paid 6 figures while doing only 40-50 hrs a week. AND this can happen both within your first few years working and your advanced/senior years.

Anyways, I'm just writing what I know to be a fact amongst MANY high profile well established institutions/corporations. If you and/or others disagree (based on whatever) that's your prerogative. This is about what I know to be facts and not a discussion of ideas.

All said in a friendly and respectful way...

 

[bronx43]

Hard work is not optional, it is a must. But (1)hard work is not measured by the number of hours. (2)Actually, people who can "deliver" but don't have to stay in the office after 6-7pm everyday to do so, are seen as the better performers are are more likely to rise in the ranks.

The part I don't agree with is that putting in 80+ hrs a week is a MUST in other corporate professions in order to stay in them. It's optional. You CAN stay in those professions and you CAN have a high profile AND get promoted and you CAN be paid 6 figures while doing only 40-50 hrs a week. AND this can happen both within your first few years working and your advanced/senior years.

Anyways, I'm just writing what I know to be a fact amongst MANY high profile well established institutions/corporations. If you and/or others disagree (based on whatever) that's your prerogative. This is about what I know to be facts and not a discussion of ideas.

All said in a friendly and respectful way...

I honestly don't know many professions where you can get away with 40-50 hours/week during the early part of your career, while making $100k+ (with the potential of 50-100% more in the latter part of your career.) I would think I know all the lucrative careers out there, but apparently you have information that claims otherwise.

Care to share?

 

[drblueshades]

The young attorneys (associates) I know who work at top Manhattan firms are making over $150k plus bonuses in their first year out of law school, and most average 50-60 hours per week. Of course, they have some crazy weeks and unpredictable hours at times, but anecdotally they seem to work less than my colleagues in residency. I do know one associate at a major Manhattan firm who works more like 80 hours per week, but he pulled down $300k after bonuses...

I'd never want their job anyway, though

 

[NotAProgDirector]

It is very difficult to compare different professions. There is no doubt that residents work hard. However, many programs have removed overnight call. 80 hour weeks exist but they are not "mandated". 80 is the max. My PGY-3's have ~8 months of 40 hour weeks.

Also lost in this comparison (of law to medicine) is the fact that essentially all US MD grads get a residency, and then all of those end up with historically very stable jobs. Law, on the other hand, a few people make it into big law firms and do well financially. Many law graduates (from US law schools) end up not doing anywhere near as well.

 

[Law2Doc]

...
Also lost in this comparison (of law to medicine) is the fact that essentially all US MD grads get a residency, and then all of those end up with historically very stable jobs. Law, on the other hand, a few people make it into big law firms and do well financially. Many law graduates (from US law schools) end up not doing anywhere near as well.

That's actually intentionally "lost in this comparison" because it's an apples and oranges issue. You can really only look at the top X% of law grads because there are many times more of them than residents (many times more schools, most with bigger classes), and most really wouldn't be competitive for other professional fields (you can be a lawyer with a C average in college). So you basically have to look at the top 20 schools, and the top couple of % at the other schools, to get a similar sized and credentialed group to those graduating US med school. And when you look at that group, then most actually do quite well. FWIW, this is not just my opinion, Atul Gawande made the same point in a NY Times article a few years back. You have to compare med students to people in other fields who could have been med students if you want a fair comparison. Looking at some dude who got a gentleman's C throughout college and then went on to some no-name law school is really not going to be a fair comparison to the person who got "mostly A's" and jumped through all the hoops to get into an allopathic med school, and their career trajectory won't be a fair comparison either. You have to compare apples to apples. And when you do that, most of the people you are looking at (when looking at a comparable number, cut off the top of law) actually do quite well.

FWIW, IMHO most of the people on here, had they applied themselves toward law the same way they applied themselves toward medicine, would have gotten into good schools and would have from there gotten into big firms. Having a lot of smarts and a better than average work ethic gets the job done in that field, just like any other. You might not have the chops to be a litigator, might not enjoy all the reading and writing involved, but to be a cog in the great law firm machine, someone with the workaholic attitude of a premed, and the same good head on your shoulders that is required in medicine, would do wonderfully.

