Welcome To Hell
Ahh, July 1st.
It came around so fast, just a mere two months of sleeping in and traveling since you walked across that stage with your medical degree in hand. Today’s a new day. Today begins the ritualistic flogging of new interns across the nation.
Waking up at 7am used to seem early, but now it will be considered late. Weekends will now simply be another work day of another work week. Pimping will take on a whole other meaning now that you have to grin and bear it. Personalities that you thought never existed will be encountered every minute of your existence. While once sacred in your mind, medicine will — at some point — be something that you hate, even for a brief moment.
With the sound of a beeping pager going off somewhere in the background, we welcome you to Hell.
We’re glad you’re here.
I just finished my first week of pathology residency. I’ve woken up at 7 a.m. every morning and been out the door by 5:30 p.m. It’s July 4th and I am goofing off at home, since we didn’t have to come in. I am off this weekend and most weekends. And I’m not on call until September.
After reading your comments about the proposed 56 hour work week, I found it interesting to read an editorial representing the other side. I’ve read the majority of things you’ve written on this website, and as a 4th year medical student, I agree with you on the hazing and malignant atmosphere that med students have to go through. However, I do agree with the article that not all fields in medicine are equal and some specialties may require more than 56 hours of training to produce competent doctors.
That said, here’s the article “Duty hours and neurosurgical education” …
http://www.aans.org/young_neurosurgeons/spring_08.asp#DutyHours
(scroll down just a little bit)
You can definitely get the sense that the author has that “old school surgeon” mentality in him.
Ditto what “name” said. I am a pathology resident and am working pretty normal hours (and they’ll get shorter as I get the hang of grossing and dictating.) No call for me until November. My “patients” are duodenal biopsies and mastectomy specimens (as you can guess, they are compliant and don’t complain much.)
4th years, the field you choose now will haunt you until the end. Take a good look at your intended field and ask yourself “do I want to be doing this when I’m 50?”
Then, promptly abandon it and go for path/rads/derm/pm&r.
Hoover, this is an important time for a 4th year student, as they’ll be making decisions that will determine their futures. Now might be a good time to resurrect (or write some new) articles about choosing a field etc. I’d be happy to do some guest commentary.
CC: What is “/pm&r”?
I’m currently an english major, working on med-school pre-reqs, as well. At first, this site frightened me, but the more & more I read, the more & more I’m interested in the field, specifically pathology.
CC, what is pm&r?
physical medicine and rehab
Physical medicine and rehabilitation. Also known as “plenty of money and relaxation.”
what i didn’t like about pm&r was that they were deluged in paperwork, and that the physical and occupational therapists had MUCH MORE fun than the pm&r docs did. essentially, pm&r docs order the physical therapists to have amazing fun with the patients (play basketball with them, board games, etc.). the docs don’t have time for that. sucks.
not having to actually see patients, while still having a pivotal role in patient care, intellectual challenge, an excellent lifestyle, an excellent lifestyle, an excellent lifestyle, $200-250k pay, call taken from home, most nights and weekends off, no internship year, lots of fellowship opportunities and an excellent lifestyle, is what makes one particular field of medicine king.
pathology rules.
for the record, pm&r docs typically enjoy a good lifestyle but really don’t get paid much more than your typical primary care doc.
it should be called sm&pr. “some money & plenty of relaxation”
What you do NOT know about physiatry (PM&R) is that the money is similar (actually 50k MORE but close enough) to an internist/hospitalist/primary care (I.M.). (that 50k makes a big difference). But its the HOURS and predictability of PM&R that make it so lucrative. You can always choose to work a 55 hour week as a physiatrist and make an extra 100k a year… now it becomes “plenty of money” instead of “some money”. That’s not even what I wanted to tell you about…it’s the fellowships that feed out of PM&R. You have some unbelievable fellowships and you are on your way to double or even triple the pay (easily). I know interventionalists who work a standard 32 hour 4 day week and make between 500k and a million. That my friend is “plenty”. The key to this specialty is doing one or even two fellowships and then taking over alot of money making procedures and then their is the outpatient care and more primary med aspects that come into play. PM&R is gem and a hidden secret amongst derm and rads (i think some day PM&R guys w/ fellowships will be the next plastics sug, derm, rads, or cardiothoracic surg guys)
Pathologists are also exposed to sh*tloads of carcinogens and other toxins on a daily basis.
Most people consider patient contact to be a plus. William Carlos Williams wouldn’t be a famous writer if he didn’t have his patients to be inspired by.
