Attendings who keep their medical school students until 5pm

[jdh71]

I can't believe all of the bitter nonsense found throughout this thread. ITT: whiners

We need people in sub specialties who have at minimum a basic understand of all the specialties in order to provide the best expert opinion in proper context.

This is the reason that dentists and optometrists (professionals in their own right) are largely useless as tits on a turtle if needing to do or understand anything outside of their very narrow view of their specialty.

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[NWwildcat2013]

First off, in surgery it is usually the residents who have the most interaction with the students.

Second, as I mentioned in my post, you are all adults. I should not have to tell you to come to rounds, come to surgery, come to clinic, follow patients, take ownership of patients, etc. This was fairly common knowledge when I was a med student. By the time we got to third year, my classmates and I all knew the drill. Maybe it is different now.

And, I am not suggesting that you be scutted out. I am just asking you show show some interest in being at the hospital. That's all. If you need to be told to be interested in being at the hospital, maybe you chose the wrong career.

Sorry if that is harsh, but the days of hand holding are over.

It is slightly different I think. I consider myself an enthusiastic person and have always been able to jump into new work and pick it up quickly, but being a medical student now is like navigating a minefield.

My residents are so busy that they often disappear to go to work or procedures without telling me. Why do I need to be told? Why am I not their perfect shadow? Well, I try my best and for the first few days I always stick to them like glue, but I find that is usually a nuisance to them. They want to be able to have the freedom to chart without having a dumb third year breathing down their neck and asking questions and they also want to be able to jump up from their computer and go see a patient about something whenever they want. I always try to quickly ask where they are going and follow them, but sometimes it is too fast and many times when I end up following its clear that they are in a hurry and not in the mood to teach or have a stranger following them. I AM interested and I DO have tons of good questions, but the pressures placed on residents don't allow me to interact as I had hoped. Too be fair, Im sure the residents wish it wasn't this way too. "Be interested, but don't be so interested that it slows us down."

Nothing I do at my institution is real. If I write a note, it has to be in Word on my computer because I can't do a real one even if it is cosigned and I can't even open one up but not complete it. I'd prefer that because you can't pull lab values or other information directly into word, so its impossible to efficiently write notes like that.

Pre-rounds and rounds are probably still like what you experienced (residents at my institution do a good job of helping/teaching during those), but afternoon work rounds are not. The massive amount of charting means residents must be hyper-efficient and it doesn't allow for a very organic conversation or interaction with your resident.

Perhaps it is all resident dependent... whether from the individual personality of a resident or the overall resident culture of your institution.

 

[Perrotfish]

Your apprenticeship model sounds interesting - limiting factor, as with many things, is money. Who will pay for these trainees/apprentices?

The second point you make, if I may read through the sarcasm, is less convincing. Are you telling me that you do not know anyone who started medical school thinking they wanted to be an internist and then changes their mind after being exposed to each field third year? There were plenty of people in my class for whom third year decided their ultimate specialty - myself included.

I don't believe that residents really need to be paid for. Most new white collar employees, including new PAs/NPs within our own system, are more trouble than they're worth in the first year or two. They still get paid because normal employers look past those first two years. If we created a system where Residents were entry level employees, with the expectation that they would stay within the group that trained them, I think that employers see would their initial salary as an investment. That is, again, just what employers of new engineers do now. It would also allow compensation to rise more organically with a Resident's worth to the group rather than in rigid lockstep with the rest of the nation.

The sarcasm (sorry if it was thick) was to point out that choosing a profession is not a unique problem to medicine. College students might change careers if they rotated through lots of options rather than picking the one they found the most appealing. There's even a mechanism to do that: they could take a year off of college to do a series of unpaid internships. However most students conclude, I think correctly, that while there would be a benefit to that the opportunity cost is too high. Multiple years of students' lives, particularly at the cost of up to 70K of high interest student loan debt a year, is a lot to trade for exposure.

On a related note, sometimes I wonder if medical subspecialties have become needlessly sorted by personality type because of all the exposure we give students. I think, like a lot of medical students, deciding against a given specialty was less about realizing that I didn't like the work of a than that I didn't fit in with the personality type and lifestyle hat tended to go along with it. Maybe surgery would have less burnout if they didn't make it so clear that they are selecting for aggressive, type A workoholics. Maybe Pediatrics would be a more competent profession if we didn't make it so clear that we preferred passive aggressive, part time employees. Less exposure might give the different medical subspecialties a healthier mix of personalities and work ethics.

 

[ProfMD]

I don't believe that residents really need to be paid for. Most new white collar employees, including new PAs/NPs within our own system, are more trouble than they're worth in the first year or two. They still get paid because normal employers look past those first two years. If we created a system where Residents were entry level employees, with the expectation that they would stay within the group that trained them, I think that employers see would their initial salary as an investment. That is, again, just what employers of new engineers do now. It would also allow compensation to rise more organically with a Resident's worth to the group rather than in rigid lockstep with the rest of the nation.