 

[oldbearprofessor]

First, as for (a), I think you are being a bit myopic and self important there. The young lawyer who works to close the deal that builds the NICU is hardly doing something less important than the doctor who works in the NICU. Some would argue that the former actually does something more important, because without his efforts, far more infants are impacted. Don't kid yourself that doctor's work is more important than everyone elses. It may have the MOST DIRECT impact because you are actually working with the patient, but not usually the greatest. Every time you drive on a road, go into a building, turn on a diagnostic machine, prescribe a medication, the work of hundreds of young lawyers and business personnel makes this actually happen.

Actually, having worked in multiple NICUs in multiple continents in which there was no reliable supply of clean water, electricity and/or oxygen, BUT, there were trained pediatricians and sometimes neonatologists, I'd say that the folks that provide these services and keep electricity going to the broken incubators are more important even than the lawyers who wrote the contracts that built the buildings that housed the babies that are cared for by the neonatologists (for two zuzim ). I'm not sure that's what was really meant here though.

Even in the US, one could argue that the benefactors who gave the money that hired the lawyers who arranged the contractors who build the NICU that housed the babies were more important than the neonatologists who cared for the babies (who want more than two zuzim for their work ). You get the idea - deciding who is most important in all this is a tough challenge.

Regardless, the other night I was called in the middle of the night from my in-house call room after working about 20 hours for a baby whose heart rate was 30 and oxygen sat was unmeasurable. In that situation, the neonatologists, nurses, etc have a few seconds/minutes to solve the problem, make an intervention (or 2 or 3) and save the baby's life. I'm generally guessing that this is more stressful on a per OT hour than the lawyer who stays up to 2 AM working on the contract or on the other issues needed. Great respect have I for such lawyer (really), but their OT isn't the same stress as my OT or the intern's OT. If it it, my child, the future lawyer, needs to not do contract law.

 

[Law2Doc]

Actually, having worked in multiple NICUs in multiple continents in which there was no reliable supply of clean water, electricity and/or oxygen, BUT, there were trained pediatricians and sometimes neonatologists, I'd say that the folks that provide these services and keep electricity going to the broken incubators are more important even than the lawyers who wrote the contracts that built the buildings that housed the babies that are cared for by the neonatologists (for two zuzim ). I'm not sure that's what was really meant here though.

Even in the US, one could argue that the benefactors who gave the money that hired the lawyers who arranged the contractors who build the NICU that housed the babies were more important than the neonatologists who cared for the babies (who want more than two zuzim for their work ). You get the idea - deciding who is most important in all this is a tough challenge.

Regardless, the other night I was called in the middle of the night from my in-house call room after working about 20 hours for a baby whose heart rate was 30 and oxygen sat was unmeasurable. In that situation, the neonatologists, nurses, etc have a few seconds/minutes to solve the problem, make an intervention (or 2 or 3) and save the baby's life. I'm generally guessing that this is more stressful on a per OT hour than the lawyer who stays up to 2 AM working on the contract or on the other issues needed. Great respect have I for such lawyer (really), but their OT isn't the same stress as my OT or the intern's OT. If it it, my child, the future lawyer, needs to not do contract law.

I get what you are saying -- my point was that it's pretty arrogant for the prior poster to presume that s/he is the most important career out there; a lot of people's effort are required to make this wheel go round. That you are on the front line doesn't mean that the person further back in the picture isn't making what you do even possible.

As for whether the stress is the same, I have to say, having been on both sides now, that stress is stress. Both fields can be very high stakes. It doesn't really change things if you are furiously working to keep someone alive who is circling the drain, or you are furiously working to make sure a deal gets done and people don't lose millions, their livelihood, homes, etc. In medicine the stakes are peoples' lives and health. In law the stakes are money (in criminal law the stakes might also be people's lives, but we will put that aside). Sadly, my experience is that people actually tend to be more upset when they lose the latter. People aren't happy when you tell them Uncle Ed didn't make it, but they will scream, curse, break things and threaten your life if you tell them you just cost them $1,000,000. So I'm not really sure who is working under more stress, actually. It's a sad commentary about the human condition, but many people can shrug off the loss of a loved one easier than they will shrug off financial ruin. And when you are at a big firm working on big deals, that's exactly what's at stake -- money in very large denominations. More than you can ever pay back. And if you screw up -- misunderstand a relatively benign looking clause in a contract perhaps-- you can cost people big money. The difference between a happy client and some temporary career security, and a livid client and bosses wondering whether you are too much of a liability to work there, and a risk of being named in the legal malpractice suit by an unhappy client (yes, malpractice exists in both fields). I don't think any field has a monopoly on stress.

