Current M3's: Chosen Specialty?

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GuyWhoDoesStuff said:
Medical students, by and large, are surrounded by other medical students who continuously perpetuate the "you're a horrible person for not wanting to devote 30 hours a day to saving dying African babies" if the issue of preserving a reasonable lifestyle is brought up. I won't launch into the tired discussion of how medicine is one of the only fields in which having anything but Mother Theresa-esque ambitions earns you castigation from your colleagues and the public, but I'm sure we all get the idea.

It's the 500lb gorilla in the corner that no one wants to talk about.

I, for one, applaud Dr.VanNostran for having the sense to realize that it is possible to enjoy a fulfilling career in medicine AND still maintain a desirable quality of life.
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THIS x infinity (even though I want to do general surgery)
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GuyWhoDoesStuff said:
Medical students, by and large, are surrounded by other medical students who continuously perpetuate the "you're a horrible person for not wanting to devote 30 hours a day to saving dying African babies" if the issue of preserving a reasonable lifestyle is brought up. I won't launch into the tired discussion of how medicine is one of the only fields in which having anything but Mother Theresa-esque ambitions earns you castigation from your colleagues and the public, but I'm sure we all get the idea.

It's the 500lb gorilla in the corner that no one wants to talk about.

I, for one, applaud Dr.VanNostran for having the sense to realize that it is possible to enjoy a fulfilling career in medicine AND still maintain a desirable quality of life.
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No but the fact that EVERYONE wants to do EM/Rads/Derm/Gas and do it for 40.0 hours a week is the exact reason why medicine is pu$$ified. The majority of med students were told they were special and don't have to work. That's why the midlevels are swooping in and stealing what is rightfully ours. All of medicine in the 80's used to be hard core. IM was Q3-4 and you did 100+ a week. Neurosurgery was Q2-3, General Surgery was Q3, CT was Qlife. Now who knows, maybe tort and reduced payments through medicare took away that incentive to work the life away, but ****, even med students now b*tch and moan about 9 hour days. I'll say it again, it's the reason why the field is getting snatched from under us.


General Surgery for me.


Edit: Don't get me wrong, I love my wife and enjoy spending time with her, but she knew beforehand that we will never have breakfast together and even as a attending, dinner probably will be late. Weekends are no guarantee as well. Gotta pay to play. Medicine is a special field. Most people don't let you cut them open/do invasive tests/give medicine unless you've logged some serious hours. This isn't the same as fixing your toilet or depositing your check. People let you work on their BODY. Put in the hours to learn how. Algorithms (which is 90% of medicine) will make us like the nurses, except we have the knowledge of how and why. That's what make us special.
 
Mr Cookie Pants said:
No but the fact that EVERYONE wants to do EM/Rads/Derm/Gas and do it for 40.0 hours a week is the exact reason why medicine is pu$$ified. The majority of med students were told they were special and don't have to work. That's why the midlevels are swooping in and stealing what is rightfully ours. All of medicine in the 80's used to be hard core. IM was Q3-4 and you did 100+ a week. Neurosurgery was Q2-3, General Surgery was Q3, CT was Qlife. Now who knows, maybe tort and reduced payments through medicare took away that incentive to work the life away, but ****, even med students now b*tch and moan about 9 hour days. I'll say it again, it's the reason why the field is getting snatched from under us.


General Surgery for me.


Edit: Don't get me wrong, I love my wife and enjoy spending time with her, but she knew beforehand that we will never have breakfast together and even as a attending, dinner probably will be late. Weekends are no guarantee as well. Gotta pay to play. Medicine is a special field. Most people don't let you cut them open/do invasive tests/give medicine unless you've logged some serious hours. This isn't the same as fixing your toilet or depositing your check. People let you work on their BODY. Put in the hours to learn how. Algorithms (which is 90% of medicine) will make us like the nurses, except we have the knowledge of how and why. That's what make us special.
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One of my old "hardcore" attendings on IM took the students on the rotation aside a few months ago and said "you know, more and more you young kids are choosing specialties based on having a good life. You don't want to work weekends, you want evenings free to spend with your family, etc. And I think that is GREAT!"

This caught me completely off guard, but basically he went into a long discussion about how he thinks it's ridiculous that the whole "I just HAVE to work 150 hours a week BECAUSE I'M A BADASS DOCTOR" mentality is what's driving away/burning out so many physicians.
 
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Mr Cookie Pants said:
No but the fact that EVERYONE wants to do EM/Rads/Derm/Gas and do it for 40.0 hours a week is the exact reason why medicine is pu$$ified. The majority of med students were told they were special and don't have to work. That's why the midlevels are swooping in and stealing what is rightfully ours. All of medicine in the 80's used to be hard core. IM was Q3-4 and you did 100+ a week. Neurosurgery was Q2-3, General Surgery was Q3, CT was Qlife. Now who knows, maybe tort and reduced payments through medicare took away that incentive to work the life away, but ****, even med students now b*tch and moan about 9 hour days. I'll say it again, it's the reason why the field is getting snatched from under us.


