I thought I’d try something new and go for an incredibly easy way for users to submit articles to MedSchool Hell. I’ve finally got all of the kinks worked out and the contribution page is now up. Please note that this is only in beta at the moment, and depending on the outcome and user interest, may or may not continue in the future.

Who Can Submit

Anyone can submit posts or articles to MedSchool Hell. Even if you have your own blog and would like to make a guest contribution, I encourage you to do so.

Submission Rules

1. Any blatantly obvious spam submissions will not be published under any circumstances. This includes relevant content with numerous irrelevant links back to a site or blog that do not contribute to the content of the post. If your plans are to submit spam content, don’t waste your time. It takes me 2 seconds to delete a post.
2. Submitting a post does not guarantee that the information will be published. I want to keep the quality of the content at MSH as high as possible. If your submission is not published, it doesn’t necessarily mean that it sucks. Please do not take it personally as there are a lot of criteria that will determine whether or not a post is published.
3. Please pay attention to spelling, grammar, sentence structure, etc. Any submissions that need to be mass-edited will most likely not be published. A firm grip on the English language is a huge plus.
4. Please keep submissions relevant to medical school, residency training, tips for medical students, medical school humor, etc.
5. A name and email address is required to submit posts. You have the option of including a URL that is linked to your name. You may use whatever name you wish, and I encourage you to use a pen name for your writing since your name will show up as the author of the post. Your email address will never be shown.
6. When contributing content, it’s a good idea to include a short introductory paragraph so that readers can learn who you are early in your article.
7. User-contributed posts will be prefaced with “This post is a user-contributed topic” as the first line of the post in order to distinguish contributed content from content written by the regular MSH authors.
8. Everything will be 100% guaranteed anonymous if you use a fake name. Don’t worry about anybody finding out who you are. You can even use a fake email address. It doesn’t matter to me.
9. These rules are subject, and highly likely, to change.
10. Most importantly, have fun! I want MSH to become an excellent source of information from various authors, so don’t be shy. =)

I guess that’s about it. Please feel free to contact me if you have any further questions. I look forward to seeing some of your contributed stuff!

Popularity: 3% [?]

How many times have you heard “it’s a sign of weakness?” This clever jab of an insult comes mostly from the surgery camp based on my experiences. This saying and a dollar will buy you a 20 oz. Coke, and here’s why.

Weakness Is A Product of the Creator

Weakness is nothing more than the opinion of the accuser. They think you are weak by participating in some action that they deem exemplifies weakness in you. However, to a “normal” person, your actions are seen as very common. Weakness never comes into the equation.

It is the training (or more accurately, brainwashing) that has led these people to feel this way. Molds are cast early in training, and to deviate from that mold is a “sign of weakness” in itself. That is what they would have you to believe.

The Inbreeding of Inaccurate Thoughts

These abnormal schools of thought are inbred within the various specialties of medicine. As the medical student is taught that taking time off is a “sign of weakness”, he begins to believe that this is in fact the case. As his training continues into residency, this misconception is further hammered into his head by frequent reminders from upper-level staff.

By the time he reaches attending status, he is a super-breeder of misinformation. Years of brainwashing has taken its toll, and he himself believes that false information is true. The process then goes full-circle, as the attending inseminates lower-level residents who in turn inseminate their juniors.

It’s an orgy of falsities.

Weakness In Action

Many of you may be wondering what all of the hoopla is about. Here’s a list of frequently cited “weak” actions on the part of residents and medical students:

• Working less than 80 hours per week
• Taking more than 2 days per month off
• Wanting to eat at least once during the day
• Being sleep deprived and showing it at work
• Putting your family before your work
• Taking a full Saturday off instead of rounding until noon
• Calling into work sick

If you take a close look at all of the above “weak” actions, you’ll see that they really don’t show any weakness whatsoever.

Dehydration and Rotations

While on my internal medicine rotation, we had a resident who was obviously sick and should have stayed at home. Every 3 or 4 hours he would receive a liter of fluids through a hep lock that he kept wrapped up in gauze. Wouldn’t any normal person stay home under these same conditions? I questioned him on why he wasn’t at home in the bed where he should have been. His reply? It’s a sign of weakness to stay home when you’re sick.

If this isn’t evidence of the mind conditioning that takes place during the medical training process, I challenge you to find what is.

