Attendings who keep their medical school students until 5pm

[prettylittlebird]

If there is something going on, I expect students, interns, residents etc to be here. If there isn't, I expect them to get the **** out of the hospital. Life is too short to hang out in the hospital for no reason. That having been said, if something is going on and you can't be found, you are not going to like your eval. It isn't exactly hard.

This is how things should be but sadly a lot of people don't feel this way. @sloop is getting a lot of hate but the gist what he's saying gets at the heart of what is wrong with medical training which is that you have a lot of burned out residents and attendings who perpetuate this unhealthy culture of overwork because it's something they had to go through. They may even believe that it helped them in their own training to be on long shifts and doing night calls as a medical student but the reality is that it's a waste of time for a student to be at the hospital if they aren't learning. They're a student, their job is to learn and they should be put in situations where educational opportunities will be provided for them. It helps no one for them to have to beg and badger to get to do a procedure or talk to a patient or be useful.

There's a reason why there's such a high rate of depression, suicide, alcohol abuse etc. among doctors and a lot of it (definitely not all, but a significant portion) has to do with work culture. I think it behooves us to think about how we can improve things rather than fall back on the old "I went through it and turned out great therefore this is the right way to do things" mantra

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[jdh71]

This is how things should be but sadly a lot of people don't feel this way. @sloop is getting a lot of hate but the gist what he's saying gets at the heart of what is wrong with medical training which is that you have a lot of burned out residents and attendings who perpetuate this unhealthy culture of overwork because it's something they had to go through. They may even believe that it helped them in their own training to be on long shifts and doing night calls as a medical student but the reality is that it's a waste of time for a student to be at the hospital if they aren't learning. They're a student, their job is to learn and they should be put in situations where educational opportunities will be provided for them. It helps no one for them to have to beg and badger to get to do a procedure or talk to a patient or be useful.

There's a reason why there's such a high rate of depression, suicide, alcohol abuse etc. among doctors and a lot of it (definitely not all, but a significant portion) has to do with work culture. I think it behooves us to think about how we can improve things rather than fall back on the old "I went through it and turned out great therefore this is the right way to do things" mantra

All the righteous indignation really misses what is actually happening though. @sloop and you are arguing against one big strawman. All the thrashing was beautiful to behold, and when you tackled him I giggled a bit, but no one, and I repeat, no one actually advocates working long hours because they worked long hours. You work long hours because it's not about you. This job is about patients. And taking care of patients can and will be inconvenient to nights, weekends, holidays, birthday parties, and basketball games. Cancer, sepsis, heart attacks, acute cholecystitis, etc. don't respect your lifestyle boundaries. So if you're signing up to do this, you're signing up to work long hours because that's the job. It's like complaining that being a cop or marine is "dangerous". JFC. Were you even paying attention when you did all that shadowing you said you did when you applied??

Now, all of that doesn't mean you are somehow obligated to literally kill yourself for others. None of us exist specifically for the mere existence of others only. We do get to have lives. You do get to set healthy work boundaries. But this isn't a normal job and we are not tasked with doing normal things. This is the job. Those long hours are what you do to do it correctly for people that are counting on you to do it correctly. If you can't handle this side of the arrangement maybe you're in the wrong place and training to do the wrong thing. It's not about you. It's about them.

 

[Cytarabine]

All the righteous indignation really misses what is actually happening though. @sloop and you are arguing against one big strawman. All the thrashing was beautiful to behold, and when you tackled him I giggled a bit, but no one, and I repeat, no one actually advocates working long hours because they worked long hours. You work long hours because it's not about you. This job is about patients. And taking care of patients can and will be inconvenient to nights, weekends, holidays, birthday parties, and basketball games. Cancer, sepsis, heart attacks, acute cholecystitis, etc. don't respect your lifestyle boundaries. So if you're signing up to do this, you're signing up to work long hours because that's the job. It's like complaining that being a cop or marine is "dangerous". JFC. Were you even paying attention when you did all that shadowing you said you did when you applied??

Now, all of that doesn't mean you are somehow obligated to literally kill yourself for others. None of us exist specifically for the mere existence of others only. We do get to have lives. You do get to set healthy work boundaries. But this isn't a normal job and we are not tasked with doing normal things. This is the job. Those long hours are what you do to do it correctly for people that are counting on you to do it correctly. If you can't handle this side of the arrangement maybe you're in the wrong place and training to do the wrong thing. It's not about you. It's about them.

On an away rotation, staff complained to me about students at the home institution who would tell staff they're no longer going to follow a patient because they didn't feel it was educational. Strong sense of patient ownership

 

[IlDestriero]

On an away rotation, staff complained to me about students at the home institution who would tell staff they're no longer going to follow a patient because they didn't feel it was educational. Strong sense of patient ownership

Hahahaha. That's straight to pass at best.
You don't have to do much, but expect your evaluation to reflect your interest.


--
Il Destriero

 

[sloop]

All the righteous indignation really misses what is actually happening though. @sloop and you are arguing against one big strawman. All the thrashing was beautiful to behold, and when you tackled him I giggled a bit, but no one, and I repeat, no one actually advocates working long hours because they worked long hours. You work long hours because it's not about you. This job is about patients. And taking care of patients can and will be inconvenient to nights, weekends, holidays, birthday parties, and basketball games. Cancer, sepsis, heart attacks, acute cholecystitis, etc. don't respect your lifestyle boundaries. So if you're signing up to do this, you're signing up to work long hours because that's the job. It's like complaining that being a cop or marine is "dangerous". JFC. Were you even paying attention when you did all that shadowing you said you did when you applied??

Now, all of that doesn't mean you are somehow obligated to literally kill yourself for others. None of us exist specifically for the mere existence of others only. We do get to have lives. You do get to set healthy work boundaries. But this isn't a normal job and we are not tasked with doing normal things. This is the job. Those long hours are what you do to do it correctly for people that are counting on you to do it correctly. If you can't handle this side of the arrangement maybe you're in the wrong place and training to do the wrong thing. It's not about you. It's about them.