The sarcasm (sorry if it was thick) was to point out that choosing a profession is not a unique problem to medicine. College students might change careers if they rotated through lots of options rather than picking the one they found the most appealing. There's even a mechanism to do that: they could take a year off of college to do a series of unpaid internships. However most students conclude, I think correctly, that while there would be a benefit to that the opportunity cost is too high. Multiple years of students' lives, particularly at the cost of up to 70K of high interest student loan debt a year, is a lot to trade for exposure.

On a related note, sometimes I wonder if medical subspecialties have become needlessly sorted by personality type because of all the exposure we give students. I think, like a lot of medical students, deciding against a given specialty was less about realizing that I didn't like the work of a than that I didn't fit in with the personality type and lifestyle hat tended to go along with it. Maybe surgery would have less burnout if they didn't make it so clear that they are selecting for aggressive, type A workoholics. Maybe Pediatrics would be a more competent profession if we didn't make it so clear that we preferred passive aggressive, part time employees. Less exposure might give the different medical subspecialties a healthier mix of personalities and work ethics.

I see your point. I still value my more comprehensive medical education and my residency experience, even if it was a bit masochistic at times.

As for payment - except for the primary care exception, residents cannot bill for services rendered. Therefore, either the attending a would have to cover the new person's salary or the rules would have to change.

 

[VA Hopeful Dr]

I see your point. I still value my more comprehensive medical education and my residency experience, even if it was a bit masochistic at times.

As for payment - except for the primary care exception, residents cannot bill for services rendered. Therefore, either the attending a would have to cover the new person's salary or the rules would have to change.

One does wonder if specialties by their very nature self-select certain personalities as opposed to the people in the same specialities selecting for certain personalities. n=1 I know, but the first family doctor I rotated with is when I decided that FM was right for me. That said, that guy was a huge douche and to this day I dislike him quite a bit. Same thing with at least half of the faculty at my med school's FM program.

 

[sliceofbread136]

Pathology

Pretty sure pathology requires some knowledge of medicine

 

[ProfMD]

Pretty sure pathology requires some knowledge of medicine

But after medical school they never again lay eyes on a living patient. Wasn't that your point? Your argument was that radiologists, dermatologists, psychiatrists, etc all do an internship and therefore benefit directly from M3 year.

Pathologists do not do any direct patient care after medical school graduation. Now, I think they do benefit from the medical school experience in order to help with their own practice. I am curious as to how you argue that they benefit, given your previously stated opinions about how useless M3 rotations are unless you plan on doing that speciality.

 

[Perrotfish]

One does wonder if specialties by their very nature self-select certain personalities as opposed to the people in the same specialities selecting for certain personalities. .

I think its both. Certain work demands, to some extent, a certain personality, but socialization then amplifies and exaggerates that self selection.

 

[sliceofbread136]

But after medical school they never again lay eyes on a living patient. Wasn't that your point? Your argument was that radiologists, dermatologists, psychiatrists, etc all do an internship and therefore benefit directly from M3 year.

Pathologists do not do any direct patient care after medical school graduation. Now, I think they do benefit from the medical school experience in order to help with their own practice. I am curious as to how you argue that they benefit, given your previously stated opinions about how useless M3 rotations are unless you plan on doing that speciality.

They have to know to know medical diseases to do their job?

This seems pretty simple to me, maybe I'm missing something

 

[ProfMD]

They have to know to know medical diseases to do their job?

This seems pretty simple to me, maybe I'm missing something

Can't they learn that from a book? After all, if there is nothing for you to get out of being in surgery (since you are not going to be a surgeon), how is there anything for them to get out of any of third year? After all, if being in the OR is so useless to you, how is seeing any patient third year of use to a budding pathologist?

 

[sliceofbread136]

Can't they learn that from a book? After all, if there is nothing for you to get out of being in surgery (since you are not going to be a surgeon), how is there anything for them to get out of any of third year? After all, if being in the OR is so useless to you, how is seeing any patient third year of use to a budding pathologist?

To see the diseases and processes that they will be working with? I will not have much of anything to do with the OR aside from consulting surgery. Your example still doesn't make sense to me

 

[ProfMD]

To see the diseases and processes that they will be working with? I will not have much of anything to do with the OR aside from consulting surgery. Your example still doesn't make sense to me

You do not want to be able to see the procedures that your patients will be having? If you are their doctor, I guarantee they will ask you. You could always tell them you do not know, they should just wait to talk to the surgeon. Alternatively, you could act like their doctor and provide some information. Your patients will appreciate it if you are able to relieve some degree of their anxiety.

Histological sections, on the other hand, could not care less if the pathologist has seen a living patient with the disease or just read about it in a book.

 

[sliceofbread136]

You do not want to be able to see the procedures that your patients will be having? If you are their doctor, I guarantee they will ask you. You could always tell them you do not know, they should just wait to talk to the surgeon. Alternatively, you could act like their doctor and provide some information. Your patients will appreciate it if you are able to relieve some degree of their anxiety.

Histological sections, on the other hand, could not care less if the pathologist has seen a living patient with the disease or just read about it in a book.

I will say they can discuss the details of their surgery with their surgeon/surgery team... I can tell them about why the surgery is indicated and the details of their disease but beyond that I don't know why they would ask me.

