Why Are We Pessimists?

[Postictal Raiden]

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Hi follow psychiatrists,

I am a neurologist but I was wondering if one of you, deep thinkers, can explain to me why we, as a medical community, alway negative.

Personally, I am a glass-half-full-type of a person. However, everyone around me is pessimistic about the future of this career. Quite frankly, it started to rub off on me.

Whether it is among my small circle of physician friends or on the internet (SDN and a large physician FB group), everyone is expecting the worst in the future. Salary cuts, midlevel encroachment, outsourcing to overseas, oversaturation, and now AI taking over.

In fact, I came to this subforum to seek some positivity and was surprised to see these negative thoughts being discussed. It is ridiculous. Oversaturation in psychiatry? You kidding me!!!
Fear of AI in psychiatry? Even more bizarre.

I don’t observe similar behavior from other professions despite them being much, much more replaceable.

Please help me understand what prompts this gloomy outlook among us.

 

[TheRightMedication]

One nice thing about being cynical is you get to be right all the time.

 

[PikminOC]

Hi follow psychiatrists,

I am a neurologist but I was wondering if one of you, deep thinkers, can explain to me why we, as a medical community, alway negative.

Personally, I am a glass-half-full-type of a person. However, everyone around me is pessimistic about the future of this career. Quite frankly, it started to rub off on me.

Whether it is among my small circle of physician friends or on the internet (SDN and a large physician FB group), everyone is expecting the worst in the future. Salary cuts, midlevel encroachment, outsourcing to overseas, oversaturation, and now AI taking over.

In fact, I came to this subforum to seek some positivity and was surprised to see these negative thoughts being discussed. It is ridiculous. Oversaturation in psychiatry? You kidding me!!!
Fear of AI in psychiatry? Even more bizarre.

I don’t observe similar behavior from other professions despite them being much, much more replaceable.

Please help me understand what prompts this gloomy outlook among us.

Psych deals with all the same issues as every other field. Midlevel encroachment is even more in psych.

 

[forchinet121]

Negativity bias - Wikipedia

en.m.wikipedia.org

 

[smalltownpsych]

Humans like to complain to each other and when it comes to the field of medicine or the healthcare industry, there is a lot to complain about. I do find some of the chicken little phenomena a bit amusing, but there are real problems in our systems and I don’t think that the powers that be can be trusted to fix any of it. We tend to be generally nice and caring people that actually enjoy helping people and that’s part of why we chose this career. They are soulless creatures that enjoy helping themselves at the expense of all others while smiling and telling you they are helping to protect people from evil medical providers like us.

 

[G Sheb]

Here's my hypothesis (and it's just a hypothesis).

I think a large chunk of physicians are not happy with their employed jobs.
Toxic culture at work, dealing with difficult patients, being told what to do, feeling that you don't have control, and of course the pressure of performance and all the anxiety of messing up and the legal challenges that come with it.

If you're unhappy in what you're doing or feel burned down by it, you are going to be negative about a lot of things, even unreasonably so.

This forum can also sometimes be a dump for anxieties. You know, it's easier to spill out your irrational, anxious side here than to rant in front of your spouse or something.

 

[PsyDr]

Easy: There is an expected and normative flow of conversation. “Hi. How’re you?” “Good”…. Socially, that pattern of interaction is usually neutral to positive across the board. Even when it is a difficult subject, societies have created ways to turn negative into neutral.

In healthcare, that interactive pattern is violated. Every response is negative. “How’re you?” “Bad!”. And the scale of negativity is shifted to the extremes. This response pattern extends beyond clinical interactions, with responsibility being attributed beyond the reasonable, from admin, billing, etc (e.g., You’re not working hard enough, this patient was mad because you wouldn’t prescribe them heroin, the decapitated person died and it’s your fault).

Then you shift the rewards away. Almost definitively, your successes don’t come back. Admin doesn’t want to reward extra work, fearing that you’ll ask for more, so you see no reward to that.

This creates a negative environment in the absence of positivity.

Watch how little thanks it takes for physicians to remember. That is telling.

 

[Splenda88]

Physicians don't realize how good they STILL have it. Things could alway be better, but compared to my friends who are engineers, I am doing ok.

Most of us can literally pay off a $500k home in 4-5 years while maxing out our 401 and IRA. I don't know anyone in my circle who is not a physician that can do that.

It's the grass is greener phenomenon.

 

[Postictal Raiden]

Easy: There is an expected and normative flow of conversation. “Hi. How’re you?” “Good”…. Socially, that pattern of interaction is usually neutral to positive across the board. Even when it is a difficult subject, societies have created ways to turn negative into neutral.

In healthcare, that interactive pattern is violated. Every response is negative. “How’re you?” “Bad!”. And the scale of negativity is shifted to the extremes. This response pattern extends beyond clinical interactions, with responsibility being attributed beyond the reasonable, from admin, billing, etc (e.g., You’re not working hard enough, this patient was mad because you wouldn’t prescribe them heroin, the decapitated person died and it’s your fault).

Then you shift the rewards away. Almost definitively, your successes don’t come back. Admin doesn’t want to reward extra work, fearing that you’ll ask for more, so you see no reward to that.

This creates a negative environment in the absence of positivity.

Watch how little thanks it takes for physicians to remember. That is telling.

Thank you. This is the answer I was looking for.

I understand there are many challenges being a professional in the healthcare system, but these challenges aren’t unique to us. Many other professions have their share of adversaries. In fact, we have it better than most. Nevertheless, the level of negativity sensed within the healthcare profession is blown out of proportion. To put it bluntly, we come across as a bunch of ungrateful, entitled complainers.

We have so many things to celebrate, from solid job security to high level of income to a healthy reputation in the society. Instead, we tend to forget and succumb to the negative, unproductive prospective.

But you’re right, it is the nature of what we deal with on daily basis. We see and experience a side of humanity that very few other professions can barely begin to fathom. This, in turns, changes us.

 

[Splenda88]

Thank you. This is the answer I was looking for.

I understand there are many challenges being a professional in the healthcare system, but these challenges aren’t unique to us. Many other professions have their share of adversaries. In fact, we have it better than most. Nevertheless, the level of negativity sensed within the healthcare profession is blown out of proportion. To put it bluntly, we come across as a bunch of ungrateful, entitled complainers.