 

[oldbearprofessor]

It doesn't really change things if you are furiously working to keep someone alive who is circling the drain, or you are furiously working to make sure a deal gets done and people don't lose millions, their livelihood, homes, etc. In medicine the stakes are peoples' lives and health. In law the stakes are money (in criminal law the stakes might also be people's lives, but we will put that aside). Sadly, my experience is that people actually tend to be more upset when they lose the latter.

I have no doubt that there is stress in both areas. I don't have any experience with legal mistakes, but I do have considerable experience with dealing with families whose baby has just died or had some horrible event occur, and, I'd be surprised to see that people are more upset by a legal mistake. Kind of hard to do a comparison though, so we'll never really know. I would presume that it's easier to remedy a legal mistake than a medical mistake that leads to death or brain damage in a newborn, and this would affect the stress level of the young doctor or lawyer.

I would still believe, and again, I recognize I've only seen one side of the story, that the stress on a young doctor of having moments to successfully do something (intubate, place a chest tube, etc) to save a newborn's life or future is greater on a per OT hour than the night working lawyer. You are welcome to disagree. This situation is not rare, but is routine in an NICU night leading to the overall high level of stress among trainees working very long hours in that setting, which is the topic of this thread. This is much better in many circumstances now with in-house attendings.

 

[BlondeDocteur]

I have to agree with L2D here. Those corporate law jobs in Manhattan which everyone is supposedly drooling over have horrible hours and are extremely stressful.

When we're not on-call, we're not on call. Imagine carrying your pager with you literally every minute of every day of every month of every year-- those blackberries go off at all hours, often at 11 PM on Saturday with a "we need this on our desk by 8 AM tomorrow."

Attrition, esp involuntary attrition, is very high. The first layoffs start after the 2nd year. Of 40 who start in a department (litigation, corporate, M&A) at a given firm office, perhaps one will make partner a decade later. The stress of being the one outed-- even if you hate your job-- is always looming over you.

The work is intrinsically unrewarding, very rarely intellectually challenging, and often tedious.

My spouse billed 2800 hrs/yr and went his first 9 months at his firm without a single day off. Not a single day. We only saw each other because I would spend weekends and weeknights in his office, studying across from him. His routine hours were 10 AM - 1 AM, including Saturday & Sunday. And when there was a trial ramping up, you literally did not come home for a week. They had showers and a sort of call room for that. Nothing in medicine compares.

And yes, the compensation was quite nice-- but it had to be, since no one in their right mind would do that job for anything but great money.

And remember-- he was one of the lucky ones! The top 1% who are even given the chance to earn a high salary. The average JD in this country (all ages, all amts of yrs in practice) earns $55,000.

I can't tell you how many times I would hang out with his colleagues and they would tell me how lucky I was to be in medicine, how it was such an interesting and rewarding field, and they would have given anything to feel like their lives had some kind of purpose other than making money. (Incidentally, I as a med student was the only female spouse who 'worked'). All of them, with the exception of the most android-like dude, were making dreamy plans of getting out.

 

[avatarftw]

a

 

[bronx43]

I don't think that you can compare the average JD to the average MD/DO. As previous posters have commented, to get into law school its really not that hard. That "55,000 average yearly salary" includes people that got 2.5 GPA's in college majoring in relatively easy majors like english and political science.

Heck, its not that hard to get a 3.5+ in non science classes--well, many would agree with me.

A more appropriate comparison, which has been stated before, is to look at people with similar intelligence and work ethic and compare their compensation in medicine and law.

