The Big Mega Millions Residency Question

[8744]

I love all the people who state that they would go through residency and fellowship.

Seriously, after that first night of "Why am I here if I don't have to be?", that would end.

Here's the conversation:



The Scene: 4AM. You are fielding multiple admits. You are tired. You have a complicated patient you are trying to present to your attending who you have called at home. The attending wants the full "Patient is a 57-year old woman with a history of..." type presentation. You just want to give the pertinent details with your assesment and plan so you can get to five admissions you have waiting and who need to stop hogging ED beds. The attending keeps interrupting.

Medicine Attending (4AM): Hmm...have you calculated her Creatinine Clearance?

You: It's 72.

Medicine Attending: How did you calculate it?

You: The lab calculates it for us.

Medicine Attending: What number did you get using Cockcroft and Gualt?

You: The lab calculates it for us.

Medicine Attending: Yes, doctor, but you should check their calculations. Read me her lab values and I'll walk you through it.

You: Never mind. I quit. Admit your own goddamn patients.

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[deleted109597]

I'm honestly not sure if I will do one fellowhip or three right now.

Why in God's green earth?

Otherwise, I would be concerned about being as competitive as possible for a job at a teaching hospital or private practice.

Uh, for what? The Hem-Onc/Cards/ID jobs out there?

 

[hermione]

Here's the conversation:



The Scene: 4AM. You are fielding multiple admits. You are tired. You have a complicated patient you are trying to present to your attending who you have called at home. The attending wants the full "Patient is a 57-year old woman with a history of..." type presentation. You just want to give the pertinent details with your assesment and plan so you can get to five admissions you have waiting and who need to stop hogging ED beds. The attending keeps interrupting.

Medicine Attending (4AM): Hmm...have you calculated her Creatinine Clearance?

You: It's 72.

Medicine Attending: How did you calculate it?

You: The lab calculates it for us.

Medicine Attending: What number did you get using Cockcroft and Gualt?

You: The lab calculates it for us.

Medicine Attending: Yes, doctor, but you should check their calculations. Read me her lab values and I'll walk you through it.

You: Never mind. I quit. Admit your own goddamn patients.

Genius, and so true. As well as the first time my senior resident asked "Did you do a rectal on the patient?"..."No, his cc is cough and our admit dx is pneumonia."..."Yes, but you still need to do the rectal."...bam. Done. No looking back.
Then again I'm 9 months into this hell that is internship, so maybe I'm a little jaded and bitter at this point...

 

[Faebinder]

Genius, and so true. As well as the first time my senior resident asked "Did you do a rectal on the patient?"..."No, his cc is cough and our admit dx is pneumonia."..."Yes, but you still need to do the rectal."...bam. Done. No looking back.
Then again I'm 9 months into this hell that is internship, so maybe I'm a little jaded and bitter at this point...

Seriously.. do you think they made you do that out of hate and spite?

I remember a story of this resident, he walked over to the secertary of the big dog in the department. He was a senior so its not like he was an intern. I dont know what was with his attitude, but he grabbed the stapler and opened it and tossed the staples in the garbage and then tossed the stapler at the secretary's desk and told her "The stapler needs refilling." and when she told him to refill it himself, he told her "I don't do that, I'm a doctor." She told him to get f**k out of the office.

Now to me, stories like that tell me that there are people out there with so much s**t running on them that they lose their minds cause I just cant believe there are humans that have reached this far up the ladder of medicine with a stick up their a$$.

*God, I hope I never turn this way after residency.*

 

[danielmd06]

Why in God's green earth?

Uh, for what? The Hem-Onc/Cards/ID jobs out there?

I'm not an Internal Medicine resident. I'm doing Neurology.

I think everyone would behave a little differently if they were suddenly faced with the option of never having to work another day in their lives, and I'm not passing any judgement on anyone who is saying that they would quit right then and there. I'm only saying that I would finish my residency, would still finish at least one fellowship, and would continue to use the education I worked so hard for. I love neuroimaging enough to want to continue doing it...even if I didn't have to.

