It's a time-honored tradition in medicine to shit on the generation below you. Especially if they're a trainee. I don't know what psychology prompts this. I remember ten years ago as a medical student the older physicians complaining how we had it so easy because they didn't have to follow the 80-hour workweek rule. But keep your attitude up, and remember that you *are* a part of making things better!
I rarely work with medical students as a community ED physician, but when I do occasionally run into them, I'm always impressed and never find anyone to be lazy or entitled or unmotivated. I am fully on Team Career rather than Team Calling. The only reason I'm still doing my job is to pay down my student loans.
I hated the abuse of med school (1993-1997) and residency so much that I vowed when I gained attending power that I would always endeavor to be kind and respectful to my students.
I was walking an intern through a case and she ran out in tears. I was surprised, but then I realized I'm the asshole.
Maybe. You were the one who can assess your assholery.
I have not made any residents cry (yet?) but I have has a student tell me that my questions were causing discomfort and I should stop. I was leading a case discussion with the handful of MS3s on rotation. Not knowing the answer is uncomfortable, but that discomfort is not bad and should not be avoided. That’s learning.
there is so much discomfort as part of being a physician! patients and their families, other doctors, trainees, nurses. being right and even knowing the answer doesnt necessarily even help…
>Not knowing the answer is uncomfortable, but that discomfort is not bad and should not be avoided. That’s learning.
As a former educator, this is perfection. I used to drill this into my students' heads daily. Learning *doesn't* require functioning in an abusive and antiquated system as a badge of honor (how many more studies need to be done on mistakes made out of sleep deprivation?) but it does require pushing yourself out of your comfort zone more and more every day, which requires sitting with the uncomfortable stuff, challenging why you find it uncomfortable, and working to push past that point into breakthrough. That's not exclusive to professional training; that's learning in general.
> Not knowing the answer is uncomfortable, but that discomfort is not bad and should not be avoided. That’s learning.
That’s the issue doc. They think that discomfort is bad
I think it’s easy to forget how challenging it can be to be in that early learning stage. Emotions can run high for many people and there is also a lot of self doubt coming into play. I can see how easy it could be to casually provide instruction or correction to a new grad that might make them break down in tears if they were already on the edge.
But there is always a chance you could just be the jaded asshole without realizing it.
Unless you were being some kind of extreme asshole, disagree. Medicine requires some level of basic coping skills, you can't accomodate everyone no matter how unreasonable. Does the average normal adult student find you to be an asshole is the question
Did you tell the student they were dumb/put them down? Or just ask them fair questions they didn't know?
Pimping is fine and necessary. But of course y'all should be nice about it
When people say this they often imagine themselves as the ones being affronted by the older generation. Don't forget that one day, you will be the older doc and the med students will be doing things that were unthinkable for you when you were in training and then dismiss you as being a "classic millenial/gen z" (boomer). I think it's important to constantly evaluate why we do the things we do in training and why things are the way they are but it's also important to recognize that sometimes there's a good reason for doing some of the more unpleasant things we have to do in medicine that might not be fully understood until well after training is over.
You're right. There is truth to both sides of this.
From thw student side, I should be allowed to sleep at night most of the time. I should be allowed to get married and have kids.
However, some of my classmates have complained about having to show up to clinic on time for example. Obviously that's BS
This is such an interesting phenomenon to me, because as a PA I didn't experience any of this (except for the one-off physician on occasion). I've been very fortunate in my mentors, many of which were MDs that took a very active interest in my training, and none of whom shit in me. My current physician was previously the head of the resident department at his old job and has been a truly fabulous mentor.
Definitely. The one that stands out the most is the MD who did my cardiology training as a student. He was always very involved in making sure I was getting good training. I actually thought he didn't like me much because he was generally pretty quiet, but it was just me, a massive extrovert, misinterpreting his introverted nature. I found out from another student he had that he thought I was quite smart and hoped I would choose cardiology one day(which was great, because he is probably the smartest person I've ever met, frustrating that he was also so nice).
Same. I got recruited to come in and work with the MD who's also residency director, and in the first week he pointed out I don't report to him and I'm not an employee, I'm supposed to be a partner. To his credit, that has turned out to be true, even when we disagree about how to do stuff. It's a pretty great post for a PA. (And hilariously, I'm paid hourly where he's on salary, so leadership's attitude to me working late or taking on extra work is different than it is for him.)
When I was new, I felt really bad because I knew I wasn't pulling my weight and our in baskets were huge and I was working till 7 PM every night and still behind. The first year was absolutely fucking awful. I was having full panic attacks at around the 1 year mark.
I think I'm in the minority of my PA colleagues on this, but it's insane to me that there isn't some form of PA residency. I had to cobble together some sort of self residency that I'm sure has huge blind spots.
I had a similar sense of overwhelm when I was salaried and in primary care.
The larger question of how we non-physicians can be good clinicians without structured residency crosses into philosophy pretty fast. For me, it's a question of making sure the role is well-enough defined that it's not just "do what the docs do, only maybe not the complex stuff" and that people who say "just ask if you have a question" are really willing and able to answer those questions.
This actually is a huge source of my burnout. At my org I'm expected to do everything the fully trained MDs do except half the pay. My scheduling is the same as all the MDs but I'm paid less than half. There's no blocks on the schedule for complexity, it's basically first come first serve on my schedule. Theoretically I'm not supposed to see hospital followups for high complexity patients, but in practice I regularly get them scheduled.
I don't mind accepting that I have a lower level of training, and my pay reflects that. I do resent that I'm paid like I'm lesser, but asked to be the same.
Amen, this is the truth. It's hard because it feels like it's sink or swim. I have a wonderful sp, but if we're seeing 25 patients a day it's hard to discuss those cases. Lots of workup comes from me self teaching myself on up-to-date, podcasts, CME, etc. I feel that I'm a good clinician, but abused by the system in the complexity and scope of just see it all because you have openings.
Yea. I feel like I have become an incredibly strong clinician. I've seen several things that the fully certified and much more experienced clinicians have never seen before and I have a reputation for just weird diagnoses.
At the same time, because I have access I'm often treated as the defacto urgent care. I had an honest to god takastubos cardio myopathy last month and a patient with an episode of Acute HFrEF with an EF of 10 to 15 percent who argued with me about going to the ER and wanted to drive herself (fortunately a friend came for her, her EF wasn't know at the time of the appointment, previously was 45%). I've had 2 PEs in the primary care clinic, which gives me nightmares.
https://historyhustle.com/2500-years-of-people-complaining-about-the-younger-generation/
Everyone has always complained about the next generation. That's just human nature, and medicine is no different.
I mean when I was in residency the 80-hour average work week was still in place. So you weren't supposed to work more than that. But that was still relatively new and I think before the early 00s there were no restrictions at all and residents regularly worked a lot more than that. I think med students had the same rules.
Have the rules changed? 80 hours is still a fucking lot of hours.
I was trained in the era of the introduction of the “new rules” of 80 hour weeks and 30hour shifts limits. Despite being asked every week by our PD to violate these rules and lie about violating these rules when asked, we were called a weak generation for not agreeing to work unlimited hours. They hid behind the mantra that we were hurting patient care through unnecessary handoffs.
My colleague fell asleep after a 30hour call shift and got into a car accident on the way home, and the only concerns were how long she was going to be out for, and how they rest of us would be covering her shifts. The system was unnecessarily cruel, and I wouldn’t want anyone to have to go through what I went through.
For those like OP wanting and fighting for a better life: Great! But the problem is the system is still unnecessarily cruel, which you’ll soon find out. And we need your help to fix it, because it’s rapidly getting worse since the pandemic. They are still hiding behind the lie that everything we are fighting for is going to hurt patient care. The sooner we all realize it’s not new doctor vs old doctor, doctor vs nurses, doctor vs mid levels, etc., but it’s all healthcare professionals vs a broken system that wants us to fight each other instead of fixing things, the better.
Hear hear.
There is a remaining significant step in our mental framework. Our cultural revolution.
We need to accept that systemic changes will lead to better care in the long term *but* will harm patients in the short term.
The heartless systems governing care, mostly seeking profit, will always wring their labor dry. We need to accept that it will attempt to use altruism and martyrdom against us.
Setting boundaries on time commitment, work volumes, work conditions, etc... these create gaps in care. Some are cautious against this, citing pstient harm. But the truth is, we will *always* be on the edge of disaster. We will never have "surplus" staffing required unless it is forced upon the institutions by labor or law. And law isn't helping.
Hey, I am currently in the US but I got my education in a developing country where all medical students and doctors work shit hours for very little pay with a lack of equipment, are understaffed, sometimes killed by angry patients with criminal backgrounds, and often suffer burnout. Like, it is a norm over there. And I can tell you we have dedicated doctors and not so much, good ones and bad ones, and everything in between, including bullies and a-holes. People who think you need to suffer because they suffered to get where they are having issues they need to process. The environment has changed. It always changing, that's life. Plus, there is no need to suffer to graduate or to be a caring doctor.
Also, I remember we were taught to draw the lines you mentioned above to protect ourselves.
Shit, then I went full Sith mode when I left academics and went pharma consulting.
Attendings at the ER where I take my EMS patients bristle at the sound of me talking to younger PharmDs and MDs about life outside a hospital and real work-life balance.
I was almost *persona non grata* when I helped a very experienced PharmD exit clinical care to my side of things.
So… where can I learn this power?
Jk have brain damage, stuck doing academic bullshit forever. At least I have medical students to regale how much better/harder things were back in my day?
I think that in the distant past, medicine offered more to doctors than it does now. Pay your dues, be rewarded with money and respect and a good career. With the intrusion of an administrative class that uses us, chews us up and spits us out, the investment isn't worth the reward.
I would love to see a complete revamping of the US medical education system, with a 6 yr college-med school education, more residency spots with better hours and maybe an extra year added to get the case numbers. Call nights offset by days off. Decent benefits, livable wage, paid vacation. We'd probably have to double the number of med school and residency spots to achieve it, because right now, the system is carried on the backs of young doctors who are overworked, underpaid, and not respected.
I've gotten to a point in my career (the end of it) where I can pick and choose where I work and how much. #locums (do people hashtag anymore?) Anyway, I work to pay for things I want to do, and if a situation isn't working for any reason, I have the freedom to move on.
I applaud the new generation of students and residents who see that life has to have a balance. My kids never considered medicine because they saw an unbalanced situation.
Ask how many of those older docs would work the exact same hours if they were to get paid the same amount even if they didn’t work at all.
Everyone knows it’s a career, some are just in more denial than others.
Maybe this is a case where the extremes of their side stand out, but most people are somewhere in the middle. Calling out sick inappropriately isn't setting boundaries on your upper limit of work hours. It just hurts your peers and builds resentment. I hope that this behavior isnt commonplace. Not participating in "scut work" because there's nothing to be learned from it is a self limiting belief. Wait until you become an attending and then put your foot down on BS from administrators. Creating a better work culture and boundaries will be more likely to happen if we work together rather than against each other. It's trainees vs older attendings, when it should be all of us against the bean counters.
As a guy who just realized he graduated medical school 17 years ago. (Has it really been that long? Yeesh). I fully get it. Actually, anytime I hear the “it’s a calling”, that’s a red flag that someone wants something for nothing. Medicine has been preying on the idealistic, hopeful, altruistic nature of the people who set out to become doctors for so long it’s become an expectation that you will “suffer for your art”.
And that’s kind of sick and twisted, and frankly, abusive.