This is poor reasoning to make a rotation required anyway. Should we also have a mandatory 4 week rotation through the cath lab? Maybe rad onc too, I'm sure I'll be getting plenty of cancer patients.

Seeing disease processes in living people could educational in identifying autopsy findings, and knowing the treatment remifications of their reads could effect what is emphasized. Since you seem to be perseverating on this point, maybe it would be possible for pathology to be a non-MD track. I don't know since I have no interest.

 

[Wordead]

I will say they can discuss the details of their surgery with their surgeon/surgery team... I can tell them about why the surgery is indicated and the details of their disease but beyond that I don't know why they would ask me.

This is poor reasoning to make a rotation required anyway. Should we also have a mandatory 4 week rotation through the cath lab? Maybe rad onc too, I'm sure I'll be getting plenty of cancer patients.

Seeing disease processes in living people could educational in identifying autopsy findings, and knowing the treatment remifications of their reads could effect what is emphasized. Since you seem to be perseverating on this point, maybe it would be possible for pathology to be a non-MD track. I don't know since I have no interest.

That's funny, I was thinking psych should be a non-MD track. You'll never use medicine outside of that intern year, so what's the point?

 

[sliceofbread136]

That's funny, I was thinking psych should be a non-MD track. You'll never use medicine outside of that intern year, so what's the point?

Some do, and psych meds do have medical complications. But honestly though you might be right, I've seen a psychiatrist who had to google what orthostatic hypotension was before

 

[mistafab]

I've met psychosomatic medicine (C/L) psychiatrists who understood disease processes front to back. These psychiatrists have to - this type of fellowship trains psychiatrists who see complicated patients day in, day out.

Some do, and psych meds do have medical complications. But honestly though you might be right, I've seen a psychiatrist who had to google what orthostatic hypotension was before

 

[sliceofbread136]

I've met psychosomatic medicine (C/L) psychiatrists who understood disease processes front to back. These psychiatrists have to - this type of fellowship trains psychiatrists who see complicated patients day in, day out.

That's cool

 

[mistafab]

Neat

That's cool

 

[Doctor4Life1769]

You need to be careful asking to leave early. Broach it first with the resident who seems the most simpatico. That can be a fire starter with the wrong resident or attending. I have seen it ruin the rotation for the student a couple times. I always sent the student home once nothing was left except scut work.
You do get spoiled the first two years. Your time is pretty much your own, which changes completely in the clinical years.

Aw dang.
I'm such a simpatico.
I usually have the students leave around 3p when not on call after I have provided them with a 2pm lecture for about 45 mins.
In the clinic? They can follow my last pt out the door or stick around for a 10-20 min lecture on something interesting from the day.

 

[ThoracicGuy]

No, you would be right if you said those things. Those rotations were worthless to you, every bit as worthless as my surgery rotations were to me. While nothing in medical school, or life, is completely without value, the yield of seeing rotations in specialties you're not going into is as close to being worthless as anything in life will every be.

Its not like medical school was designed with the goal of 'exposure'. It was designed, in the late 1800s, to give students the skills they needed to be a doctor in the late 1800s. Everyone needed surgery because every new grad was expected to be able to do the handful of basic surgeries then available, and they were expected to do them unsupervised the day that they graduated. Everyone delivered babies because all doctors delivered babies. They did Internal medicine and Pediatrics because everyone covered clinics and the floors of their cottage hospitals. There were a handful of students that they knew would be specializing in Pediatrics, Surgery, or Venereology, but that percentage was so vanishingly small that they just weren't worth adapting for.

Medicine keeps changing, but every time it change, rather than adapting, the medical-education complex just staples more training onto whatever used to be the end of the training process. This makes sense from their perspective: since the training is legally mandatory and the end goal is lucrative enough to keep attracting eager students educators have no incentive to eliminate the ever increasing layers of vestigial education. So now if you want to do Pediatric heart surgery you need to go through 4 years of utterly worthless undergrad, to be allowed to attend 4 years of largely worthless medical school, to get to spend 5 years dealing with 80% worthless general surgery residency, so that you can be allowed to start a 50% useless Pediatric surgery fellowship, so that you can finally be allowed to spend two years learning to do the thing you actually plan to do for a living in your Pediatric CT surgery sub fellowship

Just so you know, pediatric heart surgery requires either general surgery, then ct surgery, then congenital fellowship OR I6 ct surgery followed by a congenital fellowship. There is no pediatric surgery fellowship involved...

 

[mimelim]

I will say they can discuss the details of their surgery with their surgeon/surgery team... I can tell them about why the surgery is indicated and the details of their disease but beyond that I don't know why they would ask me.

This is poor reasoning to make a rotation required anyway. Should we also have a mandatory 4 week rotation through the cath lab? Maybe rad onc too, I'm sure I'll be getting plenty of cancer patients.

Seeing disease processes in living people could educational in identifying autopsy findings, and knowing the treatment remifications of their reads could effect what is emphasized. Since you seem to be perseverating on this point, maybe it would be possible for pathology to be a non-MD track. I don't know since I have no interest.

