I actually think it is just a job (as opposed to a “calling” as we sometimes perceive of a different/older gen) (I finished subspecialty in 2002). At the end of the day, QoL matters.
But…but…(to borrow from JMM)…
You still gotta do the bleeping job you signed up for (and if you didn’t know the amount of work your program was going to expect of you, you’re a moron who will be an idiotic doc). Also, any horsebleep day you take off is another one your colleagues have to suck up and cover for your sorry butt.
If there are true legit medical issues (including actual mental health concerns), then by all means, take all the time you need. I would have no problem covering for a colleague with a legit health issue. But taking days cuz “work’s hard” or “you’re tired”….give me a freakin break. Just another example of the coddling the younger gen has become reliant upon. Grow up already, welcome to adulthood, time to start behaving like a professional.
Can i say anything here? Looks like i can. This conversation here is healthy and essential, not just to medicine or even to other careers/jobs/professions/occupations. Here's why:
The corporatocracy RULES all of our lives in every possible way. The more you begin to 'see' it... the more you see how destructive, insidious, deep, and widespread it is. It has CHANGED everything for ALL of us. Fundamentally... in ways that most of us truly don't recognize. THIS is what's at the center of ALL of these issues discussed here and elsewhere. Once you begin to see it... you can't un-see it. And it's pretty wild.
The world we ancient BOOMERS grew up in... and began our lives and families... *no longer exists.* The implications of this tectonic shift are enormous. EVERYTHING being discussed here needs to be considered in this context.
Whether y'all see it thru this big lens or not... it's the REAL underlying issue of our time. It's the SCALE of this basic change to all of our lives in ways we don't necessarily see that doesn't change its significance or impact. It's up to us to start 'looking up' and stop blaming each other for the outcomes that often seem bizarre and disturbing. Everything discussed here is evidence of our disconnect with each other and what it all really means.
Many of us are looking thru our own narrow lens because it's the (only) one we know. Most of us do that. Why wouldn't we? Normal. However... realizing how our diverse views fit into the much larger picture is essential if we're all going to successfully meet the challenges and not self-destruct from the inside out. Long term, that is.
We ALL need to stop the moralizing, judging and finger-pointing at each other for starters. Open our eyes, ears and MINDS... since our survival depends on it. We're all in the same boat. Yes.
Everything shifted over our Boomer lifetimes in ways that those of us who grew up depending on the basics of life being available and attainable for all of us simply didn't notice. We just 'worked hard and played by the rules' We didn't see it happening because we were busy working, raising families, yadda, yadda. And because it was (intentionally) kinda like the old story of how do you boil a frog ...
We Boomers were told and taught to accept that lots of things we didn't like (seemed 'unfair' or whatever) were 'just the way it is.' Grow up and do your work. It's what we did. No one even questioned it. Why would we? The older we are here, the more that that is likely our base or frame of reference. And while we were living our lives in the old setup... it morphed completely.
Here's what's happened that seems to me the source of such dissonance here: so many people of the younger generations... including my own kids born in the 70s... and their kids born late 90s into 2010s ... live in a progressively and drastically changed world. In every possible way, whether we (incredibly fortunate oldsters!!!) see it or not... their world is NOT the one we had.
The youngest ones today started life in a totally different world than the one we all knew/know and took for granted ... like that the sky is blue and grass is green.
Focusing on 'individual' responsibility and dedication, etc... is still needed and no one younger here is trying to say it's not. They are NOT saying that! <-- Please get this, my fellow Boomers.
THE SYSTEM THEY'RE LIVING AND WORKING IN IS FUNDAMENTALLY DIFFERENT IN SERIOUS WAYS FOR THE MOST PART. AND IT'S THE ONLY ONE THEY'VE EVER KNOWN. We have no more idea what it's like to be them than they know what it's like to be us. We come from totally diverse eras. We got lucky. They did not.
As someone commented, if y'all were starting at square one *today* as they are, you'd likely find the situations as difficult and often unworkable in their present iterations as they do. They not disrespecting their work, professions, patients or any of that stuff. Read what Heather from Australia had to say!
For you younger folks, struggling mightily to do your best, maintain a *healthy* life/work balance (what a concept!!), keep your heads above water while the system tries to drown you if that produces short term profit ... please do NOT blame us Boomers. We did NOT create this mess, either.
The Corporatocracy grew out of the natural efforts to keep our dedication to 'individual liberty' and capitalism front and center for America, in particular. Politics and economics are way out of control because the system that tries to support and balance them serves the corporatocracy right now... and nothing else. It's like a machine... with very little protections for exploited people, animals, environment, small biz... or ANYTHING that gets in its way of creating profits. It's NOT human.
It can't continue this way much longer. Constructive, productive, creative things are definitely happening at the grassroots level by people who are working on different pieces out of the necessities of their own lives. And these disparate pieces may possibly provide a new foundation for after the implosion into which the corrupt system is naturally collapsing.
You can believe this or not. Doesn't change the reality, like you can believe in the law of gravity or not. We need to work together, learn how we can support one another for the sake of all of us. Cheers!
I agree with you in the sense that externalities have changed btw your gen and my gen and the current gen. The 2 biggest that come to mind are the burden of student loan debt, and the general cost of living and that basic American dream of buying a house. Particularly when these are compared to each gen’s earning potential and capacity.
And obviously the complexity of medicine has changed considerably over the last 3 generations. In my field, you don’t treat MI’s with bedrest and stool softeners anymore.
But I’m not sure I’d say the work is so much harder in medicine for the current gen relative to any other field for the current gen. Every line of work is more complex than it used to be. And the cost of living struggles of the current gen of new docs are not that different from the same struggles of any kid of that age.
So does the average doc of each gen have it as easy or as hard, relative to the average member of their cohort generation? And how would that ratio compare btw generations? (Ie do current young’s docs have it 120% harder than their age cohorts? Was my gen of docs only 95% as hard? Was your gen of docs only 70% as hard? Is it a bigger sacrifice to be a doc now relative to being anything else, compared to times gone by?).
I’m not sure. If the answer is yes, then maybe you can defend some special accommodation. (They’re taking a bigger hit to be a doc than we did). But if the answer is no, then I think current young docs should do what young docs have always done in generations of yore: suck it up and get ‘er done.
I'm sorry, all this important discussion aside, MI was treated with STOOL SOFTENER? Put aside work ethic, this is absolutely the largest generational gap between us 😂
Agree. I finished medicine & cardiology at UW Seattle 1985 and there was a little bit of Band of Brothers attitude vis a vis missing a day. Sometimes you work for your “peers” and go there extra mile to as not let them down. Sounds corny but I think true. We were all soldiers in a fight for survival.
I don’t think my contemporaries and I thought we were taking Omaha beach or anything of the sort. But there was a certain amount of personal pride and fortitude involved in doing our job (that we willingly signed up for).
I don’t recall anyone in my residency or fellowship engaging in any of the bs depicted in this OP.
In this realm, I’m thinking “new” is not “better”.
I am treated like shit by a hospital corporation and attendings that don’t care about me or my patients and pays me the equivalent of $14.32 an hour whilst 300K in debt of course it’s a fucking job! Artificially protracted training to utilize is a cheap labor. Just because you were abused as a resident doesn’t give you the permission to abuse future residents, think about making the future better for all of those in medicine, even if you were hurt. Lost some respect for you Vinay.
“Artificially protracted training?” So, you really think you’ve seen enough to safely practice independently? I am impressed with your confidence. You think you’re a better physician than the rest of us.
Making a presumption (based upon personal information you revealed), I graduated from medical school in 1988 and likely have practiced unsupervised for more years than you’ve been alive. Everyday I encounter patients for whom I do not feel prepared and I get over my feelings. My advice to you, TiredFellow, embrace the learning opportunities you have and be happy you are paid a salary that you can live on and keeps you from further adding to your debt.
So you're saying that the training involving being overworked, overwhelmed, treated poorly, and underpaid still did nothing to prepare you for the patients you see every day?
You seem to be advancing TiredFellow's argument rather than countering it!
Learning isn't shift-based. If one is caring for a sick patient, finish it. Don't clock out. I'm an Anesthesiologist and even I still check on my patients for days related to the outcomes of their surgeries. And that's because I take my PROFESSION (not a job) seriously, and I do care about the health of the people I treat.
I was a fellow once too, and the hours do seem ridiculous. But, when you are an attending, you may be in a practice where it's just you. You are it. Always on the clock. This is training for being an attending.
Not at all! Seasoned physicians are humbly aware of their abilities and limitations. My point for TiredFellow is to appreciate and embrace the learning opportunities afforded and available in the training environment.
I fear for anyone being treated by a clinician with this attitude. Find another way to pay off that 300k. And you will save many more lives, including your own.
Grown ups and professionals don’t behave a certain way or treat others the way they deserve to be treated— we behave and treat others in a way that demonstrates our character, our values. I can’t respect someone’s choice to be a liar or cheat the system. Be better.
Damn, I hope to never be under your tender mercies. I earned way less than you back in the days when there were no restrictions on hours worked. I don't want to abuse anybody. I just think that training made me a better doctor, as opposed to a whiny baby. You learn there are things bigger than you, and your worst day in residency is nothing compared to a family being told their child has cancer.
We never took time off that wasn't necessary. Someone had to cover for you and that was one of your fellow residents.
Did you really say that no one has the right to complain about their working conditions because there's a child somewhere out there being diagnosed with cancer?
No I'm saying it put all my petty sh*t in perspective. My very first patient as a newly minted MD was a 16yo girl dying of a brain tumor. Just thinking about this kid always gave me perspective. She didn't get a day off from struggles that were way worse than mine.
And I never once thought about complaining about my working conditions the way I see the complaining here. I was overworked, I was tired, I was often overwhelmed. But so were we all, and we frankly expected it. We complained about a bad call night, being paired with a black cloud, being a black cloud, an attending that was a crap teacher, but not about the work. It was the reason we were there.
You were overworked. You were tired. You were often overwhelmed.
I usually recommend to someone to switch to another employer if these are their regular working conditions, but you're saying that this is not only perfectly fine but expected? Is this the case with all doctors?
I get the idea that there are people who have it much worse than you. How far does this extend though? Should coal miners not bother complaining about working conditions because a 16yo girl was/is dying of brain cancer? Or only white-collar professionals are not allowed to complain?
Everyone is going to complain about their job/ profession, regardless of what that job/ profession is. This generation happens to have a platform on which they can voice these complaints, have them seen by the world, and then have people comment on them- whether that be supportive commenting or calling them “whiny babies.” My point: as Su-zan said, context is important. The fact that there is a place to communicate these thoughts easily to the world and a cultural shift that allows this platform to be used regularly as a norm does not make this generation “whiny babies” anymore than the older generations complaining in person to friends made THEM “whiny babies.” This is also only ONE of the major contextual shifts that has occurred and needs to be considered. Moreover, attacking one another because of the frustrations we express is not helpful to furthering the conversation on how we can help one another further the profession and create doctors who are prepared- intellectually, emotionally, and socially- to take care of patients in the best way possible.