I remember the bad old days of being on a 36 hour shift with constant insanity, never a moment’s break, barely eating, not remembering the last time I actually peed, falling asleep at the end of shift after every sentence or two I charted, trying desperately to finish up so I could get the blessing to leave without being handed more scut. Then falling asleep at red lights on the way home. Or maybe the time I almost shit my pants because finding time to go to the bathroom was almost impossible some days and you’d be returning pages while perched on the throne. Or the patient that was positively offended that I yawned while taking a history from them at 4am.
Allllllll that shit was terrible. Terrrrrrible. And they paid me like 45k a year and gave me two days off a month. Yeah, that altruism is G O N E. This is a job and I will do my job well, but i’m not coming in on my day off to attend a fucking meeting. None of this above and beyond crap. I’m doing my job and then going home, leave me alone.
Yeah. *I* can have a calling. No problem there.
It’s when *someone* *else* wants you to chair a committee or oversee a sepsis mortality reduction program or help get the hospital ready for an OSHA/JCAHO inspection but they don’t think you should be reimbursed for the work you are doing because “It’s a calling.”.
*That’s* what I’m referring to.
Without knowing what really happened or was said, a few possibilities arise. Medicine is both a calling and a career. We're medics, not martyrs, but this is also a pretty rough career to have if you have no personal investment in it whatsoever. Boundaries are important! Having a reasonable life matters, and old guard doctors who insist on being available for patient care at all times at the expense of everything else are making a choice, for themselves, that they cannot impose on everyone. Good for you for having other things in your life. Defend that!
But boundaries aren't everything.
On the other side, there are medical students—and residents, and physicians—who feel entitled to treat this not just as a career but as not a career. Medical school means working long hours, including overnight, including random shifts. It means that because residency demands the same, and then often so does employment. Medicine is a 24-7-365 (or 366!) job. Not everyone works all those days and hours, obviously, but people have to take all of those hours. Even the miserable 3 am on Sunday morning.
"I don't want to be abused" is not the same as "I work 9-5 and take off when I want." It would be nice, but that isn't how medicine works. It isn't how a lot of jobs work. I am sympathetic, and there is a slow culture shift to covering for each other for obligations and needs and just wanting or needing to take time off, but there are also practical and legal and ethical reasons that people need to show up to work.
That isn't what you said or meant? Well, you didn't say what you said or meant, so here we are.
My career has been short. I can't really say that medical students these days are different. But even when I was the medical student, I was outraged by some of my cohort behaving in ways that would not be acceptable in any non-nepotism/sinecure job. You have to work. Sometimes you have to do work that is not fun. Sometimes you have to do scut, because every job has scut, and only the rarified few get "people" to cover scut for them.
Not to be a “pick me” resident but my program has been struggling with some residents who feel they can call out whenever and however frequently they want to. Like, my bröther in Osler,
1. Didn’t you learn about what the demands would be while you were going through the years-long pre-med and med school cycle?
2. Our expectations are (I find) quite reasonable, and nothing compares to my father’s days in the early ‘80s of q3 24 hr call
3. We do have numbers and metrics we have to meet to be allowed to graduate and practice independently
4. Perhaps most importantly, when you call out, your friends have to cover for you.
We’ve had a few people who have had ti take significant time off due to health or family emergencies, which I get, life / shit happens. It also hasn’t escaped me that I don’t have kids or other commitments that some of my colleagues face.
Just confused by those who got to this point and then act shocked they’re expected to *checks notes* show up to work and do so on time on a regular basis.
Anyway, back to yelling at clouds.
I do think that medicine should be more than just a job *for colleagues*, not just patients. If you get sick, I will cover for you. No expectation that you pay me back, just that you pay it back when someday, someone is sick and needs you to cover. Generally, I aim for no questions asked. If you request time off in advance for vacation, I will respect that. I will not call you or email you; my job is to provide coverage so you can have a life. Or watch paint dry, whatever; your use of time is your business!
If you’re just being a flake and abusing your colleagues’ support, yes, I will start questioning. I don’t *want* to work extra, I am *willing* because I want the same consideration from you if I need it. I’ve had those colleagues. Occasionally it’s bad family or medical stuff, and that’s frustrating for me but part of the job. In the short term, at least, I’ll pick up the slack. Sometimes it’s just taking advantage, and I get sick of it fast.
My goal is to be able to drop everything and leave if I have to, or if I end up having an acute medical crisis. I expect that. I expect the same for you. It’s been sad for me that not everyone else is on the same page.
I’m curious why these individuals don’t realize this? Were they pushed into medicine by their elders and did it because they felt they had to? Were they raised entitled, and didn’t realize that life and work can be hard and sometimes you don’t get your way? Have they never worked a job before? Truly curious, as a medical student that is graduating this year.
I went into medicine because there was no other job I could see myself coming home from every day feeling fulfilled. The hours suck, difficult patients can be emotionally and physically exhausting, you sacrifice your 20’s+ to education, and beyond that you make so many personal sacrifices the rest of your life. But it felt and still feels like the correct path for me. I always thought my peers in med school had the same thought process.
Honestly, every year we have at least one resident who has literally never had a paid job before residency. They blame all the general shittiness of being an employee on medicine in particular, get super burned out really quickly, and then they either stick around being a dark cloud on every experience or leave to another residency and then leave that one also.
Yes!! I can always pick out students who have never had a job anywhere before. I would much rather work with the B student who worked at Applebees than the A student who has never interacted with a human in his life.
I feel like a LOT of med students/residents have never done anything other than go straight through their education to get to their first real job and when they find out it’s kinda hard they label it abusive. I agree with the poster who said there’s a difference between “abuse” and “it’s not a 9 to 5” and I’m only a second year attending but gosh darn it, kids these days need to suck it up a little bit. That being said, there’s been a lot of positive improvements made in medical education especially around calling out the kind of sexist/racist/classist/ableist BS that was once absolutely pervasive and accepted as “part of it” but there’s still more that can be done. But being required to work hard and grueling hours while learning how to care for people’s literal lives SHOULD BE HARD.
It's such an interesting dichotomy where I am so grateful that I have a union that has won us better benefits, and how we have been able to successfully advocate for the removal of 28hr call at my program...things that do help with wellbeing and improving our material conditions. At the same time, we have students who tell us "it negatively impacts my wellness to follow more than 1 patient" and residents who sign-out an actively coding patient so that they can go home at 3PM, and it makes me wonder if people genuinely assume that they can avoid any semblance of challenge in the job.
> "I don't want to be abused" is not the same as "I work 9-5 and take off when I want." It would be nice, but that isn't how medicine works. It isn't how a lot of jobs work.
This is only a function of supply and demand. When a buyer gets desperate enough, they will provide 9-5 and take off when I want (or buy sufficient redundancy). And when a seller gets desperate enough, they will sell on call labor.
I have seen hundreds of medical students. The main difference is that the newest med students have much less deference to authority.
New med students are very willing to walk out, issue a complaint, report borderline activity. It has forced out some of my colleagues that were sexually inappropriate or physically harsh to those around them. These people were stellar on the medical side but were really off in other ways.
At the same time, students are not as willing to challenge medical treatment as much. I think it is because it is so easy to find an algorithm online and much harder to see and find alternatives? I see A LOT more dependence on info coming from up-to-date rather than coming from a recent paper they read in a journal.
As far as hours, they have a lot more time for other activities and even make commitments that they prioritize over medicine. “i cant give the presentation because I have a soccer game” is something you would never hear because there wouldnt be enough time to think about joining a soccer league. But some time, they will need to learn that all of these other things are second priority to taking care of acute needs. I have had a very few students that very much should not have become doctors and that are dangerous. The most common characteristic is that they are students that slide in because of some connection and werent really interested in medicine as a way of helping people.
I would say that it is due to the fear of being sued that people can no longer challenge treatment. If you follow local guidelines or up to date and you have a bad outcome them it's hard to fault. However if I go off a random journal and get a bad outcome I'm gonna be sued and the hospital may not back you. It's an unfortunate part of the job now that the longest and most detailed notes one writes tend to be for people with nothing really wrong with them who complains a lot.
Also I think that playing soccer or taking part in sport should be promoted by us. Medicine shouldn't need to be something that you have to dedicate your whole life to. Why should people who try to promote good health lead the least healthy lives from both physical and mental well being? I think I might take a leaf out of their book and starting telling people I need to leave on time to make it to training
Lastly why do I feel like you're trying to defend people who have physically and sexually harassed students? They should definitely be "forced out" as they probably can't be trusted with vulnerable people (ie patients)
what a great reply!
“people can no longer challenge treatment” the best time to challenge treatments is in medical school when you have no responsibility. progress can only be made by recognizing the weaknesses of present care and challenging it. learning how to do this responsibly is the best that i can offer.
“the longest and most detailed notes one writes…”too often trur.
“playing soccer or taking part in sport should be promoted by us. Why should people who try to promote good health lead the least healthy lives from both physical and mental well being? I think I might take a leaf out of their book and starting telling people I need to leave on time to make it to training”yes. medical students are healthier in many ways with the way they live now.
“Medicine shouldn't need to be something that you have to dedicate your whole life to.”this is a totally different attitude than previously. ok to not make it life’s devotion as long as you dont prioritize your avtivities over patient lives. this is a very messed up area especially with the way businesses are commercializing care. the current students are going to have to solve this problem.
“why do I feel like you're trying to defend people who have physically and sexually harassed students? They should definitely be "forced out" as they probably can't be trusted with vulnerable people (ie patients)” this is just to point out that the activism of current students is leading to positive changes that had been brushed under the carpet for decades in ways that never would have happened (and didnt happen) before. It represents a great change in the way that power is wielded.
of all the changes the only two that worry me are:
1- i can envision a day where doctors are generally not willing to take care of patients if it is inconvenient for them. anyone who has worked in an ED or tried to get a consult already knows this can already be a huge problem in a number of ways and i fear it will get worse.
2- medicine being reduced to AI protocols.
Thankfully we have a talented group of physicians to work on these problems. But a lot of lawyers, politicians, and businesses will be working against them at the same time.
> I see A LOT more dependence on info coming from up-to-date rather than coming from a recent paper they read in a journal.
Do you think this is a bad thing, though? There are "new papers" coming out every other day with some revolutionary claim, and I don't think that the habit of challenging data that is well estabilished through larger studies is necessarily a quality. When you get to the limits of costumary protocols, then it makes sense to consider the newer, often weaker evidence, I'd say.
part of my problem is that i am pre-aggregated protocols and helped put together many protocols. much of the most important information comes through new papers and conference presentations.
my hope is that my students/residents will be able to look at the protocols, learn/know their weaknesses and provide better care and move care of all patients forward.
learning how to read and adapt new literature is the most important part of that. we all do it badly at first. i expect med students to generally have awful ideas that improve with training. but every once in a while a med student will have a brilliant insight that comes from
ignorance and not knowing protocols. unfortunately, this is what i am seeing less of (less bad ideas, less brilliant ideas…less ideas in general).
the good thing about accessible protocols is that the care of patients is improving especially for rare conditions.
A journal article a day keeps the lawsuits away.
Some strong advice I got early on. At least keep your finger on the pulse of the field you've dedicated your professional life to. There are resources to help you keep up to date on some of the newer goings on in most fields (EMRAP/EMCrit are great).
I don’t know - are the long hours, excessive expectations and pressure to be dedicated to work really all that special to medicine anymore? My husband and brother are high income earners. My husband’s direct manager got fired late last week and they’ve had 630 am meetings trying to sort who’s doing what until they can hire someone new. He finds his job a calling and feels a certain amount of guilt that he can’t support his team the way he wants.