You will be a better PCP/IM physician if you have a cursory understanding of surgery. For many/most patients it is not good enough to say to them, "Sorry, ask your surgeon" for every question. In the same way that I need to be able to explain the nuances of end stage renal disease to a patient that requires AV access, you will be better able to care for your patients if you understand the level 1 knowledge of what other specialties you interact with do. The only way to get that for surgery is to be a part of that process for a couple of months. There are basic questions that patients are going to ask you as an inpatient or outpatient that they may not get answered for several days or weeks or a month by turfing it to another provider. Certainly, specific details of the surgery should always be answered by the surgical team and it is right to defer. But, you come off looking like an idiot if you don't have cursory knowledge. This gets relayed by patients all the time. Surgeons are guilty of the reverse all the time and will turf ALL medical questions, even the stupidest, smallest stuff and it harm their physician-patient relationship as a result. That doesn't make the paradigm right.

Speaking of not looking stupid. The same goes for calling consults. If your future referral patterns have you interacting with surgeons (in either direction), it behooves you to have a basic understanding of what they do.

 

[IlDestriero]

I think that all this whining about wasted time, useless rotations, etc. is just a combination of laziness and buying into the Cool Aid that the APNs are pouring. These classes and rotations may not directly affect your day to day practice, but they form the solid of foundation of your medical knowledge. That foundation is one of the key differences between us and those who pretend to be us. It is certainly not useless. If you want to cut corners and build your foundation on a bed of sand, you picked the wrong pathway.


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Il Destriero

 

[Psai]

I think that all this whining about wasted time, useless rotations, etc. is just a combination of laziness and buying into the Cool Aid that the APNs are pouring. These classes and rotations may not directly affect your day to day practice, but they form the solid of foundation of your medical knowledge. That foundation is one of the key differences between us and those who pretend to be us. It is certainly not useless. If you want to cut corners and build your foundation on a bed of sand, you picked the wrong pathway.


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Il Destriero

It's a lot easier to look back and see how much value something had than when you're in the middle of it. When I was in the middle of a 12 hour open aaa I was like damn this sucks but I gained a better understanding of what it's like to be a surgeon and a healthy understanding of what the word emergent actually means.

 

[IlDestriero]

I gained ... a healthy understanding of what the word emergent actually means.

Please teach this to the OB crowd. They don't understand what it means at all.


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Il Destriero

 

[mimelim]

Please teach this to the OB crowd. They don't understand what it means at all.


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Il Destriero

Emergent is when they spear the common iliac with a trochar.

 

[jdh71]

It's a lot easier to look back and see how much value something had than when you're in the middle of it. When I was in the middle of a 12 hour open aaa I was like damn this sucks but I gained a better understanding of what it's like to be a surgeon and a healthy understanding of what the word emergent actually means.

The tensest room I was ever in was as a student in an emergent open repair.

 

[sliceofbread136]

You will be a better PCP/IM physician if you have a cursory understanding of surgery. For many/most patients it is not good enough to say to them, "Sorry, ask your surgeon" for every question. In the same way that I need to be able to explain the nuances of end stage renal disease to a patient that requires AV access, you will be better able to care for your patients if you understand the level 1 knowledge of what other specialties you interact with do. The only way to get that for surgery is to be a part of that process for a couple of months. There are basic questions that patients are going to ask you as an inpatient or outpatient that they may not get answered for several days or weeks or a month by turfing it to another provider. Certainly, specific details of the surgery should always be answered by the surgical team and it is right to defer. But, you come off looking like an idiot if you don't have cursory knowledge. This gets relayed by patients all the time. Surgeons are guilty of the reverse all the time and will turf ALL medical questions, even the stupidest, smallest stuff and it harm their physician-patient relationship as a result. That doesn't make the paradigm right.

Speaking of not looking stupid. The same goes for calling consults. If your future referral patterns have you interacting with surgeons (in either direction), it behooves you to have a basic understanding of what they do.

Not going to be a PCP, but they can wait for as long as it takes. I'll be able to tell them as much as uptodate tells me, unless it's a lap Chole for which I have become a world renowned expert these past few weeks.

Calling consults is important but you get that more from seeing surgical consults

 

[Conejito]

I am new here. I have read every single post in this thread. It has been interesting to follow the pain and suffering that comes with being a med student, a resident and attending. I am looking forward to this pain once I begin med school.

Given that, I have a cousin who is an anesthesiologist and he works just 6 months of the year. He enjoys the other 6. He also has a pain clinic. He works semi-hard during those 6 months but it's nothing of the type of Inquisition style torture all of you speak of and endure.

I also have two friends who are nephrologists and they have worked out the same type of deal. They work 6 months and enjoy life, travel and relax the other 6 months. So I do not understand what I am reading here. I can understand some suffering during residency but not as an attending.

I shall follow the same route as they did. I have another friend who is a path resident who tells me his weeks are usually 40 hours with the rare weeks being 80. Those are the rough rotations. So what gives here? Are we all on the same space and time dimension here or what?

Believe me if it where as horrendous as you guys state I wouldn't waste my time in this ridiculous pursuit. I'd drive a truck cross country and read textbooks for fun.

 

[Conejito]

OP, I feel you dude there is so much wasted time, effort, years, in medical education, no wonder NPs think they can do whatever family medicine docs do , they probably can. Its not their education is too short, its that MD training in this country is overly long and wasteful. The length of most training obviously serves are a filter to keep most sensible people out of medicine.