Medical training is supposed to be hard work. This should surprise absolutely zero people. It’s already way cushier now than it used to be. There was no such thing as “duty hours” back in the day.
Now, from a patient safety pov, some of the changes are for the better. Ultimately that’s the prism where rubber meets road.
But remember absolutely no one is owed a career in medicine. So if the kitchen’s too hot….maybe some might find digging ditches to be an easier vocation.
And OMG it’s a couple of years in your 20s and 30s….how fragile are people these days?
So why were you surprised about the working condition?? There is no secret about the demands of medical training.
Your comments tell me that you really do not have any idea of how much you don’t know, nor how to learn. The more you see and do, the more you learn. And there is always something to learn.
I think you didn’t do your research about what is involved in medical training. This poor planning makes me concerned for your future patients.
Or you thought you could handle it, but couldn’t. If so then get out and find a job you can handle.
As a senior physician, my experience is that the care of hospitalized patients is physically and emotionally demanding; and that most interns and residents work hard to care for their patients. I frequently see them helping each other out with the many menial tasks that accompany patient care. Attending physicians can model teamwork and camaraderie by taking some of the team's scutwork themselves, especially at shift's end when everyone is tired and efficiency wanes. So when your own work is done, the team is exhausted, and it's late with more work to do, dictate that discharge summary, fill out that Certificate of Medical Necessity Form, even go consent the patient for transfusion. In my experience, the team will be eternally grateful and know how much you care for them.
When I was interviewing for general surgical internships in 1978, I visited NYU where the house staff were on call every other night and every other "power weekend". They all had the "thousand yard stare". I chose a program that was more kindly, only every third night call, etc. Medicine and surgery will always be professions and considered as such by the best among us. However, I can recall making stupid, nonlethal mistakes because I was sleep deprived while in training. Truck drivers and professional pilots have mandatory rest schedules. It's not a difficult argument to make make for medical training. According to my best friend and former med school classmate who spent his career in academic medicine, house staff over the decades have become more "fractious" and less resilient.
This is one of the most disgusting things I have read in a long list of disgusting things going on in medicine these days. I have already written about the degradation of residency training ( https://www.city-journal.org/article/bad-policies-leaving-next-generation-of-surgeons-unprepared ). I finished my residency in general surgery in 1984 and my plastic surgery residency in 1989. During that term, I missed one day of work because of the flu, when I had a 105+ degree fever. It would never have occurred to any of us residents to take a "mental health" or "fake sick" day after a tough night on call. Part of medical training is to learn to function effectively and safely under duress and when fatigued. You won't always have back up. If we had been caught faking mental or physical illness, we would have been canned, plain and simple. If you are not willing to sacrifice your sleep, comfort, or discretionary time for patients, find another profession. I am not some dumbass "we suffered, so you have to suffer" type who thinks everyone in medicine needs to martyr themselves. Medicine, by its very nature, demands more of us than almost any other profession except perhaps the military. There will be times when all other considerations, including vacations, birthdays, family events, etc. must take a back seat to the patients we took an oath to care for. To the resident who said, "Your well being is NOT superceded by any duties to a patient. To hell with that disgusting attitude," YOU disgust me. Get out of medicine now, before you kill somebody.
Studies have show you just had more errors. You didn't learn sh!7 better. You just learned to survive which was bad for you and your patients. Yall old timers created this toxic environment. Good riddance to yall and hope the world become a nicer more empathetic place to all.
What studies are those, exactly? I would pit my experience and observations over 45 years against your supposed studies. Please name a single one. The tone of your comment is both disrespectful and indicates you have no idea what you are talking about. I find it interesting that you presume to know whether I was well trained or not (I was) and how my training affected me. I am 72 and still practicing surgery. Would you dare to share how old you are and what you do?
You probably made a shit ton of errors that probably lead to negative patient outcomes as a result of being overworked (as did many of your colleagues who trained with you back in the day). And nah, you're a sad old man. Get off the internet lol
Dr. Bosshardt, I am deeply saddened and concerned about the thought and action that you have regarding the way your practice medicine. You mentioned about your oath for patient, meanwhile, as far as I recall, the first oath we all take to practice medicine is “DO NO HARM”. You said as a surgeon and plastic surgeon, you only took a day off due to “flu” with fever 105 degree, which likely means that you had worked the day either before or after the 105 degree fever when you are extremely contagious when you are carrying the flu virus. Your action of choosing to work despite being sick not only jeopardizes your coworkers health and wellbeing, but also most importantly, you also expose your patient who is at their most vulnerable state to the flu virus which could be lethal perioperatively. No need to mention that your physical condition would be impaired by the flu that you might perform under your optimal condition, you might argue that, but if I were your patient, I would never want you to touch me not saying cut me open when you had 105 fever the day ahead, period. Medicine is not cowboy, is not to compare who is the toughest, but is to deliver the best possible to patient. If you can’t deliver your best, then don’t, since it is irresponsible to your patient. You can feel disgusted, but this disgust does not mean you are right. “Fake sick” is never right, it is unethical, meanwhile we might need a systematic way to think why residents are “Fake sick” rather than simply told them to “get out of medicine now”.
An interesting substack ID. I am a Senior Fellow at Do No Harm, an organization dedicated to restoring Hippocratice medicine. Are you a physician? Your comment deserves a proper answer and I will do my best. My bout with flu during residency is a bit of a blur. I know I went home and a co-resident stopped by my house and gave me 2 liters of IV fluid, which saved me a trip to the emergency room. I recovered over the weekend and was back at work on Monday. My only other true sick day, other than Covid, was another bout of flu with a 105+ degree fever. I remember it well. I started the day feeling fine, oddly enough, and had a full day of surgery. scheduled. Half way into the first case, it hit me like a freight train and I knew I could not finish the day. I finished that surgery- it went well and patient did fine, and canceled the rest of the day. I barely made it home and collapsed on the sofa from which I barely rose the next 3 days. I remember it so well because I get the flu shot every year and that was the year that the shot predicted the wrong flu strain and was only about 30% effective. I have had numerous instances of colds when I did not feel my best. There are several things about respiratory viruses that I know as a physician. Your are actually most infectious in the prodromal stage- before you really have symptoms. Most are spread aerosol or hand to face contact. They enter typically through eyes or nose. Masking mitigates, but does not prevent spread and have to be worn properly to be even a little effective (one reason why they were so useless during Covid. Most people had no clue how to wear them). When I felt I had a cold, I wore a mask when seeing patients, limited my time with them, and scrupulously washed my hands before and after. I also let patients know in case they wanted to re-schedule. I don't recall any that ever did. As a physician, I cannot stay home simply because I don't feel well. Some patients must be seen and private practice physicians like me often do not have the luxury of shifting them to another physician on such short notice. I know most physicians of my generation have worked throught countless colds and flus. It is a fact of life in medicine. You work whether you feel well or not. Patients come first. This is not to say physicians should ignore their health. There has to be some nuance and context in this issue, not to mention a little common sense. Your other point about not operating except under optimal conditions is important to the issue on the original post, which was residents taking mental health days and fakesick days. Part of medical training is learning to work under pressure. There will be days when you will not feel your best or or you may be seriously overwhelmed with patients, etc. You have to learn to perform under pressure. What is not mentioned is that, when a resident takes a fakesick day, it puts more stress and strain on their co-residents. When you are in the middle of an operation and things go sour, as they can, you have to be able to pull yourself together and do what needs to be done; you can't always call for help. I cannot cancel an operation simply because I do not feel my best. Also, your best will not always be the same on any given day for any of a number of reasons. Surgeons are a superstitious lot, e.g. never say how well a case is going in the middle of surgery because surely in the next moment something will go wrong. Silly, but there is truth to this. Perfection does not exist in medicine or surgery, but you will always strive to do your best everytime, for every patient, regardless of extenuating circumstances. If you cannot commit to doing this, you should seek another career other than medicine. I can speak with 45 years of experience and as I look back, I know that, whether an operation was successful or not, I always gave my best that day. I also know that my results and complication rate were on par with the best practices in my specialty. Rick
Thank you for your response and narration on what you experience during your bout of flu, Rick. I know you have attempted to do the best with your way on your flu day, but could there be a better way? I am a physician myself yes, that is why I am stressing the importance of delivery the best quality of care to patient. You mentioned that when you feel like hit by a train, you still finished your first case and patient did fine. In my opinion, it is not because you make the best choice for your patient, but it is fortunate and luck happens to stand by your side that day. The case could have been a simple cholecystectomy but could have been a Whipple procedure, either could potentially gone south because you are forcing yourself. You said surgeons never say how well case goes in the middle because things happens, meanwhile as one yourself you know how your body feels and you are actually operating under impairment, and the choice you made could have caused catastrophic result. Glad in your case it did not. I am not sure if by then your attending knew you feel sick and continue to let you finish your case, but if I were in that spot, I would have told my attending and ask my colleague to take over because patient deserves a surgeon who doesn’t feel being hit by a train. You said your best self is different every day, but I am certain when you get the flu you are far from your best in any given day. Speak if flu, as you said, it requires aerosole isolation and surgical mask unfortunately does not provide the level of protection. By seeing patient while you have URI and possible flu, could have costed them their health/life (mortality rate is low but not zero), their chance to have operation( I don’t think they will be operated on fevering if they caught flu on your pre op visit), or other things. Flu is still contagious before and after onset of fever, less infectious doesn’t means no. You mentioned that in your private practice it is hard for you to have back up, and I am fully aware and understand, however it is unfortunately a systematic issue, in residency there happen to be back ups available. Like I said, calling “Fake Sick” is unethical, and uncollegial, and never right. But calling a sick day for mental health/wellbeing should not be “Fake” (in fact it is a real sick day) and stigmatized. Several physicians die from suicide every year, and many had suffered from mental health issues long before that happened, they either didn’t have a chance to take good care of themselves or exacerbated by some events. If a physician/resident need a day off for taking care of them and they don’t die, I would be more than happy to work extra harder on that day to cover their duty since I knew they would do the same to me (I also got my practice of resilience and work under stress as well isn’t it). If you are truly advocating Hippocrates medicine, then stop advocating practicing when physically and mentally impaired and being proud of it, because these are wrong and dangerous and KILLS patients which is the fundamental violation of Hippocrates oath and patients human right.
I'm not a doctor, but I sympathize with the guy who says "it's just a job."
I have tremendous respect for doctors who feel it is a calling for them to tend and heal the sick. But corporations don't pay you or make decisions based on it being your calling.