General Surgery for me.


Edit: Don't get me wrong, I love my wife and enjoy spending time with her, but she knew beforehand that we will never have breakfast together and even as a attending, dinner probably will be late. Weekends are no guarantee as well. Gotta pay to play. Medicine is a special field. Most people don't let you cut them open/do invasive tests/give medicine unless you've logged some serious hours. This isn't the same as fixing your toilet or depositing your check. People let you work on their BODY. Put in the hours to learn how. Algorithms (which is 90% of medicine) will make us like the nurses, except we have the knowledge of how and why. That's what make us special.
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As the 75-year-old dinosaur transplant surgeon who helps out in anatomy says:

"Wives come and go, but surgery is eternal."
 
Mr Cookie Pants said:
No but the fact that EVERYONE wants to do EM/Rads/Derm/Gas and do it for 40.0 hours a week is the exact reason why medicine is pu$$ified. The majority of med students were told they were special and don't have to work. That's why the midlevels are swooping in and stealing what is rightfully ours. All of medicine in the 80's used to be hard core. IM was Q3-4 and you did 100+ a week. Neurosurgery was Q2-3, General Surgery was Q3, CT was Qlife. Now who knows, maybe tort and reduced payments through medicare took away that incentive to work the life away, but ****, even med students now b*tch and moan about 9 hour days. I'll say it again, it's the reason why the field is getting snatched from under us.


General Surgery for me.


Edit: Don't get me wrong, I love my wife and enjoy spending time with her, but she knew beforehand that we will never have breakfast together and even as a attending, dinner probably will be late. Weekends are no guarantee as well. Gotta pay to play. Medicine is a special field. Most people don't let you cut them open/do invasive tests/give medicine unless you've logged some serious hours. This isn't the same as fixing your toilet or depositing your check. People let you work on their BODY. Put in the hours to learn how. Algorithms (which is 90% of medicine) will make us like the nurses, except we have the knowledge of how and why. That's what make us special.
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jesus christ
 
GuyWhoDoesStuff said:
Just be thankful. The more people like him there are to fill these roles, the less likely it is that YOU'LL be the one stuck hating your life in 30 years.
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I actually like what I'm doing, compared to everyone else who will be moving on to career #2 the moment they pay down their loans. It just sickens me to see the lack of respect for the field any more. The 80 hour week has hastened that mentality.

I still rest my case that that's the reason why midlevels are swooping in. If you WONT claim your turf, you CANT.
 
Mr Cookie Pants said:
I actually like what I'm doing, compared to everyone else who will be moving on to career #2 the moment they pay down their loans. It just sickens me to see the lack of respect for the field any more. The 80 hour week has hastened that mentality.

I still rest my case that that's the reason why midlevels are swooping in. If you WONT claim your turf, you CANT.
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Yeah, but you're going to have another kind of midlevel to deal with. The one swooping in on your wife.
 
Serious question:

Why is 80 hours a week not enough? What is enough? 90? 100?

I fully expect to work many weeks over this limit as a resident, and will probably work some under this limit. And I'm fine with all of it, because it comes with the territory. But why do we make such a freaking big deal about this? Is there any extra learning that occurs when you're on hour 90 that doesn't at hour 80? Are patients really better served by someone who has worked that much? I realize that service is a part of residency just as education is a part of residency, but where's the line?
 
Mr Cookie Pants said:
I actually like what I'm doing, compared to everyone else who will be moving on to career #2 the moment they pay down their loans. It just sickens me to see the lack of respect for the field any more. The 80 hour week has hastened that mentality.

I still rest my case that that's the reason why midlevels are swooping in. If you WONT claim your turf, you CANT.
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I guess what I find odd is your equating "not wanting to work 100 hour weeks" with "lack of respect for the field."
 
The line was chosen rather arbitrarily. I went to a lecture on the evolution of residency reform and the gist was the the head of the commission thought 100 hours was too many and 60 hours was too few so he settled on 80.
 
GuyWhoDoesStuff said:
I guess what I find odd is your equating "not wanting to work 100 hour weeks" with "lack of respect for the field."
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I don't WANT to work 100 hour weeks, but I will if I have to. That's the difference. Patients, politicians and competitors see it too. The fewer hours people work, the more they complain. Lifestyle wasn't even an option 20 years ago. It was your life. There's even a lot of surgery programs going to a float system. It's a win win for everybody. Hours don't make the physician, but I've met tons of people who are going into specialty X only because they work shifts and no call. That's a recipie for burnout in my book. It's a mindset. Our Xbox, netflix, streaming this and that generation doesn't have it. It is what it is, but it's one piece in the puzzle as to why we make half as much as we did back in the day.
 