I agree. I do have an anesthesiologist cousin who works just 6 months of the year. Have two friends who are nephrologists with the same gig. 6 on and 6 off. This jdh71 fellow operates on a whole different plane. He seems to be a workaholic.

There are many physicians who work semi hard and take many months off. I worked for a cardiac surgeon who had plenty of time off. He did complain though. He as many surgeons in Miami are just independent contractors for the hospital. No surgeries meant no dinero.

Some months were pretty bad he told me. Yet he does have a mansion in Gables Estates. He told me that was in the good old days. He's been practicing 30 years.

 

[Amygdarya]

So I do not understand what I am reading here. I can understand some suffering during residency but not as an attending.

That's because most doctors are not anesthesiologists or pathologists.
So yeah, go ahead and get that truck driving job.

 

[Conejito]

That's because most doctors are not anesthesiologists or pathologists.
So yeah, go ahead and get that truck driving job.

LOL!!!
They did a study showing cross country truck drivers were ahead of physicians when it comes to salaries. After so many years of not earning money to get the degree, racking up an astronomical debt load that will take decades to pay off and taxes that will eat up your eventual earnings, truckers were way ahead.

I'm in it for the challenge not the money. I love the hospital I volunteered in and the patients. I love the brain twisting it takes to become a physician but the money is no longer there. All entering this field are entering into a climate of declining wages. So I have been told by many old time doctors specifically the heart surgeon I used to work for.

Before I forget, I have read many of your posts. I've enjoyed them and congrats on your achievements especially the MCAT retake and propelling it to a 38. No small feat indeed

 

[Perrotfish]

I think that all this whining about wasted time, useless rotations, etc. is just a combination of laziness and buying into the Cool Aid that the APNs are pouring. These classes and rotations may not directly affect your day to day practice, but they form the solid of foundation of your medical knowledge. That foundation is one of the key differences between us and those who pretend to be us. It is certainly not useless. If you want to cut corners and build your foundation on a bed of sand, you picked the wrong pathway.


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Il Destriero

If the knowledge was that important we would be maintaining it. As an attending I'm spending at least 20 minutes a day on CME, and another 40 reading on patients that I wasn't 100% sure about during the day. That's for skills I use every day. Do you know how long its been since I reviewed OB? Or reviewed anything about surgery besides the indications for and outcomes of the procedures? I've mostly forgetten even the small subset of surgery knowledge that hasn't completely changed since I studied it. I also don't know anyone else that does much better than me in terms of reading outside of their field. If this knowledge is so important, why isn't it important that I hold on to any of it?

Third year isn't foundational. It could be. They could let people choose their professsions earlier, and then put them through a curriculum that would give them an intense theoretical grounding in every piece of knowledge they'd need as a resident. I could have spent a month on each and every Pediatric Subspecialty and still had time to do a couple of Sub-Is. I would have been so much better as an Intern. But instead I did adult surgery, because the powers that be decided that I would never be able to take care of a crashing Neonate without that all important 'foundational' month of adult bariatric surgery.

The APNs are winning because we can't adapt.

 

[NWwildcat2013]

If the knowledge was that important we would be maintaining it. As an attending I'm spending at least 20 minutes a day on CME, and another 40 reading on patients that I wasn't 100% sure about during the day. That's for skills I use every day. Do you know how long its been since I reviewed OB? Or reviewed anything about surgery besides the indications for and outcomes of the procedures? I've mostly forgetten even the small subset of surgery knowledge that hasn't completely changed since I studied it. I also don't know anyone else that does much better than me in terms of reading outside of their field. If this knowledge is so important, why isn't it important that I hold on to any of it?

Third year isn't foundational. It could be. They could let people choose their professsions earlier, and then put them through a curriculum that would give them an intense theoretical grounding in every piece of knowledge they'd need as a resident. I could have spent a month on each and every Pediatric Subspecialty and still had time to do a couple of Sub-Is. I would have been so much better as an Intern. But instead I did adult surgery, because the powers that be decided that I would never be able to take care of a crashing Neonate without that all important 'foundational' month of adult bariatric surgery.

The APNs are winning because we can't adapt.

Perrotfish for President!


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[Dires]

I agree. I do have an anesthesiologist cousin who works just 6 months of the year. Have two friends who are nephrologists with the same gig. 6 on and 6 off. This jdh71 fellow operates on a whole different plane. He seems to be a workaholic.

There are many physicians who work semi hard and take many months off. I worked for a cardiac surgeon who had plenty of time off. He did complain though. He as many surgeons in Miami are just independent contractors for the hospital. No surgeries meant no dinero.

Some months were pretty bad he told me. Yet he does have a mansion in Gables Estates. He told me that was in the good old days. He's been practicing 30 years.

Are you in the US?

If so... Do yourself a favor and lower your expectations. Otherwise you're going to have a really bad time.

 

[Conejito]

Are you in the US?

If so... Do yourself a favor and lower your expectations. Otherwise you're going to have a really bad time.