 

[uclabruins47]

Finish School, Residency, Get a Job....I'm hear because I want to be a doctor. So what, you have alot of money now, am I going to sit on my a$$ all day long? I want to be a doctor, everything else is really second to that. Sure I would have a much more comfortable lifestyle and would be able to help my family and friends.... Wait isn't everyone becoming a doctor for altruistic reasons?

no, unless you're that naive to believe so. for me i would graduate, and then tackle internship to see how it is.

life is short, you only get one chance to live

 

[deleted109597]

I'm just asking what three fellowships you would do, that's all.

 

[8744]

Seriously.. do you think they made you do that out of hate and spite?

I remember a story of this resident, he walked over to the secertary of the big dog in the department. He was a senior so its not like he was an intern. I dont know what was with his attitude, but he grabbed the stapler and opened it and tossed the staples in the garbage and then tossed the stapler at the secretary's desk and told her "The stapler needs refilling." and when she told him to refill it himself, he told her "I don't do that, I'm a doctor." She told him to get f**k out of the office.

Now to me, stories like that tell me that there are people out there with so much s**t running on them that they lose their minds cause I just cant believe there are humans that have reached this far up the ladder of medicine with a stick up their a$$.

*God, I hope I never turn this way after residency.*

It's not that at all. The little one-act play I posted was an actual conversation I had at 4AM with one of my attendings (minus the last line). She wasn't trying to be mean or difficult, but as she told me, she was just trying teach me.

This is fine. But it was four in the friggin' morning. Not the time to pimp me about Cockhault-Gualt.

This speaks to another point about which I am working on an article for my blog, namely the concern that shortening residency work hours will detract from our education. In fact, the current residency training system itself detracts from our education as it was designed for a time when things moved much slower at the hospital, there was less to know, and while residents may have actually lived at the hospital, their duties were not so onerous as to preclude their reading and studying on their own or attending conferences and "Grand Rounds."

Today, there is a lot to know and running around the hospital all night spending the majority of that time wrangling paperwork is not only inefficient but it makes it impossible to keep up with the basic knowledge that is essential for a modern physician. I will be on call tonight. My pager is already going off now with enough regularity where I can't really do anything that requires concentration. Starting at about 5PM I will be on my feet until at least 6AM. Even if I get a break I'll probably just pass out on the couch in the residents room until the pager wakes me up again. When I get home I'll probably sleep until five, get up, spend time with my family, go to bed, and then report back for more of the same on Saturday when I have call again. Couple that with a normal 13-hour work day and when can anybody study with the concentration required so it is not a chore (which it shouldn't be)?

"But Panda, you learn by seeing patients."

Sure, but of all the time spent on a patient, most of it is not spent with the patient but, like I said, wrestling with the increasingly complicated paperwork. It takes an hour to admit a patient...and I am sometimes accused of rushing things.

 

[8744]

...Seriously.. do you think they made you do that out of hate and spite?

No. It's fear and lack of common sense which seem to be the governing ideal of most of medicine.

 

[danielmd06]

I'm just asking what three fellowships you would do, that's all.

Sorry, I misunderstood. I currently want to complete fellowships in Neuroimaging, Vascular/Stroke, and INR.

I've slowly gotten interested in Pain and Sleep, too. But I absolutely love Neuroimaging.

 

[dpmd]

My first thought was that I would go to my first choice residency director and start putting hundred dollar bills on the table until they give me a spot. Then I realized that is crazy (feeling a little desperate after not matching last year). I love medicine, and I really want to do the specialty I have chosen. However, I could probably find something else that would give my life meaning without entailing the unpleasantness of the current training environment in the US. Maybe I could do a cush intern year in order to get my license (maybe do it over more than one year so the hours are minimal). Then I could work with someone in my chosen specialty as sort of an apprentice (couple of days a week, minimal hours, and with lots of vacation). I would never reach attending status, but that wouldn't really matter since I wouldn't need an income. I assume I would never become really proficient in a lot of things, but maybe I could focus on one or two procedures that are more interesting to me. I would have a nice house with a waterslide, cool looking jacuzzi, fish tank floors, and all the other things I see on those shows on rich people's houses that I like. I would finally get to go to schiltterbahn, and I would pay to use it for just me and my family/friends for a couple of days (no lines, yea!). I would never cook, clean the house, or drive in traffic ever again. I would pay for every person in my extended family to go to school if they want, and I would buy up the houses around my grandma's house so each of my aunts/uncles/cousins that currently live with her could move out but still be nearby. I would probably start some kind of charitable foundation too.