We have so many things to celebrate, from solid job security to high level of income to a healthy reputation in the society. Instead, we tend to forget and succumb to the negative, unproductive prospective.

But you’re right, it is the nature of what we deal with on daily basis. We see and experience a side of humanity that very few other professions can barely begin to fathom. This, in turns, changes us.

I also think working a few jobs before becoming a physician can also help put things in perspective. The reality is that most job sucks

 

[TheRightMedication]

I don't agree with this idea that we work with suffering and this warps us in a unique way.

You dont have to be a bhuddist to observe that suffering is fundamental to existence. Everyone deals with it, not just us. If anything, our ability to ameliorate suffering should empower us.

It's true that we enjoy greater material wealth than 99 percent of all humans who have existed thus far. We still have legitimate material complaints as outlined above regarding what's happened to our profession and who profits from it.

I think it is the material concerns that make is grumpy, not philosophical concerns.

 

[Crayola227]

Physicians don't realize how good they STILL have it. Things could alway be better, but compared to my friends who are engineers, I am doing ok.

Most of us can literally pay off a $500k home in 4-5 years while maxing out our 401 and IRA. I don't know anyone in my circle who is not a physician that can do that.

It's the grass is greener phenomenon.

Yes, well, I would say that in that case there is more to lose so I would not be surprised if as well, people still have anxieties about THAT changing. Because like you just pointed out, all that has to happen are some of these feared changes, I mean we are not so many steps removed from what you describe where your friends are at.

If you coupled what @PsyDr is describing as the work culture, with the loss of the rewards you mention, that changes the entire calculus to something sucky and the potential for that, I'm not surprised it's quite anxiety inducing.

 

[psychemdoc]

Hi follow psychiatrists,

I am a neurologist but I was wondering if one of you, deep thinkers, can explain to me why we, as a medical community, alway negative.

Personally, I am a glass-half-full-type of a person. However, everyone around me is pessimistic about the future of this career. Quite frankly, it started to rub off on me.

Whether it is among my small circle of physician friends or on the internet (SDN and a large physician FB group), everyone is expecting the worst in the future. Salary cuts, midlevel encroachment, outsourcing to overseas, oversaturation, and now AI taking over.

In fact, I came to this subforum to seek some positivity and was surprised to see these negative thoughts being discussed. It is ridiculous. Oversaturation in psychiatry? You kidding me!!!
Fear of AI in psychiatry? Even more bizarre.

I don’t observe similar behavior from other professions despite them being much, much more replaceable.

Please help me understand what prompts this gloomy outlook among us.

Not a psychiatrist so take it with a grain of salt. Nevertheless the things that plague psychiatrists plague other physicians so it might apply to others. My running theory is that what plagues all of them is the vested interests. All physicians, unless coming from serious wealth and have no material concerns or cares, are duly concerned about maintaining the professional moat around them. Encroachment from other specialists and from mid levels are both threats to that. Decreased reimbursements is a threat to that. You get the idea. But unlike another trades we can’t hop, switch, and pivot into something else. It’s the trappings of earning our stripes through all of these years of training that makes us extra anxious about the possibility of losing our livelihoods, lifestyles, or personal sense of self worth. You put in this effort and then you get scared that someone else could come and take it away from you is a common thing to human nature and as we get older we become even more cautious with our attained status, goods, wealth, etc. because we can’t/refuse to pivot again to something else that society might need from us.

 

[Crayola227]

Thank you. This is the answer I was looking for.

I understand there are many challenges being a professional in the healthcare system, but these challenges aren’t unique to us. Many other professions have their share of adversaries. In fact, we have it better than most. Nevertheless, the level of negativity sensed within the healthcare profession is blown out of proportion. To put it bluntly, we come across as a bunch of ungrateful, entitled complainers.

We have so many things to celebrate, from solid job security to high level of income to a healthy reputation in the society. Instead, we tend to forget and succumb to the negative, unproductive prospective.

But you’re right, it is the nature of what we deal with on daily basis. We see and experience a side of humanity that very few other professions can barely begin to fathom. This, in turns, changes us.

Eh, I greatly disagree with this on many levels.

You are seeking an answer to confirm your bias, not actually understand where the negativity comes from and why some of it is justified, it looks to me when you said "this is the answer I was looking for" that you were more interested in confirming your existing beliefs but maybe I'm wrong.

I'm glad for you if you still feel physicians have a healthy reputation in society. Let us know what part of the country you work in.

Lastly, when you compare medicine to other professions, I think you need to consider what is unique to medicine.

When you work in tech and your bosses are trying to slash costs and asking you to cut corners, it's frustrating. The code isn't going to work as well, the end user will be frustrated. My partner is a contractor. Sure, some things he does if not done correctly could be dangerous. But he is his own boss, so he has control over the corners and how much time he spends making sure a job is done to his satisfaction.

The level of responsibility and stakes in our profession is a totally different ball game. Our bosses pressure us to save time, and something can be missed and someone could die. I've seen it multiple multiple times. Then, the work itself, walking someone through their cancer is different than fixing someone's toilet. I'm not trying to minimize my partner's work, just an off hand comparison I'm trying to make.

 

[Crayola227]

Not a psychiatrist so take it with a grain of salt. Nevertheless the things that plague psychiatrists plague other physicians so it might apply to others. My running theory is that what plagues all of them is the vested interests. All physicians, unless coming from serious wealth and have no material concerns or cares, are duly concerned about maintaining the professional moat around them. Encroachment from other specialists and from mid levels are both threats to that. Decreased reimbursements is a threat to that. You get the idea. But unlike another trades we can’t hop, switch, and pivot into something else. It’s the trappings of earning our stripes through all of these years of training that makes us extra anxious about the possibility of losing our livelihoods, lifestyles, or personal sense of self worth. You put in this effort and then you get scared that someone else could come and take it away from you is a common thing to human nature and as we get older we become even more cautious with our attained status, goods, wealth, etc. because we can’t/refuse to pivot again to something else that society might need from us.