Please explain? Not interested in surgery as the surgeon who I worked for told me not to waste my time. The payoff (output) doesn't compensate the study time and testing required (input). He's a heart surgeon.

Not interested in oncology since I wouldn't prescribe on others a course of treatment that I wouldn't prescribe on myself. I am in the USA. I guess being a gas guy like my cousin or path or the ICU seems to be of interest.

 

[NWwildcat2013]

Please explain? Not interested in surgery as the surgeon who I worked for told me not to waste my time. The payoff (output) doesn't compensate the study time and testing required (input). He's a heart surgeon.

Not interested in oncology since I wouldn't prescribe on others a course of treatment that I wouldn't prescribe on myself. I am in the USA. I guess being a gas guy like my cousin or path or the ICU seems to be of interest.

ICU docs work a lot too.


Sent from my iPhone using SDN mobile

 

[Giovanotto]

Please explain? Not interested in surgery as the surgeon who I worked for told me not to waste my time. The payoff (output) doesn't compensate the study time and testing required (input). He's a heart surgeon.

Not interested in oncology since I wouldn't prescribe on others a course of treatment that I wouldn't prescribe on myself. I am in the USA. I guess being a gas guy like my cousin or path or the ICU seems to be of interest.

Can you elaborate on this?

 

[Fatalis]

@OP: if you are MS3, such is life of staying when there is nothing to do. As other suggested, have UW loaded on your phone/tablet/ read. It does suck as during MS1-2 your time was your time. With any job however, there is down time, but it doesn't mean you can peace out. It is annoying getting up and knowing in the back of your mind, you really aren't needed in the rotation [for most of mine anyway]. Make the best of it and stick with it because MS4 is truly the best year of your life!

 

[Conejito]

Can you elaborate on this?

Between me and my parents we've seen close to 100 friends and family with different types and stages of cancer. Despite the usual course of treatments which involves surgery, chemotherapy and radiation they all died.

The treatment caused unbelievable pain and suffering. Despite all attempts to prolong life, not one survived remission. This is our experience. So I couldn't study a field and prescribe treatments on others I would never do on myself.

I was told once by a med school professor to get into radiation oncology. He said there's tons of money there. I just listened respectfully and gave no opinion knowing fully well I would never even think of going that route.

 

[NWwildcat2013]

@OP: if you are MS3, such is life of staying when there is nothing to do. As other suggested, have UW loaded on your phone/tablet/ read. It does suck as during MS1-2 your time was your time. With any job however, there is down time, but it doesn't mean you can peace out. It is annoying getting up and knowing in the back of your mind, you really aren't needed in the rotation [for most of mine anyway]. Make the best of it and stick with it because MS4 is truly the best year of your life!

I wish I could study at the hospital. a.) I don't really have any time. b.) when I do I absolutely cannot focus c.) if Im able to focus enough to do a few questions I retain nothing.

Hope I get better at this because right now Im basically not able to study at all since I am on a busy rotation. I have no idea what is normal, so I hope Im not screwed.

 

[coffee-doc]

Between me and my parents we've seen close to 100 friends and family with different types and stages of cancer. Despite the usual course of treatments which involves surgery, chemotherapy and radiation they all died.

The treatment caused unbelievable pain and suffering. Despite all attempts to prolong life, not one survived remission. This is our experience. So I couldn't study a field and prescribe treatments on others I would never do on myself.

I was told once by a med school professor to get into radiation oncology. He said there's tons of money there. I just listened respectfully and gave no opinion knowing fully well I would never even think of going that route.

so I work in a pretty respectable breast cancer clinic as a 'research specialist' and this post got me thinking. I really wonder what I would do in this situation. I had an immediate family member get cancer and we all pushed them for chemo but it really did look like it sucked. But the stuff I do here is pretty incredible. I have seen Stage IV heavily metastisized cancer disappear within a two week span because of some of the research we do here. Even though I get paid a a dog**** wage, I really like working here because I feel as if I am doing good for others. So I think I would put myself in "pursue conventional treatment but when we hit Stage IV, pull the bucket list out and go to Europe and do drugs" group

 

[ProfMD]

Between me and my parents we've seen close to 100 friends and family with different types and stages of cancer. Despite the usual course of treatments which involves surgery, chemotherapy and radiation they all died.

The treatment caused unbelievable pain and suffering. Despite all attempts to prolong life, not one survived remission. This is our experience. So I couldn't study a field and prescribe treatments on others I would never do on myself.

I was told once by a med school professor to get into radiation oncology. He said there's tons of money there. I just listened respectfully and gave no opinion knowing fully well I would never even think of going that route.

While you should not enter onc or rad onc if you are not comfortable with these treatments, it is important to note that treatment and prognosis are heavily dependent on a number of factors including the type of tumor, the grade, the stage, risk stratification, age, comorbidities, etc.

You're experience, while tragic, is not necessarily generalizable.

 

[jl lin]

While you should not enter onc or rad onc if you are not comfortable with these treatments, it is important to note that treatment and prognosis are heavily dependent on a number of factors including the type of tumor, the grade, the stage, risk stratification, age, comorbidities, etc.

You're experience, while tragic, is not necessarily generalizable.