 

[EctopicFetus]

I just think my attitude would be different. Money would be NO issue at all. Honestly the liability would worry me, but what I would do is throw my money in a trust and in effect be broke. This is kind of my plan now. This was I can protect the money I earned and prevent (to some degree) the local meth heads with 2 teeth from getting richer than I could ever imagine!

 

[EctopicFetus]

If you are rich your teeth should look better than this.

 

[GooglieGoo]

Sorry, I misunderstood. I currently want to complete fellowships in Neuroimaging, Vascular/Stroke, and INR.

I've slowly gotten interested in Pain and Sleep, too. But I absolutely love Neuroimaging.

Why not a fellowship in PTT as well? J/K.
I'd do two fellowships: one in whatever I wanted to do clinically, and the other in sitting on a beach for 4 months per year. Only the most selective universities offer the second, so I'll have to work really hard during my first fellowship to get it. Or maybe I'll just scrumble into it.

 

[Mayhem]

I'd finish med school. It's not that much left anyway, plus as a student I have no real responsibility. I'd apply for residency but only to the single best programme in the hardest specialty. That way when I don't get in (because my grades are blah) I can lie to myself and say I tried. After which I would promptly disappear to some out of the way paradise and never lift a finger again in my life.

I love all the people who would continue and do residency but I know I'm not the one. I love medicine and if the way it was taught changed then I would stay. But right now the only reason I hold my tongue is because I am 3 years and many thousands of dollars in and I have no marketable skills. The things I would say to people if I had money would get me thrown out so fast I'd get whiplash.

 

[DebDynamite]

deleted

 

[Leforte]

My wife and I were actually talking about this the other day.

No doubt - Would quit the next day. I agree with one of the other posters about getting a PA or NP to do the scutwork, too. I'd feel a little guilt about having the other residents take my call and would buy each resident a sweet ride (We take home call - better known as car call since we just bounce from one hospital to another on call).

Retire to some hot, sunny country and pursue my real interests -

Ask anyone in residency and I'm sure they'd all say the same thing.

As far as continuing to practice - you'd be a walking target for litigation. The lawyers have nothing to loose! They'd file a lawsuit and offer a small settlement right up front. Even if it's BS, it would cost you more to hire a lawyer to represent you - So of course you'd settle after the 10th one. And if you're stupid enough to continue in medicine, you'd realize that despite your wanting to contribute to society, everyone else is looking to hit the malpractice jackpot - financed by you of course.

We had a family sue a local ENT for performing unnecessary surgery (T&A) on 4 year old kid and accused the doctor of performing surgeries to make $$$$ (the family had medicaid). No post-op bleeding, no issues, and is perfect post-op. The lawsiut was filed 6 weeks after the surgery. The family quickly offered a settlement for $50k, the malpractice company told the doctor to agree to the termsit, which the surgeon refused - so the malpractice company refused to pay for the lawyer, and told him he was on his own. He spent ~$100k on the defense and was found not guilty. In his defense argument, he demonstrated to the court that he actually LOST $$$ treating medicaid patients (once you look at the daily cost of an office staff, malpractice, office space, transcription, etc), but felt a civic duty to take care of underprivileged children. So he's $100k poorer, but did it so a mapractice settlement would not be reported to the National Practitioner Database. Needless to say, he doesn't see medicaid pts any longer.

NOW - you have $100+ Million in the bank. You want to guess how many people will be coming after you?

Word of advice - put everything in your partners name and live in a non-community property state.

I could go on - but will leave it for another thread.