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Mr Cookie Pants said:
No but the fact that EVERYONE wants to do EM/Rads/Derm/Gas and do it for 40.0 hours a week is the exact reason why medicine is pu$$ified. The majority of med students were told they were special and don't have to work. That's why the midlevels are swooping in and stealing what is rightfully ours. All of medicine in the 80's used to be hard core. IM was Q3-4 and you did 100+ a week. Neurosurgery was Q2-3, General Surgery was Q3, CT was Qlife. Now who knows, maybe tort and reduced payments through medicare took away that incentive to work the life away, but ****, even med students now b*tch and moan about 9 hour days. I'll say it again, it's the reason why the field is getting snatched from under us.


General Surgery for me.


Edit: Don't get me wrong, I love my wife and enjoy spending time with her, but she knew beforehand that we will never have breakfast together and even as a attending, dinner probably will be late. Weekends are no guarantee as well. Gotta pay to play. Medicine is a special field. Most people don't let you cut them open/do invasive tests/give medicine unless you've logged some serious hours. This isn't the same as fixing your toilet or depositing your check. People let you work on their BODY. Put in the hours to learn how. Algorithms (which is 90% of medicine) will make us like the nurses, except we have the knowledge of how and why. That's what make us special.
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Refreshing to see I'm not the only one who thinks like this. :thumbup:
 
Mr Cookie Pants said:
No but the fact that EVERYONE wants to do EM/Rads/Derm/Gas and do it for 40.0 hours a week is the exact reason why medicine is pu$$ified. The majority of med students were told they were special and don't have to work. That's why the midlevels are swooping in and stealing what is rightfully ours. All of medicine in the 80's used to be hard core. IM was Q3-4 and you did 100+ a week. Neurosurgery was Q2-3, General Surgery was Q3, CT was Qlife. Now who knows, maybe tort and reduced payments through medicare took away that incentive to work the life away, but ****, even med students now b*tch and moan about 9 hour days. I'll say it again, it's the reason why the field is getting snatched from under us.


General Surgery for me.


Edit: Don't get me wrong, I love my wife and enjoy spending time with her, but she knew beforehand that we will never have breakfast together and even as a attending, dinner probably will be late. Weekends are no guarantee as well. Gotta pay to play. Medicine is a special field. Most people don't let you cut them open/do invasive tests/give medicine unless you've logged some serious hours. This isn't the same as fixing your toilet or depositing your check. People let you work on their BODY. Put in the hours to learn how. Algorithms (which is 90% of medicine) will make us like the nurses, except we have the knowledge of how and why. That's what make us special.
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I agree somewhat but there needs to be a middle ground. One of my attendings talked to us today about how they were worked too hard back in the day and there were times they felt like zombies and really shouldn't have been taking care of patients in that state. He also said he thinks the pendulum has swung too far in the other direction and people aren't being trained hard enough (of course there will be much variation between institutions).

I have no expectation of working 40 hours of week and not going into rads because of the misconception that it's a cake gig. I really don't know any medical field where the average is 40 hours a week. The large majority of people won't be doing EM/Rads/Derm/Gas so even if everyone in those fields had that mentality it wouldn't account for what you're saying overall about medicine.
 
Any field where you are not personally, critically important for unscheduled situations can be a lifestyle specialty.

Anesthesia might be a considered a lifestyle specialty, but I don't feel like I need to practice that way. I would be happy to work 60 hours/week with call, at least while I'm young.

More importantly, I don't see why it is necessary to get so judgmental about other people's choices. Everyone has their reasons, and for the most part there is a need for all types. Especially if they are only working 40 hours/week!
 
The other issue is that a lot of people are doing fields because it represents what they're interested in, exclusive of lifestyle. I'm interested in rads because I think interventional rads is going to be a major part of the future of procedural medicine. I'm doing prelim surgery prior to it simply because I think it's the best preparation for rads in general. I would still do it even if the hours were twice as long.
 
Sorry all, I didn't mean to nearly derail things. It is just one of the amusing things of SDN, for better or worse.

Anyway, I'm technically not an M3 for a couple more weeks but I will contribute to the thread to makeup for my previous comment that almost wrecked it. :p

I am constantly between Ortho, Rads and EM with anesthesia and PM&R as dark horses that wouldn't really surprise me to move up in the ranks.

When all is said and done, I have the strong impression I will end up in radiology. My friends all seem to think the same thing about me.

Reasons:
1) My father is a radiologist and my mom was a radiology technician, all typical jokes aside, my viewpoint of medicine is centered around radiology. While most people see surgeons, internists, etc. as premeds with their unique styles, I was always surrounded by imaging and interventional stuff.

2) Provides opportunity to pursue my interests in tech and usability engineering, if I so choose. I did my undergrad in information sciences and wrote a thesis on PACS implementation. I also did cognitive psych type research on decision making and image studies where I got to play with eye tracking and what not.

3) Chances to do procedures and go more clinical if I want to or find I miss the more clinical aspects.