At any moment you will be terminates for no reason other than that you are not useful to them. Maybe medicine is an outlier in this regard, but every other industry I've been in and that I've seen has a corporate structure which places no value on you despite their protestations that you "are like family" to them.
I don't think saying "it's just a job" is an excuse to do mediocre work, or to leave extra work for others. Rather it's a response to a corporate culture that lies to your face about being "part of their family" while at the same time making decisions to downsize or eliminate positions without barely any notice.
I love the work that I do, but I know that if I were to quit tomorrow the boss will just post my position on the job board the next day without a thought.
I am a retired physician - so let me offer an experienced perspective.
When someone’s life is in your hands, or it is someone’s child whose suffering needs attention, or you’re looking into the eyes of someone’s tragedy - it is not ‘just a job’…!!! Anyone who does not get this needs to go somewhere and find just a job.
When the water treatment plant I designed is constructed and a town has reliably clean drinking water for the first time, or when a building collapses and dozens of lives are tragically lost and the families are desperate for answers as to how or why this happened and ask me to investigate, or if I make a bad call and the crack in the concrete is worse than I thought and the bridge collapses and crushes 7 people just waiting at the red light in their car - it also feels not 'just a job'.
Maybe you find it insulting for a profession to be called 'a job'. I would think you'd find it more insulting for a corporation to demand better results while at the same time penalizing you for taking the time to deliver better results because that additional time is costing them revenue they could be getting if you had finished sooner and moved onto the next patient/project/job.
I don't know how long you have been retired for, but I recall having a similar discussions with my father before he passed away (he retired around 2003); the job market has changed dramatically in the last couple of decades. You are, in general, not rewarded for loyalty or hard work. You're rewarded for providing a particular skill set at a particular time. There is no metric in your performance review for how many babies you consoled, how many left with a smile after speaking or seeing you, how many "fires" you put out while helping other professionals. It all comes down to whether the corporation still feels you bring more value than you cost.
Certainly! It might be said that all jobs are more than just a job, and persons - like an airline pilot (or taxi driver) need/must understand that what they do is often more important that they may know. But you seem to want us to believe that putting one’s selfish priorities above a duty to those they serve is to be acceptable and understandable. I see things rather differently.
How soon before you open a free clinic serving everyone?
This is obviously a rhetorical question, my point being that you already put selfish priorities above your duties to serve when you ask for a salary with benefits.
A common thread I hear among the physicians in these comments is that taking days off results in other physicians needing to pick up the slack. Instead of griping about others not working hard enough, why not increase the supply of doctors and medical professionals by eliminating State licensing requirements?
Rick, medicine is a job, a profession, and also a cult. We say candlelight vigils to corpses, swear sacred oaths, and engage in ritualistic abuse (sleep deprivation) of our acolytes and apprentices. We kill ourselves, sometimes literally, “for our patients.” And the cult accepts these death sacrifices with murmuring mixed feelings — observe the comments on news articles in regard to residents who die by suicide.
As compassionate as we are for our patients, the training insists that we administer no compassion for our trainees. Instead we demand toughness and resiliency from our cult members. And the cultish way of enforcing resiliency is, apparently, heaps of antipathy and abuse.
P.S. I really appreciate your thoughtful comments, Rick M. Thank you.
exactly that. I don't know how it is going in US, I live in western Europe, and I know for a fact that our occupied-bed-count-based model of medicine funding lead us to severe shortage of beds and personnel. The capitalist model doesn't really work for medicine, there needs to be a different approach. And of course doctors are human and need to be able to manage their personal needs while being doctors, nobody is an ironman, they all need sleep and they all need to be able to have a life outside of the hospital and patient care.
You are missing the relevant point entirely - practical realities exist for all, put disingenuous claims of illness intended to shirk responsibility - to be justified by ‘its just a job’ is despicable irrespective of the job. This is made even more abhorrent when the services to be rendered are services to persons suffering and in need.
What ever economic methods used to finance the work, mendacious attitudes are despicable.
Instead of shaming people who take days off by calling in sick, and relegating the work that most people do as "just a job" in a very condescending manner, while they earn on average $60K per year (lower for other demographics) in comparison to the average of $165K per year for doctors (nearly 3 times the average American salary), your argument would work much better as such:
Doctors are extremely well-paid and in a highly regulated environment with many priveleges that are not afforded to most people, they should be planning vacation days in advance rather than calling in sick at the last minute which results in patients having to reschedule their appointments or other doctors needing to cover for them.
So far the majority of comments have been moral grandstanding about never calling in sick and that you should expect to work yourself to the brink of death. No one outside of medicine shares this belief.
I trained at the same time as Vinay and also had a 4 year gap in dental care. I took a single day off during residency when I was too sick to climb the stairs to my apartment without resting along the way and skipped my grandmother’s funeral without even mentioning to anyone that she died since I had absorbed the message that I wasn’t allowed to have needs or feelings. A co-resident interviewed for fellowship 2 days after giving birth. Our model is not one to be fully emulated.
I think Vinay is right that ultimately it is up to attendings to communicate and demonstrate the value of Integrity in our work as physicians, so that they absorb a message of professionalism that allows space for our own human needs while honoring the unique privilege of being valuable to patient care.
integrity of the work doesn't exclude the fact that doctors (or future doctors, in training or residency) are also humans and they need some wiggle room to bounce back from whatever they have on their plate on top of their professional duties, and be fully there with their patients.
I believe there is a difference between "wiggle room" and taking off fake sick or mental health days because you just had a rough night on call...........
sleep deprivation is a real thing, and rough nights on call or in a ward are a repetitive reality, taking place several times per week for months, at least. I don't think people are actually taking sick or mental health days after their first night on duty. Unless you can prove to me that this is exactly what is happening, and I am wrong to assume that this is the accumulation of stress and sleep shortage.
All I can say is that, in seven years of residency (5 in general surgery and 2 in plastic surgery) I cannot recall a single instance when a resident called in fake sick or took a "mental health" day. Not one. I trained in 1978-84 and 1987-89. I happen to believe that the residents of that generation provided better care to patients in the hospital than do residents today. I can't prove it, of course, but everything I have observed regarding the state of medical education today just reinforces that conviction. And, no, I am not some ancient dinosaur who believes residents should be used and abused and that they have to suffer because we did. I just don't see that we suffered all that much. Granted the technological advances, I think medicine in general provided patients with better care in many areas. The corporatization of medicine and reduced residency hours have contributed to a regression in many of the subtle intangibles that define medicine. One example is the lack of ownership of residents for their patients because of the rapid changes in shifts and patient handoffs which cripple the ability to truly follow the same patient from admission to discharge.
Residents are more willing to take care of other if they feel like they are being taken care of. In the current system, it’s going to be hard for a resident to feel an overriding sense of duty to their program or to their patients when they’re underpaid, potentially drowning in debt, being kept away from their friends and families, and while their mid-level colleagues work fewer hours for more pay. Pre-med applicants are idealistic because they haven’t yet experienced how exploitative the current residency system is.
I was in Residency 2001-2004, so admittedly there are dynamics at play for you that I did not experience (there were fewer APPs working in the hospital setting at that time, so we weren’t constantly reminded if we had chosen another path we would have a real job by now, and the corporate climate is different—all staff being asked to do even more with less compared to my time, though the limit on the hours per week you can work started when I was still in training—so THAT part is easier for you), but medical residents have ALWAYS been cheap labor & underpaid. Residency is a trade off: you work really hard, and you work for low pay so that you can be steeped in complex medical cases while still under the tutelage of your seasoned Attendings, and learn your trade. The training HAS to be challenging, so that you are ready to fly solo & be able to handle exhausting real life medical situations when you are done— the stakes are much higher than most professions—it’s critical that you are competent. I am sorry that you do not feel supported in your program. Try to hang in there & remember things won’t always be this hard. Do what you can—my husband would come have dinner with me when I was on-call—he understood I could be called away at any moment, but he made the effort & it helped us get through. I understand there is sometimes a fine line between being worked hard & being abused—Hospitals and Program directors need to create good cultures & go to bat for their residents—but please don’t lose sight of why you started this journey & the patients who are relying on you. It IS a journey, and a long one. One has to weigh all this when trying to decide which level of training you want to pursue, and it’s a tough choice. For me, I feel like it was worth it. It is a special profession. My unsolicited advice: live under your means for a few more years, look for loan repayment opportunities (NHSC, Military, Indian Health service, Rural communities, etc.). I wish you the best, AND I agree with Vinay—I can do both at once.
Thanks for your response Dr. Rivera. I'm still a lowly M3 so I'm not in the thick of it yet, but I based my comment on my own past job experience and level of student loan debt. Having worked in multiple jobs prior to medical school, I can say it makes a world of difference when your superiors treat you with respect and you feel appropriately valued. I agree, medical training needs to be difficult, and I'm aware that residents have always been cheap labor. The difference today is that the costs to attend medical school have skyrocketed. In addition to rising tuition, students have to defer their training (and years of earning an attending's salary) in order to pad their resumes simply to have a chance of getting in to medical school. The hustle doesn't stop once you're in medical school. This is a topic that Dr. Prasad writes about frequently. At the same time, interest rates are rising and physician reimbursement rates are going down. I'm constantly reminded by one of my academic advisors, an emergency medicine physician, that "the golden age of medicine is over" and salaries aren't going back to what they used to be. I want to be idealistic about medicine but its difficult when I have predatory tuition staring at me at one end and the system asking me for more unpaid labor in the form of resume-padding research and volunteering at the other. I think its hypocritical for many of the commenters here to be chiding the younger generation for not being idealistic or dedicated enough when the rest of the system is so blatantly cynical. The message from the olds seems to be "money for me, idealism for thee." I think residents SHOULD work long hours for the purpose of their training. That doesn't mean they need to be so woefully undervalued. They should at least earn as much as their PA and NP colleagues. If that were the reality, you would see many fewer residents calling out "fake sick".
Zac, I appreciate your points. I agree medical school tuition has become an enormous issue, literally & figuratively. I am also concerned about the growing number of pre-Med students being steered to take on more debt before they even get started. It is not right & I am sorry this is happening.
My comments have gone missing or not been posted when I have tried to share similar advice on DOXIMITY, but I’ll try again here: During my unplanned/ unwanted gap year, I moved home. I got a full-time job at a lab that manufactures products for lab instruments & a part time job at a Nursing Home where I was trained to be a CNA. It was not glamorous, but it allowed me to use my degree, earn some money, not go further into debt/actually pay off some of my undergraduate debt., spend time with my family & get some clinical experience. I was also given the opportunity to compete in my first marathon, in Alaska, as part of the Leukemia Society’s Team in Training. I didn’t plan any of those things, but at the end of it all, I had gained new perspectives, proven to myself I could handle a challenging schedule & was still drawn to medicine as a career. My second attempt was successful, but when I graduated from the private medical school I had gone to, my debt was in the 6 figure range. I worked at a Community Health Center & was able to get some loan repayment through National Health Service Corp. I think there should be more opportunities like this for loan repayment. It is a “win-win” situation for young doctors with debt & communities in need. I think the whole system has suffered, at least in part, because of the loss of the Independent practice as a common entity. I think your best shot is to be willing to do unconventional things. Live under your means initially, stick to a budget, look for loan repayment programs (see first comment). Once you have your debt under control, try to be your own boss or join a small group. Question things—this forum is a great platform for that. Best of luck to you.