I was speaking with brother the other night. His boss was texting him at 7 pm about getting some work done for a big deadline.
I actually have much better boundaries than these two and more of an ability to say no to additional work.
If either one of these guys said “I have boundaries” they’d probably be fired.
Maybe I’m still a relatively young and naive doctor but I feel like I still remember what it was like to be a med student. I try to keep that in mind when I’m interacting with them (ie send them home as soon as possible so they can study for shelf exams, spend time prepping them for rounds, gas them up in front of attendings, teach them actually useful things, etc…).
Every doctor was a med student at some point, it’s wild to me how quickly some forget how shitty it can be to be a med student being on the wards for the first time.
You make a lot of good points, but IMO they are to a discussion that nobody was having.
The issue isn't with setting boundaries or some perception of dedication. It's with entitlement and the difficult transition you guys tend to have going from being career students (through MS2) towards entering a legitimate place of work. The hospital isn't your classroom in the same sense that the lecture hall was, yet many of you treat it that way.
Because competitiveness for residency is almost entirely based on step 2 score now and the average step 2 score continues to rise year after year. Unfortunately clinical experience doesnt translate to better exam scores and it’s time spent that could’ve been spent doing Uworld
I'm not sure what point you're trying to make. The weight has simply shifted from step 1 to step 2, but in general nothing has really changed outside of that. This isn't the issue I'm referring to.
I'm an academic surgeon. I understand that you need to study in order to reach your goals. I'm fairly fresh to practice so those hardships aren't even a distant memory. The problem I'm referring to is that many students struggle to transition to "the real world" after spending basically a decade locked in a classroom setting. The hospital is a place where regular people come to earn their livings caring for the ill. Medical education is a secondary mission. I've had students claim that they deserve to participate in a variety of activities because they are "paying to be there." The reality is you're owed a certain amount of exposure and nothing more. Beyond that, your education is solely the responsibility of the adult human being who enrolled. You are paying for an **opportunity**, just like we did, and it should be treated as such. The moment your education becomes anything greater than a miniscule inconvenience to patient care it will be reprioritized. The students who understand this tend to be more successful and get more and greater opportunities on their rotations. The ones that expect experiences to be spoon fed to them will receive the contractual bare minimum.
>The reality is you're owed a certain amount of exposure and nothing more. Beyond that, your education is solely the responsibility of the adult human being who enrolled. You are paying for an
>
>opportunity
>
>, just like we did, and it should be treated as such. The moment your education becomes anything greater than a miniscule inconvenience to patient care it will be reprioritized.
I deal with all of this a lot with the more recent years of residents and this is a great point often difficult to deliver, thanks for taking the time to write it out.
Oh I’m sorry I thought you’re initial point was being frustrated with students “using the hospital as a classroom” as in literally using it as a classroom to study anki/UW instead of patient care. I’ve heard a lot of docs gripe about that.
I completely agree with your point then. There’s a lot of entitled and out of touch med students and the patients care should never be compromised. They aren’t test subjects after all.
On top of that, some rotations have some ungodly hours, and somehow students are expected to keep up with studying afterward, because we all know a tired mind is definitely facilitative in learning and retaining info.
So the solution is to either try to fit some studying while rotating, risking being seen as lazy, uninterested, etc. Or just be fucking miserable when we get home and cram as much UW as possible. Some attendings are just miserable as fuck and they want to spread their misery as much as possible.
Edit: at the risk of doxing myself, just some examples of the bullshit other people in my cohort had to deal with. 1 FM preceptor crammed 7+ students into a small room and almost every pt had to be seen by a student; charting not finished on site had to be done at home. And then they'd text you on the weekend after going over your charts to berate you to fix things. Another kept students for >12 hours for whatever bullshit surgery stuff they had to do and students regularly failed the shelf for that rotation. Another marked a student as "uninterested" and "did the bare minimum to pass" even though they always stayed late and missed only 1 on-call call because the doc decided a single text early in the morning or late at night was enough of a warning to make sure the student was awake and to the 45+ min trip across town.
It’s essentially two full time jobs. I’m not sure if attendings forget how much studying has to be done at home too or if it circles back to this post as another case of “I did it like this so you should too”
I’m sorry can you post your source for that somewhere? Why do all the competitive programs and specialties have progressively higher step scores then? Most PDs will tell you the first thing they look at is step 2 score and honors.
this just...isn't true? the 2022 PD survey report even shows that only 4% of residency programs don't consider STEP 2 in how they select applicants for interviews (https://www.nrmp.org/wp-content/uploads/2022/09/PD-Survey-Report-2022_FINALrev.pdf)
>there are some specialties where the majority of programs blind themselves completely to your Step 2
Lmao what
Then by what criteria are they weeding out the thousands of apps to get to the decent candidates? Because I guarantee you the few people who work on setting up IIs aren't sifting through your apps without looking at scores.
If your entire life and world revolves around medicine, that's great for you. But I know very few people that their world and life revolves around their job. At the end of the day this is a job, and we all have people to come home to, hobbies, vacations, etc. I see no problem viewing medicine as a job
Not a Dr- but in my field you could replace the word “doctor” with “teacher” and everything you wrote still applies. One difference is many teachers are unionized (pros and cons to that) and have been for awhile - but the attitude/ approach of those who are veteran teachers versus those graduating and starting their careers now is basically a 1:1 to what you’re outlining here for Drs.
I agree with a lot of this take. I hope that the younger generation tolerates less of the blatant profit motivated exploitation of physicians (nurses, RTs, pharmacists etc) that is endemic to the American healthcare system. At the same time, until changes happen in more systemic and organized ways, individual practitioners in the current system who take this approach will tend to expose the gaps in adequate staffing and support that are papered over by worker exploitation. That will either place the burden to fill those gaps on your colleagues or open up patients to direct harm. While I truly believe that administration and profit motivated healthcare are entirely at fault, those who continue to sacrifice their own time and mental energy to protect the patients in these circumstances deserve respect (in my opinion) and will probably resent you for the worsening of their exploitation in response to your individual boundaries.
No one hates med students who work well; it's a mistake to go into medicine thinking that just because you're some years into the career you know what the full responsibility of being someone's designated physician is like.
Near retirement age doc here. I totally support you. I’ve ALWAYS believed the working hours expected of physicians are inhumane. The economic model that modern medicine is based upon requires efficiency, it’s a business model. They want more of the diseases they can make the most money from. So docs work more and more hours, when they complain too much the hospital hires NPs and PAs to do the work of the physician without reducing the physicians hours as much as possible, and they fail to promote prevention, because they can’t bill big money for that. It’s a disease model that promotes illness for everyone. Win-win for them. I couldn’t be more supportive of the goal to reduce work hours. You know what you need to refresh you, not these ridiculous wellness crackpots. The culture of medical training has been twisted and perverted to support this awful system. I am building a prevention center to try to address this problem - at great financial loss for me, but I don’t care. I do care about your future and want for you all to be happier than we were.
there are still some bleeding hearts like myself who got a 100th percentile MCAT score and want to do rural family medicine. But I'll admit I'm in the minority these days
I think the issue is that the "modern" medical student thinks that you \*can't\* have a good work-life balance while also being a dedicated to your patients. They're not mutually exclusive.
>The modern medical student's approach to medicine being more of a career than a calling has everything to do with our warped medical system, and nothing to do with our dedication to patients.
The system has a lot to do with it, no doubt. But at the same time, the "modern" medical student is also the generation that is losing the trust of their patients and the reputations of physicians, and don't realize the "medicine is a career not a calling" attitude plays right into the system which seeks to take away power from physicians and put it into the hands of corporations i.e. big pharma, insurance, and healthcare admins.
But the reality is you're going to see a difference in the quality of care of physicians that work harder and are more dedicated to their patients than those that don't. And by "you" I mean not just the patient, but other physicians and healthcare colleagues. At some point you have to stop worrying about "sticking it to the man" and remember that your job \*is\* indeed about the patient. If you want maximum possible money or work-life balance go into another field, it's easier, faster to obtain, and less painful. But also stop pretending that physicians don't make enough to live comfortably and stress-free in 95% of cases.
I expect a lot of downvotes for this but holy shit does it get tiring reading about this mentality sometimes. Attitudes like this make it worse for everyone because at the core it's pure selfishness that doesn't seek to improve the system and throws everyone else under the bus.
>Please don't hate us for wanting better for ourselves.
don't worry you i already hate you for this smug ass comment ugh
Agree 100%, although I try to carefully control my schedule and patient volume to avoid burnout. I think the bigger issue with more recent medical students is a larger percentage thinking with 'boundary setting' that they can get away with absolutely toxic behaviors. There are plenty of medical students that think they will be able to not evaluate the patient wearing the MAGA hat, refuse to see them, or that they can treat the patient with a MAGA hat differently than other patients. In all 3 cases a potentially career ending move if you are an attending physician or even a resident. As a second example I have seen more of- to think that the rules of showing up on time, being honest about clinical findings and labs or when one is not sure of what they are, and at least pretending to give a shit don't apply to them. In real world practice a serious breach of professionalism or petty backstabbing can be a career ending move very rapidly, and where one may have to be responsible for and be duty bound to have best interests at heart in all situations for a patient whom they viscerally hate- a direct example being that former Palestinian resident who had an old twitter post literally saying she would give Jewish patients the wrong medications on purpose, and then trying to cover this up when state medical boards became interested in it. This kind of stuff pours gasoline on the increasing smoke of general distrust of physicians.
Some of my classmates have said they won't take care of patients like you mentioned. It's absolutely wild.
I always ask premeds this now during interviews.
The first time they try to do this in residency, like the first day it happens the most likely outcome is instantly fired and training license suspended by the board. If they are lucky, the program will merely threaten to cut off their head. As an attending, doing this is patient abandonment of the worst kind, breach of hospital policy/call responsibilities and would result in hospital suspending privileges, reporting to NPDB so nobody else will hire you, and hospital would probably report to state board. After state board investigates they would most likely suspend your medical license. If the patient sues, they will win and insurance company may not even cover if it is with malicious intent/criminal act. These students will eventually figure out the hard way that in the real world, you cannot do this at all. If you do this in your own outpatient practice, then perhaps you could survive till the inevitable board complaint gets your license suspended.
Your youth is showing. Whoever said that to you seems to have gotten it right. The modern med student isn't special.
[Med students these days](https://old.reddit.com/r/Residency/comments/1aw1gez/im_a_medical_student_and_was_curious_if_current/)
I have worked with the same 3 MDs for 10 years. We have had 4 newbie MDs come and go through our office. The old docs always have the same complaints that these new docs are just “not as committed as they used to be.” I applaud every single one of them for getting experience and walking away. Unpaid on call, weekend hours,etc. The older docs are set in their ways and their level of service is impressive, but exhausting. None have young children and when they did all of their spouses stayed home. Good for those who are able to break free and separate the job from your lives 💛
Medicine is a special profession, like several others. Our patients rely upon us to make the best decisions for them- not for us.
That means waking up at 2AM for a patient with dead bowel, instead of punting it till 8AM. Or leaving your child's basketball game for a patient with a STEMI who needs a cath. It's choosing to have the hard conversation about vaccines/weight/smoking/whatever, when you know you can instead just say "ready to quit? no? okay, see you in 1 year" and get through the day 20 minutes faster.
Doctors have an immense power differential over patients, and we are obligated to act selflessly in our patient's best interests. That doesn't mean sacrificing yourself, all day every day, but no, it is not like being a used car salesman or tattoo artist.