It depends on your perspective. One man’s hell…
agreed. “one man’s hell…” exactly. i’m just glad everyone else’s hell isn’t mine
i’ve never heard any cases or read any reports about an increased risk of developing any form of cancer as a pathologist, though
Somz, thanks for the neurosurgery article. I feel like I need to comment on some parts of it:
“…you feel the “creeping chill” of sleep deprivation, that unshakable sense that you’re cold and slowing down and you’re making a superhuman effort to keep your eyes open and stay on task…
…you just want to stop, lie down, and go to sleep (or maybe just die).
But you can’t because the patient you just admitted with traumatic intracerebral contusions needs an EVD and if you don’t place it, that patient will herniate and die…”
Now, if you were that patient with traumatic intracerebral contusions, would you like an EVD to be placed on you by a person who makes superhuman effort to stay awake? Would you like to be in a plane flown by a pilot who makes superhuman effort to stay awake?
And the worst thing is, the person who wrote that article doesn’t see the irony of it.
Now, pathology is by no means a walk in a park. You need to know a lot and make a decision that creates a big difference in a patient’s life. What I appreciate in pathology, however, is the fact that you always take your time to make a diagnosis, you are never pressured and you always have your collegues to consult if you are not sure.
Apparently, in neurosurgery you need to abandon your humanity and become some kind of superhero. The trouble is, no matter how qualified you are, you are still human and have limitations. I’m sure that once surgeons realize that and become more humble, all these preventable medical errors (and there are as many as 100000 per year) will go down precipitously.
An excellent point, Zuwie. Surgeons in particular still hold onto the idea that there is a “calling” to be a doctor and a sense of invulnerability with it. The new generation tends to have less of it, but it does persist. I remember talking to a surgery resident friend about the proposed 56 hour work week, and he balked at the notion because it would make surgery “like a regular person job”. Wait, surgeons are regular people (with normal sleep requirements)? What a crazy idea!
I think part of the reason that so many physicians are disgruntled with the current state of the profession is the doctor-unfriendly environment. Paperwork, litigation, medical student debt, resident work hours, etc. Unfortunately, I believe it is largely due to physicians’ continued self sabotage. Doctors are (and have been) trained with the idealistic mentality that health care is more than a service and that there is some sacred ideal behind it. Thus, they currently push themselves to the limit in training and practice to take care of patients that often refuse to take responsibility of their own health and sue at the drop of a hat. While the ideal may have been true decades ago, the truth is that the medical field in this country is currently a business that makes profit for insurance companies at the expensive of the doctor. It is the failure of doctors to protest against these things and defend themselves that has allowed the situation to get so bad.
Wow, that’s probably the most cynical bit I’ve ever wrote.
i agree, physicians should strike but people would die…what does it take to wake-up the people and physicians also?
Zuwie, the author of the article I mentioned wrote another article that addresses your question about “who would want an EVD placed by someone making a superhuman effort to stay awake”.
http://www.acgme.org/acWebsite/bulletin/bulletin02_04.pdf
(last article in the PDF)
“the medical field in this country is currently a business that makes profit for insurance companies at the expensive of the doctor”
Is this written by the same person who writes this blog? If so, it’s a good thing you are out of medicine now. If it’s not the blogger, I hope you are not in medicine. I’m a physician and take great pride in what I do. I’m not nearly as cynical as the above statement and it couldn’t be further from the truth. People on the fringe who make statements such as this really get under my skin.
If you can’t stand the heat, get out of the kitchen.
But once you leave the kitchen, if all you do is talk about the heat, you need to get a life.
In response to MD’s December 4th comment to Somz’s statement on July 15… I think that, unfortunately for physicians, the medical field is indeed a business that makes profit for insurance companies at the expense of the doctor. The large insurance profits are an undeniable fact. The expense of the doctor is more of a gray area, I think. What it does is it takes the sense of control a physician has over his practice down a few notches and forces the physician to play the game by a set of rules that are not his own. I also agree with Somz that the average physician works entirely too hard. From what I have seen so far, attending physicians who push themselves too hard almost invariably develop a hurried demeanor and the resultant poor bedside manner. This extra hustle and bustle is unnecessary and detrimental to patient care. Additionally, I agree that physicians in general do not fight very hard to improve conditions for themselves. It is a little bit sad for me as a new physician to look back on the old days of the profession in which doctors were, generally, more revered, better paid, and more satisfied. However, I can rest comfortably in knowing that I did not have a hand in that loss of status and that I will be able to make a good living as an MD, even though I will have to play the game by someone else’s rules. Game on!