TiredFellow, your comment is one that demonstrates the need for a “laugh” response not simply Substack’s “like” option. Do you really believe your generation, with nocturnalist rotations and hour restrictions and curtailment of intellectual hazing (pimping the residents and students), is the first to be challenged during medical training? I ask you to unmask yourself and reveal your name and community simply for public safety.
I'm not sure this is a particularly professional comment. I think TiredFellow has some views you don't agree with, but doxxing is contrary to most every online space's terms. I think keeping it civil is valuable.
Admit to being older than dirt, so I have no sympathy with slackers. Internship in a pediatric hospital was 36 hours on (inpatient ward duty, then on call that night, then stay until 3 pm sign out the next afternoon), go home and sleep, and have a 8-10 hour shift the third day; wash, rinse, repeat. We did our own admission evals, including drawing blood/cath urine/LP and IV's if needed. In the NICU we did resuscitations including intubation, chest tube, lines, etc. We learned by watching, doing, and teaching, as old school as that sounds, and it worked. We were exhausted. But we would never think of leaving before we were supposed to, because we cared for the folks we worked with. It's not exaggeration to say that we saw fellow residents walk around with an IV drip if we had gotten gastro with dehydration. In hind sight it would be considered abuse, but we didn't think of it that way. And just imagine, all without the internet, computerized anything, or mobile phones.
Yea and you probably did a lot of things wrong that no one knew about at the time. Having technology has just made people have to work harder to do things right and know everything up to date. Your chicken scratch notes didn't help anyone and didn't require as much redundancy. Times have changed and your old way of thinking would fail if you started from scratch today.
I'm sorry you went through that. I know for damn sure if I was pulling those hours my notes would look like a frog fingerpainting the keyboard. I would honestly be concerned for what errors I would commit in that state. Maybe I'd learn more, but I know I'd kill someone in the process. I don't think that math works out for me.
It may shock you, but no one ever was injured or compromised by my care. We somehow managed to do damn good work and had the “second eyes” of amazing senior residents, nurses and attending physicians who were there for us. I’m sorry you think that just because we were tired, that we were error prone idiots. Not so.
Hahaha saying "no one ever was injured or compromised by my care" is such a bizarre and wild statement, not only because you can't back that up, but also because you're probably too old to remember at this point. Data is data- if you work shifts that long- you will make mistakes and patients will be negatively affected. Also- the dichotomy of describing the hours you dedicated to patient care while watching your coresidents compromise their own health around you is a testament to how broken the system was back then (not to mention how broken it still is now). There's 10x more shit that residents and medical students learn this day in age compared to back then, the debt is incredible, EMR is 10x worse, and you have no idea what the process is like today so please keep your "back in my day..." comments to yourself you dingus
You don't know me or anything about my practice. I'm glad I don't know you either, because I already find you an uninformed know it all who has no idea what I know or don't know about "the process today", so keep your disrespectful and juvenile comments to yourself. If you are in direct patient care in any fashion, I feel sorry for your patients. You are clearly pretty impressed with yourself, and I will go out on an equally opinionated limb as you and say that you have no idea what more experienced and caring physicians have done and continue to do. You have "no data to back up" your assumptions.
No matter what you say, the statement "no one was ever compromised or injured by my care" is shocking. Get a grip and self reflect enough to realize that with the amount of time you worked, your patients likely did suffer. And don't feel sorry for my patients, they're being treated by a doctor who cares about their outcome AND is well rested enough to give them quality care. I feel sorry for you and your medical training, as well as your past patients who likely suffered. Sad!
You are completely wrong and unaware of anything to do with my past or present professional life. Stop acting like you do. This thread has been taken over by someone with nothing to say and a lot of attitude. Have a good life in your perfect bubble. P
I will say, however, that the sleep deprivation that residents must endure has got to be bad for them and for their patients. The need for sleep is a basic medical understanding—yet we ask people to work 24-hour shifts? Or not have enough time for adequate sleep between shifts? How does this help anybody?
exactly. Young trainees and residents are now treated as corks for any holes in the unit where they work. How is that supposed to make them good doctors? rhetorical question.
Have I ever called in fake sick? Sure I have. Maybe a couple of times over a four year residency . I never abused it, but sometimes I just needed a mental health day and they didn’t exist back then. The stress and hours we dealt with as residents was overwhelming sometimes. When I did my residency, there wasn’t any limit on the number of hours we worked in a week. 1990-1994.
Maybe medicine isn't just a job, but when I'm in a system that is hellbent on a perfectionist ideal where anything less than perfect is crucified, where drs aren't respected (let alone junior doctors) and the EMR is the bane of my life, and it's a toxic work environment where I don't have the time to provide quality care, let alone the systemic constraints, and where I feel like there's so much low value or no value care on the one hand and toxic low quality cheapest-possible hospital care to offer people on the other... Where it's hard to feel like I'm doing good, though I try to remind myself that being a decent human being for patients to interact with is something...
When I feel burnt out, unappreciated, devalued, bullied by superiors... Then taking a day off for me is appealing. I'd love to have a sense of camaraderie, a sense of community, a sense that I was doing good, actually helping people like I wanted to do when I started med school... Then taking time out for me would be unthinkable. I'd be part of something bigger than me, something that nurtured me and valued me. For me the problem is a loss of morale and sense of moral injury, combined with the ever higher/more rigid standards expected of us, the loss of professional autonomy (here in Australia criticizing official COVID policy endangers your medical registration)...
Medicine used not to be just a job. Back when there were staff cafes, sleeping quarters at the hospital for drs who needed to catch a nap, and medicine was slower and more personal. That's why I did medicine. For a kind of practice that no longer exists. To offer slow medicine, relationship medicine, to be able to genuinely provide person centred care for patients who wanted it. I'd work myself damn hard if I could see myself providing quality care. But reality is it's not going to happen, society doesn't value me and my kind of medicine.
Treat junior doctors like they've got an important vocation, care for them, create community - and fake sick days will plummet. Treat us like commodities and don't be surprised when we prioritise our needs over our patients... Society needs to value us and look after us and then we'll look after you (our patients).
Why should I sacrifice myself for a system that doesn't value me and is just getting worse and worse? I did medicine to do things differently. Medicine has become just a job, and that's very sad. I'd love to have a vocation but that requires a system that values me and doesn't treat me as a cog in a healthcare industry. I wish medicine was a vocation, a calling, but nowadays it's just a job and we're cogs in a machine.
Why is it so bad for it to be "just a job?" Is there something inherently bad with a job?
What's wrong with someone who is knowledgeable and competent at their profession, but prefers to do other things such as traveling, spending time with family, or enjoying other hobbies rather than live-and-breathe their profession 24/7?
What makes medicine unique in that it requires its professionals to sacrifice all other desires and goals in order to continue being a professional? Is everyone being hyperbolic and I'm misinterpreting it, or are you literally not allowed to have a vacation once in a while as a physician?
"What makes medicine unique in that it requires its professionals to sacrifice all other desires and goals in order to continue being a professional?
If you have to ask this question, it is a good thing you are not a physician. Or, are you? Because no one is saying you cannot have a life and practice good medicine. I and countless physicians like me are proof that you can. I have been married 42 years, have three children and six grandchildren, and love what I do. I plan to retire soon, after 45 years as a physician and 35 of those years in my current practice. I know I will miss it, but I have other interests and want to indulge them. However, we know that there are times when we will have to delay gratification in order to obtain the necessary training to practice safely and competently, and that there will be times when our personal needs and desires will have to take a back seat to the real medical needs of the patients that rely on us. Some day, when you are a patient and have a medical emergency you will understand this better. Do you want a physician who places their work/life balance ahead of you or someone who has dedicated themselves to being thoroughly trained and helping you through a medical crisis? I know what my answer is.
If it is so obvious why physicians must sacrifice so much in pursuit of their careers, then why not give an answer?
It sounds like you're saying there is not really any difference because all I've read from your response is that sometimes you have to delay gratification but you can still pursue other interests while you're a doctor. Sounds exactly like having a work/life balance.
In the past year I've had a medical emergency (flu, pneumonia, sepsis) that resulted in going to the ER, my father had a medical emergency (pneumonia) which led to his death, and all the doctors and staff were quite competent and caring. However, the time seeing them and speaking with them was extremely limited and it was always a surprise when they would show up and I was never able to contact the doctor directly with questions (there was always an intermediary). It seems like I'm supposed to have deference and treat doctors as though they are walking saints because of how much they sacrifice yet at the same time wanting to know when the doctor will show up, asking for appointments to be on-time, or even being able to ask a question directly to the doctor without having to have intermediaries fielding my questions is treated as unfair and out-of-bounds.
Your saying "just wait until you have a medical emergency" is the equivalent of a plumber telling you "just wait until your pipes burst". It's all irrelevant, we each have our specific skills and tasks to do. Most of us just do our jobs to the best of our ability without demanding respect from others.
If you don't get it with what I have already written, then you will have to find someone who can explain it better to you. Cue the line from Shawshank Redemption in which Andy Dufresne queries the Warden Norton, "How you can be so obtuse?" Peace out.........
I am a Gyn Oncologist and Ob/Gyn residents rotate with us(private practice/voluntary faculty). The number of vacation days/sick days/doctor appointments/advocacy days, etc. is staggering. Of a 20-30 day rotation(not many weekends with us) some residents are only on service actually 7-10 days. Scary to think that this is one of their primary surgical rotations. No wonder I do more and more benign Gyn surgery.
I actually think it is just a job (as opposed to a “calling” as we sometimes perceive of a different/older gen) (I finished subspecialty in 2002). At the end of the day, QoL matters.
But…but…(to borrow from JMM)…
You still gotta do the bleeping job you signed up for (and if you didn’t know the amount of work your program was going to expect of you, you’re a moron who will be an idiotic doc). Also, any horsebleep day you take off is another one your colleagues have to suck up and cover for your sorry butt.
If there are true legit medical issues (including actual mental health concerns), then by all means, take all the time you need. I would have no problem covering for a colleague with a legit health issue. But taking days cuz “work’s hard” or “you’re tired”….give me a freakin break. Just another example of the coddling the younger gen has become reliant upon. Grow up already, welcome to adulthood, time to start behaving like a professional.