4) For whatever reason, I've always loved the beauty and complexity in the images. To me, it is like going to an art museum every day and not only appreciating the work of a master artist, but developing the knowledge to explain and interpret the reasoning behind the brush strokes, lighting, symbolism, etc. It is playing "Where's Waldo?" with Michaelangelo's Universal Judgement. As an extension of that, I enjoy taking crazy amounts of information and organizing it in a way to educate/help others. Sappy and a little cliche, but oh well. :p
 
MossPoh said:
Sorry all, I didn't mean to nearly derail things. It is just one of the amusing things of SDN, for better or worse.

Anyway, I'm technically not an M3 for a couple more weeks but I will contribute to the thread to makeup for my previous comment that almost wrecked it. :p

I am constantly between Ortho, Rads and EM with anesthesia and PM&R as dark horses that wouldn't really surprise me to move up in the ranks.

When all is said and done, I have the strong impression I will end up in radiology. My friends all seem to think the same thing about me.

Reasons:
1) My father is a radiologist and my mom was a radiology technician, all typical jokes aside, my viewpoint of medicine is centered around radiology. While most people see surgeons, internists, etc. as premeds with their unique styles, I was always surrounded by imaging and interventional stuff.

2) Provides opportunity to pursue my interests in tech and usability engineering, if I so choose. I did my undergrad in information sciences and wrote a thesis on PACS implementation. I also did cognitive psych type research on decision making and image studies where I got to play with eye tracking and what not.

3) Chances to do procedures and go more clinical if I want to or find I miss the more clinical aspects.

4) For whatever reason, I've always loved the beauty and complexity in the images. To me, it is like going to an art museum every day and not only appreciating the work of a master artist, but developing the knowledge to explain and interpret the reasoning behind the brush strokes, lighting, symbolism, etc. It is playing "Where's Waldo?" with Michaelangelo's Universal Judgement. As an extension of that, I enjoy taking crazy amounts of information and organizing it in a way to educate/help others. Sappy and a little cliche, but oh well. :p
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Person A - "Look at the beautiful symmetry of that glioblastoma multiforme? What's the symbolism in it, you think?"
Person B - "This poor sap is gonna die soon."

Really, dude?
 
I am pursuing Ortho.

Different aspects of med school have factored into my decision:

1.) I have had a great mentor (our school's past residency director/now chair) in the department who took me on for a research project the summer before M1 and has since given me a lot of opportunities. All around good experience with the people in the department at my school.

2.) I like the biomechanics/technical aspect of ortho. I majored in physics in undergrad and have enjoyed the research I've done in med school. I also like the idea of getting into the industry side of ortho hardware and would like to develop tools and equipment. I enjoy the OR.

3.) I love working with my hands. I feel like I'm actually doing something for the patient as opposed to telling the nurse to push some meds.

4.) I'm not a fan of rounding. I've enjoyed all of my rotations, but given the option of 6 hour power rounds in an IM setting, or 6 minute lightning rounds in ortho, it's an obvious choice for me.
 
With so much changing, how much do you guys expect to make before taxes in 3-6 years?? I'm guesstimating 250-300K...thats my hopeful wishing.
 
GuyWhoDoesStuff said:
Medical students, by and large, are surrounded by other medical students who continuously perpetuate the "you're a horrible person for not wanting to devote 30 hours a day to saving dying African babies" if the issue of preserving a reasonable lifestyle is brought up. I won't launch into the tired discussion of how medicine is one of the only fields in which having anything but Mother Theresa-esque ambitions earns you castigation from your colleagues and the public, but I'm sure we all get the idea.

It's the 500lb gorilla in the corner that no one wants to talk about.

I, for one, applaud Dr.VanNostran for having the sense to realize that it is possible to enjoy a fulfilling career in medicine AND still maintain a desirable quality of life.
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I agree. This is largely why I'm pursuing a surgical subspecialty with better hours and less intense call than general surgery.

Why do we need to become superhumans without relationships to be successful physicians. We preach health, well-being, and self-care to our patients, but then eat McDonald's 4x on a 35 hour call with no sleep and no regular exercise? That's ridiculous.
 
"Live to Work" or "Work to live"?

Why should doctors be EXPECTED to Unquestioningly devote themselves to a 100hr work week? If you choose those hours, it's your choice. But choosing not to makes you 'soft, weak, and Pussified?'? Seriously Cookie? You think you're hardcore because you want to spend your life at work? :laugh:. Continue to think you're harder because you want to work more.

Name another profession that ~expects~ this commitment of you, claiming that 60hr work weeks are "Too little"-- and 'altruistic elitists' spout off how 'soft', 'weak', and 'pussified' you are if you don't abide?...

Hardcore is pushing your personal limits, Making yourself happy, and Finding balance in YOUR life.

As I said, Do you work to live, or Live to work?


Back on topic--

Neurology or Ophtho
 
Darktide said:
"Live to Work" or "Work to live"?