The True Weak

Although any physician in any specialty is capable of spreading this false message through mind conditioning processes, surgeons are most likely the ones with the greatest amount of skill in this arena.

I’m here to set the record straight:

• It’s not a sign of weakness to work less than 80 hours per week. This is known as efficiency and budgeting your time wisely.
• It’s not a sign of weakness to take more than 2 days off per month. This is known as being human and having a life.
• It’s not a sign of weakness to want to eat three meals per day, on time. This is known as sustenance.
• It’s not a sign of weakness to show sleep deprivation at work. Sleep is known as a basic requirement for life.
• It’s not a sign of weakness to put your family before your work. This is known as being a good husband/wife/father/mother.
• It’s not a sign of weakness to want a full Saturday off every week. This is known as rest.
• It’s not a sign of weakness to call in sick to work. This is known as calling in sick to work.

The only true “sign of weakness” is when you actually buy what the man is selling. Resisting the purchase and going against the grain shows that you are strong, courageous, and looking after what’s most important in your life.

Popularity: 64% [?]

Maybe it’s just me, but I come across things that physicians and residents say in my daily reading that really make me wonder about medicine in general. Let’s look at a few:

I do think it still has to be a fairly nurturing environment (as much as is possible in medicine) to help you feel emotionally and physically better.

After reading this, you seem to think that medicine actually produces very few nurturing environments. Given that the burnout and depression rates are higher for people in medicine, you would expect the exact opposite to be true, and that medicine would provide a good social support system for residents and physicians in need. That’s not the case.

I’m totally burned out. I’m 8.5 months into surgical residency, no vacation yet. With the exception of 1 Friday-Sunday weekend in September and 1- 3 day weekend at the holidays (which I had to take q2 for a week to get), I havent spent more than 48 hours away from the hospital in 8 months. …it has to get better, right? It cant get any worse…

No explanation needed. I really feel for this person, though. If I could hire him or her to work for me, I’d give them as much time off as needed.

From what I have noticed, the 80 hour restriction is just a joke. It is all politics. Most of my friends in residency work well over 80 hours and are told by their programs to lie. It is just very unfortunate.

No surprise here. I’ve known that this has been going on for a long time. The catch-22 has you. Locked up like a caged animal, and there’s nothing you can do about it.

I am 14 hours into a 30 hour shift . . . but I am an intern . . . nevermind.

Where else can you appreciate these kinds of hours? The military, fire-fighting, and others come to mind. The working conditions are better. Much better.

Would I do it all over again? Ask me again in 4 years when I’ve finished residency. I’ve got a feeling that 4 years of medical school was a lot easier than the next 4 years.

I’ve got a feeling that this guy’s feeling is spot on.

My usual advice when someone asks me if they should go to med school is to try and talk them out of it. If they still want to go … they will probably be ok. You have to love what we do or the medical machine will grind you into a pulp. And I do love what I do, but I think even I am getting ground down with time.

Even a true love for medicine doesn’t stop the medical grind machine from doing its job. This is the way it was designed. First it brainwashes you, and then it grinds. Slowly.

If I could go back in time, I would pay the medical schools NOT to accept me. I want my life back. It’s not what you think. Trust me. Get out while you can.

My thoughts exactly. Getting out of medicine is a bit trickier than you might imagine, but it can be done. I’m living proof.

Idealism is difficult to maintain in the climate of the modern medical system.

Pre-meds, you’ll learn what this quote is about in time. For the time being, just take it from me that it’s true. Truer than you’ll ever know. Maybe one day you’ll look back on this day as you sit here reading this, and realize it for yourself.

Until then, Godspeed.

Popularity: 10% [?]

I read through a very interesting post tonight at SDN where the OP asked the question of whether or not he should finish his last few months of prelim year in medicine now that he has matched into a pathology spot for 2007.

Most of the early replies are “stick it out” and “don’t quit.”

Kimberly Cox then posted what happened when a similar situation happened at her program.

We had a Prelim resident who did the same - basically got a position in the scramble and called and said she would not be coming in again. Not only did that upset everyone (adding to their call schedule), it was unprofessional…our PD made sure her new PD knew about what he was getting.

Wow. You know, that PD is an asshole.

Private companies aren’t allowed to release information on why employees left a previous job unless gross misconduct or illegal activity was involved. That’s the problem. Residency programs can do whatever the hell they want to because there is no free market competition. Adam_K sums it up nicely.