Can i say anything here? Looks like i can. This conversation here is healthy and essential, not just to medicine or even to other careers/jobs/professions/occupations. Here's why:
The corporatocracy RULES all of our lives in every possible way. The more you begin to 'see' it... the more you see how destructive, insidious, deep, and widespread it is. It has CHANGED everything for ALL of us. Fundamentally... in ways that most of us truly don't recognize. THIS is what's at the center of ALL of these issues discussed here and elsewhere. Once you begin to see it... you can't un-see it. And it's pretty wild.
The world we ancient BOOMERS grew up in... and began our lives and families... *no longer exists.* The implications of this tectonic shift are enormous. EVERYTHING being discussed here needs to be considered in this context.
Whether y'all see it thru this big lens or not... it's the REAL underlying issue of our time. It's the SCALE of this basic change to all of our lives in ways we don't necessarily see that doesn't change its significance or impact. It's up to us to start 'looking up' and stop blaming each other for the outcomes that often seem bizarre and disturbing. Everything discussed here is evidence of our disconnect with each other and what it all really means.
Many of us are looking thru our own narrow lens because it's the (only) one we know. Most of us do that. Why wouldn't we? Normal. However... realizing how our diverse views fit into the much larger picture is essential if we're all going to successfully meet the challenges and not self-destruct from the inside out. Long term, that is.
We ALL need to stop the moralizing, judging and finger-pointing at each other for starters. Open our eyes, ears and MINDS... since our survival depends on it. We're all in the same boat. Yes.
Everything shifted over our Boomer lifetimes in ways that those of us who grew up depending on the basics of life being available and attainable for all of us simply didn't notice. We just 'worked hard and played by the rules' We didn't see it happening because we were busy working, raising families, yadda, yadda. And because it was (intentionally) kinda like the old story of how do you boil a frog ...
We Boomers were told and taught to accept that lots of things we didn't like (seemed 'unfair' or whatever) were 'just the way it is.' Grow up and do your work. It's what we did. No one even questioned it. Why would we? The older we are here, the more that that is likely our base or frame of reference. And while we were living our lives in the old setup... it morphed completely.
Here's what's happened that seems to me the source of such dissonance here: so many people of the younger generations... including my own kids born in the 70s... and their kids born late 90s into 2010s ... live in a progressively and drastically changed world. In every possible way, whether we (incredibly fortunate oldsters!!!) see it or not... their world is NOT the one we had.
The youngest ones today started life in a totally different world than the one we all knew/know and took for granted ... like that the sky is blue and grass is green.
Focusing on 'individual' responsibility and dedication, etc... is still needed and no one younger here is trying to say it's not. They are NOT saying that! <-- Please get this, my fellow Boomers.
THE SYSTEM THEY'RE LIVING AND WORKING IN IS FUNDAMENTALLY DIFFERENT IN SERIOUS WAYS FOR THE MOST PART. AND IT'S THE ONLY ONE THEY'VE EVER KNOWN. We have no more idea what it's like to be them than they know what it's like to be us. We come from totally diverse eras. We got lucky. They did not.
As someone commented, if y'all were starting at square one *today* as they are, you'd likely find the situations as difficult and often unworkable in their present iterations as they do. They not disrespecting their work, professions, patients or any of that stuff. Read what Heather from Australia had to say!
For you younger folks, struggling mightily to do your best, maintain a *healthy* life/work balance (what a concept!!), keep your heads above water while the system tries to drown you if that produces short term profit ... please do NOT blame us Boomers. We did NOT create this mess, either.
The Corporatocracy grew out of the natural efforts to keep our dedication to 'individual liberty' and capitalism front and center for America, in particular. Politics and economics are way out of control because the system that tries to support and balance them serves the corporatocracy right now... and nothing else. It's like a machine... with very little protections for exploited people, animals, environment, small biz... or ANYTHING that gets in its way of creating profits. It's NOT human.
It can't continue this way much longer. Constructive, productive, creative things are definitely happening at the grassroots level by people who are working on different pieces out of the necessities of their own lives. And these disparate pieces may possibly provide a new foundation for after the implosion into which the corrupt system is naturally collapsing.
You can believe this or not. Doesn't change the reality, like you can believe in the law of gravity or not. We need to work together, learn how we can support one another for the sake of all of us. Cheers!
I agree with you in the sense that externalities have changed btw your gen and my gen and the current gen. The 2 biggest that come to mind are the burden of student loan debt, and the general cost of living and that basic American dream of buying a house. Particularly when these are compared to each gen’s earning potential and capacity.
And obviously the complexity of medicine has changed considerably over the last 3 generations. In my field, you don’t treat MI’s with bedrest and stool softeners anymore.
But I’m not sure I’d say the work is so much harder in medicine for the current gen relative to any other field for the current gen. Every line of work is more complex than it used to be. And the cost of living struggles of the current gen of new docs are not that different from the same struggles of any kid of that age.
So does the average doc of each gen have it as easy or as hard, relative to the average member of their cohort generation? And how would that ratio compare btw generations? (Ie do current young’s docs have it 120% harder than their age cohorts? Was my gen of docs only 95% as hard? Was your gen of docs only 70% as hard? Is it a bigger sacrifice to be a doc now relative to being anything else, compared to times gone by?).
I’m not sure. If the answer is yes, then maybe you can defend some special accommodation. (They’re taking a bigger hit to be a doc than we did). But if the answer is no, then I think current young docs should do what young docs have always done in generations of yore: suck it up and get ‘er done.
I'm sorry, all this important discussion aside, MI was treated with STOOL SOFTENER? Put aside work ethic, this is absolutely the largest generational gap between us 😂
Well, that’s a bit before my time as a doc. But the original TIMI and ISIS trials were in my lifetime.
Agree. I finished medicine & cardiology at UW Seattle 1985 and there was a little bit of Band of Brothers attitude vis a vis missing a day. Sometimes you work for your “peers” and go there extra mile to as not let them down. Sounds corny but I think true. We were all soldiers in a fight for survival.
I don’t think my contemporaries and I thought we were taking Omaha beach or anything of the sort. But there was a certain amount of personal pride and fortitude involved in doing our job (that we willingly signed up for).
I don’t recall anyone in my residency or fellowship engaging in any of the bs depicted in this OP.
In this realm, I’m thinking “new” is not “better”.
I am treated like shit by a hospital corporation and attendings that don’t care about me or my patients and pays me the equivalent of $14.32 an hour whilst 300K in debt of course it’s a fucking job! Artificially protracted training to utilize is a cheap labor. Just because you were abused as a resident doesn’t give you the permission to abuse future residents, think about making the future better for all of those in medicine, even if you were hurt. Lost some respect for you Vinay.
“Artificially protracted training?” So, you really think you’ve seen enough to safely practice independently? I am impressed with your confidence. You think you’re a better physician than the rest of us.
Making a presumption (based upon personal information you revealed), I graduated from medical school in 1988 and likely have practiced unsupervised for more years than you’ve been alive. Everyday I encounter patients for whom I do not feel prepared and I get over my feelings. My advice to you, TiredFellow, embrace the learning opportunities you have and be happy you are paid a salary that you can live on and keeps you from further adding to your debt.
So you're saying that the training involving being overworked, overwhelmed, treated poorly, and underpaid still did nothing to prepare you for the patients you see every day?
You seem to be advancing TiredFellow's argument rather than countering it!
Learning isn't shift-based. If one is caring for a sick patient, finish it. Don't clock out. I'm an Anesthesiologist and even I still check on my patients for days related to the outcomes of their surgeries. And that's because I take my PROFESSION (not a job) seriously, and I do care about the health of the people I treat.
I was a fellow once too, and the hours do seem ridiculous. But, when you are an attending, you may be in a practice where it's just you. You are it. Always on the clock. This is training for being an attending.
Not at all! Seasoned physicians are humbly aware of their abilities and limitations. My point for TiredFellow is to appreciate and embrace the learning opportunities afforded and available in the training environment.
I fear for anyone being treated by a clinician with this attitude. Find another way to pay off that 300k. And you will save many more lives, including your own.
Grown ups and professionals don’t behave a certain way or treat others the way they deserve to be treated— we behave and treat others in a way that demonstrates our character, our values. I can’t respect someone’s choice to be a liar or cheat the system. Be better.
Damn, I hope to never be under your tender mercies. I earned way less than you back in the days when there were no restrictions on hours worked. I don't want to abuse anybody. I just think that training made me a better doctor, as opposed to a whiny baby. You learn there are things bigger than you, and your worst day in residency is nothing compared to a family being told their child has cancer.
We never took time off that wasn't necessary. Someone had to cover for you and that was one of your fellow residents.
Did you really say that no one has the right to complain about their working conditions because there's a child somewhere out there being diagnosed with cancer?
No I'm saying it put all my petty sh*t in perspective. My very first patient as a newly minted MD was a 16yo girl dying of a brain tumor. Just thinking about this kid always gave me perspective. She didn't get a day off from struggles that were way worse than mine.
And I never once thought about complaining about my working conditions the way I see the complaining here. I was overworked, I was tired, I was often overwhelmed. But so were we all, and we frankly expected it. We complained about a bad call night, being paired with a black cloud, being a black cloud, an attending that was a crap teacher, but not about the work. It was the reason we were there.
You were overworked. You were tired. You were often overwhelmed.
I usually recommend to someone to switch to another employer if these are their regular working conditions, but you're saying that this is not only perfectly fine but expected? Is this the case with all doctors?
I get the idea that there are people who have it much worse than you. How far does this extend though? Should coal miners not bother complaining about working conditions because a 16yo girl was/is dying of brain cancer? Or only white-collar professionals are not allowed to complain?
It's pretty obvious why the burnout rate among doctors is so high if you think about it.
Everyone is going to complain about their job/ profession, regardless of what that job/ profession is. This generation happens to have a platform on which they can voice these complaints, have them seen by the world, and then have people comment on them- whether that be supportive commenting or calling them “whiny babies.” My point: as Su-zan said, context is important. The fact that there is a place to communicate these thoughts easily to the world and a cultural shift that allows this platform to be used regularly as a norm does not make this generation “whiny babies” anymore than the older generations complaining in person to friends made THEM “whiny babies.” This is also only ONE of the major contextual shifts that has occurred and needs to be considered. Moreover, attacking one another because of the frustrations we express is not helpful to furthering the conversation on how we can help one another further the profession and create doctors who are prepared- intellectually, emotionally, and socially- to take care of patients in the best way possible.
Medical training is supposed to be hard work. This should surprise absolutely zero people. It’s already way cushier now than it used to be. There was no such thing as “duty hours” back in the day.
Now, from a patient safety pov, some of the changes are for the better. Ultimately that’s the prism where rubber meets road.
But remember absolutely no one is owed a career in medicine. So if the kitchen’s too hot….maybe some might find digging ditches to be an easier vocation.