Oh, stop. You're misstating my position. I don't think that people often explicitly make the argument that med students should stay late because they had to. I'm saying that I think this is fundamentally the reason why they end up making them stay late much of the time. I don't think parents who use abusive forms of punishment on their kids are usually making the explicit argument that it's right simply because it happened to them—they make some ****ty rationalizing argument about how it made them a better person.

Not everybody goes into medicine intending to work terrible hours. It is not unrealistic to plan on going into a field like psych, derm, or some others because you want to work fairly normal hours. Everybody has limits on how much they want to work in comparison to how much free time they have. Not everyone is going into general surgery, IM, OB/GYN, or whatever. The idea that one is signing up for the job of a surgeon or a hospitalist by going to medical school is completely dumb.

As a result of the point above, the goal of a clerkship is not to train someone to be a surgeon, hospitalist, obstetrician, etc. It's to teach medical students the broadly relevant basics of medical/surgical management, knowledge of which is expected of medical school graduates. This brings me back to my point from earlier—if the experience is not educational, there is no justification for keeping the med student there.

Regarding @Cytarabine, I have encountered both philosophies on medical student rotations. I've been told before that I should keep following/writing notes on a patient until they are discharged. I've also been told on other rotations to stop seeing patients because they are no longer educational. Both of these have been things attendings and residents have told me to do. Whatever they tell me, I do. If I'm not explicitly told, I try to get a feel for the general vibe of the rotation and do what I think I'm expected to. That said, I think it's dumb for med students to follow patients when it's clearly not an educational experience anymore. I've done this and it's terrible. You can spend an entire 6 wk rotation writing "continue metoprolol, discharge to hospice pending X" for the barely responsive post-stroke patient down the hall who has disputed power of attorney, etc. I know because I've done this. Med student notes are (supposedly at least) purely educational. They are not there for medico-legal documentation and informing patient care like resident notes. So, while it might make sense for a resident to write this note every day, it doesn't make sense for a med student to.

 

[jdh71]

Oh, stop. You're misstating my position. I don't think that people often explicitly make the argument that med students should stay late because they had to. I'm saying that I think this is fundamentally the reason why they end up making them stay late much of the time. I don't think parents who use abusive forms of punishment on their kids are usually making the explicit argument that it's right simply because it happened to them—they make some ****ty rationalizing argument about how it made them a better person.

Not everybody goes into medicine intending to work terrible hours. It is not unrealistic to plan on going into a field like psych, derm, or some others because you want to work fairly normal hours. Everybody has limits on how much they want to work in comparison to how much free time they have. Not everyone is going into general surgery, IM, OB/GYN, or whatever. The idea that one is signing up for the job of a surgeon or a hospitalist by going to medical school is completely dumb.

As a result of the point above, the goal of a clerkship is not to train someone to be a surgeon, hospitalist, obstetrician, etc. It's to teach medical students the broadly relevant basics of medical/surgical management, knowledge of which is expected of medical school graduates. This brings me back to my point from earlier—if the experience is not educational, there is no justification for keeping the med student there.

Regarding @Cytarabine, I have encountered both philosophies on medical student rotations. I've been told before that I should keep following/writing notes on a patient until they are discharged. I've also been told on other rotations to stop seeing patients because they are no longer educational. Both of these have been things attendings and residents have told me to do. Whatever they tell me, I do. If I'm not explicitly told, I try to get a feel for the general vibe of the rotation and do what I think I'm expected to. That said, I think it's dumb for med students to follow patients when it's clearly not an educational experience anymore. I've done this and it's terrible. You can spend an entire 6 wk rotation writing "continue metoprolol, discharge to hospice pending X" for the barely responsive post-stroke patient down the hall who has disputed power of attorney, etc. I know because I've done this. Med student notes are (supposedly at least) purely educational. They are not there for medico-legal documentation and informing patient care like resident notes. So, while it might make sense for a resident to write this note every day, it doesn't make sense for a med student to.

The reason the hours are long is because the hours are long. No one argues that the hours make you a better physician. You're not better. It's just the job. Maybe the important point is to understand those long hours even if all you are doing is being available in case a patient does need you. There is some education in that. And maybe you need to learn how to best make use of your time during down time?

 

[sloop]

The reason the hours are long is because the hours are long. No one argues that the hours make you a better physician. You're not better. It's just the job. Maybe the important point is to understand those long hours even if all you are doing is being available in case a patient does need you. There is some education in that. And maybe you need to learn how to best make use of your time during down time?

I really think these are all rationalizations. Again, take psych for instance. The hours in psych are not that intense. They certainly don't have to be as an attending. From what I've seen, they're not all that bad for PGY-3/4s either (the places I have seen, PGY-3 is mostly outpatient psych and PGY-4 is mostly elective time. At best you are "conditioning" such a medical student for the hours they'll face for a couple of years.

Of course there's the aspect of being around in case a patient needs you, but I honestly don't think most people in medical school are unaware of this. I don't think that without long hours in med school, doctors on call would respond to pages with "I don't care if the patient's dying, I'll round on them in the morgue tomorrow!"

And again, not everybody is going into IM or surgery. Different fields have different propensities for having these sorts of unscheduled "patient needs you, you have to be here no matter what" scenarios. Psych and derm both have pretty low instances of this. I've almost never seen an attending shrink in the hospital in the middle of the night. There are actually relatively few situations which might warrant this. They can happen, but you're definitely overstating it by saying "hey, these long hours are part of the job, so better get used to it." They're not part of the job for every specialty (outside of maybe the first one or two years of residency).

 

[jdh71]

I really think these are all rationalizations. Again, take psych for instance. The hours in psych are not that intense. They certainly don't have to be as an attending. From what I've seen, they're not all that bad for PGY-3/4s either (the places I have seen, PGY-3 is mostly outpatient psych and PGY-4 is mostly elective time. At best you are "conditioning" such a medical student for the hours they'll face for a couple of years.

Of course there's the aspect of being around in case a patient needs you, but I honestly don't think most people in medical school are unaware of this. I don't think that without long hours in med school, doctors on call would respond to pages with "I don't care if the patient's dying, I'll round on them in the morgue tomorrow!"