^^^^^
This

 

[sloh]

Not a psychiatrist so take it with a grain of salt. Nevertheless the things that plague psychiatrists plague other physicians so it might apply to others. My running theory is that what plagues all of them is the vested interests. All physicians, unless coming from serious wealth and have no material concerns or cares, are duly concerned about maintaining the professional moat around them. Encroachment from other specialists and from mid levels are both threats to that. Decreased reimbursements is a threat to that. You get the idea. But unlike another trades we can’t hop, switch, and pivot into something else. It’s the trappings of earning our stripes through all of these years of training that makes us extra anxious about the possibility of losing our livelihoods, lifestyles, or personal sense of self worth. You put in this effort and then you get scared that someone else could come and take it away from you is a common thing to human nature and as we get older we become even more cautious with our attained status, goods, wealth, etc. because we can’t/refuse to pivot again to something else that society might need from us.

FIRE asap. Our degree/title comes with an enormous shovel. Gotta capitalize on it!

 

[Sushirolls]

Can't come out swinging like a giant azz mo fo ray of sunshine...

Remember 30-40 years ago how doctors were thought of as greedy and golfing at noon? Didn't take long for insurance/admin/hospitals/patients to tear that down. Now we are being poisoned by woke, politically correct scat.

Misery loves company, and those with nice things, or nice auoras, etc, tick people off and they want to tear it down.

Being a pessimist also conveys a level of dissatisfication that means you are likely to look over into the next valley to see if the grass is greener. This propagates humanity across the globe... had we not, and just staying in one valley, content, we'd have risked being eradicated for some reason.

Pessimism was biologically selected for.

 

[Splenda88]

FIRE asap. Our degree/title comes with an enormous shovel. Gotta capitalize on it!

Almost all us can cut down to PT (2 days/wk) after 10 yrs, still live an upper middle class lifestyle and cruise into retirement if we manage our $$$ semi decently.

Things are getting worse for everyone else. I am pretty sure you all have heard about the one-income household factory worker raising 2-3 kids in a decent neighborhood in the 1970s. Even 2-income factory workers can't raise a family of 5 in a decent neighborhood these days. Only big time professionals are able to do that now.

 

[PikminOC]

Physicians don't realize how good they STILL have it. Things could alway be better, but compared to my friends who are engineers, I am doing ok.

Most of us can literally pay off a $500k home in 4-5 years while maxing out our 401 and IRA. I don't know anyone in my circle who is not a physician that can do that.

It's the grass is greener phenomenon.

It's not just about $$$. The level of responsibility for physicians is very high. The aurora shooter psychiatrist Dr Fenton wrote a book about all the stress she was under given that her patient killed so many people. Suicides, overtaking meds, etc fall under our responsibility.

 

[badskittles]

We are pessimists cause of NP mills

 

[PikminOC]

Almost all us can cut down to PT (2 days/wk) after 10 yrs, still live an upper middle class lifestyle and cruise into retirement if we manage our $$$ semi decently.

Things are getting worse for everyone else. I am pretty sure you all have heard about the one-income household factory worker raising 2-3 kids in a decent neighborhood in the 1970s. Even 2-income factory workers can't raise a family of 5 in a decent neighborhood these days. Only big time professionals are able to do that now.

Then people should not have so many kids if they can't provide $$ or emotional support for them.
I'm a physician with no kids as there's no time to spend with them.

I did way too much school to now work part time.

 

[annoyedpsychiatrist]

These are my gripes about medicine i supppose: Ultimately I believe I have it good and better than most but these are the things I feel more of on days im burnt out.

1. With how student loans are, we basically attach a boulder and chain to each student and say "ok, just pick yourself up and run up that mountain like everyone else, itll be fine!". Medical schools get away with murder charging ridiculous tuition and inevitably people end up with >300k debt at an unreasonable interest rate. The COVID pause was a miracle for some people. If you end up not doing PSLF, then you have really hustle to erase your debt and basically start from scratch. Student loans are a complete joke and need an overhaul.

2. Its degrading seeing how hard I work, and the more I make, the more i ultimately lose in taxes. This really hits us the hardest. The rich are smart enough to pay zero to minimal income tax but the upper middle class takes the weight of the tax burden (and even the middle class really). You could end up paying roughly 34% of your income in taxes, and STILL you have to consider property tax, sales tax, state tax, etc. At a certain point working more has diminishing returns as the time spent working doesnt fairly equal the income generated.

3. We are heading to this bizarre trend where "the customer is always right" in psychiatry. Were encouraged to treat sick people, and then people who have very little insight are given reviews to attack us when they dont get what they want. Its degrading sometimes, tbh and a lot of health systems are adopting these metrics. So many times where I refused giving xanax 4x a day and then get a scathing review as a result.

4. Oftentimes the people who run healthcare arent always in touch with reality of situations

 

[psychemdoc]

FIRE asap. Our degree/title comes with an enormous shovel. Gotta capitalize on it!

Mixed feelings about this response for many reasons. 1. The feel of the urgency to FIRE asap is a another stress factor due to the worries stated above. It’s not a solution to the worries started above. It’s a mitigation strategy. Nothing wrong with it but it ain’t a way to make us optimistic, but actually adds another reason to put up more with things we can’t tolerate.

2. FIRE is great and doable for most physicians, but it also comes at great cost to the here and now. Maybe you have young kids. You won’t get that time back when you’re 60 and FIREd. You may have parents alive and in good health now. You won’t get that when you’re 60-70 and you’re FIREd but they’re mostly senile/limited in mobility.

3. I’m still personally jealous of your personal shovel [mention]sloh [/mention] cause your numbers are incredible fine site and I’m not sure how easily replicable! Lol

 

[Sushirolls]

These are my gripes about medicine i supppose: Ultimately I believe I have it good and better than most but these are the things I feel more of on days im burnt out.

1. With how student loans are, we basically attach a boulder and chain to each student and say "ok, just pick yourself up and run up that mountain like everyone else, itll be fine!". Medical schools get away with murder charging ridiculous tuition and inevitably people end up with >300k debt at an unreasonable interest rate. The COVID pause was a miracle for some people. If you end up not doing PSLF, then you have really hustle to erase your debt and basically start from scratch. Student loans are a complete joke and need an overhaul.