Medicine treats people terribly. Brainwashing people into thinking it’s their life so they can be treated like shit by private equity is how I woke up at 39 and realized I’d wasted my life. No one you work with gives a crap about you, and your patients would rather see the NP. So yeah it’s a career now
I think it's possible to view it simultaneously as a calling, a career, and likely a series of jobs.
The calling part for me includes worker reforms, especially unionizing and fighting back against the administrators and insurers. It includes my vision of what I want my work to be like, and that means a life similar to what I advocate for my patients. I try to set an example by eating vegetables, sleeping, exercising, etc.
The career part is how I see my jobs fitting together in a narrative... one where I have moved towards my goals of specific ways of practicing. I am at a rural FQHC and taking care of mainly kids with Medicaid. I've added specific skills along the way in behavioral health, where I have seen gaps. The career aspect includes community advocacy-- eg, getting my local hospital to start a carseat fitting station, and lobbying for better medicaid funding with legislators.
The job part is the specific employer and working conditions-- I feel dedicated to quality work (calling, career) but in regards to employers, I don't feel loyalty unless they earn it by treating me fairly. I protect my free time from my boss.
part of my problem is that i am before aggregated protocols and helped put together many protocols. much of the most important information comes through new papers and conference presentations.
my hope is that my students/residents will be able to look at the protocols, learn/know their weaknesses and provide better care and move care of all patients forward.
learning how to read and adapt new literature is the most important part of that. we all do it badly at first. i expect med students to generally have awful ideas that improve with training. but every once in a while a med student will have a brilliant insight that comes from
ignorance and not knowing protocols. unfortunately, this is what i am seeing less of (less bad ideas, less brilliant ideas…less ideas in general).
the good thing about accessible protocols is that the care of patients is improving especially for rare conditions.
> In my years of residency and fellowship these issues got worse and worse over the years
Out of curiosity, is it getting worse and worse, or are you noticing it more as you have moved from student, to resident, to attending? Or in other words, as your position has changed from student to teacher? Before you'd be focused inwardly and as you gained experience, and responsibilities, these trends have become more apparent?
The point is whether your perspective is what is making it seem like an increase in prevalence or whether it is a real increase in prevalence. Put simply, how much is this due to your positional bias. You are more likely to notice these things as an attending who is teaching because you interact with more students today than you did when you were a student. You were unlikely to interact with more than a handful of other students when you were a student yourself.
Of course, we should also consider cohort differences as well. How acceptable was it to say you were taking time off for sports when you were training compared to today?
Do you remember that scene in Dead Poets Society where Keating makes the kids stand on his desk? This is my issue with comments like yours. Your perspective of "what it was like in my day" is like that. Back in your day, you were looking up (student). Now you are looking down (attending, or whatever your title is). That change in perspective is important. Ignore it all you want. But I am a scientist. I'd be a piss poor scientist if I couldn't spot this very obvious bias in sampling. Thankfully I am not a piss-poor scientist and can see this one that is right in front of me. And I didn't even need to go to med school to see it.
Actually, I am more interested in data. Hard numbers. Not opinions. Believe it or not but I don't need a med school degree to understand and interpret it.
Your dismissal of the idea that you may be operating from a biased position is more telling than anything. Maybe it is something you should consider. In the meantime, i will await the publishing of the paper on the topic before I take a position. Im a proponent of Evidence-based practices in all forms of education. Otherwise it is the same old song and dance that has been going on for decades.
Maybe the system will be saved by docs like me, who could retire, but won't. I worked in big pharma for more than two decades, always keeping a foot in the clinic as a volunteer and teaching at a major med school. A year ago, two years after the big pharma company paid me to relocate to a different state, they laid me off. I jumped back into the clinic one and a half days a week, at one of the top academic medical centers in the world, paid a pittance, working my ass off, but loving every minute of it. I am seeing patients who were referred to the clinic often six months earlier. I will keep doing this til the day I croak. Had I not had the benefits of a prior big pharma salary, I would not be able to do this, but here I am, doing the kind of work I did when I started, and loving every minute of it.
I mean i consider it a pretty cool job. The issue is if you crank up the workload and liability it’s a first class ticket in the burnout express. Not much you can do about the liability, but managing workload is essential.
Which is unfortunate when most physicians are employees with no say in workload. I have friends in derm that see 7-8 patients an hour. I think medicine can be cool, but not in the way most jobs are structured and I think burnout rates kinda point that out too.
Physicians have all the say in the world about being an employee or not. Unfortunately there are a lot of laws that make being employed the ‘easier’ path, but there always is the choice.
If I were starting training today, my more balanced goals and "B- work ethic" might survive in 4-year MD school. As it was, I'm very happy to have made the call to aim at PA school instead, and my career is in a good place. Even in a very chill specialty, I feel like the ability to punt to a Board-Certified MD or DO whenever I feel like it is a nice bonus.
Meanwhile, the brutal hazing of the tougher residencies is pretty much based on the model developed by a cocaine addict, and nothing has ever made more sense. https://medicaljustice.com/a-century-of-brutal-call-schedules-the-libby-zion-case-and-cocaine-3-converging-stories/
Mental health is still dismissed as not significant enough to warrant adequate attention. As the old guard dies out, we will see more and more healthy relationships being established with a more appropriate work-life balance but it will take time. Time to gain acceptance, time for people to move out of the workforce. And time for the opinions of the older generation to loosen its hooks on the younger generation. Will there need to be a reassessment on outcomes for the reduced hours of training? Sure. Bring it on. We will get to see if our assumptions are right or wrong when it comes to all of it. Arguing to stay the same without change isn't practicing evidence based medicine in the end. Let's do the comparisons and see.
I think that is a fair statement about how medical students in 2024 vs 1984 view medicine. It was and still is a calling for some. Some of my closest friends chose primary care even with stellar board scores. Some of them chose a career in homeless/underserved/rural medicine instead of being a concierge for pay primary care physician. To me they are doing what they are passionate about and it called to them. I think where the lack of understanding comes from is when prior doctors look at today’s landscape and realize we had to know more than they had to know (new medication, new technology, new procedures, etc.) and doing it with less dedicated time than they had to and it is hard to reconcile how that could be possible. And it isn’t.
This is when I get downvoted into the abyss because people can’t be honest with themselves. Medical training for future MDs and DOs does not deter the mediocre or below average student anymore. That leads to primary care physicians opening up ketamine spas that are run by NPs because they are treating medicine as a business/career. That leads to physicians not being able to handle conjunctivitis, sinusitis, diverticulitis without multiple subspecialty consults. While I agree that the older generation needs to stop punching down, their concerns are valid.
No, this isn’t it at all. The medical students are entitled and lazy AF, and the quality has declined dramatically. Their fund of knowledge has never been more limited. They have no incentive to study harder or outwork their peers. It’s an actual crisis.
Look some of y'all boomer attendings have told me I should go to work with a fever and work 36 hour shifts.
Look, if wanting to go to bed after a 24 hour shift or stay home when I'm sick makes me a bad doctor, then so be it. I'm down to work 80 hours a week as a third year, but some of y'all are crazy
Also, thanks for taking up for the youngsters OP
"The modern medical student's approach to medicine being more of a career than a calling has everything to do with our warped medical system, and nothing to do with our dedication to patients."
1. Why do you say so?
2. Warped medical system? What are you talking about?
"I think doctors see medical students draw boundaries for their lives and assume that we don't care as much about the patients, our education, or the medical field. On the contrary I think we care a lot,"
3. Why do say "we care a lot" if people like you draw boundaries for their lifes now?
"and that creates a dissonance when we are immediately faced with the abusive medical system we are going into."
4. Abusive medical system? What are you talking about?
"Doctors face terrible burnout nowadays trying to deal with the broken system that ultimately proves a major barrier to care"
5. Why do you say that doctors nowadays face a terrible burnout nowadays trying to deal with the broken system?
"Students have decided early on to adopt a nihilistic attitude towards the system as a whole because we anticipate that burnout. We know the system will drain any bleeding heart it can find, so we refuse to bleed."
6. Nihilistic attitude? Refusing to bleed? What are you talking about?
"I'm sorry that this monstrous system used you."
7. Why?
"I'm sorry you were made to think that it was necessary, honorable, and requisite to being a good doctor."
8. Why?
"I'm sorry that the system has disillusioned you because of everything you've experienced in your career."
9. Why?
"Please don't hate us for wanting better for ourselves."
10. Why??
As a pre-med student I 100% agree. I personally pursuing medicine out of passion and I'll most likely pursue full time missionary medicine after paying off my debts and getting financially stable but way too many students are pursuing it for the wrong reason imo. The vast majority of people who start off freshman year of undergrad want to become a doctor either because of parental pressure or because they want to have a mansion and drive a tesla. Most of them end up dropping to business or CS by organic chemistry sophomore or junior year.
The vast majority of students just view things as boxes to be checked off and now that I'm sticking my nose in the medical student reddit and stuff it doesn't seem to be any different. You need a 520+ mcat, you need high gpa, you need clinical experience, you need research, you need clinical volunteer work, you need non clinical volunteering, you need to save a village in Africa, etc. Although many people get matriculated without having everything, it kinda just turns everything into a rat race where you're checking off boxes rather than trying to gain a foundation in healthcare experience and develop as a future provider.
It honestly drives me insane how much people think of it as a "game" in many ways. I recommend a lot of freshman pre-meds become EMTs or something for the experience and they always say things like "doesn't everyone have emt med schools don't care I want to do something unique to differentiate my application" and it turns into starting BS nonprofits or getting your name on as many papers as possible with minimal contribution. I wish schools would look more for a foundation rather than all these weird criteria for students to be unique, but that's just my opinion at the moment that's subject to change down the line.
Anyways maybe I should have just done engineering or something freshman I would make a lot more money building missiles for lockheed martin to lob over to third world countries but now I'm stuck on this path because of passion.
I know this sounds crazy but sometimes I miss the torture of residency during the pre 80 hour work week limits.
There was something very bonding about being part of a group of collective suffering. It made my residency class tight in a way that I dont think is possible in the days of time limits.
Now that's not to say that working 120 hours a week is good, it's clearly not and it creates a lot of pathology. But I'll never forget finishing intern year with 10 of my residency classmates, we literally went to hell and got out on the other side and it changed my life in a way that I dont think modern residents/med students can appreciate.
There was a national survey done about 40 years ago asking about life experiences that changed us for better or worse. #1 on the list was becoming a parent, #2 was losing a child, and #3 was becoming a doctor. I bet if you repeated that survey today, becoming a doctor wouldnt even break the top 20.
Reddit is very much an echo chamber for your exact opinion. If you are just looking for affirmation, this post will probably give you what you want. If you actually want a different perspective, find an old school doctor whose patient care you respect and admire who is horrified by the modern attitude of students and genuinely seek their perspective. I don't think you have any real interest in considering the merits of other perspectives and most people on this subreddit constantly post similar perspectives, so I am not sure what you are really trying to accomplish here
It's a time-honored tradition in medicine to shit on the generation below you. Especially if they're a trainee. I don't know what psychology prompts this. I remember ten years ago as a medical student the older physicians complaining how we had it so easy because they didn't have to follow the 80-hour workweek rule. But keep your attitude up, and remember that you *are* a part of making things better! I rarely work with medical students as a community ED physician, but when I do occasionally run into them, I'm always impressed and never find anyone to be lazy or entitled or unmotivated. I am fully on Team Career rather than Team Calling. The only reason I'm still doing my job is to pay down my student loans.
I hated the abuse of med school (1993-1997) and residency so much that I vowed when I gained attending power that I would always endeavor to be kind and respectful to my students. I was walking an intern through a case and she ran out in tears. I was surprised, but then I realized I'm the asshole.