Why should doctors be EXPECTED to Unquestioningly devote themselves to a 100hr work week? If you choose those hours, it's your choice. But choosing not to makes you 'soft, weak, and Pussified?'? Seriously Cookie? You think you're hardcore because you want to spend your life at work? :laugh:. Continue to think you're harder because you want to work more.

Name another profession that ~expects~ this commitment of you, claiming that 60hr work weeks are "Too little"-- and 'altruistic elitists' spout off how 'soft', 'weak', and 'pussified' you are if you don't abide?...

Hardcore is pushing your personal limits, Making yourself happy, and Finding balance in YOUR life.

As I said, Do you work to live, or Live to work?


Back on topic--

Neurology or Ophtho
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My need for 100 hour week isn't about 'altruistic elitism' its about learning a craft as well as staking a claim. The freaking AMA hates doctors, and doctors hate themselves by watering down the field. You went to captain school, why let some midlevel fly the plane. If you aren't willing to work, you can't complain about the way things are. If you want to be like every other profession, we soon will be paid as much and respected as much as everybody else. Do I want to work 100 hours a week? No. Will I? Yes. I hope not to as an attending, but you gotta pay your dues. But not only that, I want to learn to take care of patients. Give me 5 years of 100 hours over 8 years of 60. And also, there's a huge difference between 100 hours and 60, a happy middle ground in there, for residency. As you go into practice the call pool can get bigger and those hours drop.


But the point of this is that it's not 'hardcore'. It was the freaking norm not to long ago. Sad state we're in. Now before I turn into a Misterioso type caricature, I'm going to calm down.
 
Mr Cookie Pants said:
My need for 100 hour week isn't about 'altruistic elitism' its about learning a craft as well as staking a claim. The freaking AMA hates doctors, and doctors hate themselves by watering down the field. You went to captain school, why let some midlevel fly the plane. If you aren't willing to work, you can't complain about the way things are. If you want to be like every other profession, we soon will be paid as much and respected as much as everybody else. Do I want to work 100 hours a week? No. Will I? Yes. I hope not to as an attending, but you gotta pay your dues. But not only that, I want to learn to take care of patients. Give me 5 years of 100 hours over 8 years of 60. And also, there's a huge difference between 100 hours and 60, a happy middle ground in there, for residency. As you go into practice the call pool can get bigger and those hours drop.


But the point of this is that it's not 'hardcore'. It was the freaking norm not to long ago. Sad state we're in. Now before I turn into a Misterioso type caricature, I'm going to calm down.
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What in the hell are you talking about? You think midlevel creep is about hours worked? Jesus Christ. It's about a need of service, politics, and money. Have fun working your fingers to the bone. It won't change a thing.
 
sideways said:
What in the hell are you talking about? You think midlevel creep is about hours worked? Jesus Christ. It's about a need of service, politics, and money. Have fun working your fingers to the bone. It won't change a thing.
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I like your posts, and as usual... I agree with this statement. :thumbup:

Cookie is one naive sonofab!tch.... he'll learn quickly when his wife starts hittin up the mailman. :laugh:
 
Mr Cookie Pants said:
No but the fact that EVERYONE wants to do EM/Rads/Derm/Gas and do it for 40.0 hours a week is the exact reason why medicine is pu$$ified. The majority of med students were told they were special and don't have to work. That's why the midlevels are swooping in and stealing what is rightfully ours. All of medicine in the 80's used to be hard core. IM was Q3-4 and you did 100+ a week. Neurosurgery was Q2-3, General Surgery was Q3, CT was Qlife. Now who knows, maybe tort and reduced payments through medicare took away that incentive to work the life away, but ****, even med students now b*tch and moan about 9 hour days. I'll say it again, it's the reason why the field is getting snatched from under us. .
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Wow, this is so hardcore, I'm not even sure how to respond. No doubt there will be a whole spectrum of effort / time-commitment, so you can't possibly throw your line of thinking on training doctors and med students in general.

Also, the reason why "the field is getting snatched" isn't because doctors aren't hardcore enough. It's likely because it's so hardcore that few people decide to go into it, and there is currently a shortage of certain doctors, namely primary practice. Midlevels are definitely not taking over the jobs of specialists or even internists.
 
The real question is why lifestyle is so expendable with some professions. If I could take a 50% pay cut as a surgeon and work half as much, it would be an easy choice to go into surgery. I've heard rumors that such is possible in private practice, but I wouldn't know since all we're exposed to is the hubris and neuroticism of academic surgery.

Mr Cookie Pants said:
My need for 100 hour week isn't about 'altruistic elitism' its about learning a craft as well as staking a claim.
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I think it's understood that "lifestyle" is a post-residency consideration. In any case, the public doesn't "respect" 100 hour work weeks - they tend to see that sort of thing as reckless, thus the push for caps on resident hours. I agree that we need to learn, and I'll take 100x5 over 60x8 easy, but phrases like "pay your dues" and "captain school" just smacks of the sort of ego-driven masochistic posturing that makes me want to leave medicine and never look back.