And again, not everybody is going into IM or surgery. Different fields have different propensities for having these sorts of unscheduled "patient needs you, you have to be here no matter what" scenarios. Psych and derm both have pretty low instances of this. I've almost never seen an attending shrink in the hospital in the middle of the night. There are actually relatively few situations which might warrant this. They can happen, but you're definitely overstating it by saying "hey, these long hours are part of the job, so better get used to it." They're not part of the job for every specialty (outside of maybe the first one or two years of residency).

Not rationalization. Reality. Maybe it's sinking in and you'd like it to be different? Even psych and derm will be dealing with horse**** way longer than they would like. Medicine isn't a 9-5 job with clean cut breaks even for the lightest hour specialties.

 

[VA Hopeful Dr]

I really think these are all rationalizations. Again, take psych for instance. The hours in psych are not that intense. They certainly don't have to be as an attending. From what I've seen, they're not all that bad for PGY-3/4s either (the places I have seen, PGY-3 is mostly outpatient psych and PGY-4 is mostly elective time. At best you are "conditioning" such a medical student for the hours they'll face for a couple of years.

Of course there's the aspect of being around in case a patient needs you, but I honestly don't think most people in medical school are unaware of this. I don't think that without long hours in med school, doctors on call would respond to pages with "I don't care if the patient's dying, I'll round on them in the morgue tomorrow!"

And again, not everybody is going into IM or surgery. Different fields have different propensities for having these sorts of unscheduled "patient needs you, you have to be here no matter what" scenarios. Psych and derm both have pretty low instances of this. I've almost never seen an attending shrink in the hospital in the middle of the night. There are actually relatively few situations which might warrant this. They can happen, but you're definitely overstating it by saying "hey, these long hours are part of the job, so better get used to it." They're not part of the job for every specialty (outside of maybe the first one or two years of residency).

A) Very few 1st/2nd year med students accurately pick their specialty B) Even psych often ends up having to work longer hours when the patients require it. In residency we called in derm at 2am for what we thought was Stevens-Johnson, she showed up. Granted she said it was the first time she'd been in the ICU since residency, but she showed up like you're supposed to do.

 

[Cytarabine]

Hahahaha. That's straight to pass at best.
You don't have to do much, but expect your evaluation to reflect your interest.


--
Il Destriero

Not here, not giving students honors is an administrative headache apparently

 

[Cytarabine]

Oh, stop. You're misstating my position. I don't think that people often explicitly make the argument that med students should stay late because they had to. I'm saying that I think this is fundamentally the reason why they end up making them stay late much of the time. I don't think parents who use abusive forms of punishment on their kids are usually making the explicit argument that it's right simply because it happened to them—they make some ****ty rationalizing argument about how it made them a better person.

Not everybody goes into medicine intending to work terrible hours. It is not unrealistic to plan on going into a field like psych, derm, or some others because you want to work fairly normal hours. Everybody has limits on how much they want to work in comparison to how much free time they have. Not everyone is going into general surgery, IM, OB/GYN, or whatever. The idea that one is signing up for the job of a surgeon or a hospitalist by going to medical school is completely dumb.

As a result of the point above, the goal of a clerkship is not to train someone to be a surgeon, hospitalist, obstetrician, etc. It's to teach medical students the broadly relevant basics of medical/surgical management, knowledge of which is expected of medical school graduates. This brings me back to my point from earlier—if the experience is not educational, there is no justification for keeping the med student there.

Regarding @Cytarabine, I have encountered both philosophies on medical student rotations. I've been told before that I should keep following/writing notes on a patient until they are discharged. I've also been told on other rotations to stop seeing patients because they are no longer educational. Both of these have been things attendings and residents have told me to do. Whatever they tell me, I do. If I'm not explicitly told, I try to get a feel for the general vibe of the rotation and do what I think I'm expected to. That said, I think it's dumb for med students to follow patients when it's clearly not an educational experience anymore. I've done this and it's terrible. You can spend an entire 6 wk rotation writing "continue metoprolol, discharge to hospice pending X" for the barely responsive post-stroke patient down the hall who has disputed power of attorney, etc. I know because I've done this. Med student notes are (supposedly at least) purely educational. They are not there for medico-legal documentation and informing patient care like resident notes. So, while it might make sense for a resident to write this note every day, it doesn't make sense for a med student to.

To make clear, these are students telling staff of their own initiative. That's presumptuous at best for a student to tell staff they know a patient holds no more learning potential, disregarding the patient ownership aspect. I'm fine with staff or a resident letting a student have a chance to drop a neurovegetative brick

 

[Mass Effect]

This is how things should be but sadly a lot of people don't feel this way. @sloop is getting a lot of hate but the gist what he's saying gets at the heart of what is wrong with medical training which is that you have a lot of burned out residents and attendings who perpetuate this unhealthy culture of overwork because it's something they had to go through. They may even believe that it helped them in their own training to be on long shifts and doing night calls as a medical student but the reality is that it's a waste of time for a student to be at the hospital if they aren't learning. They're a student, their job is to learn and they should be put in situations where educational opportunities will be provided for them. It helps no one for them to have to beg and badger to get to do a procedure or talk to a patient or be useful.

There's a reason why there's such a high rate of depression, suicide, alcohol abuse etc. among doctors and a lot of it (definitely not all, but a significant portion) has to do with work culture. I think it behooves us to think about how we can improve things rather than fall back on the old "I went through it and turned out great therefore this is the right way to do things" mantra

Wait, what? In what universe is staying at work until 5 p.m. considered unhealthy???

 

[Mass Effect]

I really think these are all rationalizations. Again, take psych for instance. The hours in psych are not that intense. They certainly don't have to be as an attending. From what I've seen, they're not all that bad for PGY-3/4s either (the places I have seen, PGY-3 is mostly outpatient psych and PGY-4 is mostly elective time. At best you are "conditioning" such a medical student for the hours they'll face for a couple of years.