You either die a hero or live long enough to see yourself become a villain
I don't think I've ever seen a more appropriate use of this meme.
Maybe. You were the one who can assess your assholery. I have not made any residents cry (yet?) but I have has a student tell me that my questions were causing discomfort and I should stop. I was leading a case discussion with the handful of MS3s on rotation. Not knowing the answer is uncomfortable, but that discomfort is not bad and should not be avoided. That’s learning.
there is so much discomfort as part of being a physician! patients and their families, other doctors, trainees, nurses. being right and even knowing the answer doesnt necessarily even help…
>Not knowing the answer is uncomfortable, but that discomfort is not bad and should not be avoided. That’s learning. As a former educator, this is perfection. I used to drill this into my students' heads daily. Learning *doesn't* require functioning in an abusive and antiquated system as a badge of honor (how many more studies need to be done on mistakes made out of sleep deprivation?) but it does require pushing yourself out of your comfort zone more and more every day, which requires sitting with the uncomfortable stuff, challenging why you find it uncomfortable, and working to push past that point into breakthrough. That's not exclusive to professional training; that's learning in general.
> Not knowing the answer is uncomfortable, but that discomfort is not bad and should not be avoided. That’s learning. That’s the issue doc. They think that discomfort is bad
I think it’s easy to forget how challenging it can be to be in that early learning stage. Emotions can run high for many people and there is also a lot of self doubt coming into play. I can see how easy it could be to casually provide instruction or correction to a new grad that might make them break down in tears if they were already on the edge. But there is always a chance you could just be the jaded asshole without realizing it.
Unless you were being some kind of extreme asshole, disagree. Medicine requires some level of basic coping skills, you can't accomodate everyone no matter how unreasonable. Does the average normal adult student find you to be an asshole is the question
Did you tell the student they were dumb/put them down? Or just ask them fair questions they didn't know? Pimping is fine and necessary. But of course y'all should be nice about it
Why do you say that you're the asshole? What happened?
When people say this they often imagine themselves as the ones being affronted by the older generation. Don't forget that one day, you will be the older doc and the med students will be doing things that were unthinkable for you when you were in training and then dismiss you as being a "classic millenial/gen z" (boomer). I think it's important to constantly evaluate why we do the things we do in training and why things are the way they are but it's also important to recognize that sometimes there's a good reason for doing some of the more unpleasant things we have to do in medicine that might not be fully understood until well after training is over.
You're right. There is truth to both sides of this. From thw student side, I should be allowed to sleep at night most of the time. I should be allowed to get married and have kids. However, some of my classmates have complained about having to show up to clinic on time for example. Obviously that's BS
>It's a time-honored tradition ~~in medicine~~ to shit on the generation below you. Could apply any place, any time, tbh.
This is such an interesting phenomenon to me, because as a PA I didn't experience any of this (except for the one-off physician on occasion). I've been very fortunate in my mentors, many of which were MDs that took a very active interest in my training, and none of whom shit in me. My current physician was previously the head of the resident department at his old job and has been a truly fabulous mentor.
You had good admin at those places. Bad admin, I believe falls to “what you permit you promote”
Definitely. The one that stands out the most is the MD who did my cardiology training as a student. He was always very involved in making sure I was getting good training. I actually thought he didn't like me much because he was generally pretty quiet, but it was just me, a massive extrovert, misinterpreting his introverted nature. I found out from another student he had that he thought I was quite smart and hoped I would choose cardiology one day(which was great, because he is probably the smartest person I've ever met, frustrating that he was also so nice).
Same. I got recruited to come in and work with the MD who's also residency director, and in the first week he pointed out I don't report to him and I'm not an employee, I'm supposed to be a partner. To his credit, that has turned out to be true, even when we disagree about how to do stuff. It's a pretty great post for a PA. (And hilariously, I'm paid hourly where he's on salary, so leadership's attitude to me working late or taking on extra work is different than it is for him.)
When I was new, I felt really bad because I knew I wasn't pulling my weight and our in baskets were huge and I was working till 7 PM every night and still behind. The first year was absolutely fucking awful. I was having full panic attacks at around the 1 year mark. I think I'm in the minority of my PA colleagues on this, but it's insane to me that there isn't some form of PA residency. I had to cobble together some sort of self residency that I'm sure has huge blind spots.
I had a similar sense of overwhelm when I was salaried and in primary care. The larger question of how we non-physicians can be good clinicians without structured residency crosses into philosophy pretty fast. For me, it's a question of making sure the role is well-enough defined that it's not just "do what the docs do, only maybe not the complex stuff" and that people who say "just ask if you have a question" are really willing and able to answer those questions.
This actually is a huge source of my burnout. At my org I'm expected to do everything the fully trained MDs do except half the pay. My scheduling is the same as all the MDs but I'm paid less than half. There's no blocks on the schedule for complexity, it's basically first come first serve on my schedule. Theoretically I'm not supposed to see hospital followups for high complexity patients, but in practice I regularly get them scheduled. I don't mind accepting that I have a lower level of training, and my pay reflects that. I do resent that I'm paid like I'm lesser, but asked to be the same.
Amen, this is the truth. It's hard because it feels like it's sink or swim. I have a wonderful sp, but if we're seeing 25 patients a day it's hard to discuss those cases. Lots of workup comes from me self teaching myself on up-to-date, podcasts, CME, etc. I feel that I'm a good clinician, but abused by the system in the complexity and scope of just see it all because you have openings.
Yea. I feel like I have become an incredibly strong clinician. I've seen several things that the fully certified and much more experienced clinicians have never seen before and I have a reputation for just weird diagnoses. At the same time, because I have access I'm often treated as the defacto urgent care. I had an honest to god takastubos cardio myopathy last month and a patient with an episode of Acute HFrEF with an EF of 10 to 15 percent who argued with me about going to the ER and wanted to drive herself (fortunately a friend came for her, her EF wasn't know at the time of the appointment, previously was 45%). I've had 2 PEs in the primary care clinic, which gives me nightmares.
https://historyhustle.com/2500-years-of-people-complaining-about-the-younger-generation/ Everyone has always complained about the next generation. That's just human nature, and medicine is no different.
80 hours work-week rule??? Did older physicians go through that?????
I mean when I was in residency the 80-hour average work week was still in place. So you weren't supposed to work more than that. But that was still relatively new and I think before the early 00s there were no restrictions at all and residents regularly worked a lot more than that. I think med students had the same rules. Have the rules changed? 80 hours is still a fucking lot of hours.
I was trained in the era of the introduction of the “new rules” of 80 hour weeks and 30hour shifts limits. Despite being asked every week by our PD to violate these rules and lie about violating these rules when asked, we were called a weak generation for not agreeing to work unlimited hours. They hid behind the mantra that we were hurting patient care through unnecessary handoffs. My colleague fell asleep after a 30hour call shift and got into a car accident on the way home, and the only concerns were how long she was going to be out for, and how they rest of us would be covering her shifts. The system was unnecessarily cruel, and I wouldn’t want anyone to have to go through what I went through. For those like OP wanting and fighting for a better life: Great! But the problem is the system is still unnecessarily cruel, which you’ll soon find out. And we need your help to fix it, because it’s rapidly getting worse since the pandemic. They are still hiding behind the lie that everything we are fighting for is going to hurt patient care. The sooner we all realize it’s not new doctor vs old doctor, doctor vs nurses, doctor vs mid levels, etc., but it’s all healthcare professionals vs a broken system that wants us to fight each other instead of fixing things, the better.
Hear hear. There is a remaining significant step in our mental framework. Our cultural revolution. We need to accept that systemic changes will lead to better care in the long term *but* will harm patients in the short term. The heartless systems governing care, mostly seeking profit, will always wring their labor dry. We need to accept that it will attempt to use altruism and martyrdom against us. Setting boundaries on time commitment, work volumes, work conditions, etc... these create gaps in care. Some are cautious against this, citing pstient harm. But the truth is, we will *always* be on the edge of disaster. We will never have "surplus" staffing required unless it is forced upon the institutions by labor or law. And law isn't helping.
Hey, I am currently in the US but I got my education in a developing country where all medical students and doctors work shit hours for very little pay with a lack of equipment, are understaffed, sometimes killed by angry patients with criminal backgrounds, and often suffer burnout. Like, it is a norm over there. And I can tell you we have dedicated doctors and not so much, good ones and bad ones, and everything in between, including bullies and a-holes. People who think you need to suffer because they suffered to get where they are having issues they need to process. The environment has changed. It always changing, that's life. Plus, there is no need to suffer to graduate or to be a caring doctor. Also, I remember we were taught to draw the lines you mentioned above to protect ourselves.
Are you going to do your steps and try to get into a US residency? Curious when I saw your tag.
Much to learn you still have … when you look at the dark side, careful you must be. For the dark side looks back …
Shit, then I went full Sith mode when I left academics and went pharma consulting. Attendings at the ER where I take my EMS patients bristle at the sound of me talking to younger PharmDs and MDs about life outside a hospital and real work-life balance. I was almost *persona non grata* when I helped a very experienced PharmD exit clinical care to my side of things.
So… where can I learn this power? Jk have brain damage, stuck doing academic bullshit forever. At least I have medical students to regale how much better/harder things were back in my day?
If you go to the dark side…
You need anyone else? 🙋🏼♀️
Thanks Nietzsche/Yoda
The multi-classing is strong with this one
I think that in the distant past, medicine offered more to doctors than it does now. Pay your dues, be rewarded with money and respect and a good career. With the intrusion of an administrative class that uses us, chews us up and spits us out, the investment isn't worth the reward. I would love to see a complete revamping of the US medical education system, with a 6 yr college-med school education, more residency spots with better hours and maybe an extra year added to get the case numbers. Call nights offset by days off. Decent benefits, livable wage, paid vacation. We'd probably have to double the number of med school and residency spots to achieve it, because right now, the system is carried on the backs of young doctors who are overworked, underpaid, and not respected. I've gotten to a point in my career (the end of it) where I can pick and choose where I work and how much. #locums (do people hashtag anymore?) Anyway, I work to pay for things I want to do, and if a situation isn't working for any reason, I have the freedom to move on. I applaud the new generation of students and residents who see that life has to have a balance. My kids never considered medicine because they saw an unbalanced situation.
Ask how many of those older docs would work the exact same hours if they were to get paid the same amount even if they didn’t work at all. Everyone knows it’s a career, some are just in more denial than others.
Maybe this is a case where the extremes of their side stand out, but most people are somewhere in the middle. Calling out sick inappropriately isn't setting boundaries on your upper limit of work hours. It just hurts your peers and builds resentment. I hope that this behavior isnt commonplace. Not participating in "scut work" because there's nothing to be learned from it is a self limiting belief. Wait until you become an attending and then put your foot down on BS from administrators. Creating a better work culture and boundaries will be more likely to happen if we work together rather than against each other. It's trainees vs older attendings, when it should be all of us against the bean counters.