2. Its degrading seeing how hard I work, and the more I make, the more i ultimately lose in taxes. This really hits us the hardest. The rich are smart enough to pay zero to minimal income tax but the upper middle class takes the weight of the tax burden (and even the middle class really). You could end up paying roughly 34% of your income in taxes, and STILL you have to consider property tax, sales tax, state tax, etc. At a certain point working more has diminishing returns as the time spent working doesnt fairly equal the income generated.

3. We are heading to this bizarre trend where "the customer is always right" in psychiatry. Were encouraged to treat sick people, and then people who have very little insight are given reviews to attack us when they dont get what they want. Its degrading sometimes, tbh and a lot of health systems are adopting these metrics. So many times where I refused giving xanax 4x a day and then get a scathing review as a result.

4. Oftentimes the people who run healthcare arent always in touch with reality of situations

1) Student loans don't NEED an overhaul. People who are taking them need to treat it like any other loan transaction. Is this a sound business deal? Most people its not. You should not be taking loans out to pay for an English or Communications major. Secondly, college prices are rising because of the steady flow of practically guaranteed money. They also rise because we stopped treating students like adults and now like an extension of children... student health... and advisors. Listening to the dumbing down of grading by professors, the direct and indirect messaging that freshmen are a crop that needed to be harvested [reach graduation to get a degree] instead of the history of protecting academia as an institution of integrity. Student loans are merely a symptom of the greater issues facing academia.

2) Hence the reason to lean conservative in one's voting patterns. And if those politicians aren't voting like a fiscal Libertarian, vote them out.

3) Sigh. The best solution I got, is open your own practice. Become the CEO.

4) They are in touch, they don't care. That's what makes them so adept in meetings to placate and actively listen to the problems issues that should be addressed.

 

[comp1]

As described above, the global why of anxiety is evolutionary psychology. Those who assumed the noise in the night was a tiger didn't get eaten and reproduced more. That said, I don't think an internet forum is likely the place to assuage pessimism. It's the place to grow it unless you're specifically into battling it like me. This is a place where people with anxieties concentrate. It starts off with getting into med school or even the right undergrad, then doing well in med school, then the Steps, matching, finding just the right job and well now you've lived almost half of your life under this extreme cloud of anxiety where you could lose everything you worked for at the drop of a hat. You expect people to just...move on and be at peace with what they have? Not in the least, no, they will be looking for the next thing that could be a barrier, a burden or a possible source of loss. This is not all physicians, but it is those who started early with their anxiety on a student doctor forum.

 

[Merovinge]

These are my gripes about medicine i supppose: Ultimately I believe I have it good and better than most but these are the things I feel more of on days im burnt out.

1. With how student loans are, we basically attach a boulder and chain to each student and say "ok, just pick yourself up and run up that mountain like everyone else, itll be fine!". Medical schools get away with murder charging ridiculous tuition and inevitably people end up with >300k debt at an unreasonable interest rate. The COVID pause was a miracle for some people. If you end up not doing PSLF, then you have really hustle to erase your debt and basically start from scratch. Student loans are a complete joke and need an overhaul.

2. Its degrading seeing how hard I work, and the more I make, the more i ultimately lose in taxes. This really hits us the hardest. The rich are smart enough to pay zero to minimal income tax but the upper middle class takes the weight of the tax burden (and even the middle class really). You could end up paying roughly 34% of your income in taxes, and STILL you have to consider property tax, sales tax, state tax, etc. At a certain point working more has diminishing returns as the time spent working doesnt fairly equal the income generated.

3. We are heading to this bizarre trend where "the customer is always right" in psychiatry. Were encouraged to treat sick people, and then people who have very little insight are given reviews to attack us when they dont get what they want. Its degrading sometimes, tbh and a lot of health systems are adopting these metrics. So many times where I refused giving xanax 4x a day and then get a scathing review as a result.

4. Oftentimes the people who run healthcare arent always in touch with reality of situations

It is ridiculous for the ultra wealthy to pay no taxes by taking out loans against their shares and then stepping up in basis when they die to pay 0% tax? Obviously yes.

Is it silly that long-term cap gains rates are much lower than money earned from actual labor? I would argue also yes. The tax system clearly is designed to be heavily carried by individuals like US doctors (high salary, no/little tax deductions).

However the US tax burden is still among the lowest of the developed world. I think that it's preposterous to be upset about a 37% marginal tax rate for those of us fortunate enough to live in a society as well run as our own and who make as much money as we do. Having a progressive tax system is critical to prevent even more wealth inequality than we are already seeing occur. The real problem is long-term cap gains and not having higher brackets for the 0.01% (e.g. for income over 10 million in a year).

 

[annoyedpsychiatrist]

It is ridiculous for the ultra wealthy to pay no taxes by taking out loans against their shares and then stepping up in basis when they die to pay 0% tax? Obviously yes.

Is it silly that long-term cap gains rates are much lower than money earned from actual labor? I would argue also yes. The tax system clearly is designed to be heavily carried by individuals like US doctors (high salary, no/little tax deductions).

However the US tax burden is still among the lowest of the developed world. I think that it's preposterous to be upset about a 37% marginal tax rate for those of us fortunate enough to live in a society as well run as our own and who make as much money as we do. Having a progressive tax system is critical to prevent even more wealth inequality than we are already seeing occur. The real problem is long-term cap gains and not having higher brackets for the 0.01% (e.g. for income over 10 million in a year).

I wouldnt mind paying the taxes I pay, if it wasnt for the fact that my medical school essentially cost me 350k at 6% interest to where the interest alone is >20,000 dollars annually. PSLF is a game changer and ultimately so was the loan freeze but the progressive tax system I have many issues with because I would argue that many middle class get screwed on their taxes given the complexity of the system, and that upper middle get screwed because they dont have too many options while the people that its designed to target walk away without significant burden.

Ultimately again, thats why Im not complaining because my life is quite good. Im simply saying that the systems we have designed are a complete mess.