But the point of this is that it's not 'hardcore'. It was the freaking norm not to long ago.
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So was [fasicism, slavery, whatever] at some point. Appealing to normalcy is never going to be a lasting argument.
 
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Well then, there are certainly some people I never, ever want to meet, let alone work with, in this thread. Even if we do end up in the OR together, I'll happily raise and lower the bed for you between rounds of Sudoku and Ninja Fruit. I'll also high-five the CRNA coming in to give me a lunch break as I walk out of the room. After that, I'll go home at or before 5 PM to my wife and kids who'll all still remember my name in my house that's bigger than yours because I make more money. :smuggrin:
 
I can somewhat understand where Cookie is coming from. From a learning standpoint I do support him. When you become an attedning there is no one to report to who you can say "hey does this sound right? I have only seen part of the evolution of this disease so I know what will happen for the 1st 12 hours but I had to go home so I don't know the different variations of what happens at hours 13 and 14". Books can not teach you everything which is why we have residencies to begin with.

My school made us take call with the residents and I am grateful because I learned best when I saw the full evolution of disease from presentation in the ED to improvement in the ICU after being weaned from a night of maxed out pressors. Medicine is a PROFESSION - and while I too want a life outside of medicine we need to have a certain level of dedication to our craft. Work hour restrictions have gotten to the point where I believe they compromise our education (decreased hours/learning) and harm patients (increased handoffs - I've seen some narrow misses).

We either have to put the time in during residency or I believe problems will arise later. I would not be surprised if the next suggestion the IOM has to extend residency training to combat a lack of experience they will see as the next big problem.
 
inspirationmd said:
I can somewhat understand where Cookie is coming from. From a learning standpoint I do support him. When you become an attedning there is no one to report to who you can say "hey does this sound right? I have only seen part of the evolution of this disease so I know what will happen for the 1st 12 hours but I had to go home so I don't know the different variations of what happens at hours 13 and 14". Books can not teach you everything which is why we have residencies to begin with.

My school made us take call with the residents and I am grateful because I learned best when I saw the full evolution of disease from presentation in the ED to improvement in the ICU after being weaned from a night of maxed out pressors. Medicine is a PROFESSION - and while I too want a life outside of medicine we need to have a certain level of dedication to our craft. Work hour restrictions have gotten to the point where I believe they compromise our education (decreased hours/learning) and harm patients (increased handoffs - I've seen some narrow misses).

We either have to put the time in during residency or I believe problems will arise later. I would not be surprised if the next suggestion the IOM has to extend residency training to combat a lack of experience they will see as the next big problem.
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this is, of course, demonstrably wrong.
 
VoiceofReason said:
this is, of course, demonstrably wrong.
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There has definitely been improvement from the days of 120 hours a week but now things are different. I do not have a problem with 80 hours a week, that is tough but certainly manageable. I believe that was necessary. But when we are required to have something like 10 hour naps between working and when we can not take call during what has always been called one of the most high yield years of residency then we get to the point where learning becomes compromised. The amount of information we must learn continues to increase and they are only shortening the hours more and more. At a certain point the only option becomes to increase the length of residency or graduate doctors who have not had enough experience.

And are you honestly saying that you have not seen potentially serious mistakes be narrowly avoided with hand offs? Sleep deprivation is dangerous but so are increased handoffs. There has to be a balance.
 
inspirationmd said:
There has definitely been improvement from the days of 120 hours a week but now things are different. I do not have a problem with 80 hours a week, that is tough but certainly manageable. I believe that was necessary. But when we are required to have something like 10 hour naps between working and when we can not take call during what has always been called one of the most high yield years of residency then we get to the point where learning becomes compromised. The amount of information we must learn continues to increase and they are only shortening the hours more and more. At a certain point the only option becomes to increase the length of residency or graduate doctors who have not had enough experience.

And are you honestly saying that you have not seen potentially serious mistakes be narrowly avoided with hand offs? Sleep deprivation is dangerous but so are increased handoffs. There has to be a balance.
Click to expand...

You just said the same thing again in a different way with no added support.

You are demonstrably wrong, studies show no real difference in patient outcomes.

When you say "balance" do you mean I should develop my own personal case of diabetes just so that I can learn to treat yours?
 
MilkmanAl said:
Well then, there are certainly some people I never, ever want to meet, let alone work with, in this thread. Even if we do end up in the OR together, I'll happily raise and lower the bed for you between rounds of Sudoku and Ninja Fruit. I'll also high-five the CRNA coming in to give me a lunch break as I walk out of the room. After that, I'll go home at or before 5 PM to my wife and kids who'll all still remember my name in my house that's bigger than yours because I make more money. :smuggrin:
Click to expand...
You really made a strong case for choosing a career in anesthesia. Good thing that those CRNAs can relieve you and do the exact same job as you imply. Keep on playing sudoku until your hospital fires the MD group in favor of CRNAs and retains a few MDs for supervision. Or better yet, the surgeons will be the supervisor of the CRNA. Suddenly your mcmansion isn't looking so great.