Of course there's the aspect of being around in case a patient needs you, but I honestly don't think most people in medical school are unaware of this. I don't think that without long hours in med school, doctors on call would respond to pages with "I don't care if the patient's dying, I'll round on them in the morgue tomorrow!"

And again, not everybody is going into IM or surgery. Different fields have different propensities for having these sorts of unscheduled "patient needs you, you have to be here no matter what" scenarios. Psych and derm both have pretty low instances of this. I've almost never seen an attending shrink in the hospital in the middle of the night. There are actually relatively few situations which might warrant this. They can happen, but you're definitely overstating it by saying "hey, these long hours are part of the job, so better get used to it." They're not part of the job for every specialty (outside of maybe the first one or two years of residency).

Except that even psych requires 24-hour call and/or nightfloat and 12-hour shifts.

 

[sloop]

Except that even psych requires 24-hour call and/or nightfloat and 12-hour shifts.

Yes, I realize this. I'm not discounting that. I'm just saying that it's not like "hey you realized what you were getting into" when a good number of psych attendings do not take call or have entirely outpatient practices.

I'm not saying that there are specialties where things are awesome all the time and you'll never have long days. I'm just saying that this is not the every day reality in every field. If you seriously think medicine necessarily involves long hours no matter what field you go into, you obviously don't have much experience with different fields of medicine. A 12 hour workday would be a long day for your average attending psychiatrist.

Training is only a few years. These people are trying to say the long hours are a way of life we chose by going to med school. This is clearly not the case for everyone.

My argument was that specialties where you're going from like 4 or 5 in the morning to 5 PM don't really leave real time for any sort of life when you factor in all the necessary stuff you have to do in a day. In that sense, unless you are a very special kind of person who is entirely sustained by work, it's an unhealthy existence.

There's a big difference between a 9 to 5 job and a 4 to 5 job.

 

[IM88]

There's a big difference between a 9 to 5 job and a 4 to 5 job.

I don't think anyone disagrees with this statement. Your psychiatry argument seems to be a strawman, though, in that medical school isn't designed to train psychiatrists (or internists, or surgeons, or dermatologists, etc.). I'd argue the goal is to prepare students to become competent physicians, regardless of their specialty. Sure, some clerkships aren't set up to make efficient use of student's time, and I think that should be addressed. To argue that 3-6 months of ~12 hour days is an "unhealthy existence," though, seems a bit hyperbolic. If you use that time wisely, with the mentality that there is always something to learn, it will pay dividends in the future. People will respect that you know how to call consults with relevant clinical questions, or provide a concise sign-out, or efficiently evaluate patients - these skills only come with experience. Until there are effective competency-based evaluation systems in medical school, time is a pretty good proxy for experience.

 

[sloop]

I don't think anyone disagrees with this statement. Your psychiatry argument seems to be a strawman, though, in that medical school isn't designed to train psychiatrists (or internists, or surgeons, or dermatologists, etc.). I'd argue the goal is to prepare students to become competent physicians, regardless of their specialty. Sure, some clerkships aren't set up to make efficient use of student's time, and I think that should be addressed. To argue that 3-6 months of ~12 hour days is an "unhealthy existence," though, seems a bit hyperbolic. If you use that time wisely, with the mentality that there is always something to learn, it will pay dividends in the future. People will respect that you know how to call consults with relevant clinical questions, or provide a concise sign-out, or efficiently evaluate patients - these skills only come with experience. Until there are effective competency-based evaluation systems in medical school, time is a pretty good proxy for experience.

I don't think it's healthy to work that much. I'm sorry, but I think that human beings are more than just things that work. I think people need time during the day to be themselves, decompress, have hobbies and interests, and spend time with loved ones. When I'm at the hospital that long, I feel like my conversations with my significant other always have pressing time constraints on them and become more shallow. I don't have time for other things I enjoy. I start to get irritated when my parents want to talk on the phone for too long or habitually call when I'm eating (one of the few times during the day that I would set aside for myself to relax alone). This was substantially better on psych where I really loved what I was doing (and yes, I did wind up with a couple of very long days/weeks on my psych rotation), but it still isn't good and I don't think it's healthy, particularly if sustained. I'll deal with it to get to the ends I want, but it's not a healthy lifestyle for me and I don't think I'm that unusual.

 

[cbrons]

My problem is that there are just too many rotations in M3/M4 when you do literally nothing but sit around. They've made it so medicolegally (and economically, for your preceptors), its virtually impossible for you to do little more than shadow like a pre-med student. That's the most depressing part to me about medical school... that the vast majority of it is a criminal waste of time.

 

[jdh71]

I don't think it's healthy to work that much. I'm sorry, but I think that human beings are more than just things that work. I think people need time during the day to be themselves, decompress, have hobbies and interests, and spend time with loved ones. When I'm at the hospital that long, I feel like my conversations with my significant other always have pressing time constraints on them and become more shallow. I don't have time for other things I enjoy. I start to get irritated when my parents want to talk on the phone for too long or habitually call when I'm eating (one of the few times during the day that I would set aside for myself to relax alone). This was substantially better on psych where I really loved what I was doing (and yes, I did wind up with a couple of very long days/weeks on my psych rotation), but it still isn't good and I don't think it's healthy, particularly if sustained. I'll deal with it to get to the ends I want, but it's not a healthy lifestyle for me and I don't think I'm that unusual.

Sounds like you picked the wrong profession.

 

[Hangry]

I don't think it's healthy to work that much. I'm sorry, but I think that human beings are more than just things that work. I think people need time during the day to be themselves, decompress, have hobbies and interests, and spend time with loved ones. When I'm at the hospital that long, I feel like my conversations with my significant other always have pressing time constraints on them and become more shallow. I don't have time for other things I enjoy. I start to get irritated when my parents want to talk on the phone for too long or habitually call when I'm eating (one of the few times during the day that I would set aside for myself to relax alone). This was substantially better on psych where I really loved what I was doing (and yes, I did wind up with a couple of very long days/weeks on my psych rotation), but it still isn't good and I don't think it's healthy, particularly if sustained. I'll deal with it to get to the ends I want, but it's not a healthy lifestyle for me and I don't think I'm that unusual.