^This...

and

so I work in a pretty respectable breast cancer clinic as a 'research specialist' and this post got me thinking. I really wonder what I would do in this situation. I had an immediate family member get cancer and we all pushed them for chemo but it really did look like it sucked. But the stuff I do here is pretty incredible. I have seen Stage IV heavily metastisized cancer disappear within a two week span because of some of the research we do here. Even though I get paid a a dog**** wage, I really like working here because I feel as if I am doing good for others. So I think I would put myself in "pursue conventional treatment but when we hit Stage IV, pull the bucket list out and go to Europe and do drugs" group

You present the available research re: disease and treatments, what they entail--pluses and minuses, and you LET THE PATIENT DECIDE. This can be applicable in all fields of medicine.

 

[Giovanotto]

XXXX

 

[deleted451730]

A lot of the people against me are tools. Today, we did patient presentations, rounded, went through didactic lectures, and I finished my note. All we had to do in the afternoon was do a quiz packet while we were in hospital which we could have done at home. Luckily our residents which recognized this and were trying to send us home earlier, were finally able to. If there is nothing for med students to do, let us study at home and use materials we have access to there but not the hospital. Luckily, I have had really good residents who recognized this and let us go if we were useless and not learning anything. Honestly, this is really is an attending problem. Its like they forget when they were once medical school students. If there is something for us to help with or learn, I want to to it or learn. But if we are just sitting around and doing nothing, then its not helpful to just be there. And lastly, I'm not a idiot. I have never asked to leave early or implied. I always ask to help.

P.S: I am having a really really hard time accepting that all these people on sdn are perfect shining angelic students that have pure hearts and don't question anything in life.

I don't understand what everyone is complaining about regarding med students and hours. We want to learn, we want to help out and (some, like me) would love to do procedures and get involved, no matter what time I stay til, etc. But when we are hard-working, diligent, punctual students who don't complain and ask if there's anything we can do, and we are still told to just hang around arbitrarily until 6, 7 just to hit that magical number of hours, it's doing a disservice to our education. Isn't that the whole point of rotations, education in practice of medicine? It's pointless if the "practice" part is removed from 3rd/4th year because residents don't want to teach or attendings don't want us actually doing something substantial, etc.

What some physicians who have been in practice many years have had a hard time understanding is that compared with the "back in the day" mantra, we modern medical students do diddly squat on actual rotations, sometimes when even begging to do something, anything to justify spending 12+ hours a day away from the resources we need to study for the board exams that matter even more to us than ever back in the day and quite literally determine where we can apply for residency and in what specialty we can even pursue. On top of that, our student evaluations often look very similar to each others', perpetuating the cycle of boards becoming the sole distinguishing factor among prospective resident applicants, further perpetuating our desire to learn in hospital but if for nothing else to go home and study all day. Like the saying goes, "I have never let my schooling interfere with my education."

 

[NWwildcat2013]

I don't understand what everyone is complaining about regarding med students and hours. We want to learn, we want to help out and (some, like me) would love to do procedures and get involved, no matter what time I stay til, etc. But when we are hard-working, diligent, punctual students who don't complain and ask if there's anything we can do, and we are still told to just hang around arbitrarily until 6, 7 just to hit that magical number of hours, it's doing a disservice to our education. Isn't that the whole point of rotations, education in practice of medicine? It's pointless if the "practice" part is removed from 3rd/4th year because residents don't want to teach or attendings don't want us actually doing something substantial, etc.

What some physicians who have been in practice many years have had a hard time understanding is that compared with the "back in the day" mantra, we modern medical students do diddly squat on actual rotations, sometimes when even begging to do something, anything to justify spending 12+ hours a day away from the resources we need to study for the board exams that matter even more to us than ever back in the day and quite literally determine where we can apply for residency and in what specialty we can even pursue. On top of that, our student evaluations often look very similar to each others', perpetuating the cycle of boards becoming the sole distinguishing factor among prospective resident applicants, further perpetuating our desire to learn in hospital but if for nothing else to go home and study all day. Like the saying goes, "I have never let my schooling interfere with my education."

So true. The problem for me is that the 12 h/day spent at the hospital is still mentally and physically draining despite being educationally low yield, so I struggle to capitalize on the 1-2 hours per night I have to study.

 

[jl lin]

I don't understand what everyone is complaining about regarding med students and hours. We want to learn, we want to help out and (some, like me) would love to do procedures and get involved, no matter what time I stay til, etc. But when we are hard-working, diligent, punctual students who don't complain and ask if there's anything we can do, and we are still told to just hang around arbitrarily until 6, 7 just to hit that magical number of hours, it's doing a disservice to our education. Isn't that the whole point of rotations, education in practice of medicine? It's pointless if the "practice" part is removed from 3rd/4th year because residents don't want to teach or attendings don't want us actually doing something substantial, etc.

What some physicians who have been in practice many years have had a hard time understanding is that compared with the "back in the day" mantra, we modern medical students do diddly squat on actual rotations, sometimes when even begging to do something, anything to justify spending 12+ hours a day away from the resources we need to study for the board exams that matter even more to us than ever back in the day and quite literally determine where we can apply for residency and in what specialty we can even pursue. On top of that, our student evaluations often look very similar to each others', perpetuating the cycle of boards becoming the sole distinguishing factor among prospective resident applicants, further perpetuating our desire to learn in hospital but if for nothing else to go home and study all day. Like the saying goes, "I have never let my schooling interfere with my education."