Cookiepants has a point to some extent in terms of making yourself irreplaceable and owning your turf.
 
*sigh* It's supposed to be a joke. A joke with a pretty large kernel of truth, mind you, but a joke nonetheless.

edit: For the record, I'd rather make less money and be "replaceable" than sell my soul to my job.
 
MilkmanAl said:
*sigh* It's supposed to be a joke. A joke with a pretty large kernel of truth, mind you, but a joke nonetheless.

edit: For the record, I'd rather make less money and be "replaceable" than sell my soul to my job.
Click to expand...
I realize the joke, yet the kernel of truth is what is drawing some of the laziest/most passive people from my class. People far too lazy to defend their turf.
 
DrBowtie said:
Cookiepants has a point to some extent in terms of making yourself irreplaceable and owning your turf.
Click to expand...


Except that cookiepants' supporting argument for owning your turf is based almost entirely on the concept that one must devote 100 hour weeks in the hospital in order to do so.
 
Wow, this could not have turned into something further from the topic. Annoying. What is so wrong with posting board scores and relating them to one's chosen specialty? It's not rocket science that higher board scores open more doors for medical students and I think it's fairly interesting to see everyone's chosen specialty.

Step 1: 249
Specialty: Ortho Surgery
 
Step 1: 249
Specialty: Diagnostic Radiology
 
VoiceOfReason,

Ok, I will try with some evidence this time. Here are some links to studies published recently in specialties spanning Family Medicine, Cardiothoracic Surgery, Gen Surg, Anesthesia and Neurosurg.

1)

http://www.ncbi.nlm.nih.gov/pubmed/19258094

This study looks at Cardiothoracic Surgery residents and examines Pre and Post Duty hour changes in operative experience. Concludes that "the overall volume of thoracic surgery cases was not significantly different after the implementation of the 80-hour work-week restriction. The total number of cardiac cases logged was substantially less during the same time period, and therefore as a result, the total number of cases performed after the implementation of the work-hour restrictions was also reduced. Although recent data have not shown an improvement in patient outcomes after restriction of resident work hours, we speculate that in a time of increasingly complex cases, reduction in resident case volumes caused by work-hour restrictions and decreasing cardiac cases might lead to inadequate operative experience."

2)
http://www.ncbi.nlm.nih.gov/pubmed/17989554

Anesthesia study that shows that while residents perceive a better sense of wellness overall that "it remains unclear if there has been an improvement in patient safety or quality of resident education." This is even though Anesthesia faculty have noticed an increase in their workloads and an increased need to hire additional staff.

3)
http://www.ncbi.nlm.nih.gov/pubmed/19927506

Gen Surg study that indicates that pre vs post duty hours there has been " a statistically significant decrease in the number of total chief cases...The significant decrease in the number of total chief cases demonstrates that the work hour restriction most affected the chief year operative experience. Further evaluation of resident participation in nonoperative facets may reveal additional deficiencies of surgical training under work hour restrictions."

4)
http://www.ncbi.nlm.nih.gov/pubmed/17549647

Family Medicine faculty felt that "residency education and patient care were not positively affected by duty hours" and "Twenty percent of faculty members are considering leaving academic medicine in relation to duty hours."

5)
http://www.ncbi.nlm.nih.gov/pubmed/19409028

Neurosurgeons believe possible further restrictions down to the 56 hour work week would cause problems. Also their written board certification exam scores experienced a statistically significant drop from 2002 to 2006 even though Step 1 scores remained roughly unchanged.

"Most chief residents and program directors believed the 80-hour workweek compromised resident training (96%) and decreased resident surgical experience (98%). Respondents also believed that the 80-hour workweek threatened patient safety (96% of program directors and 78% of chief residents) and access to quality care (82% of program directors and 87% of chief residents). When asked about the effects of a 56-hour workweek, all program directors and 98% of the chief residents indicated that resident training and surgical education would be further compromised. Most respondents (95% of program directors and 84% of chief residents) also believed that additional work-hour restrictions would jeopardize patient care."


Personally I was impressed that this much is out there in the literature given what I believe is political pressure to denounce resident hours as monstrous and a general travesty to patients even at the 80 hour per week threshold (which I believe is reasonable though I do not start residency for 2 more weeks). I will admit that my position was originally from my own observations on rotations and with consideration for my learning style but there is some evidence to support my position as well.

Again I am not saying that improvements in patient outcomes have not been noted since the drop from the 100-120 hour weeks but that if we continue dropping the work hours then its inevitable that we will eventually reach a point where our experience level during residency will be less than previous recent residency graduates and we will graduate as attendings not as well equipped to practice medicine. That is unless we do fellowships or other additional training (which you are already seeing in Gen Surg with minimally invasive fellowships according to some gen surg residents I know). Given how complex medicine continues to become in conjunction with the desire not to increase residency length some sort of reckoning is coming imo.
 
inspirationmd said:
VoiceOfReason,

Ok, I will try with some evidence this time. Here are some links to studies published recently in specialties spanning Family Medicine, Cardiothoracic Surgery, Gen Surg, Anesthesia and Neurosurg.