Leforte

 

[EctopicFetus]

Leforte, I would finish and I have 2.5 yrs of residency left. I would hide all my money so those bastards couldnt sue me. If I decided to continue in medicine after I would work the 2-5 shifts a month in the ED OR I would set up some clinic run almost exclusively by midlevels, I would then get richer!

Then I would pursue ways to change the medical system. It is awful. That and I love my residency and my field (EM).

 

[TRAMD]

My PD: "Doesn't that intern have clinic today?"
Nurse: "Yes Dr."
PD: "Page him!"
Nurse: "We tried to, the page was answered by a sun-bather whom found the pager buried in the sand on a beach in the Cayman Islands. When I described the intern to the sun-bather, he said that described the new owner of the hotel he is staying at and that the new owner just left in a Lamborghini with two blondes."

 

[me454555]

Before I quit, I'd pimp out the call room w/plasma's and comfortable furniture. Then go out like that guy in half baked F--- you, F---you, F---- you, your kewl, F-- you , I'm out!!

 

[cdql]

My wife and I were actually talking about this the other day.

No doubt - Would quit the next day. I agree with one of the other posters about getting a PA or NP to do the scutwork, too. I'd feel a little guilt about having the other residents take my call and would buy each resident a sweet ride (We take home call - better known as car call since we just bounce from one hospital to another on call).

Retire to some hot, sunny country and pursue my real interests -

Ask anyone in residency and I'm sure they'd all say the same thing.

As far as continuing to practice - you'd be a walking target for litigation. The lawyers have nothing to loose! They'd file a lawsuit and offer a small settlement right up front. Even if it's BS, it would cost you more to hire a lawyer to represent you - So of course you'd settle after the 10th one. And if you're stupid enough to continue in medicine, you'd realize that despite your wanting to contribute to society, everyone else is looking to hit the malpractice jackpot - financed by you of course.

We had a family sue a local ENT for performing unnecessary surgery (T&A) on 4 year old kid and accused the doctor of performing surgeries to make $$$$ (the family had medicaid). No post-op bleeding, no issues, and is perfect post-op. The lawsiut was filed 6 weeks after the surgery. The family quickly offered a settlement for $50k, the malpractice company told the doctor to agree to the termsit, which the surgeon refused - so the malpractice company refused to pay for the lawyer, and told him he was on his own. He spent ~$100k on the defense and was found not guilty. In his defense argument, he demonstrated to the court that he actually LOST $$$ treating medicaid patients (once you look at the daily cost of an office staff, malpractice, office space, transcription, etc), but felt a civic duty to take care of underprivileged children. So he's $100k poorer, but did it so a mapractice settlement would not be reported to the National Practitioner Database. Needless to say, he doesn't see medicaid pts any longer.

NOW - you have $100+ Million in the bank. You want to guess how many people will be coming after you?

Word of advice - put everything in your partners name and live in a non-community property state.

I could go on - but will leave it for another thread.

Leforte

Is it possible to keep lottery winnings like that a secret? If so, maybe litigation isn't that big a problem?

 

[cdql]

Before I quit, I'd pimp out the call room w/plasma's and comfortable furniture. Then go out like that guy in half baked F--- you, F---you, F---- you, your kewl, F-- you , I'm out!!

I'd love to be there to see the reactions in the room!

 

[Mayhem]

I'd probably react the same way. Sorry for all the other needy folks but what happened to this ENT is not right.

 

[Dr. Dukes]

hire other doctors to work with and then enjoy doing medicine 10am-3pm, 4 days a week

You'd become a dentist?

 

[raptor5]

I am thinking I would either contact venture capitalists to build a Children's hospital in Allentown, PA (in conjuction with LVH probably) or pay (ie donate) to politicians to help the malpractice situation in PA. Ed Rendell is a hard sell, I may not have enough money. I would also give relatives money and donate to my hometown health initiatives that I undoubtedly am a part of. My school gets nothing. Those greedy SOBs get nothing. I may set up a white male nontraditional scholarship at my school since they are severely lacking, but I interview all recipients.