The problem with that comparison is that medicine is largely homogenized, with respect to compensation. A top 1% talent at Harvard Medical School, who pursues internal medicine would make the same as an average talent who pursues internal medicine.
Sure, there are lucrative fields that attract smarter people, but income potential is ever-changing in medicine - a variability that will be exaggerated in the coming years due to reform.
In big law, the most talented graduates from the best law schools will end up making the most money. If you went to a crappy law school, you're not getting a lucrative corporate law job.

 

[avatarftw]

a

 

[SoCuteMD]

I have to agree with L2D here. Those corporate law jobs in Manhattan which everyone is supposedly drooling over have horrible hours and are extremely stressful.

When we're not on-call, we're not on call. Imagine carrying your pager with you literally every minute of every day of every month of every year-- those blackberries go off at all hours, often at 11 PM on Saturday with a "we need this on our desk by 8 AM tomorrow."

Attrition, esp involuntary attrition, is very high. The first layoffs start after the 2nd year. Of 40 who start in a department (litigation, corporate, M&A) at a given firm office, perhaps one will make partner a decade later. The stress of being the one outed-- even if you hate your job-- is always looming over you.

The work is intrinsically unrewarding, very rarely intellectually challenging, and often tedious.

My spouse billed 2800 hrs/yr and went his first 9 months at his firm without a single day off. Not a single day. We only saw each other because I would spend weekends and weeknights in his office, studying across from him. His routine hours were 10 AM - 1 AM, including Saturday & Sunday. And when there was a trial ramping up, you literally did not come home for a week. They had showers and a sort of call room for that. Nothing in medicine compares.

And yes, the compensation was quite nice-- but it had to be, since no one in their right mind would do that job for anything but great money.

And remember-- he was one of the lucky ones! The top 1% who are even given the chance to earn a high salary. The average JD in this country (all ages, all amts of yrs in practice) earns $55,000.

I can't tell you how many times I would hang out with his colleagues and they would tell me how lucky I was to be in medicine, how it was such an interesting and rewarding field, and they would have given anything to feel like their lives had some kind of purpose other than making money. (Incidentally, I as a med student was the only female spouse who 'worked'). All of them, with the exception of the most android-like dude, were making dreamy plans of getting out.

As the daughter of a partner in one of these firms, I have to say that what you are representing is one side that is not necessarily the only path. I was born the year my father started at the firm he's at and he worked a lot. By the time I was 6 or 7 he was able to be home enough to coach my soccer game and be a pretty involved dad. He was responsible for post-work pickup from my babysitter's half of the time. He made equity partner. My best friend had a similar position and she usually worked late-ish (9 AM - 830 PM was her usual). She rarely worked weekends and was definitely putting in fewer hours than I was during my third year of medical school. Was she on the partner track? Absolutely not (by choice). But she was making the same (inflated) salary that every first, second, and third year associate was making at a Manhattan law firm. She now has another job that is a better fit for her but is still doing very well financially (I don't actually think she took a pay cut when she left her big firm).

The hellish life of an associate is definitely a CHOICE - one can work at one of the big firms and bill 2000 hours for the year (likely working somewhere around 3000 to achieve this), get some good experience and a big name on his/her resume and go elsewhere without ever making aprtner or being on the partner track.

 

[bronx43]

My argument is that if you look at the GPA and LSAT of those students accepted to the "top tier" of law schools its really not that impressive.

A very high percentage are accepted compared to medicine and one doesn't even have to take the "hard science courses" nor volunteer, interview, etc.

You're right. They aren't that impressive, but neither are scores from an unranked medical school.
It's really a case by case comparison for income in medicine vs law. There are a percentage of people in medical school, who can make more money in law. And likewise, there are people in law, who can make more money in medicine. But, overall, I think most people in medicine probably couldn't have made more money in law.

 

[bassvp]

Just an honest question,

But on all those surveys that compare average hours and average pay of different medical/surgical specialties, it looks like the average attending works ~55-60hrs/week. Several comments in this thread had suggested that even attendings would work 80+/wk. Are these numbers flawed or is there something that I'm missing?

http://www.medfriends.org/specialty_hours_worked.htm