We get it, you need a chill lifestyle. Not everyone needs that, and more relevantly, not every field in medicine has that. Third year is about more than just teaching students "broadly relevant basics of medical/surgical management", but about exposing them to a variety of careers they are going to be choosing for the rest of their lives. These careers come with certain demands, and without adequate exposure to those demands students cannot make an informed choice about their future careers. Not everyone came into third year like you, dead set on a career already.

Would it be a good idea for a fresh third year to work cush hours on surgery, realize they really enjoy it, then go to residency and get slammed and realize they had no idea what they were getting into? Of course not. As you said above, training is only a few years of your life (and in the case of third year, only a few months of your life). Suck it up and get through it like everyone else. Trust me, we didn't all love our mandatory psych rotation. That was more painful than surgery or obgyn for me. Granted, at least I had better hours on the rotations I was miserable in, but remember that on the other hand you will be working fairly chill hours for a shorter residency compared your classmates that love surgery, and maybe that will help you get through your hellish 8 weeks of staying until 5 pm..

 

[Señor S]

My problem is that there are just too many rotations in M3/M4 when you do literally nothing but sit around. They've made it so medicolegally (and economically, for your preceptors), its virtually impossible for you to do little more than shadow like a pre-med student. That's the most depressing part to me about medical school... that the vast majority of it is a criminal waste of time.

Very much agree, and anedotally I think there has been a big shift this way even in the past few (say, 5-10) years, nevermind what things were like a few decades ago.

Would it be a good idea for a fresh third year to work cush hours on surgery, realize they really enjoy it, then go to residency and get slammed and realize they had no idea what they were getting into?

This is probably the best argument for longer hours as a third year, but I still don't know having to stay until 5 PM watching people write notes is useful.

 

[Zebra Hunter]

Not rationalization. Reality. Maybe it's sinking in and you'd like it to be different? Even psych and derm will be dealing with horse**** way longer than they would like. Medicine isn't a 9-5 job with clean cut breaks even for the lightest hour specialties.

This is an incredibly weak argument for advocating sticking around the hospital when all work is done as a medical student. I don't think you actually appreciate how uneventful afternoons are for a medical student on IM in 2016, hell, they are pretty uneventful for residents, too, at least in the 1 month I was required to do an IM rotation. As a resident, I actually have work to do and things to accomplish, so it is pretty easy for me to work 12 hours straight, seeing 2 patients per hour and not complain or bat an eye. How would you like it if hospital administration required you to sit in a room watching your residents write notes, call consults, and speak with nurses for 2-4 hours after all of your work was done for the day?

I doubt most of the medical students complaining on this thread will have issue transitioning to the hours once they are in residency. I complained about the exact same things in medical school, and I have no issue handling the workload in residency, and I actually love the work I do. Their complaints are valid and I don't think they should be cast aside as whining from lazy medical students as many are doing in this thread.

 

[jdh71]

This is an incredibly weak argument for advocating sticking around the hospital when all work is done as a medical student. I don't think you actually appreciate how uneventful afternoons are for a medical student on IM in 2016, hell, they are pretty uneventful for residents, too, at least in the 1 month I was required to do an IM rotation. As a resident, I actually have work to do and things to accomplish, so it is pretty easy for me to work 12 hours straight, seeing 2 patients per hour and not complain or bat an eye. How would you like it if hospital administration required you to sit in a room watching your residents write notes, call consults, and speak with nurses for 2-4 hours after all of your work was done for the day?

I doubt most of the medical students complaining on this thread will have issue transitioning to the hours once they are in residency. I complained about the exact same things in medical school, and I have no issue handling the workload in residency, and I actually love the work I do. Their complaints are valid and I don't think they should be cast aside as whining from lazy medical students as many are doing in this thread.

Oh yes. I don't appreciate it because . . . . . I was never a medical student? Are you drunk?

 

[Zebra Hunter]

Oh yes. I don't appreciate it because . . . . . I was never a medical student? Are you drunk?

I see you glossed over the 2016 part. There is a significant difference in clinical medical education now from even 10 years ago.

 

[jdh71]

I see you glossed over the 2016 part. There is a significant difference in clinical medical education now from even 10 years ago.

I doubt it.

 

[jdh71]

JFC. Now it's special pleading because today's medical students are so much more special with regards to how bad it can be as a student? Did I just enter bizzaro world?

 

[Cytarabine]

JFC. Now it's special pleading because today's medical students are so much more special with regards to how bad it can be as a student? Did I just enter bizzaro world?

I don't think his point was that it's bad in the sense of brutal hours. More so bad in the sense of less opportunity to "do", though I think that's bled up past UME

 

[jdh71]

I don't think his point was that it's bad in the sense of brutal hours. More so bad in the sense of less opportunity to "do", though I think that's bled up past UME

I was a Med student 10 years ago. I wasn't doing bedside thoracotomies either.

 

[Cytarabine]

I was a Med student 10 years ago. I wasn't doing bedside thoracotomies either.

Central line? LP? Para? Thora?

 

[prettylittlebird]

Wait, what? In what universe is staying at work until 5 p.m. considered unhealthy???

I think you're confused, that's not what I said at all. I was quoting mimelim saying he had the right attitude about medical training. Staying at work until 5 pm is normal however staying in clinic past the time of usefulness serves no purpose for a student who is there to learn. That was my main point

 

[jdh71]

Central line? LP? Para? Thora?

I did get a single para. And 5 or 6 intubations but that was about it. Some suturing.

 

[Zebra Hunter]

I doubt it.

How many central lines, IVs, A-lines did you place as a med student? How many patients would you cover in a day in medical school? Did your notes matter?

Just a few simple things that have changed due to either EMR, liability concerns, and just change in medical school culture.

JFC. Now it's special pleading because today's medical students are so much more special with regards to how bad it can be as a student? Did I just enter bizzaro world?

No, you are just overly dramatizing the issues presented to you. You should try to relax and think about it rationally. What is the benefit of having a medical student stay when all work is done and there are no lectures? Is there a benefit to the team? Of course not. Is there a benefit to the student? Well the only benefit you brought up is so that they know what the hours are like on the job, which is a painfully weak argument. Most medical students are already familiar with putting in long hours studying.