And OMG it’s a couple of years in your 20s and 30s….how fragile are people these days?
So why were you surprised about the working condition?? There is no secret about the demands of medical training.
Your comments tell me that you really do not have any idea of how much you don’t know, nor how to learn. The more you see and do, the more you learn. And there is always something to learn.
I think you didn’t do your research about what is involved in medical training. This poor planning makes me concerned for your future patients.
Or you thought you could handle it, but couldn’t. If so then get out and find a job you can handle.
Oh, my.
As a senior physician, my experience is that the care of hospitalized patients is physically and emotionally demanding; and that most interns and residents work hard to care for their patients. I frequently see them helping each other out with the many menial tasks that accompany patient care. Attending physicians can model teamwork and camaraderie by taking some of the team's scutwork themselves, especially at shift's end when everyone is tired and efficiency wanes. So when your own work is done, the team is exhausted, and it's late with more work to do, dictate that discharge summary, fill out that Certificate of Medical Necessity Form, even go consent the patient for transfusion. In my experience, the team will be eternally grateful and know how much you care for them.
When I was interviewing for general surgical internships in 1978, I visited NYU where the house staff were on call every other night and every other "power weekend". They all had the "thousand yard stare". I chose a program that was more kindly, only every third night call, etc. Medicine and surgery will always be professions and considered as such by the best among us. However, I can recall making stupid, nonlethal mistakes because I was sleep deprived while in training. Truck drivers and professional pilots have mandatory rest schedules. It's not a difficult argument to make make for medical training. According to my best friend and former med school classmate who spent his career in academic medicine, house staff over the decades have become more "fractious" and less resilient.
This is one of the most disgusting things I have read in a long list of disgusting things going on in medicine these days. I have already written about the degradation of residency training ( https://www.city-journal.org/article/bad-policies-leaving-next-generation-of-surgeons-unprepared ). I finished my residency in general surgery in 1984 and my plastic surgery residency in 1989. During that term, I missed one day of work because of the flu, when I had a 105+ degree fever. It would never have occurred to any of us residents to take a "mental health" or "fake sick" day after a tough night on call. Part of medical training is to learn to function effectively and safely under duress and when fatigued. You won't always have back up. If we had been caught faking mental or physical illness, we would have been canned, plain and simple. If you are not willing to sacrifice your sleep, comfort, or discretionary time for patients, find another profession. I am not some dumbass "we suffered, so you have to suffer" type who thinks everyone in medicine needs to martyr themselves. Medicine, by its very nature, demands more of us than almost any other profession except perhaps the military. There will be times when all other considerations, including vacations, birthdays, family events, etc. must take a back seat to the patients we took an oath to care for. To the resident who said, "Your well being is NOT superceded by any duties to a patient. To hell with that disgusting attitude," YOU disgust me. Get out of medicine now, before you kill somebody.
R. Bosshardt, MD, FACS
Studies have show you just had more errors. You didn't learn sh!7 better. You just learned to survive which was bad for you and your patients. Yall old timers created this toxic environment. Good riddance to yall and hope the world become a nicer more empathetic place to all.
Kaki,
What studies are those, exactly? I would pit my experience and observations over 45 years against your supposed studies. Please name a single one. The tone of your comment is both disrespectful and indicates you have no idea what you are talking about. I find it interesting that you presume to know whether I was well trained or not (I was) and how my training affected me. I am 72 and still practicing surgery. Would you dare to share how old you are and what you do?
Rick
Hey Rick-
You probably made a shit ton of errors that probably lead to negative patient outcomes as a result of being overworked (as did many of your colleagues who trained with you back in the day). And nah, you're a sad old man. Get off the internet lol
Sorry. I thought I was having a conversation with adults. Life is to short to waste my time on discussions with children. Peace out.
Dr. Bosshardt, I am deeply saddened and concerned about the thought and action that you have regarding the way your practice medicine. You mentioned about your oath for patient, meanwhile, as far as I recall, the first oath we all take to practice medicine is “DO NO HARM”. You said as a surgeon and plastic surgeon, you only took a day off due to “flu” with fever 105 degree, which likely means that you had worked the day either before or after the 105 degree fever when you are extremely contagious when you are carrying the flu virus. Your action of choosing to work despite being sick not only jeopardizes your coworkers health and wellbeing, but also most importantly, you also expose your patient who is at their most vulnerable state to the flu virus which could be lethal perioperatively. No need to mention that your physical condition would be impaired by the flu that you might perform under your optimal condition, you might argue that, but if I were your patient, I would never want you to touch me not saying cut me open when you had 105 fever the day ahead, period. Medicine is not cowboy, is not to compare who is the toughest, but is to deliver the best possible to patient. If you can’t deliver your best, then don’t, since it is irresponsible to your patient. You can feel disgusted, but this disgust does not mean you are right. “Fake sick” is never right, it is unethical, meanwhile we might need a systematic way to think why residents are “Fake sick” rather than simply told them to “get out of medicine now”.
DoNoHarm1,
An interesting substack ID. I am a Senior Fellow at Do No Harm, an organization dedicated to restoring Hippocratice medicine. Are you a physician? Your comment deserves a proper answer and I will do my best. My bout with flu during residency is a bit of a blur. I know I went home and a co-resident stopped by my house and gave me 2 liters of IV fluid, which saved me a trip to the emergency room. I recovered over the weekend and was back at work on Monday. My only other true sick day, other than Covid, was another bout of flu with a 105+ degree fever. I remember it well. I started the day feeling fine, oddly enough, and had a full day of surgery. scheduled. Half way into the first case, it hit me like a freight train and I knew I could not finish the day. I finished that surgery- it went well and patient did fine, and canceled the rest of the day. I barely made it home and collapsed on the sofa from which I barely rose the next 3 days. I remember it so well because I get the flu shot every year and that was the year that the shot predicted the wrong flu strain and was only about 30% effective. I have had numerous instances of colds when I did not feel my best. There are several things about respiratory viruses that I know as a physician. Your are actually most infectious in the prodromal stage- before you really have symptoms. Most are spread aerosol or hand to face contact. They enter typically through eyes or nose. Masking mitigates, but does not prevent spread and have to be worn properly to be even a little effective (one reason why they were so useless during Covid. Most people had no clue how to wear them). When I felt I had a cold, I wore a mask when seeing patients, limited my time with them, and scrupulously washed my hands before and after. I also let patients know in case they wanted to re-schedule. I don't recall any that ever did. As a physician, I cannot stay home simply because I don't feel well. Some patients must be seen and private practice physicians like me often do not have the luxury of shifting them to another physician on such short notice. I know most physicians of my generation have worked throught countless colds and flus. It is a fact of life in medicine. You work whether you feel well or not. Patients come first. This is not to say physicians should ignore their health. There has to be some nuance and context in this issue, not to mention a little common sense. Your other point about not operating except under optimal conditions is important to the issue on the original post, which was residents taking mental health days and fakesick days. Part of medical training is learning to work under pressure. There will be days when you will not feel your best or or you may be seriously overwhelmed with patients, etc. You have to learn to perform under pressure. What is not mentioned is that, when a resident takes a fakesick day, it puts more stress and strain on their co-residents. When you are in the middle of an operation and things go sour, as they can, you have to be able to pull yourself together and do what needs to be done; you can't always call for help. I cannot cancel an operation simply because I do not feel my best. Also, your best will not always be the same on any given day for any of a number of reasons. Surgeons are a superstitious lot, e.g. never say how well a case is going in the middle of surgery because surely in the next moment something will go wrong. Silly, but there is truth to this. Perfection does not exist in medicine or surgery, but you will always strive to do your best everytime, for every patient, regardless of extenuating circumstances. If you cannot commit to doing this, you should seek another career other than medicine. I can speak with 45 years of experience and as I look back, I know that, whether an operation was successful or not, I always gave my best that day. I also know that my results and complication rate were on par with the best practices in my specialty. Rick
Thank you for your response and narration on what you experience during your bout of flu, Rick. I know you have attempted to do the best with your way on your flu day, but could there be a better way? I am a physician myself yes, that is why I am stressing the importance of delivery the best quality of care to patient. You mentioned that when you feel like hit by a train, you still finished your first case and patient did fine. In my opinion, it is not because you make the best choice for your patient, but it is fortunate and luck happens to stand by your side that day. The case could have been a simple cholecystectomy but could have been a Whipple procedure, either could potentially gone south because you are forcing yourself. You said surgeons never say how well case goes in the middle because things happens, meanwhile as one yourself you know how your body feels and you are actually operating under impairment, and the choice you made could have caused catastrophic result. Glad in your case it did not. I am not sure if by then your attending knew you feel sick and continue to let you finish your case, but if I were in that spot, I would have told my attending and ask my colleague to take over because patient deserves a surgeon who doesn’t feel being hit by a train. You said your best self is different every day, but I am certain when you get the flu you are far from your best in any given day. Speak if flu, as you said, it requires aerosole isolation and surgical mask unfortunately does not provide the level of protection. By seeing patient while you have URI and possible flu, could have costed them their health/life (mortality rate is low but not zero), their chance to have operation( I don’t think they will be operated on fevering if they caught flu on your pre op visit), or other things. Flu is still contagious before and after onset of fever, less infectious doesn’t means no. You mentioned that in your private practice it is hard for you to have back up, and I am fully aware and understand, however it is unfortunately a systematic issue, in residency there happen to be back ups available. Like I said, calling “Fake Sick” is unethical, and uncollegial, and never right. But calling a sick day for mental health/wellbeing should not be “Fake” (in fact it is a real sick day) and stigmatized. Several physicians die from suicide every year, and many had suffered from mental health issues long before that happened, they either didn’t have a chance to take good care of themselves or exacerbated by some events. If a physician/resident need a day off for taking care of them and they don’t die, I would be more than happy to work extra harder on that day to cover their duty since I knew they would do the same to me (I also got my practice of resilience and work under stress as well isn’t it). If you are truly advocating Hippocrates medicine, then stop advocating practicing when physically and mentally impaired and being proud of it, because these are wrong and dangerous and KILLS patients which is the fundamental violation of Hippocrates oath and patients human right.
Thank you for this. Great response. 🤗
Thank you for your support and kind word 😊.
I'm not a doctor, but I sympathize with the guy who says "it's just a job."
I have tremendous respect for doctors who feel it is a calling for them to tend and heal the sick. But corporations don't pay you or make decisions based on it being your calling.
At any moment you will be terminates for no reason other than that you are not useful to them. Maybe medicine is an outlier in this regard, but every other industry I've been in and that I've seen has a corporate structure which places no value on you despite their protestations that you "are like family" to them.
I don't think saying "it's just a job" is an excuse to do mediocre work, or to leave extra work for others. Rather it's a response to a corporate culture that lies to your face about being "part of their family" while at the same time making decisions to downsize or eliminate positions without barely any notice.