As a guy who just realized he graduated medical school 17 years ago. (Has it really been that long? Yeesh). I fully get it. Actually, anytime I hear the “it’s a calling”, that’s a red flag that someone wants something for nothing. Medicine has been preying on the idealistic, hopeful, altruistic nature of the people who set out to become doctors for so long it’s become an expectation that you will “suffer for your art”. And that’s kind of sick and twisted, and frankly, abusive. I remember the bad old days of being on a 36 hour shift with constant insanity, never a moment’s break, barely eating, not remembering the last time I actually peed, falling asleep at the end of shift after every sentence or two I charted, trying desperately to finish up so I could get the blessing to leave without being handed more scut. Then falling asleep at red lights on the way home. Or maybe the time I almost shit my pants because finding time to go to the bathroom was almost impossible some days and you’d be returning pages while perched on the throne. Or the patient that was positively offended that I yawned while taking a history from them at 4am. Allllllll that shit was terrible. Terrrrrrible. And they paid me like 45k a year and gave me two days off a month. Yeah, that altruism is G O N E. This is a job and I will do my job well, but i’m not coming in on my day off to attend a fucking meeting. None of this above and beyond crap. I’m doing my job and then going home, leave me alone.
Can’t it be a career and a calling
Yeah. *I* can have a calling. No problem there. It’s when *someone* *else* wants you to chair a committee or oversee a sepsis mortality reduction program or help get the hospital ready for an OSHA/JCAHO inspection but they don’t think you should be reimbursed for the work you are doing because “It’s a calling.”. *That’s* what I’m referring to.
Good point
Without knowing what really happened or was said, a few possibilities arise. Medicine is both a calling and a career. We're medics, not martyrs, but this is also a pretty rough career to have if you have no personal investment in it whatsoever. Boundaries are important! Having a reasonable life matters, and old guard doctors who insist on being available for patient care at all times at the expense of everything else are making a choice, for themselves, that they cannot impose on everyone. Good for you for having other things in your life. Defend that! But boundaries aren't everything. On the other side, there are medical students—and residents, and physicians—who feel entitled to treat this not just as a career but as not a career. Medical school means working long hours, including overnight, including random shifts. It means that because residency demands the same, and then often so does employment. Medicine is a 24-7-365 (or 366!) job. Not everyone works all those days and hours, obviously, but people have to take all of those hours. Even the miserable 3 am on Sunday morning. "I don't want to be abused" is not the same as "I work 9-5 and take off when I want." It would be nice, but that isn't how medicine works. It isn't how a lot of jobs work. I am sympathetic, and there is a slow culture shift to covering for each other for obligations and needs and just wanting or needing to take time off, but there are also practical and legal and ethical reasons that people need to show up to work. That isn't what you said or meant? Well, you didn't say what you said or meant, so here we are. My career has been short. I can't really say that medical students these days are different. But even when I was the medical student, I was outraged by some of my cohort behaving in ways that would not be acceptable in any non-nepotism/sinecure job. You have to work. Sometimes you have to do work that is not fun. Sometimes you have to do scut, because every job has scut, and only the rarified few get "people" to cover scut for them.
Not to be a “pick me” resident but my program has been struggling with some residents who feel they can call out whenever and however frequently they want to. Like, my bröther in Osler, 1. Didn’t you learn about what the demands would be while you were going through the years-long pre-med and med school cycle? 2. Our expectations are (I find) quite reasonable, and nothing compares to my father’s days in the early ‘80s of q3 24 hr call 3. We do have numbers and metrics we have to meet to be allowed to graduate and practice independently 4. Perhaps most importantly, when you call out, your friends have to cover for you. We’ve had a few people who have had ti take significant time off due to health or family emergencies, which I get, life / shit happens. It also hasn’t escaped me that I don’t have kids or other commitments that some of my colleagues face. Just confused by those who got to this point and then act shocked they’re expected to *checks notes* show up to work and do so on time on a regular basis. Anyway, back to yelling at clouds.
I do think that medicine should be more than just a job *for colleagues*, not just patients. If you get sick, I will cover for you. No expectation that you pay me back, just that you pay it back when someday, someone is sick and needs you to cover. Generally, I aim for no questions asked. If you request time off in advance for vacation, I will respect that. I will not call you or email you; my job is to provide coverage so you can have a life. Or watch paint dry, whatever; your use of time is your business! If you’re just being a flake and abusing your colleagues’ support, yes, I will start questioning. I don’t *want* to work extra, I am *willing* because I want the same consideration from you if I need it. I’ve had those colleagues. Occasionally it’s bad family or medical stuff, and that’s frustrating for me but part of the job. In the short term, at least, I’ll pick up the slack. Sometimes it’s just taking advantage, and I get sick of it fast. My goal is to be able to drop everything and leave if I have to, or if I end up having an acute medical crisis. I expect that. I expect the same for you. It’s been sad for me that not everyone else is on the same page.
I’m curious why these individuals don’t realize this? Were they pushed into medicine by their elders and did it because they felt they had to? Were they raised entitled, and didn’t realize that life and work can be hard and sometimes you don’t get your way? Have they never worked a job before? Truly curious, as a medical student that is graduating this year. I went into medicine because there was no other job I could see myself coming home from every day feeling fulfilled. The hours suck, difficult patients can be emotionally and physically exhausting, you sacrifice your 20’s+ to education, and beyond that you make so many personal sacrifices the rest of your life. But it felt and still feels like the correct path for me. I always thought my peers in med school had the same thought process.
Honestly, every year we have at least one resident who has literally never had a paid job before residency. They blame all the general shittiness of being an employee on medicine in particular, get super burned out really quickly, and then they either stick around being a dark cloud on every experience or leave to another residency and then leave that one also.
Yes!! I can always pick out students who have never had a job anywhere before. I would much rather work with the B student who worked at Applebees than the A student who has never interacted with a human in his life.
I feel like a LOT of med students/residents have never done anything other than go straight through their education to get to their first real job and when they find out it’s kinda hard they label it abusive. I agree with the poster who said there’s a difference between “abuse” and “it’s not a 9 to 5” and I’m only a second year attending but gosh darn it, kids these days need to suck it up a little bit. That being said, there’s been a lot of positive improvements made in medical education especially around calling out the kind of sexist/racist/classist/ableist BS that was once absolutely pervasive and accepted as “part of it” but there’s still more that can be done. But being required to work hard and grueling hours while learning how to care for people’s literal lives SHOULD BE HARD.
It's such an interesting dichotomy where I am so grateful that I have a union that has won us better benefits, and how we have been able to successfully advocate for the removal of 28hr call at my program...things that do help with wellbeing and improving our material conditions. At the same time, we have students who tell us "it negatively impacts my wellness to follow more than 1 patient" and residents who sign-out an actively coding patient so that they can go home at 3PM, and it makes me wonder if people genuinely assume that they can avoid any semblance of challenge in the job.
> "I don't want to be abused" is not the same as "I work 9-5 and take off when I want." It would be nice, but that isn't how medicine works. It isn't how a lot of jobs work. This is only a function of supply and demand. When a buyer gets desperate enough, they will provide 9-5 and take off when I want (or buy sufficient redundancy). And when a seller gets desperate enough, they will sell on call labor.
I have seen hundreds of medical students. The main difference is that the newest med students have much less deference to authority. New med students are very willing to walk out, issue a complaint, report borderline activity. It has forced out some of my colleagues that were sexually inappropriate or physically harsh to those around them. These people were stellar on the medical side but were really off in other ways. At the same time, students are not as willing to challenge medical treatment as much. I think it is because it is so easy to find an algorithm online and much harder to see and find alternatives? I see A LOT more dependence on info coming from up-to-date rather than coming from a recent paper they read in a journal. As far as hours, they have a lot more time for other activities and even make commitments that they prioritize over medicine. “i cant give the presentation because I have a soccer game” is something you would never hear because there wouldnt be enough time to think about joining a soccer league. But some time, they will need to learn that all of these other things are second priority to taking care of acute needs. I have had a very few students that very much should not have become doctors and that are dangerous. The most common characteristic is that they are students that slide in because of some connection and werent really interested in medicine as a way of helping people.
I would say that it is due to the fear of being sued that people can no longer challenge treatment. If you follow local guidelines or up to date and you have a bad outcome them it's hard to fault. However if I go off a random journal and get a bad outcome I'm gonna be sued and the hospital may not back you. It's an unfortunate part of the job now that the longest and most detailed notes one writes tend to be for people with nothing really wrong with them who complains a lot. Also I think that playing soccer or taking part in sport should be promoted by us. Medicine shouldn't need to be something that you have to dedicate your whole life to. Why should people who try to promote good health lead the least healthy lives from both physical and mental well being? I think I might take a leaf out of their book and starting telling people I need to leave on time to make it to training Lastly why do I feel like you're trying to defend people who have physically and sexually harassed students? They should definitely be "forced out" as they probably can't be trusted with vulnerable people (ie patients)
what a great reply! “people can no longer challenge treatment” the best time to challenge treatments is in medical school when you have no responsibility. progress can only be made by recognizing the weaknesses of present care and challenging it. learning how to do this responsibly is the best that i can offer. “the longest and most detailed notes one writes…”too often trur. “playing soccer or taking part in sport should be promoted by us. Why should people who try to promote good health lead the least healthy lives from both physical and mental well being? I think I might take a leaf out of their book and starting telling people I need to leave on time to make it to training”yes. medical students are healthier in many ways with the way they live now. “Medicine shouldn't need to be something that you have to dedicate your whole life to.”this is a totally different attitude than previously. ok to not make it life’s devotion as long as you dont prioritize your avtivities over patient lives. this is a very messed up area especially with the way businesses are commercializing care. the current students are going to have to solve this problem. “why do I feel like you're trying to defend people who have physically and sexually harassed students? They should definitely be "forced out" as they probably can't be trusted with vulnerable people (ie patients)” this is just to point out that the activism of current students is leading to positive changes that had been brushed under the carpet for decades in ways that never would have happened (and didnt happen) before. It represents a great change in the way that power is wielded. of all the changes the only two that worry me are: 1- i can envision a day where doctors are generally not willing to take care of patients if it is inconvenient for them. anyone who has worked in an ED or tried to get a consult already knows this can already be a huge problem in a number of ways and i fear it will get worse. 2- medicine being reduced to AI protocols. Thankfully we have a talented group of physicians to work on these problems. But a lot of lawyers, politicians, and businesses will be working against them at the same time.
“Physically harsh” lol
> I see A LOT more dependence on info coming from up-to-date rather than coming from a recent paper they read in a journal. Do you think this is a bad thing, though? There are "new papers" coming out every other day with some revolutionary claim, and I don't think that the habit of challenging data that is well estabilished through larger studies is necessarily a quality. When you get to the limits of costumary protocols, then it makes sense to consider the newer, often weaker evidence, I'd say.
part of my problem is that i am pre-aggregated protocols and helped put together many protocols. much of the most important information comes through new papers and conference presentations. my hope is that my students/residents will be able to look at the protocols, learn/know their weaknesses and provide better care and move care of all patients forward. learning how to read and adapt new literature is the most important part of that. we all do it badly at first. i expect med students to generally have awful ideas that improve with training. but every once in a while a med student will have a brilliant insight that comes from ignorance and not knowing protocols. unfortunately, this is what i am seeing less of (less bad ideas, less brilliant ideas…less ideas in general). the good thing about accessible protocols is that the care of patients is improving especially for rare conditions.
A journal article a day keeps the lawsuits away. Some strong advice I got early on. At least keep your finger on the pulse of the field you've dedicated your professional life to. There are resources to help you keep up to date on some of the newer goings on in most fields (EMRAP/EMCrit are great).
I don’t know - are the long hours, excessive expectations and pressure to be dedicated to work really all that special to medicine anymore? My husband and brother are high income earners. My husband’s direct manager got fired late last week and they’ve had 630 am meetings trying to sort who’s doing what until they can hire someone new. He finds his job a calling and feels a certain amount of guilt that he can’t support his team the way he wants. I was speaking with brother the other night. His boss was texting him at 7 pm about getting some work done for a big deadline. I actually have much better boundaries than these two and more of an ability to say no to additional work. If either one of these guys said “I have boundaries” they’d probably be fired.