I am being completely sincere in asking the following questions. What percentage of M3s within the last 5 years feels/felt this way? Does it make a difference in terms of DO clinical sites vs. MD clinical sites? Has something seriously changed b/c of fear of litigation and administration regulation? Are residents under the gun, b/c they have less time in which to learn what they need in their own programs, much less time left over to teach M3s and M4s? I mean people seem to be expressing some earnest concerns, and now I am wondering if things have changed so much that students are getting shafted in terms of clinical experiences. I genuinely don't know now. What do the surveys, overall, look like? I now wonder if this has anything to do with reduced residency hours? Maybe there isn't enough time for residents to teach MSs?

 

[deleted451730]

I am being completely sincere in asking the following questions. What percentage of M3s within the last 5 years feels/felt this way? Does it make a difference in terms of DO clinical sites vs. MD clinical sites? Has something seriously changed b/c of fear of litigation and administration regulation? Are residents under the gun, b/c they have less time in which to learn what they need in their own programs, much less time left over to teach M3s and M4s? I mean people seem to be expressing some earnest concerns, and now I am wondering if things have changed so much that students are getting shafted in terms of clinical experiences. I genuinely don't know now. What do the surveys, overall, look like? I now wonder if this has anything to do with reduced residency hours? Maybe there isn't enough time for residents to teach MSs?

Thank you for taking some of us medical students seriously instead of many others who think we're a bunch of lazy, whiny students and should just suck it up because it has "always been like that" (no, it hasn't). I personally, again, love to work hard, be diligent, and punctual for the sake of professionalism and a proper clerkship education, but why even bother anymore when we have no legitimate roles under an increasingly stressed system? My notes are fake practice (partly due to EMR because now everything is tracked so it's more cumbersome to authenticate new users and allow residents to use/tweak our notes for actual use), my exams are redundant (but often more existent than residents' exams but overlooked), my presentations hardly ever exist, my exposure to procedures is completely resident/attending based and is often nil...you see our point? All those books that talk about how to "do well" on the wards...how can we when at many sites we do not even have a chance to experientially learn and prove ourselves? Hence, my point about how the formal post-rotation student evaluations these days are also often incredibly vague and hardly distinguish one student from another in many respects: "Diligent. Hard-worker. Keep reading.". And hence my point that in the end, BOARDS ARE ALL THAT MATTER in weeding applicants apart INITIALLY; thus, my point about us wanting to just go home and study in a proper manner (resources only at our disposal outside the hospital) than spend 12+ hours standing around. Step 1/2 matter so much more nowadays.

I think it's a little bit of everything compounding the problem. I'm not sure what percentage of M3's/DO/MD clinical sites are associated with it, but I definitely believe the increasingly litigiousness nature of American healthcare/malpractice and the increasing demands of patients (and "prospective patients") lead to even less incentive for medical students to hold a more substantial role on the wards. Why should I be taught how to properly suture--thinks the surgeon--if the surgeon is concerned the suture won't hold properly in the wrong hands, giving him possibly more work to correct later? Why should residents teach when they themselves are burdened by ever more disgruntled patients, increasing debt burden, and no incentive to teach unless they so individually desire? (Also: Patients who basically get free care: "Why should I have to wait and sit through this student's interview? Can I see the doctor instead? I've been waiting a whole 30 minutes...") I've had some amazing residents and preceptors who took it upon themselves to teach/pimp, but oftentimes these experiences are few and far between.

Additionally—and I'm not sure I've heard others elaborate on this—but I also believe the persistently exponentially changing roles of each specialty contribute to the difficulty in teaching and difficulty in providing an accurate picture of a specialty 5-10 years before said medical student actually becomes an attending in that already-changed field. For example—and this stretches on the time spans—but back in the day, family physicians especially in the countryside used to perform appendectomies, c-sections, vasectomies, and more minor office procedures; nowadays, though it still exists, it is hard to find and even more difficult to find that training actually used in daily practice. Heck, some family practice physicians even go so far as to not do any procedures, or see any children, or do any OB/GYN, and stick to adults...ie. "internal medicine". Or, e.g., OBGYNs used to do amniocenteses; now that they're less commonly done, the MFM-trained OBGYNs basically do them. Or, e.g., Interventional Radiology performs some procedures whereas back in the day other specialties would. Or, e.g., increasingly used interventional, non-surgical procedures provide for situations to replace historically surgical treatments. And so on...

 

[michaelrack]

Nothing I do at my institution is real. If I write a note, it has to be in Word on my computer because I can't do a real one even if it is cosigned and I can't even open one up but not complete it. I'd prefer that because you can't pull lab values or other information directly into word, so its impossible to efficiently write notes like that.

Back in my day, we had to write the labs in on a paper note.

 

[michaelrack]

That's funny, I was thinking psych should be a non-MD track. You'll never use medicine outside of that intern year, so what's the point?

Inpatient psych does require some medicine