 

[jdh71]

How many central lines, IVs, A-lines did you place as a med student? How many patients would you cover in a day in medical school? Did your notes matter?

Just a few simple things that have changed due to either EMR, liability concerns, and just change in medical school culture.


No, you are just overly dramatizing the issues presented to you. You should try to relax and think about it rationally. What is the benefit of having a medical student stay when all work is done and their are no lectures? Is there a benefit to the team? Of course not. Is there a benefit to the student? Well the only benefit you brought up is so that they know what the hours are like on the job, which is a painfully weak argument. Most medical students are already familiar with putting in long hours studying.

Studying isn't working. And being available to see patients even when nothing is currently going on is part of the job in most of the big fields we rotate through and even a big part of the job on electives through subspecialty rotations.

 

[Cytarabine]

I did get a single para. And 5 or 6 intubations but that was about it. Some suturing.

That isn't outside the realm of what's possible to get today (though I did not despite desiring to), so your experience may be similar to today. Did get to bovie/first assist on a couple ex laps. 10-15 years ago at my institution was considerably more hands on though. I suppose there's institutional variability there in addition to change over time. It feels a lot better when what you do counts for something, even if it's doing the first draft of discharge summaries for the interns

 

[jdh71]

That isn't outside the realm of what's possible to get today (though I did not despite desiring to), so your experience may be similar to today. Did get to bovie/first assist on a couple ex laps. 10-15 years ago at my institution was considerably more hands on though. I suppose there's institutional variability there in addition to change over time. It feels a lot better when what you do counts for something, even if it's doing the first draft of discharge summaries for the interns

I understand the emotional argument. And yes it would be nice if medical students mattered more. But for factors out of all of our hands they can't. So the answer is then to further limit exposure? Just send everyone home when there is still people working even if it is merely being available in case they are needed for an admit, consult, or procedure?? That doesn't make any sense when a lot of what many of us do occurs outside of business hours.

 

[Cytarabine]

I understand the emotional argument. And yes it would be nice if medical students mattered more. But for factors out of all of our hands they can't. So the answer is then to further limit exposure? Just send everyone home when there is still people working even if it is merely being available in case they are needed for an admit, consult, or procedure?? That doesn't make any sense when a lot of what many of us do occurs outside of business hours.

I don't expect you to keep track of the various posters in this thread, but I haven't made that argument. If you're on let's say medicine or peds wards though, and your team admits q4, after morning rounds on off days what's the yield in keeping students around routinely? They get to see calls fielded from nurses, they might see a couple consults get called in, they see handoff, and they see the flow of the day. Less frequently, there might be a planned event (goals of care / end of life discussion) or unplanned event (change in patient status, step up to icu, or code). But should students routinely be staying til 6 or 7 pm for these things instead of peacing out in the early afternoon? I'm asking genuinely. I have no stake in this other than my own interest in giving my students a good educational experience. This is all service dependent, but on a relatively slow service I think I'm going to have a tendency to cut students loose if I have that flexibility as an intern

 

[Zebra Hunter]

Studying isn't working. And being available to see patients even when nothing is currently going on is part of the job in most of the big fields we rotate through and even a big part of the job on electives through subspecialty rotations.

I disagree, I would absolutely classify studying under the incredibly vague definition of "work", except I'd much rather work than study. Putting in 8-10 hours of studying in a day, for me, is a lot harder than working a busy ER shift. I enjoy the latter, I despise the former, however both are mentally exhausting. If your point is that students don't truly understand what it is like to work on the wards if they are leaving early, you can blame that on the issues I have already brought up for the reasons why med students are deprived of the experiences had by med students 30 years ago more so than leaving early.

Sure being available is part of the job of many fields, but most experience this on their call days. Do you believe the educational opportunities of being available every day when nothing else is going on are significant enough to warrant this over once every 3-4 days?

Also, when you talk about students being available for procedures, it seems like you are coming at this from the perspective of someone in a field where this is not an uncommon occurrence (probably trauma attending or CC) which is probably what is biasing your opinion of leaving early. Unanticipated procedures performed on the medicine wards are fairly uncommon on a given month.

 

[jdh71]

I don't expect you to keep track of the various posters in this thread, but I haven't made that argument. If you're on let's say medicine or peds wards though, and your team admits q4, after morning rounds on off days what's the yield in keeping students around routinely? They get to see calls fielded from nurses, they might see a couple consults get called in, they see handoff, and they see the flow of the day. Less frequently, there might be a planned event (goals of care / end of life discussion) or unplanned event (change in patient status, step up to icu, or code). But should students routinely be staying til 6 or 7 pm for these things instead of peacing out in the early afternoon? I'm asking genuinely. I have no stake in this other than my own interest in giving my students a good educational experience. This is all service dependent, but on a relatively slow service I think I'm going to have a tendency to cut students loose if I have that flexibility as an intern

If there is work to be done students should be part of it. Peacing out in the early afternoon rarely happens but if you're leaving so should the student.

 

[jdh71]

I disagree, I would absolutely classify studying under the incredibly vague definition of "work", except I'd much rather work than study. Putting in 8-10 hours of studying in a day, for me, is a lot harder than working a busy ER shift. I enjoy the latter, I despise the former, however both are mentally exhausting. If your point is that students don't truly understand what it is like to work on the wards if they are leaving early, you can blame that on the issues I have already brought up for the reasons why med students are deprived of the experiences had by med students 30 years ago more so than leaving early.

Sure being available is part of the job of many fields, but most experience this on their call days. Do you believe the educational opportunities of being available every day when nothing else is going on are significant enough to warrant this over once every 3-4 days?

Also, when you talk about students being available for procedures, it seems like you are coming at this from the perspective of someone in a field where this is not an uncommon occurrence (probably trauma attending or CC) which is probably what is biasing your opinion of leaving early. Unanticipated procedures performed on the medicine wards are fairly uncommon on a given month.