Could fix the student loan system by making it where schools without certain pass rates do not get access to fed loans. Simple. Force these garbage schools to shut down and crack down on them. As a result, cap interest rates, prevent interest capitalization (which biden understands this ill give him that), and I would argue to subsidize interest rates while in medical school. if we stop access to fed loans at these ridiculous schools, then the government should theoretically lose less money, because I would assume more people would be paying towards their loans and youd have less of a default rate.

I would also propose a wealth tax for the ultra wealthy, tbh. But im also of the belief that we have misguided spending of our taxes, failed programs driven by ideology rather than practicality, and inept leadership.

Obviously there are big issues at play in our country that influence the smaller issues. Do I have it good? Yes, especially compared to others. I fully recognize that. I also worked extremely hard to get to this point and took a lot more risks.

 

[Monocles]

Fear of AI in psychiatry? Even more bizarre.

I for one, welcome our AI overlords.

Can't wait for the day where chatGPT can write all my consults for me. Or even better for a deep-fake real time video + chatGPT integration to do my virtual visits on my behalf. 😉

 

[Merovinge]

I wouldnt mind paying the taxes I pay, if it wasnt for the fact that my medical school essentially cost me 350k at 6% interest to where the interest alone is >20,000 dollars annually. PSLF is a game changer and ultimately so was the loan freeze but the progressive tax system I have many issues with because I would argue that many middle class get screwed on their taxes given the complexity of the system, and that upper middle get screwed because they dont have too many options while the people that its designed to target walk away without significant burden.

Ultimately again, thats why Im not complaining because my life is quite good. Im simply saying that the systems we have designed are a complete mess.

Could fix the student loan system by making it where schools without certain pass rates do not get access to fed loans. Simple. Force these garbage schools to shut down and crack down on them. As a result, cap interest rates, prevent interest capitalization (which biden understands this ill give him that), and I would argue to subsidize interest rates while in medical school. if we stop access to fed loans at these ridiculous schools, then the government should theoretically lose less money, because I would assume more people would be paying towards their loans and youd have less of a default rate.

I would also propose a wealth tax for the ultra wealthy, tbh. But im also of the belief that we have misguided spending of our taxes, failed programs driven by ideology rather than practicality, and inept leadership.

Obviously there are big issues at play in our country that influence the smaller issues. Do I have it good? Yes, especially compared to others. I fully recognize that. I also worked extremely hard to get to this point and took a lot more risks.

I'm sure you've worked hard, although honestly most folks in the top 1% of earners work hard. Not sure you've seen junior law firm, junior big 4 accounting, or junior consultant hours, but they absolutely equal or exceed residency/med school (particularly in psychiatry). Medicine is also arguably the least risky high income job where the std dev of outcomes, basically every other high income professional is much higher.

Yes, clearly government spending is not perfect, clearly there are pet projects, bad outcome measures, etc. That doesn't mean the answer is just less taxes than our already low historic and world-wide rates. Dealing with the underlying problems in our representative democracy first would be a big start...

 

[Candidate2017]

1) Student loans don't NEED an overhaul. People who are taking them need to treat it like any other loan transaction. Is this a sound business deal?

The problem is the gov is giving out easy money/loans, which allows med schools to hike their rates astronomically out of proportion to inflation and incomes. While I understand the need for individual responsibility, on a macro level the gov and schools are creating new physicians with increasingly larger debt burdens that limit their ability to act as true independent physicians. Each year leads to more new physicians taking employed positions, accepting conditions that are increasingly unattractive and unheard of in prior generations, and weakening the overall bargaining position of all physicians. All of which decreases the finances and QOL in the mines in which I toil.

It's not uncommon for me to run across old psychiatrists who are fully independent and dictating terms to hospitals (e.g., no call, 4-day work weeks, no weekends, NP assistance, lucrative compensation). These are the same hospitals that act as if I'm an H1-B visa migrant and expect me to accept employment under much worse financial and working conditions/hours/call.

4. Oftentimes the people who run healthcare arent always in touch with reality of situations

Hospital and insurance admin know more about the overall picture than most physicians. The average doctor doesn't have a firm grasp of billing codes and RVUs, much less the business of medicine. These admin have conferences and trade associations, and teach each other how to screw doctors over and make more money. We are experts at medicine, but they are experts at making money in medicine.

 

[whopper]

Your question might not be right for psychiatrists.

Psychiatry is NOT the study of the human mind. Psychology is that area. Our field is heavily centered on the treatment of mental health disorders via medical treatment. Want an analogy? Being a physician doesn't make us a physiologist. There's a lot of overlap but they aren't the same fields.

Things like "cynicism" aren't part of the conventional psychiatric curriculum. A lot of things aren't that people think psychiatrists know about. E.g. there have been several volumes of texts on racism in the field of psychology. That's something psychiatry doesn't study. I've yet to see 1 psychiatrist take a course in Sensory and Perception unless they took it as an an elective or happen to have psychology degree.

Even several issues in psychology that could be very important in mental health I don't see in the psychiatric curriculum such as Learned Helplessness, Anaclitic Depression, need for tactile stimulation I haven't seen in usual psychiatric academia.

From an experiential perspective, IMHO doctors are overworked. A concept taught in psychology and not psychiatry is the concept of Eustress, and of being too stressed. When people work too hard they tend to be more negative and cynical.

 

[Sushirolls]

@Candidate2017 I see your point to the dichotomy of student debt and impact on career negotiation power. But we also choose to let it.

I say this as some one who had student loan debt, said eff it, still opened up a private practice, wasn't exactly bursting at the seems, but still chose to keep it going. On paper, I most certainly shouldn't have done it. I had just a pinch more time left for PSLF... but the burn out factor, I just couldn't and wouldn't and opted not to continue with Big Box shop wRUV mining. In part, because I lowered my expectations and standards for what income should be. I've since paid off my student loans in using house equity, as I fled the tyranny of blue state for freedom of red state. In summary, golden handcuffs, for many [not all] are a chosen burden, and not a real handcuff.

*over the life of my loans, I paid more out on the principal/interest, than the original balance/principal of the loan.

 

[whopper]

In fact, I came to this subforum to seek some positivity and was surprised to see these negative thoughts being discussed. It is ridiculous. Oversaturation in psychiatry? You kidding me!!!
Fear of AI in psychiatry? Even more bizarre.