Maybe I’m still a relatively young and naive doctor but I feel like I still remember what it was like to be a med student. I try to keep that in mind when I’m interacting with them (ie send them home as soon as possible so they can study for shelf exams, spend time prepping them for rounds, gas them up in front of attendings, teach them actually useful things, etc…). Every doctor was a med student at some point, it’s wild to me how quickly some forget how shitty it can be to be a med student being on the wards for the first time.
You make a lot of good points, but IMO they are to a discussion that nobody was having. The issue isn't with setting boundaries or some perception of dedication. It's with entitlement and the difficult transition you guys tend to have going from being career students (through MS2) towards entering a legitimate place of work. The hospital isn't your classroom in the same sense that the lecture hall was, yet many of you treat it that way.
Because competitiveness for residency is almost entirely based on step 2 score now and the average step 2 score continues to rise year after year. Unfortunately clinical experience doesnt translate to better exam scores and it’s time spent that could’ve been spent doing Uworld
I'm not sure what point you're trying to make. The weight has simply shifted from step 1 to step 2, but in general nothing has really changed outside of that. This isn't the issue I'm referring to. I'm an academic surgeon. I understand that you need to study in order to reach your goals. I'm fairly fresh to practice so those hardships aren't even a distant memory. The problem I'm referring to is that many students struggle to transition to "the real world" after spending basically a decade locked in a classroom setting. The hospital is a place where regular people come to earn their livings caring for the ill. Medical education is a secondary mission. I've had students claim that they deserve to participate in a variety of activities because they are "paying to be there." The reality is you're owed a certain amount of exposure and nothing more. Beyond that, your education is solely the responsibility of the adult human being who enrolled. You are paying for an **opportunity**, just like we did, and it should be treated as such. The moment your education becomes anything greater than a miniscule inconvenience to patient care it will be reprioritized. The students who understand this tend to be more successful and get more and greater opportunities on their rotations. The ones that expect experiences to be spoon fed to them will receive the contractual bare minimum.
>The reality is you're owed a certain amount of exposure and nothing more. Beyond that, your education is solely the responsibility of the adult human being who enrolled. You are paying for an > >opportunity > >, just like we did, and it should be treated as such. The moment your education becomes anything greater than a miniscule inconvenience to patient care it will be reprioritized. I deal with all of this a lot with the more recent years of residents and this is a great point often difficult to deliver, thanks for taking the time to write it out.
Oh I’m sorry I thought you’re initial point was being frustrated with students “using the hospital as a classroom” as in literally using it as a classroom to study anki/UW instead of patient care. I’ve heard a lot of docs gripe about that. I completely agree with your point then. There’s a lot of entitled and out of touch med students and the patients care should never be compromised. They aren’t test subjects after all.
>They aren’t test subjects after all. This is a good way of putting it
On top of that, some rotations have some ungodly hours, and somehow students are expected to keep up with studying afterward, because we all know a tired mind is definitely facilitative in learning and retaining info. So the solution is to either try to fit some studying while rotating, risking being seen as lazy, uninterested, etc. Or just be fucking miserable when we get home and cram as much UW as possible. Some attendings are just miserable as fuck and they want to spread their misery as much as possible. Edit: at the risk of doxing myself, just some examples of the bullshit other people in my cohort had to deal with. 1 FM preceptor crammed 7+ students into a small room and almost every pt had to be seen by a student; charting not finished on site had to be done at home. And then they'd text you on the weekend after going over your charts to berate you to fix things. Another kept students for >12 hours for whatever bullshit surgery stuff they had to do and students regularly failed the shelf for that rotation. Another marked a student as "uninterested" and "did the bare minimum to pass" even though they always stayed late and missed only 1 on-call call because the doc decided a single text early in the morning or late at night was enough of a warning to make sure the student was awake and to the 45+ min trip across town.
It’s essentially two full time jobs. I’m not sure if attendings forget how much studying has to be done at home too or if it circles back to this post as another case of “I did it like this so you should too”
[удалено]
I’m sorry can you post your source for that somewhere? Why do all the competitive programs and specialties have progressively higher step scores then? Most PDs will tell you the first thing they look at is step 2 score and honors.
this just...isn't true? the 2022 PD survey report even shows that only 4% of residency programs don't consider STEP 2 in how they select applicants for interviews (https://www.nrmp.org/wp-content/uploads/2022/09/PD-Survey-Report-2022_FINALrev.pdf)
>there are some specialties where the majority of programs blind themselves completely to your Step 2 Lmao what Then by what criteria are they weeding out the thousands of apps to get to the decent candidates? Because I guarantee you the few people who work on setting up IIs aren't sifting through your apps without looking at scores.
If your entire life and world revolves around medicine, that's great for you. But I know very few people that their world and life revolves around their job. At the end of the day this is a job, and we all have people to come home to, hobbies, vacations, etc. I see no problem viewing medicine as a job
Not a Dr- but in my field you could replace the word “doctor” with “teacher” and everything you wrote still applies. One difference is many teachers are unionized (pros and cons to that) and have been for awhile - but the attitude/ approach of those who are veteran teachers versus those graduating and starting their careers now is basically a 1:1 to what you’re outlining here for Drs.
I agree with a lot of this take. I hope that the younger generation tolerates less of the blatant profit motivated exploitation of physicians (nurses, RTs, pharmacists etc) that is endemic to the American healthcare system. At the same time, until changes happen in more systemic and organized ways, individual practitioners in the current system who take this approach will tend to expose the gaps in adequate staffing and support that are papered over by worker exploitation. That will either place the burden to fill those gaps on your colleagues or open up patients to direct harm. While I truly believe that administration and profit motivated healthcare are entirely at fault, those who continue to sacrifice their own time and mental energy to protect the patients in these circumstances deserve respect (in my opinion) and will probably resent you for the worsening of their exploitation in response to your individual boundaries.
No one hates med students who work well; it's a mistake to go into medicine thinking that just because you're some years into the career you know what the full responsibility of being someone's designated physician is like.
Always remember: Your job doesn't love you.
Near retirement age doc here. I totally support you. I’ve ALWAYS believed the working hours expected of physicians are inhumane. The economic model that modern medicine is based upon requires efficiency, it’s a business model. They want more of the diseases they can make the most money from. So docs work more and more hours, when they complain too much the hospital hires NPs and PAs to do the work of the physician without reducing the physicians hours as much as possible, and they fail to promote prevention, because they can’t bill big money for that. It’s a disease model that promotes illness for everyone. Win-win for them. I couldn’t be more supportive of the goal to reduce work hours. You know what you need to refresh you, not these ridiculous wellness crackpots. The culture of medical training has been twisted and perverted to support this awful system. I am building a prevention center to try to address this problem - at great financial loss for me, but I don’t care. I do care about your future and want for you all to be happier than we were.
It’s not even a “career”, much less a “calling”, for the younglings now. It’s. J-O-B (a relatively high paying one at that).
there are still some bleeding hearts like myself who got a 100th percentile MCAT score and want to do rural family medicine. But I'll admit I'm in the minority these days
I think the issue is that the "modern" medical student thinks that you \*can't\* have a good work-life balance while also being a dedicated to your patients. They're not mutually exclusive. >The modern medical student's approach to medicine being more of a career than a calling has everything to do with our warped medical system, and nothing to do with our dedication to patients. The system has a lot to do with it, no doubt. But at the same time, the "modern" medical student is also the generation that is losing the trust of their patients and the reputations of physicians, and don't realize the "medicine is a career not a calling" attitude plays right into the system which seeks to take away power from physicians and put it into the hands of corporations i.e. big pharma, insurance, and healthcare admins. But the reality is you're going to see a difference in the quality of care of physicians that work harder and are more dedicated to their patients than those that don't. And by "you" I mean not just the patient, but other physicians and healthcare colleagues. At some point you have to stop worrying about "sticking it to the man" and remember that your job \*is\* indeed about the patient. If you want maximum possible money or work-life balance go into another field, it's easier, faster to obtain, and less painful. But also stop pretending that physicians don't make enough to live comfortably and stress-free in 95% of cases. I expect a lot of downvotes for this but holy shit does it get tiring reading about this mentality sometimes. Attitudes like this make it worse for everyone because at the core it's pure selfishness that doesn't seek to improve the system and throws everyone else under the bus. >Please don't hate us for wanting better for ourselves. don't worry you i already hate you for this smug ass comment ugh
Agree 100%, although I try to carefully control my schedule and patient volume to avoid burnout. I think the bigger issue with more recent medical students is a larger percentage thinking with 'boundary setting' that they can get away with absolutely toxic behaviors. There are plenty of medical students that think they will be able to not evaluate the patient wearing the MAGA hat, refuse to see them, or that they can treat the patient with a MAGA hat differently than other patients. In all 3 cases a potentially career ending move if you are an attending physician or even a resident. As a second example I have seen more of- to think that the rules of showing up on time, being honest about clinical findings and labs or when one is not sure of what they are, and at least pretending to give a shit don't apply to them. In real world practice a serious breach of professionalism or petty backstabbing can be a career ending move very rapidly, and where one may have to be responsible for and be duty bound to have best interests at heart in all situations for a patient whom they viscerally hate- a direct example being that former Palestinian resident who had an old twitter post literally saying she would give Jewish patients the wrong medications on purpose, and then trying to cover this up when state medical boards became interested in it. This kind of stuff pours gasoline on the increasing smoke of general distrust of physicians.
Some of my classmates have said they won't take care of patients like you mentioned. It's absolutely wild. I always ask premeds this now during interviews.
The first time they try to do this in residency, like the first day it happens the most likely outcome is instantly fired and training license suspended by the board. If they are lucky, the program will merely threaten to cut off their head. As an attending, doing this is patient abandonment of the worst kind, breach of hospital policy/call responsibilities and would result in hospital suspending privileges, reporting to NPDB so nobody else will hire you, and hospital would probably report to state board. After state board investigates they would most likely suspend your medical license. If the patient sues, they will win and insurance company may not even cover if it is with malicious intent/criminal act. These students will eventually figure out the hard way that in the real world, you cannot do this at all. If you do this in your own outpatient practice, then perhaps you could survive till the inevitable board complaint gets your license suspended.
Your youth is showing. Whoever said that to you seems to have gotten it right. The modern med student isn't special. [Med students these days](https://old.reddit.com/r/Residency/comments/1aw1gez/im_a_medical_student_and_was_curious_if_current/)
Haha young guy you still have a lot to learn
Well put.
I have worked with the same 3 MDs for 10 years. We have had 4 newbie MDs come and go through our office. The old docs always have the same complaints that these new docs are just “not as committed as they used to be.” I applaud every single one of them for getting experience and walking away. Unpaid on call, weekend hours,etc. The older docs are set in their ways and their level of service is impressive, but exhausting. None have young children and when they did all of their spouses stayed home. Good for those who are able to break free and separate the job from your lives 💛
Medicine is a job. The only person who benefits from us thinking it’s a calling is the c-suite.
Told a patient the other day who was being ridiculous because I’m not a deity, “This is my job and I’m employed by a business.”
I’m happy people are starting to understand that this a job. It doesn’t mean we don’t care about our patients, but our lives are more than our job.