When the team is working so should the student. None of us work just on "call" days.

 

[prettylittlebird]

I understand the emotional argument. And yes it would be nice if medical students mattered more. But for factors out of all of our hands they can't. So the answer is then to further limit exposure? Just send everyone home when there is still people working even if it is merely being available in case they are needed for an admit, consult, or procedure?? That doesn't make any sense when a lot of what many of us do occurs outside of business hours.

Your argument continually seems to be: this is the way it is there's nothing we can do about it and everyone needs to get on board. You also seem to believe it necessary to treat students like they're residents but that's not the point of being a medical student. We're not all saying "send everyone home" but a student is in a different category from a resident (as another resident on this thread mentioned previously when he said he always has something to do to fill his time but it's not so for students). I think what I personally would advocate for is a better system for everyone (this would include residents and attending physicians). It appears you are in a demanding specialty and that has colored your opinion in a significant way but I don't think the answer should ever be "it's this way and if you don't like it you shouldn't go into medicine." You're not the only one who feels that practicing medicine has to be this extreme sport and if you aren't dedicated to being overworked you're not cut out for it" but you also have to realize that there are plenty of physicians who feel very differently and strive to create a better working environment for others. There are lots of changes being made in medicine right now and I don't think there's anything wrong with supporting positive changes for everyone, not just medical students.

 

[jdh71]

Your argument continually seems to be: this is the way it is there's nothing we can do about it and everyone needs to get on board. You also seem to believe it necessary to treat students like they're residents but that's not the point of being a medical student. We're not all saying "send everyone home" but a student is in a different category from a resident (as another resident on this thread mentioned previously when he said he always has something to do to fill his time but it's not so for students). I think what I personally would advocate for is a better system for everyone (this would include residents and attending physicians). It appears you are in a demanding specialty and that has colored your opinion in a significant way but I don't think the answer should ever be "it's this way and if you don't like it you shouldn't go into medicine." You're not the only one who feels that practicing medicine has to be this extreme sport and if you aren't dedicated to being overworked you're not cut out for it" but you also have to realize that there are plenty of physicians who feel very differently and strive to create a better working environment for others. There are lots of changes being made in medicine right now and I don't think there's anything wrong with supporting positive changes for everyone, not just medical students.

What I don't think you are quite understanding is that this isn't about "feeling" a certain way, nor is it about any bravado associated with "extreme sport medicine". Medicine REQUIRES you to overwork most of the time regardless of field or subspecialty. Some will have more of this and some less, but you don't get to just "shut it off" and pretend that patients don't exist at a specified time every day. And I'm not even talking just about emergencies or urgencies. You are signing up for a job that WILL require more of you than you will find convenient most days. I don't care if you're a dermatologist, an ophthalmologist, or an psychiatrist. We do this to take care of patients and if you're actually taking care of patients it will mean doing extra, being extra, spending extra. It doesn't matter how I or you "feel" about it. "Feel" into one hand and crap into the other, let me know which fills up faster. I'm currently at work today on my "day off" doing a couple of procedures because it's the right thing to do to give people a diagnosis of the mass in their lungs today then wait two weeks when it would simply be convenient in my schedule. I'm not required to work to death. I don't exist solely for my patients. I do, however, have a real responsibility to them first and me second in most reasonable scenarios. It's not about me. This job isn't about me. It's a sweet gig and I get paid very well to do this, but at the end of the day it's about them.

And yes I do have a busy ICU and pulmonary practice. I do keep my students around during the day in the ICU in case there are learning opportunities. There is value to them in the form of them writing their notes even if I can't bill from them. The note is arguably the most important thing you will ever learn in medical school - there is so much nuance there you could drive a truck through it. Bad notes (which doesn't mean long) make for bad patient care and communication with your colleagues. When there is down time they need to be available for when things can and do happen. They can read and study until I cut them loose. Hell. They can watch freaking Netflix on an ipad for all I care as long as they are there to learn when the opportunities occur. With that said I often enough do send students and resident out early, especially if they have been working hard. I do not make student stay late in clinic if the day is done and it's just me and finishing the notes. Those are exceptions though.

 

[prettylittlebird]

What I don't think you are quite understanding is that this isn't about "feeling" a certain way, nor is it about any bravado associated with "extreme sport medicine". Medicine REQUIRES you to overwork most of the time regardless of field or subspecialty. Some will have more of this and some less, but you don't get to just "shut it off" and pretend that patients don't exist at a specified time every day. And I'm not even talking just about emergencies or urgencies. You are signing up for a job that WILL require more of you than you will find convenient most days. I don't care if you're a dermatologist, an ophthalmologist, or an psychiatrist. We do this to take care of patients and if you're actually taking care of patients it will mean doing extra, being extra, spending extra. It doesn't matter how I or you "feel" about it. "Feel" into one hand and crap into the other, let me know which fills up faster. I'm currently at work today on my "day off" doing a couple of procedures because it's the right thing to do to give people a diagnosis of the mass in their lungs today then wait two weeks when it would simply be convenient in my schedule. I'm not required to work to death. I don't exist solely for my patients. I do, however, have a real responsibility to them first and me second in most reasonable scenarios. It's not about me. This job isn't about me. It's a sweet gig and I get paid very well to do this, but at the end of the day it's about them.

And yes I do have a busy ICU and pulmonary practice. I do keep my students around during the day in the ICU in case there are learning opportunities. There is value to them in the form of them writing their notes even if I can't bill from them. The note is arguably the most important thing you will ever learn in medical school - there is so much nuance there you could drive a truck through it. Bad notes (which doesn't mean long) make for bad patient care and communication with your colleagues. When there is down time they need to be available for when things can and do happen. They can read and study until I cut them loose. Hell. They can watch freaking Netflix on an ipad for all I care as long as they are there to learn when the opportunities occur. With that said I often enough do send students and resident out early, especially if they have been working hard. I do not make student stay late in clinic if the day is done and it's just me and finishing the notes. Those are exceptions though.