Completely agree. There is such a shortage that even if every program was completely filled this shortage won't have a dent in it for several years.

 

[Merovinge]

Your question might not be right for psychiatrists.

Psychiatry is NOT the study of the human mind. Psychology is that area. Our field is heavily centered on the treatment of mental health disorders via medical treatment. Want an analogy? Being a physician doesn't make us a physiologist. There's a lot of overlap but they aren't the same fields.

Things like "cynicism" aren't part of the conventional psychiatric curriculum. A lot of things aren't that people think psychiatrists know about. E.g. there have been several volumes of texts on racism in the field of psychology. That's something psychiatry doesn't study. I've yet to see 1 psychiatrist take a course in Sensory and Perception unless they took it as an an elective or happen to have psychology degree.

Even several issues in psychology that could be very important in mental health I don't see in the psychiatric curriculum such as Learned Helplessness, Anaclitic Depression, need for tactile stimulation I haven't seen in usual psychiatric academia.

From an experiential perspective, IMHO doctors are overworked. A concept taught in psychology and not psychiatry is the concept of Eustress, and of being too stressed. When people work too hard they tend to be more negative and cynical.

I do agree that many of these things are not formally or informally taught in psychiatry. However, far more psychiatrists have degrees in psychology or lamely listen to podcasts about psychology going to and from work everyday (🖐). You can even see from discussions on this forum how in-depth understanding of psychology, philosophy, ethics etc are known to psychiatrists in a way that dwarfs most docs in most other specialties.

 

[whopper]

Psychiatrists get a lot of on-the-job experience dealing with people's mental health problems but we need to be careful with our boundaries. E.g. how much has anyone in this forum learned about marriage counseling? I've gotten NONE and I'm one of the most experienced psychiatrists I know of in terms of diverse clinical experiences (ER, inpatient, outpatient, IOP, PACT, addiction clinics, forensic, consults, eating disorder clinics, VA, state hospital).

So psychiatrist comes in, does marriage counseling, having a lot of training on Lithium but NONE in marriage counseling. Then they start talking about insights on Joseph Conrad and his writings' correlation with the human mind not having much experience in the human mind or even having read Joseph Conrad.....

My example is a bit sarcastic, but not completely off with some psychiatrists. I remember years ago there was a headline based on a paper presented by the American Psychological Association that antidepressants don't work. I reviewed the data and could point to so many holes in the data. Several news outlets had an "expert psychiatrist" many of whom never even read the original article citing antidepressants don't work, wall wanting their 15 minutes of fame and none of them could cite how the original study had several flaws in it.

 

[PsyDr]

1) A bit concerned that the reaction is to leave. Usually, it's unwise to leave when you see a problem (e.g., almost every parenting situation in human history).

2) Burnout happens when:
a. You have control of a setting taken away
b. You get demands that exceed your ability to meet expectations.

3) It is easy to convince hyper-competitive people, that unreasonable demands are achievable. They see it as a challenge, and try harder.

4) You beat it by understanding the setting, refusing to accept responsibility for things you are not responsible for, stick to the terms of your business arrangement, and make meaning where you can.

5) There are still people playing golf in medicine. They are called "administrators".

 

[whopper]

A big problem I had with working in hospitals-

* As I've said, I think about half the psychiatrists out there are horrendous. Except for 2 places I've worked, The Lindner Center and U of Cincinnati, I would come in during my on-call days and be utterly shocked with the horrendous work done by colleagues. A combination of frustration and anger, and I had a difficult situation in either not addressing it with the patient cause I was only on call or trying redo everything my idiot colleague did. Add to that if you tell the patient your colleague is an idiot you're obviously looking unprofessional.

* Most of the time I ordered a consult the doctor would play emo and not show up or throw a hissy fit. Add to this I was one of the few psychiatrists that had a better understanding of IM so the the IM doctors that knew this (and this wasn't many of them cause they alternated so much) respected it when I ordered one but more than half the time we'd get an whiney complaining IM doctor.

*Some hospitals had superficial things that were terrible but they were bad for morale. E.g. bad food.

*As with any organization some are badly run. You could even have a great department chair but the institution as a whole (I'm talking the entire hospital or university) is so bad it ruins it for everybody.

*The attitude that health care providers must accept abuse from patients in the name of being compassionate. E.g. patient assaults nurse (and not due to psychosis but purely antisocial PD) and some idiot patient advocate says that this comes with the job so the nurse has no grounds to complain.

 

[Sushirolls]

Which is one reason I am a proponent of the old ways.
Hospitals are shell organizations.
Individual independent doctors, or small independent groups of doctors who have hospital privileges are more likely to play nice with each other and things done.

Large medical groups within Big Box shops and academia... how can I avoid this consult? The independent docs, meh, Stupid consult, but I'll get paid, "Come young student/resident, let's go see this easy consult!"

One Cardiology group, or IM group gives others trouble, word spreads they are difficult, and word spreads to friends, and before you know it an independent cardiologist shows up with a new practice, and they got most of the consults. Because when people place those orders, they can choose who it goes to.

 

[forchinet121]

A big problem I had with working in hospitals-

* As I've said, I think about half the psychiatrists out there are horrendous. Except for 2 places I've worked, The Lindner Center and U of Cincinnati, I would come in during my on-call days and be utterly shocked with the horrendous work done by colleagues. A combination of frustration and anger, and I had a difficult situation in either not addressing it with the patient cause I was only on call or trying redo everything my idiot colleague did. Add to that if you tell the patient your colleague is an idiot you're obviously looking unprofessional.

* Most of the time I ordered a consult the doctor would play emo and not show up or throw a hissy fit. Add to this I was one of the few psychiatrists that had a better understanding of IM so the the IM doctors that knew this (and this wasn't many of them cause they alternated so much) respected it when I ordered one but more than half the time we'd get an whiney complaining IM doctor.

*Some hospitals had superficial things that were terrible but they were bad for morale. E.g. bad food.

*As with any organization some are badly run. You could even have a great department chair but the institution as a whole (I'm talking the entire hospital or university) is so bad it ruins it for everybody.