Medicine is a special profession, like several others. Our patients rely upon us to make the best decisions for them- not for us. That means waking up at 2AM for a patient with dead bowel, instead of punting it till 8AM. Or leaving your child's basketball game for a patient with a STEMI who needs a cath. It's choosing to have the hard conversation about vaccines/weight/smoking/whatever, when you know you can instead just say "ready to quit? no? okay, see you in 1 year" and get through the day 20 minutes faster. Doctors have an immense power differential over patients, and we are obligated to act selflessly in our patient's best interests. That doesn't mean sacrificing yourself, all day every day, but no, it is not like being a used car salesman or tattoo artist.
Medicine treats people terribly. Brainwashing people into thinking it’s their life so they can be treated like shit by private equity is how I woke up at 39 and realized I’d wasted my life. No one you work with gives a crap about you, and your patients would rather see the NP. So yeah it’s a career now
I think it's possible to view it simultaneously as a calling, a career, and likely a series of jobs. The calling part for me includes worker reforms, especially unionizing and fighting back against the administrators and insurers. It includes my vision of what I want my work to be like, and that means a life similar to what I advocate for my patients. I try to set an example by eating vegetables, sleeping, exercising, etc. The career part is how I see my jobs fitting together in a narrative... one where I have moved towards my goals of specific ways of practicing. I am at a rural FQHC and taking care of mainly kids with Medicaid. I've added specific skills along the way in behavioral health, where I have seen gaps. The career aspect includes community advocacy-- eg, getting my local hospital to start a carseat fitting station, and lobbying for better medicaid funding with legislators. The job part is the specific employer and working conditions-- I feel dedicated to quality work (calling, career) but in regards to employers, I don't feel loyalty unless they earn it by treating me fairly. I protect my free time from my boss.
part of my problem is that i am before aggregated protocols and helped put together many protocols. much of the most important information comes through new papers and conference presentations. my hope is that my students/residents will be able to look at the protocols, learn/know their weaknesses and provide better care and move care of all patients forward. learning how to read and adapt new literature is the most important part of that. we all do it badly at first. i expect med students to generally have awful ideas that improve with training. but every once in a while a med student will have a brilliant insight that comes from ignorance and not knowing protocols. unfortunately, this is what i am seeing less of (less bad ideas, less brilliant ideas…less ideas in general). the good thing about accessible protocols is that the care of patients is improving especially for rare conditions.
[удалено]
> In my years of residency and fellowship these issues got worse and worse over the years Out of curiosity, is it getting worse and worse, or are you noticing it more as you have moved from student, to resident, to attending? Or in other words, as your position has changed from student to teacher? Before you'd be focused inwardly and as you gained experience, and responsibilities, these trends have become more apparent?
[удалено]
Not what I was asking. Not surprised by the answer either.
[удалено]
The point is whether your perspective is what is making it seem like an increase in prevalence or whether it is a real increase in prevalence. Put simply, how much is this due to your positional bias. You are more likely to notice these things as an attending who is teaching because you interact with more students today than you did when you were a student. You were unlikely to interact with more than a handful of other students when you were a student yourself. Of course, we should also consider cohort differences as well. How acceptable was it to say you were taking time off for sports when you were training compared to today?
[удалено]
Do you remember that scene in Dead Poets Society where Keating makes the kids stand on his desk? This is my issue with comments like yours. Your perspective of "what it was like in my day" is like that. Back in your day, you were looking up (student). Now you are looking down (attending, or whatever your title is). That change in perspective is important. Ignore it all you want. But I am a scientist. I'd be a piss poor scientist if I couldn't spot this very obvious bias in sampling. Thankfully I am not a piss-poor scientist and can see this one that is right in front of me. And I didn't even need to go to med school to see it.
[удалено]
Actually, I am more interested in data. Hard numbers. Not opinions. Believe it or not but I don't need a med school degree to understand and interpret it. Your dismissal of the idea that you may be operating from a biased position is more telling than anything. Maybe it is something you should consider. In the meantime, i will await the publishing of the paper on the topic before I take a position. Im a proponent of Evidence-based practices in all forms of education. Otherwise it is the same old song and dance that has been going on for decades.
Maybe the system will be saved by docs like me, who could retire, but won't. I worked in big pharma for more than two decades, always keeping a foot in the clinic as a volunteer and teaching at a major med school. A year ago, two years after the big pharma company paid me to relocate to a different state, they laid me off. I jumped back into the clinic one and a half days a week, at one of the top academic medical centers in the world, paid a pittance, working my ass off, but loving every minute of it. I am seeing patients who were referred to the clinic often six months earlier. I will keep doing this til the day I croak. Had I not had the benefits of a prior big pharma salary, I would not be able to do this, but here I am, doing the kind of work I did when I started, and loving every minute of it.
It's just another shitty job. It's not that serious
I mean i consider it a pretty cool job. The issue is if you crank up the workload and liability it’s a first class ticket in the burnout express. Not much you can do about the liability, but managing workload is essential.
Which is unfortunate when most physicians are employees with no say in workload. I have friends in derm that see 7-8 patients an hour. I think medicine can be cool, but not in the way most jobs are structured and I think burnout rates kinda point that out too.
Physicians have all the say in the world about being an employee or not. Unfortunately there are a lot of laws that make being employed the ‘easier’ path, but there always is the choice.
If I were starting training today, my more balanced goals and "B- work ethic" might survive in 4-year MD school. As it was, I'm very happy to have made the call to aim at PA school instead, and my career is in a good place. Even in a very chill specialty, I feel like the ability to punt to a Board-Certified MD or DO whenever I feel like it is a nice bonus. Meanwhile, the brutal hazing of the tougher residencies is pretty much based on the model developed by a cocaine addict, and nothing has ever made more sense. https://medicaljustice.com/a-century-of-brutal-call-schedules-the-libby-zion-case-and-cocaine-3-converging-stories/
Today's medical students will hopefully save the profession one day
By golly some of us are trying
Mental health is still dismissed as not significant enough to warrant adequate attention. As the old guard dies out, we will see more and more healthy relationships being established with a more appropriate work-life balance but it will take time. Time to gain acceptance, time for people to move out of the workforce. And time for the opinions of the older generation to loosen its hooks on the younger generation. Will there need to be a reassessment on outcomes for the reduced hours of training? Sure. Bring it on. We will get to see if our assumptions are right or wrong when it comes to all of it. Arguing to stay the same without change isn't practicing evidence based medicine in the end. Let's do the comparisons and see.
I think that is a fair statement about how medical students in 2024 vs 1984 view medicine. It was and still is a calling for some. Some of my closest friends chose primary care even with stellar board scores. Some of them chose a career in homeless/underserved/rural medicine instead of being a concierge for pay primary care physician. To me they are doing what they are passionate about and it called to them. I think where the lack of understanding comes from is when prior doctors look at today’s landscape and realize we had to know more than they had to know (new medication, new technology, new procedures, etc.) and doing it with less dedicated time than they had to and it is hard to reconcile how that could be possible. And it isn’t. This is when I get downvoted into the abyss because people can’t be honest with themselves. Medical training for future MDs and DOs does not deter the mediocre or below average student anymore. That leads to primary care physicians opening up ketamine spas that are run by NPs because they are treating medicine as a business/career. That leads to physicians not being able to handle conjunctivitis, sinusitis, diverticulitis without multiple subspecialty consults. While I agree that the older generation needs to stop punching down, their concerns are valid.
No, this isn’t it at all. The medical students are entitled and lazy AF, and the quality has declined dramatically. Their fund of knowledge has never been more limited. They have no incentive to study harder or outwork their peers. It’s an actual crisis.
What’s the difference between a 3rd year medical student and a pile of poop? Nobody goes out of their way to step on a pile of poop
Look some of y'all boomer attendings have told me I should go to work with a fever and work 36 hour shifts. Look, if wanting to go to bed after a 24 hour shift or stay home when I'm sick makes me a bad doctor, then so be it. I'm down to work 80 hours a week as a third year, but some of y'all are crazy Also, thanks for taking up for the youngsters OP
"The modern medical student's approach to medicine being more of a career than a calling has everything to do with our warped medical system, and nothing to do with our dedication to patients." 1. Why do you say so? 2. Warped medical system? What are you talking about? "I think doctors see medical students draw boundaries for their lives and assume that we don't care as much about the patients, our education, or the medical field. On the contrary I think we care a lot," 3. Why do say "we care a lot" if people like you draw boundaries for their lifes now? "and that creates a dissonance when we are immediately faced with the abusive medical system we are going into." 4. Abusive medical system? What are you talking about? "Doctors face terrible burnout nowadays trying to deal with the broken system that ultimately proves a major barrier to care" 5. Why do you say that doctors nowadays face a terrible burnout nowadays trying to deal with the broken system? "Students have decided early on to adopt a nihilistic attitude towards the system as a whole because we anticipate that burnout. We know the system will drain any bleeding heart it can find, so we refuse to bleed." 6. Nihilistic attitude? Refusing to bleed? What are you talking about? "I'm sorry that this monstrous system used you." 7. Why? "I'm sorry you were made to think that it was necessary, honorable, and requisite to being a good doctor." 8. Why? "I'm sorry that the system has disillusioned you because of everything you've experienced in your career." 9. Why? "Please don't hate us for wanting better for ourselves." 10. Why??
As a pre-med student I 100% agree. I personally pursuing medicine out of passion and I'll most likely pursue full time missionary medicine after paying off my debts and getting financially stable but way too many students are pursuing it for the wrong reason imo. The vast majority of people who start off freshman year of undergrad want to become a doctor either because of parental pressure or because they want to have a mansion and drive a tesla. Most of them end up dropping to business or CS by organic chemistry sophomore or junior year. The vast majority of students just view things as boxes to be checked off and now that I'm sticking my nose in the medical student reddit and stuff it doesn't seem to be any different. You need a 520+ mcat, you need high gpa, you need clinical experience, you need research, you need clinical volunteer work, you need non clinical volunteering, you need to save a village in Africa, etc. Although many people get matriculated without having everything, it kinda just turns everything into a rat race where you're checking off boxes rather than trying to gain a foundation in healthcare experience and develop as a future provider. It honestly drives me insane how much people think of it as a "game" in many ways. I recommend a lot of freshman pre-meds become EMTs or something for the experience and they always say things like "doesn't everyone have emt med schools don't care I want to do something unique to differentiate my application" and it turns into starting BS nonprofits or getting your name on as many papers as possible with minimal contribution. I wish schools would look more for a foundation rather than all these weird criteria for students to be unique, but that's just my opinion at the moment that's subject to change down the line. Anyways maybe I should have just done engineering or something freshman I would make a lot more money building missiles for lockheed martin to lob over to third world countries but now I'm stuck on this path because of passion.
Back in my day..
I know this sounds crazy but sometimes I miss the torture of residency during the pre 80 hour work week limits. There was something very bonding about being part of a group of collective suffering. It made my residency class tight in a way that I dont think is possible in the days of time limits. Now that's not to say that working 120 hours a week is good, it's clearly not and it creates a lot of pathology. But I'll never forget finishing intern year with 10 of my residency classmates, we literally went to hell and got out on the other side and it changed my life in a way that I dont think modern residents/med students can appreciate. There was a national survey done about 40 years ago asking about life experiences that changed us for better or worse. #1 on the list was becoming a parent, #2 was losing a child, and #3 was becoming a doctor. I bet if you repeated that survey today, becoming a doctor wouldnt even break the top 20.
Reddit is very much an echo chamber for your exact opinion. If you are just looking for affirmation, this post will probably give you what you want. If you actually want a different perspective, find an old school doctor whose patient care you respect and admire who is horrified by the modern attitude of students and genuinely seek their perspective. I don't think you have any real interest in considering the merits of other perspectives and most people on this subreddit constantly post similar perspectives, so I am not sure what you are really trying to accomplish here