I love the work that I do, but I know that if I were to quit tomorrow the boss will just post my position on the job board the next day without a thought.
I am a retired physician - so let me offer an experienced perspective.
When someone’s life is in your hands, or it is someone’s child whose suffering needs attention, or you’re looking into the eyes of someone’s tragedy - it is not ‘just a job’…!!! Anyone who does not get this needs to go somewhere and find just a job.
That can be said for many jobs.
When the water treatment plant I designed is constructed and a town has reliably clean drinking water for the first time, or when a building collapses and dozens of lives are tragically lost and the families are desperate for answers as to how or why this happened and ask me to investigate, or if I make a bad call and the crack in the concrete is worse than I thought and the bridge collapses and crushes 7 people just waiting at the red light in their car - it also feels not 'just a job'.
Maybe you find it insulting for a profession to be called 'a job'. I would think you'd find it more insulting for a corporation to demand better results while at the same time penalizing you for taking the time to deliver better results because that additional time is costing them revenue they could be getting if you had finished sooner and moved onto the next patient/project/job.
I don't know how long you have been retired for, but I recall having a similar discussions with my father before he passed away (he retired around 2003); the job market has changed dramatically in the last couple of decades. You are, in general, not rewarded for loyalty or hard work. You're rewarded for providing a particular skill set at a particular time. There is no metric in your performance review for how many babies you consoled, how many left with a smile after speaking or seeing you, how many "fires" you put out while helping other professionals. It all comes down to whether the corporation still feels you bring more value than you cost.
Certainly! It might be said that all jobs are more than just a job, and persons - like an airline pilot (or taxi driver) need/must understand that what they do is often more important that they may know. But you seem to want us to believe that putting one’s selfish priorities above a duty to those they serve is to be acceptable and understandable. I see things rather differently.
How soon before you open a free clinic serving everyone?
This is obviously a rhetorical question, my point being that you already put selfish priorities above your duties to serve when you ask for a salary with benefits.
A common thread I hear among the physicians in these comments is that taking days off results in other physicians needing to pick up the slack. Instead of griping about others not working hard enough, why not increase the supply of doctors and medical professionals by eliminating State licensing requirements?
Rick, medicine is a job, a profession, and also a cult. We say candlelight vigils to corpses, swear sacred oaths, and engage in ritualistic abuse (sleep deprivation) of our acolytes and apprentices. We kill ourselves, sometimes literally, “for our patients.” And the cult accepts these death sacrifices with murmuring mixed feelings — observe the comments on news articles in regard to residents who die by suicide.
As compassionate as we are for our patients, the training insists that we administer no compassion for our trainees. Instead we demand toughness and resiliency from our cult members. And the cultish way of enforcing resiliency is, apparently, heaps of antipathy and abuse.
P.S. I really appreciate your thoughtful comments, Rick M. Thank you.
exactly that. I don't know how it is going in US, I live in western Europe, and I know for a fact that our occupied-bed-count-based model of medicine funding lead us to severe shortage of beds and personnel. The capitalist model doesn't really work for medicine, there needs to be a different approach. And of course doctors are human and need to be able to manage their personal needs while being doctors, nobody is an ironman, they all need sleep and they all need to be able to have a life outside of the hospital and patient care.
You are missing the relevant point entirely - practical realities exist for all, put disingenuous claims of illness intended to shirk responsibility - to be justified by ‘its just a job’ is despicable irrespective of the job. This is made even more abhorrent when the services to be rendered are services to persons suffering and in need.
What ever economic methods used to finance the work, mendacious attitudes are despicable.
Instead of shaming people who take days off by calling in sick, and relegating the work that most people do as "just a job" in a very condescending manner, while they earn on average $60K per year (lower for other demographics) in comparison to the average of $165K per year for doctors (nearly 3 times the average American salary), your argument would work much better as such:
Doctors are extremely well-paid and in a highly regulated environment with many priveleges that are not afforded to most people, they should be planning vacation days in advance rather than calling in sick at the last minute which results in patients having to reschedule their appointments or other doctors needing to cover for them.
So far the majority of comments have been moral grandstanding about never calling in sick and that you should expect to work yourself to the brink of death. No one outside of medicine shares this belief.
Selfish? I’m not sure we can label peoples concerns that way. It could be that trainees are treated with less respect now than I was.
Amen. Shocked at some of the commenters here.
I trained at the same time as Vinay and also had a 4 year gap in dental care. I took a single day off during residency when I was too sick to climb the stairs to my apartment without resting along the way and skipped my grandmother’s funeral without even mentioning to anyone that she died since I had absorbed the message that I wasn’t allowed to have needs or feelings. A co-resident interviewed for fellowship 2 days after giving birth. Our model is not one to be fully emulated.
I think Vinay is right that ultimately it is up to attendings to communicate and demonstrate the value of Integrity in our work as physicians, so that they absorb a message of professionalism that allows space for our own human needs while honoring the unique privilege of being valuable to patient care.
integrity of the work doesn't exclude the fact that doctors (or future doctors, in training or residency) are also humans and they need some wiggle room to bounce back from whatever they have on their plate on top of their professional duties, and be fully there with their patients.
Tetiana,
I believe there is a difference between "wiggle room" and taking off fake sick or mental health days because you just had a rough night on call...........
Rick
sleep deprivation is a real thing, and rough nights on call or in a ward are a repetitive reality, taking place several times per week for months, at least. I don't think people are actually taking sick or mental health days after their first night on duty. Unless you can prove to me that this is exactly what is happening, and I am wrong to assume that this is the accumulation of stress and sleep shortage.
All I can say is that, in seven years of residency (5 in general surgery and 2 in plastic surgery) I cannot recall a single instance when a resident called in fake sick or took a "mental health" day. Not one. I trained in 1978-84 and 1987-89. I happen to believe that the residents of that generation provided better care to patients in the hospital than do residents today. I can't prove it, of course, but everything I have observed regarding the state of medical education today just reinforces that conviction. And, no, I am not some ancient dinosaur who believes residents should be used and abused and that they have to suffer because we did. I just don't see that we suffered all that much. Granted the technological advances, I think medicine in general provided patients with better care in many areas. The corporatization of medicine and reduced residency hours have contributed to a regression in many of the subtle intangibles that define medicine. One example is the lack of ownership of residents for their patients because of the rapid changes in shifts and patient handoffs which cripple the ability to truly follow the same patient from admission to discharge.
Your last paragraph says it!
It is not communication, but culture…
Residents are more willing to take care of other if they feel like they are being taken care of. In the current system, it’s going to be hard for a resident to feel an overriding sense of duty to their program or to their patients when they’re underpaid, potentially drowning in debt, being kept away from their friends and families, and while their mid-level colleagues work fewer hours for more pay. Pre-med applicants are idealistic because they haven’t yet experienced how exploitative the current residency system is.
I was in Residency 2001-2004, so admittedly there are dynamics at play for you that I did not experience (there were fewer APPs working in the hospital setting at that time, so we weren’t constantly reminded if we had chosen another path we would have a real job by now, and the corporate climate is different—all staff being asked to do even more with less compared to my time, though the limit on the hours per week you can work started when I was still in training—so THAT part is easier for you), but medical residents have ALWAYS been cheap labor & underpaid. Residency is a trade off: you work really hard, and you work for low pay so that you can be steeped in complex medical cases while still under the tutelage of your seasoned Attendings, and learn your trade. The training HAS to be challenging, so that you are ready to fly solo & be able to handle exhausting real life medical situations when you are done— the stakes are much higher than most professions—it’s critical that you are competent. I am sorry that you do not feel supported in your program. Try to hang in there & remember things won’t always be this hard. Do what you can—my husband would come have dinner with me when I was on-call—he understood I could be called away at any moment, but he made the effort & it helped us get through. I understand there is sometimes a fine line between being worked hard & being abused—Hospitals and Program directors need to create good cultures & go to bat for their residents—but please don’t lose sight of why you started this journey & the patients who are relying on you. It IS a journey, and a long one. One has to weigh all this when trying to decide which level of training you want to pursue, and it’s a tough choice. For me, I feel like it was worth it. It is a special profession. My unsolicited advice: live under your means for a few more years, look for loan repayment opportunities (NHSC, Military, Indian Health service, Rural communities, etc.). I wish you the best, AND I agree with Vinay—I can do both at once.
Thanks for your response Dr. Rivera. I'm still a lowly M3 so I'm not in the thick of it yet, but I based my comment on my own past job experience and level of student loan debt. Having worked in multiple jobs prior to medical school, I can say it makes a world of difference when your superiors treat you with respect and you feel appropriately valued. I agree, medical training needs to be difficult, and I'm aware that residents have always been cheap labor. The difference today is that the costs to attend medical school have skyrocketed. In addition to rising tuition, students have to defer their training (and years of earning an attending's salary) in order to pad their resumes simply to have a chance of getting in to medical school. The hustle doesn't stop once you're in medical school. This is a topic that Dr. Prasad writes about frequently. At the same time, interest rates are rising and physician reimbursement rates are going down. I'm constantly reminded by one of my academic advisors, an emergency medicine physician, that "the golden age of medicine is over" and salaries aren't going back to what they used to be. I want to be idealistic about medicine but its difficult when I have predatory tuition staring at me at one end and the system asking me for more unpaid labor in the form of resume-padding research and volunteering at the other. I think its hypocritical for many of the commenters here to be chiding the younger generation for not being idealistic or dedicated enough when the rest of the system is so blatantly cynical. The message from the olds seems to be "money for me, idealism for thee." I think residents SHOULD work long hours for the purpose of their training. That doesn't mean they need to be so woefully undervalued. They should at least earn as much as their PA and NP colleagues. If that were the reality, you would see many fewer residents calling out "fake sick".
Zac, I appreciate your points. I agree medical school tuition has become an enormous issue, literally & figuratively. I am also concerned about the growing number of pre-Med students being steered to take on more debt before they even get started. It is not right & I am sorry this is happening.
My comments have gone missing or not been posted when I have tried to share similar advice on DOXIMITY, but I’ll try again here: During my unplanned/ unwanted gap year, I moved home. I got a full-time job at a lab that manufactures products for lab instruments & a part time job at a Nursing Home where I was trained to be a CNA. It was not glamorous, but it allowed me to use my degree, earn some money, not go further into debt/actually pay off some of my undergraduate debt., spend time with my family & get some clinical experience. I was also given the opportunity to compete in my first marathon, in Alaska, as part of the Leukemia Society’s Team in Training. I didn’t plan any of those things, but at the end of it all, I had gained new perspectives, proven to myself I could handle a challenging schedule & was still drawn to medicine as a career. My second attempt was successful, but when I graduated from the private medical school I had gone to, my debt was in the 6 figure range. I worked at a Community Health Center & was able to get some loan repayment through National Health Service Corp. I think there should be more opportunities like this for loan repayment. It is a “win-win” situation for young doctors with debt & communities in need. I think the whole system has suffered, at least in part, because of the loss of the Independent practice as a common entity. I think your best shot is to be willing to do unconventional things. Live under your means initially, stick to a budget, look for loan repayment programs (see first comment). Once you have your debt under control, try to be your own boss or join a small group. Question things—this forum is a great platform for that. Best of luck to you.