*The attitude that health care providers must accept abuse from patients in the name of being compassionate. E.g. patient assaults nurse (and not due to psychosis but purely antisocial PD) and some idiot patient advocate says that this comes with the job so the nurse has no grounds to complain.

Half of psychiatrists you’ve worked with being horrendous? I’m not sure if that is a psychiatry problem or your standards are too high..

 

[Merovinge]

Half of psychiatrists you’ve worked with being horrendous? I’m not sure if that is a psychiatry problem or your standards are too high..

Whooper has spent significant time in Missouri if my memory is correct. Outside of WashU, my guess would be that many psychiatrists there would be on the lower half of average.

 

[whopper]

I’m not sure if that is a psychiatry problem or your standards are too high..

Psychiatrist hasn't read STAR*D, doesn't know mixing Ibuprofen with Lithium is usually a no-no, ordered Lithium without doing labs, has a patient on Olanzapine for depression (only Olanzapine) and the patient now feels more depressed cause he's sleeping 18 hours a day, diagnoses everyone they see with Bipolar Disorder no matter what is going on. Patient started on starting dose of antidepressant that was never raised (e.g. Escitalopram 5 mg daily for 6 months) and the psychiatrist doesn't know why the patient isn't getting better.

My standards aren't too high. To expect a psychiatrist to at least know that the antidepressant needs to be pushed to a high dosage range (unless side effects, intolerability or remission) is achieved should be a lowest tier level of knowledge in our field, just like I'd expect a surgeon to be at least be able to do a suture or they shouldn't have been allowed to graduate. The bottom line is several residency programs will scrape the bottom of the barrel because psychiatry has several open spots after The Match ends. Most residents from upper tier programs will be good. Below that it's all questionable. Every field has bad people in it, but every place I've seen whether it's Cincinnati, St. Louis, NJ, PA, NYC, all have some place where several doctors are diagnosing everyone with Bipolar Disorder no matter what's going on. These psychiatrists aren't a terrible bad 1%, but more like a double-digits frequency type psychiatrist. While about 1/2 aren't diagnosing everyone with Bipolar Disorder, I see about half doing something that is a clear no-no. (Other examples? Olanzapine-patient gained dozens of lbs of weight but no metabolic follow up, no discussion of the metabolic risks of the meds).

I wouldn't have faulted a psychiatrist, 7 years ago, for not knowing what Benign Ethnic Neutropenia was, because at that time despite it being in studied for decades, it wasn't part of the conventional curriculum. Now it is, but it really should've been part of the curriculum decades ago. Other examples-not teaching the mechanism as to why Clozapine causes agranulocytosis which is a marker for the clear lack of respect our field has for the physiology behind our meds. Any respectable IM doctor wouldn't have accepted to be told a med has an effect without knowing the mechanism. The mechanism has likely been identified (remember lots of this is theory) but as you know this is not part of the teaching curriculum. Our field just accepts this without even questioning it. But to not know how to properly diagnose Bipolar Disorder or prescribe an antidepressant (I'm not talking writing the script, I'm talking understanding the right dosages). This is inexcusable.

Jeffrey Lieberman, former head of psychiatry at Columbia has written similar comments about psychiatry in his book Shrinks the Untold Story of Psychiatry. He described psychiatry as the "red headed" unwanted child of medicine.

Our own forum has an example of what I'm talking about. Tired of this

You work at a hospital that doesn't have an upper tier psych department, expect to work with a colleague diagnosing everyone with Bipolar Disorder, you come to work on the weekend and now have to see all of his patients. So what to do you? Turn your head and pretend this didn't happen? (You're violating your Oath). Try to fix this by changing everyone's meds? Only 9 out of the 12 patients you're seeing that day and patients will be asking WTF. You already talked to the department chair about this who more or less tells you he doesn't care.

Mediocrity is a choice. It's a choice I'd expect anyone calling themselves a doctor to not accept, but that's not reality.

 

[Crayola227]

Then people should not have so many kids if they can't provide $$ or emotional support for them.
I'm a physician with no kids as there's no time to spend with them.

I did way too much school to now work part time.

Ok but did you read what the poster was saying? Because I will disagree with you, the lowest paying full time job in the United States in a decent neighborhood SHOULD allow any such couple both working to have at least 2 kids, ie, replace themselves from a population standpoint.

If what we're saying is we now have a society where the common man, the workers, 2 people working full time, can't even reproduce anymore...

There is something fundamentally wrong. I get that not everyone wants kids, and I get the idea that there is such a thing as "too many" and money is a factor, but if a couple wants 2 kids and they both work full time and they can't make that happen, then society is failing. It is a failure.

Or what, they should want to be part of some sterile working class that just subsidizes the Pronatalists like Elon Musk to have a family of 15? Or struggle to even have 1? Or they should eschew reproduction in favor of being able to afford more stuff? Or to barely make ends meet anyway? How does that make one big of evolutionary sense and why should anyone want to be a part of that society?

The point is, if things have gotten to where people need to be making physician money to afford 2-3 kids in a decent neighborhood, things are not that cushy and physicians and everyone else should be very concerned.

 

[Crayola227]

Also these arguments basically saying people shouldn't have kids because they can't afford them/don't have enough time for them, acts like children are the piece of this equation to naturally sacrifice, instead of questioning why the **** as a species would want a society that members who want to reproduce can't even replace themselves in the population? I get that some people feel the need not to have kids as they work towards some other purpose, but telling someone because they work as a checkout clerk and they aren't a doctor, oh well guess you don't deserve to breed, is just, I can't even. I get Heist wasn't saying this exactly, but just consider what it says for a first world country to say that a couple working full time in a middle class job can't afford kids.

You want to talk about representation and equity, the differential representation in the gene pool is sort of the ultimate denominator.

 

[Mad Jack]

The personality types of those that go into medicine are typically very risk averse. They invest a large portion of their life in exchange for the idea that they have averted the risks that would otherwise have to be contended with in order to earn the income and prestige medicine affords them. A great deal of uncertainty has been introduced into that equation, and that uncertainty creates risk where previously there was far less. Due to their typically risk-averse nature, and combined with the level of sacrifice they put in to obtain what they believed to be lifelong security, even small risks are perceived as large. Currently the number of these small risks is many, and thus to the risk-averse mind it seems as if there is an overwhelming array of forces working to collapse their career and earning potential before they retire.