Again, you're misunderstanding what I'm saying which is that your argument that medicine requires overwork is a poor attitude to have and to perpetuate and that using the excuse that you have to overwork in order to have good patient outcomes is, in my opinion, harmful and doesn't have to be true. I'm not denying that this may the situation right now (and more for some specialties than others), but I am saying that we have the opportunity to make things better and continue making progress toward a better lifestyle for physicians that doesn't sacrifice patient care but actually results in improvements for them as well (because isn't that the point of going into medicine?). Obviously I care about patients more than anything or I wouldn't be going through medical school right now but that doesn't mean that I have to sit back and take it if I think there's anything that can be done to improve the system as a whole and please don't come back with "you can't change the system" because positive changes have already happened and will continue to happen (like the 80 hour work week). This isn't about me personally wanting to have this relaxed lifestyle, I know what I'm getting myself into, but I refuse to have the mindset of "this is how it is and there's nothing to be done" because stagnation is not the answer. I'm sorry that your experience has been such that you feel the way you do but it does not have to be that way for everyone.

 

[WilliamofOckham]

You learn for the shelf by your interaction with patients and learning about the next steps of management.

This is not really true. Shelf exams are games, like other MCQ tests, and one must learn how to play them. Very different from real life medicine.

 

[VA Hopeful Dr]

Again, you're misunderstanding what I'm saying which is that your argument that medicine requires overwork is a poor attitude to have and to perpetuate and that using the excuse that you have to overwork in order to have good patient outcomes is, in my opinion, harmful and doesn't have to be true. I'm not denying that this may the situation right now (and more for some specialties than others), but I am saying that we have the opportunity to make things better and continue making progress toward a better lifestyle for physicians that doesn't sacrifice patient care but actually results in improvements for them as well (because isn't that the point of going into medicine?). Obviously I care about patients more than anything or I wouldn't be going through medical school right now but that doesn't mean that I have to sit back and take it if I think there's anything that can be done to improve the system as a whole and please don't come back with "you can't change the system" because positive changes have already happened and will continue to happen (like the 80 hour work week). This isn't about me personally wanting to have this relaxed lifestyle, I know what I'm getting myself into, but I refuse to have the mindset of "this is how it is and there's nothing to be done" because stagnation is not the answer. I'm sorry that your experience has been such that you feel the way you do but it does not have to be that way for everyone.

I think you're not getting what he's trying to say. Could we all take the approach of "I'm working my required hours and then I'm done"? Sure. We'd end up like other countries with lengthy waits to get things done (look at the VA to see how this goes). Most of us, however, put in extra hours not because we have to or because our patients demand it, but because we're trying to do right by them and sometimes that involves extra work. Its that simple.

 

[Señor S]

Studying isn't working. And being available to see patients even when nothing is currently going on is part of the job in most of the big fields we rotate through and even a big part of the job on electives through subspecialty rotations.

You conveniently dodge the questions about what kind of hands-on experience you got. Consider the possibility that things are a little different now than they were in your day, when orders and notes were written/forged on paper and a 235 was a killer Step 1 score.

 

[VA Hopeful Dr]

You conveniently dodge the questions about what kind of hands-on experience you got. Consider the possibility that things are a little different now than they were in your day, when orders and notes were written/forged on paper and a 235 was a killer Step 1 score.

Read better...

I did get a single para. And 5 or 6 intubations but that was about it. Some suturing.

 

[Señor S]

Read better...

He didn't answer the question about how many lines he did, but even assuming he's telling the truth and not downplaying things for the sake of making a point that's still way more than I and many others have done. Think about every fun, exciting or just useful thing you got to do as a third year, and then take it all away: that's been the experience of many of us.

 

[jdh71]

You conveniently dodge the questions about what kind of hands-on experience you got. Consider the possibility that things are a little different now than they were in your day, when orders and notes were written/forged on paper and a 235 was a killer Step 1 score.

You smoking too much dope to read good??

Maybe before making accusations you should be sure you're not full of ****?

 

[jdh71]

He didn't answer the question about how many lines he did, but even assuming he's telling the truth and not downplaying things for the sake of making a point that's still way more than I and many others have done. Think about every fun, exciting or just useful thing you got to do as a third year, and then take it all away: that's been the experience of many of us.

Zero lines. Zero. It seemed clear to me since I gave a list of other procedures the lack of listing the lines would be clear to a group who thinks a 235 isn't a very good step score. But you know. Cue the muted trombones.

 

[jdh71]

Again, you're misunderstanding what I'm saying which is that your argument that medicine requires overwork is a poor attitude to have and to perpetuate and that using the excuse that you have to overwork in order to have good patient outcomes is, in my opinion, harmful and doesn't have to be true. I'm not denying that this may the situation right now (and more for some specialties than others), but I am saying that we have the opportunity to make things better and continue making progress toward a better lifestyle for physicians that doesn't sacrifice patient care but actually results in improvements for them as well (because isn't that the point of going into medicine?). Obviously I care about patients more than anything or I wouldn't be going through medical school right now but that doesn't mean that I have to sit back and take it if I think there's anything that can be done to improve the system as a whole and please don't come back with "you can't change the system" because positive changes have already happened and will continue to happen (like the 80 hour work week). This isn't about me personally wanting to have this relaxed lifestyle, I know what I'm getting myself into, but I refuse to have the mindset of "this is how it is and there's nothing to be done" because stagnation is not the answer. I'm sorry that your experience has been such that you feel the way you do but it does not have to be that way for everyone.

There isn't a way to change that I'm afraid. The extra work ("overwork") is the work of a good doctor. You are fighting a beat that can't or won't be killed. Not by people hoping and dreaming for better. What do I know though, right? I'm just a grunt in the trenches and clearly lack context.

 

[Señor S]

Zero lines. Zero. It seemed clear to me since I gave a list of other procedures the lack of listing the lines would be clear to a group who thinks a 235 isn't a very good step score. But you know. Cue the muted trombones.

It's not because we're all such high achievers, though, it just isn't that good of a score these days. Slightly above average, which is another point lost on you, namely that things like shelf exams and steps have been massively up-curved in the past few years. And this is only continuing. Studying for us means something very different than what it meant for you.