Preach! Vinay is too disconnected from the modern reality of what today’s residents face. Sad
TiredFellow, your comment is one that demonstrates the need for a “laugh” response not simply Substack’s “like” option. Do you really believe your generation, with nocturnalist rotations and hour restrictions and curtailment of intellectual hazing (pimping the residents and students), is the first to be challenged during medical training? I ask you to unmask yourself and reveal your name and community simply for public safety.
"Please reveal your true identity so that I can track you down, contact your employer, and ruin your life."
You really expect people to take this request seriously?
Don't worry, I'm just intellectually hazing you for having such a low-IQ comment.
Hey Wayne-
Interesting thoughts, you sound like a sad, sad little man.
I'm not sure this is a particularly professional comment. I think TiredFellow has some views you don't agree with, but doxxing is contrary to most every online space's terms. I think keeping it civil is valuable.
Admit to being older than dirt, so I have no sympathy with slackers. Internship in a pediatric hospital was 36 hours on (inpatient ward duty, then on call that night, then stay until 3 pm sign out the next afternoon), go home and sleep, and have a 8-10 hour shift the third day; wash, rinse, repeat. We did our own admission evals, including drawing blood/cath urine/LP and IV's if needed. In the NICU we did resuscitations including intubation, chest tube, lines, etc. We learned by watching, doing, and teaching, as old school as that sounds, and it worked. We were exhausted. But we would never think of leaving before we were supposed to, because we cared for the folks we worked with. It's not exaggeration to say that we saw fellow residents walk around with an IV drip if we had gotten gastro with dehydration. In hind sight it would be considered abuse, but we didn't think of it that way. And just imagine, all without the internet, computerized anything, or mobile phones.
Yea and you probably did a lot of things wrong that no one knew about at the time. Having technology has just made people have to work harder to do things right and know everything up to date. Your chicken scratch notes didn't help anyone and didn't require as much redundancy. Times have changed and your old way of thinking would fail if you started from scratch today.
I'm sorry you went through that. I know for damn sure if I was pulling those hours my notes would look like a frog fingerpainting the keyboard. I would honestly be concerned for what errors I would commit in that state. Maybe I'd learn more, but I know I'd kill someone in the process. I don't think that math works out for me.
It may shock you, but no one ever was injured or compromised by my care. We somehow managed to do damn good work and had the “second eyes” of amazing senior residents, nurses and attending physicians who were there for us. I’m sorry you think that just because we were tired, that we were error prone idiots. Not so.
Hahaha saying "no one ever was injured or compromised by my care" is such a bizarre and wild statement, not only because you can't back that up, but also because you're probably too old to remember at this point. Data is data- if you work shifts that long- you will make mistakes and patients will be negatively affected. Also- the dichotomy of describing the hours you dedicated to patient care while watching your coresidents compromise their own health around you is a testament to how broken the system was back then (not to mention how broken it still is now). There's 10x more shit that residents and medical students learn this day in age compared to back then, the debt is incredible, EMR is 10x worse, and you have no idea what the process is like today so please keep your "back in my day..." comments to yourself you dingus
You don't know me or anything about my practice. I'm glad I don't know you either, because I already find you an uninformed know it all who has no idea what I know or don't know about "the process today", so keep your disrespectful and juvenile comments to yourself. If you are in direct patient care in any fashion, I feel sorry for your patients. You are clearly pretty impressed with yourself, and I will go out on an equally opinionated limb as you and say that you have no idea what more experienced and caring physicians have done and continue to do. You have "no data to back up" your assumptions.
No matter what you say, the statement "no one was ever compromised or injured by my care" is shocking. Get a grip and self reflect enough to realize that with the amount of time you worked, your patients likely did suffer. And don't feel sorry for my patients, they're being treated by a doctor who cares about their outcome AND is well rested enough to give them quality care. I feel sorry for you and your medical training, as well as your past patients who likely suffered. Sad!
You are completely wrong and unaware of anything to do with my past or present professional life. Stop acting like you do. This thread has been taken over by someone with nothing to say and a lot of attitude. Have a good life in your perfect bubble. P
It's become common in high schools as well. Likely the origin.
I will say, however, that the sleep deprivation that residents must endure has got to be bad for them and for their patients. The need for sleep is a basic medical understanding—yet we ask people to work 24-hour shifts? Or not have enough time for adequate sleep between shifts? How does this help anybody?
exactly. Young trainees and residents are now treated as corks for any holes in the unit where they work. How is that supposed to make them good doctors? rhetorical question.
Nah, the boomers will tell you "tuff, we worked that much and made 0 errors that led to compromised patient care, get over it"
Have I ever called in fake sick? Sure I have. Maybe a couple of times over a four year residency . I never abused it, but sometimes I just needed a mental health day and they didn’t exist back then. The stress and hours we dealt with as residents was overwhelming sometimes. When I did my residency, there wasn’t any limit on the number of hours we worked in a week. 1990-1994.
Thanks for your fresh perspective as an older doc, Dyan.
Maybe medicine isn't just a job, but when I'm in a system that is hellbent on a perfectionist ideal where anything less than perfect is crucified, where drs aren't respected (let alone junior doctors) and the EMR is the bane of my life, and it's a toxic work environment where I don't have the time to provide quality care, let alone the systemic constraints, and where I feel like there's so much low value or no value care on the one hand and toxic low quality cheapest-possible hospital care to offer people on the other... Where it's hard to feel like I'm doing good, though I try to remind myself that being a decent human being for patients to interact with is something...
When I feel burnt out, unappreciated, devalued, bullied by superiors... Then taking a day off for me is appealing. I'd love to have a sense of camaraderie, a sense of community, a sense that I was doing good, actually helping people like I wanted to do when I started med school... Then taking time out for me would be unthinkable. I'd be part of something bigger than me, something that nurtured me and valued me. For me the problem is a loss of morale and sense of moral injury, combined with the ever higher/more rigid standards expected of us, the loss of professional autonomy (here in Australia criticizing official COVID policy endangers your medical registration)...
Medicine used not to be just a job. Back when there were staff cafes, sleeping quarters at the hospital for drs who needed to catch a nap, and medicine was slower and more personal. That's why I did medicine. For a kind of practice that no longer exists. To offer slow medicine, relationship medicine, to be able to genuinely provide person centred care for patients who wanted it. I'd work myself damn hard if I could see myself providing quality care. But reality is it's not going to happen, society doesn't value me and my kind of medicine.
Treat junior doctors like they've got an important vocation, care for them, create community - and fake sick days will plummet. Treat us like commodities and don't be surprised when we prioritise our needs over our patients... Society needs to value us and look after us and then we'll look after you (our patients).
Why should I sacrifice myself for a system that doesn't value me and is just getting worse and worse? I did medicine to do things differently. Medicine has become just a job, and that's very sad. I'd love to have a vocation but that requires a system that values me and doesn't treat me as a cog in a healthcare industry. I wish medicine was a vocation, a calling, but nowadays it's just a job and we're cogs in a machine.
Being a decent human being for the patients is HUGE.
When my profession became a job to me, I knew it was time to retire.
Why is it so bad for it to be "just a job?" Is there something inherently bad with a job?
What's wrong with someone who is knowledgeable and competent at their profession, but prefers to do other things such as traveling, spending time with family, or enjoying other hobbies rather than live-and-breathe their profession 24/7?
What makes medicine unique in that it requires its professionals to sacrifice all other desires and goals in order to continue being a professional? Is everyone being hyperbolic and I'm misinterpreting it, or are you literally not allowed to have a vacation once in a while as a physician?
Rick M,
"What makes medicine unique in that it requires its professionals to sacrifice all other desires and goals in order to continue being a professional?
If you have to ask this question, it is a good thing you are not a physician. Or, are you? Because no one is saying you cannot have a life and practice good medicine. I and countless physicians like me are proof that you can. I have been married 42 years, have three children and six grandchildren, and love what I do. I plan to retire soon, after 45 years as a physician and 35 of those years in my current practice. I know I will miss it, but I have other interests and want to indulge them. However, we know that there are times when we will have to delay gratification in order to obtain the necessary training to practice safely and competently, and that there will be times when our personal needs and desires will have to take a back seat to the real medical needs of the patients that rely on us. Some day, when you are a patient and have a medical emergency you will understand this better. Do you want a physician who places their work/life balance ahead of you or someone who has dedicated themselves to being thoroughly trained and helping you through a medical crisis? I know what my answer is.
Rick
If it is so obvious why physicians must sacrifice so much in pursuit of their careers, then why not give an answer?
It sounds like you're saying there is not really any difference because all I've read from your response is that sometimes you have to delay gratification but you can still pursue other interests while you're a doctor. Sounds exactly like having a work/life balance.
In the past year I've had a medical emergency (flu, pneumonia, sepsis) that resulted in going to the ER, my father had a medical emergency (pneumonia) which led to his death, and all the doctors and staff were quite competent and caring. However, the time seeing them and speaking with them was extremely limited and it was always a surprise when they would show up and I was never able to contact the doctor directly with questions (there was always an intermediary). It seems like I'm supposed to have deference and treat doctors as though they are walking saints because of how much they sacrifice yet at the same time wanting to know when the doctor will show up, asking for appointments to be on-time, or even being able to ask a question directly to the doctor without having to have intermediaries fielding my questions is treated as unfair and out-of-bounds.
Your saying "just wait until you have a medical emergency" is the equivalent of a plumber telling you "just wait until your pipes burst". It's all irrelevant, we each have our specific skills and tasks to do. Most of us just do our jobs to the best of our ability without demanding respect from others.
If you don't get it with what I have already written, then you will have to find someone who can explain it better to you. Cue the line from Shawshank Redemption in which Andy Dufresne queries the Warden Norton, "How you can be so obtuse?" Peace out.........
Ah yes, the classic "this is so obvious I won't even bother answering it."
Make of it what you will. I will not respond to any more comments of yours on this thread..........................
Amen.
Frightening perspective.
I am a Gyn Oncologist and Ob/Gyn residents rotate with us(private practice/voluntary faculty). The number of vacation days/sick days/doctor appointments/advocacy days, etc. is staggering. Of a 20-30 day rotation(not many weekends with us) some residents are only on service actually 7-10 days. Scary to think that this is one of their primary surgical rotations. No wonder I do more and more benign Gyn surgery.