Now if you look at people in tech, for instance, they tend to not complain as much about risk because they know they're in a field of high risk and high reward. They have invested less time, but they also have less certainty in their future. What skills will they need? What companies will make it? Will my job even be relevant in 10 years? These are things they generally accept as a part of life, the risk side of the risk:reward equation that could just as easily see them making millions working for a unicorn. I'm pretty sure the majority of physicians, if they didn't have medicine to fall back on anymore, would be quite unsettled in this sort of environment, to say the least.

 

[Mad Jack]

Also these arguments basically saying people shouldn't have kids because they can't afford them/don't have enough time for them, acts like children are the piece of this equation to naturally sacrifice, instead of questioning why the **** as a species would want a society that members who want to reproduce can't even replace themselves in the population? I get that some people feel the need not to have kids as they work towards some other purpose, but telling someone because they work as a checkout clerk and they aren't a doctor, oh well guess you don't deserve to breed, is just, I can't even. I get Heist wasn't saying this exactly, but just consider what it says for a first world country to say that a couple working full time in a middle class job can't afford kids.

You want to talk about representation and equity, the differential representation in the gene pool is sort of the ultimate denominator.

Then people should not have so many kids if they can't provide $$ or emotional support for them.
I'm a physician with no kids as there's no time to spend with them.

I did way too much school to now work part time.

I had a conversation with another doctor a few years back who was like, when are you having kids etc. And I was like, well, you know, never, it's not my thing. And he kind of made a point about how people, and particularly intelligent people, overthink having kids. People have had children in prehistory, during wars, during plagues, and in economic circumstances that are unfathomable to us today. And yet these people survived, thrived, and led to us being here today. There isn't really a right or a wrong time to have a child. Even if they make things more challenging, you will survive, and so will they, and more often than not everyone involved will be far more resilient than they would expect. My dad, for instance, worked on the road my entire life. I saw him maybe 30 days a year, but it never harmed our relationship. It taught me the value of hard work and sacrifice, and instilled values that I still hold today that likely let me succeed in medical school and beyond.

People, generally, should probably be having more kids, that's almost undeniable. And this may sound just completely insane, but I believe one full-time income should be able to support a family and it is a failure of our society that it often cannot. It is also at the heart of many of the problems low-income families face, with all the subsequent trauma, crime, and substance use that goes along with it. It is at the heart of the decline in birth rates.

That being said, I have still sided on not having children and contributing to the world in other ways.

 

[Attending1985]

For me and my disgruntled friends it’s the fact that we sacrificed huge amounts of time and money because we were promised something. We were promised autonomy, respect, to be highly valued and to have a very secure job. We have very little of this. It’s only natural to be angry when you make a huge investment without the promised return. I don’t think people going into other industries sacrifice nearly as much or have the expectations we did. Also echo the people who say pivoting out of medicine is not easy making people feel trapped which only further breeds negativity.

 

[PikminOC]

I had a conversation with another doctor a few years back who was like, when are you having kids etc. And I was like, well, you know, never, it's not my thing. And he kind of made a point about how people, and particularly intelligent people, overthink having kids. People have had children in prehistory, during wars, during plagues, and in economic circumstances that are unfathomable to us today. And yet these people survived, thrived, and led to us being here today. There isn't really a right or a wrong time to have a child. Even if they make things more challenging, you will survive, and so will they, and more often than not everyone involved will be far more resilient than they would expect. My dad, for instance, worked on the road my entire life. I saw him maybe 30 days a year, but it never harmed our relationship. It taught me the value of hard work and sacrifice, and instilled values that I still hold today that likely let me succeed in medical school and beyond.

People, generally, should probably be having more kids, that's almost undeniable. And this may sound just completely insane, but I believe one full-time income should be able to support a family and it is a failure of our society that it often cannot. It is also at the heart of many of the problems low-income families face, with all the subsequent trauma, crime, and substance use that goes along with it. It is at the heart of the decline in birth rates.

That being said, I have still sided on not having children and contributing to the world in other ways.

I would argue there are too many people on earth depleting resources.
And while esp with physicians one income can support the family, it doesn't mean the other spouse doesn't want to work. Taking care of kids is very hard. That's fine in the past people had kids, but that doesn't mean people now want to.

The world is different now that it was then.

 

[PikminOC]

Ok but did you read what the poster was saying? Because I will disagree with you, the lowest paying full time job in the United States in a decent neighborhood SHOULD allow any such couple both working to have at least 2 kids, ie, replace themselves from a population standpoint.

If what we're saying is we now have a society where the common man, the workers, 2 people working full time, can't even reproduce anymore...

There is something fundamentally wrong. I get that not everyone wants kids, and I get the idea that there is such a thing as "too many" and money is a factor, but if a couple wants 2 kids and they both work full time and they can't make that happen, then society is failing. It is a failure.

Or what, they should want to be part of some sterile working class that just subsidizes the Pronatalists like Elon Musk to have a family of 15? Or struggle to even have 1? Or they should eschew reproduction in favor of being able to afford more stuff? Or to barely make ends meet anyway? How does that make one big of evolutionary sense and why should anyone want to be a part of that society?

The point is, if things have gotten to where people need to be making physician money to afford 2-3 kids in a decent neighborhood, things are not that cushy and physicians and everyone else should be very concerned.

Jobs are different now for everyone. They aren't just 9 to 5. Lots of encroachment into family time with computers and texting etc available.

I still think there are too many people in the world and resources are dwindling.

You think $15 per hour will cover what you are asking for? How much per hour do you think it will take? For working at McDonald's etc?

Healthcare costs have a lot gone thru the roof after Obamacare was implemented. That also cuts into the amount earned.

 

[bGMx]

Could it be that *generally* the people who go into medicine were never satisfied previously, and hence are not satisfied when they thought they would be, because they never saw the "problem" as being that they are not ever satisfied?

 

[mistafab]

I'm pretty optimistic about the field... for me.

Not sure about yall. Yall are a lost cause 😂