If residents could freely transfer over to new training programs that offer better pay and working conditions, this behavior wouldn’t exist. Program directors would be kissing ass instead of overworking and over scheduling to make up for deficiencies in staffing that should have been factored into the system to begin with.

What happens, though? Programs operate with the bare minimum number of residents. If one quits or doesn’t show up, the workload is transferred over to the other residents. They have to pick up more hours, more call, and more patients to make up for a missing body.

Read the rest of this entry »

Popularity: 3% [?]

This post is part two in a two-part series. Please read part one for an introduction on working smart in medicine for maximum income generation.

Yesterday I told you that I was going to give you an example of how to exchange low-paying time for a passive income that will pay you for a lifetime.

In order to do this, let’s think inside of the box - a “doc in a box.” Yep, urgent care.

Urgent Care Is In Its Infancy

Urgent care is gaining in popularity, and when Wal-Mart starts experimenting with something in their stores, you better start taking notice. I predict that urgent care is going to explode over the next 10 years.

Now, I know what probably 75% of you are thinking right now. Urgent care physicians are paid very low salaries, so how in the world can this represent exchanging that on-sale time for premium-priced time?

Did I ever say you had to employed by somebody else at one of these urgent care centers? That’s mistake number one. You are already in the mindset that your time is on sale. The first thing is to get rid of that mindset and shoot for a new one - one where your time is valuable.

Business Medicine

Instead, let’s open a single urgent care center. Just one to start out with. Being low on funds and new at this whole entrepreneurship thing, you’ll probably want to practice some at your new facility. This is different than being employed by somebody else, though. You are now working for yourself. No matter how hard you work, you are working for you. You have more control over your free time and your paycheck. You are taking the right steps towards passive income.

As your business grows, and more physicians are employed by you to practice at your urgent care center, you are starting to see a bigger return on your investment. Perhaps you start taking more time off and your paycheck stays the same, or you choose to work more while writing yourself a bigger check each week. Flexibility is starting to come into play.

With all of this nicely positive ROI and flexibility, you choose to stop practicing altogether. At this point, you are the practice manager. Years of practicing and running the business simultaneously has taught you valuable skills. These are skills that your classmates who also matched into family medicine don’t have. These physicians are continuing to make the average family doc salary while working even more.

Business Expansion

You’ve seen the success of your single urgent care center, and you’re quite confident that you can duplicate it. Let’s open another one and do the same things. Except this time, you don’t have to practice. Let’s staff it from the get-go with physicians (or nurse practitioners) who would rather work for somebody else than work smarter. These people are a valuable commodity to you. Thank God you took the time to learn just as much about business as you did medicine. Take advantage of this.

Before you know it, you have a network of urgent care centers spread through a state, a region, or nationally. You do nothing but recruit physicians or nurse practitioners to work for you, or you can pay somebody to do that for you.

At this point, you have reached passive income status. In most cases you’re making much more than average physician salaries and working as much as you want to, when you want to.

You have taken a specialty where the average physician exchanges their time for money at rock-bottom prices, but you are now making a huge premium for your time.

That’s exactly what these guys did.

At the Wal-Mart locations, once signed in to see a doctor, patients can shop and be signaled by pager or cell phone when the doctor is ready. A queue screen in the center lobby of the clinic will give minute-by-minute wait times.

Putting The Pieces Together

1. Find a specialty that you love, or at the very least can be happy practicing
2. Work smart to leverage your time versus income
3. Start thinking about and actively creating passive income streams
4. Duplicate, duplicate, duplicate
5. Reap the rewards over time

I used urgent care as an example, but you could use any business strategy at all from investing in high-yield funds to starting other businesses completely unrelated to medicine. Ryan wrote up a nice post at SDN outlining some other strategies. I’m not saying this is easy. It’s not, it takes tons of work. The vast majority of business fail within the first year.

If you take nothing else away from this post, please remember this: Medicine is a business. If you want to go above and beyond and really blow your income numbers out of the water, you are going to have to start treating it as such. Even if you choose a low-paying specialty like family medicine, you too can make much more than the salary figures you see quoted, but you must first put yourself into the right mindset.

In the end, it’s all about what you want. Do you want to be somebody else’s employee or a 20% shareholder in a partnership track for the rest of your life, always having to pull your own weight to make your quota?

Or do you want to be the CEO?

Popularity: 7% [?]