1)

http://www.ncbi.nlm.nih.gov/pubmed/19258094

This study looks at Cardiothoracic Surgery residents and examines Pre and Post Duty hour changes in operative experience. Concludes that "the overall volume of thoracic surgery cases was not significantly different after the implementation of the 80-hour work-week restriction. The total number of cardiac cases logged was substantially less during the same time period, and therefore as a result, the total number of cases performed after the implementation of the work-hour restrictions was also reduced. Although recent data have not shown an improvement in patient outcomes after restriction of resident work hours, we speculate that in a time of increasingly complex cases, reduction in resident case volumes caused by work-hour restrictions and decreasing cardiac cases might lead to inadequate operative experience."

2)
http://www.ncbi.nlm.nih.gov/pubmed/17989554

Anesthesia study that shows that while residents perceive a better sense of wellness overall that "it remains unclear if there has been an improvement in patient safety or quality of resident education." This is even though Anesthesia faculty have noticed an increase in their workloads and an increased need to hire additional staff.

3)
http://www.ncbi.nlm.nih.gov/pubmed/19927506

Gen Surg study that indicates that pre vs post duty hours there has been " a statistically significant decrease in the number of total chief cases...The significant decrease in the number of total chief cases demonstrates that the work hour restriction most affected the chief year operative experience. Further evaluation of resident participation in nonoperative facets may reveal additional deficiencies of surgical training under work hour restrictions."

4)
http://www.ncbi.nlm.nih.gov/pubmed/17549647

Family Medicine faculty felt that "residency education and patient care were not positively affected by duty hours" and "Twenty percent of faculty members are considering leaving academic medicine in relation to duty hours."

5)
http://www.ncbi.nlm.nih.gov/pubmed/19409028

Neurosurgeons believe possible further restrictions down to the 56 hour work week would cause problems. Also their written board certification exam scores experienced a statistically significant drop from 2002 to 2006 even though Step 1 scores remained roughly unchanged.

"Most chief residents and program directors believed the 80-hour workweek compromised resident training (96%) and decreased resident surgical experience (98%). Respondents also believed that the 80-hour workweek threatened patient safety (96% of program directors and 78% of chief residents) and access to quality care (82% of program directors and 87% of chief residents). When asked about the effects of a 56-hour workweek, all program directors and 98% of the chief residents indicated that resident training and surgical education would be further compromised. Most respondents (95% of program directors and 84% of chief residents) also believed that additional work-hour restrictions would jeopardize patient care."


Personally I was impressed that this much is out there in the literature given what I believe is political pressure to denounce resident hours as monstrous and a general travesty to patients even at the 80 hour per week threshold (which I believe is reasonable though I do not start residency for 2 more weeks). I will admit that my position was originally from my own observations on rotations and with consideration for my learning style but there is some evidence to support my position as well.

Again I am not saying that improvements in patient outcomes have not been noted since the drop from the 100-120 hour weeks but that if we continue dropping the work hours then its inevitable that we will eventually reach a point where our experience level during residency will be less than previous recent residency graduates and we will graduate as attendings not as well equipped to practice medicine. That is unless we do fellowships or other additional training (which you are already seeing in Gen Surg with minimally invasive fellowships according to some gen surg residents I know). Given how complex medicine continues to become in conjunction with the desire not to increase residency length some sort of reckoning is coming imo.
Click to expand...

:thumbup::thumbup::thumbup:
 
Mr Cookie Pants said:
No but the fact that EVERYONE wants to do EM/Rads/Derm/Gas and do it for 40.0 hours a week is the exact reason why medicine is pu$$ified. The majority of med students were told they were special and don't have to work. That's why the midlevels are swooping in and stealing what is rightfully ours. All of medicine in the 80's used to be hard core. IM was Q3-4 and you did 100+ a week. Neurosurgery was Q2-3, General Surgery was Q3, CT was Qlife. Now who knows, maybe tort and reduced payments through medicare took away that incentive to work the life away, but ****, even med students now b*tch and moan about 9 hour days. I'll say it again, it's the reason why the field is getting snatched from under us.


General Surgery for me.


Edit: Don't get me wrong, I love my wife and enjoy spending time with her, but she knew beforehand that we will never have breakfast together and even as a attending, dinner probably will be late. Weekends are no guarantee as well. Gotta pay to play. Medicine is a special field. Most people don't let you cut them open/do invasive tests/give medicine unless you've logged some serious hours. This isn't the same as fixing your toilet or depositing your check. People let you work on their BODY. Put in the hours to learn how. Algorithms (which is 90% of medicine) will make us like the nurses, except we have the knowledge of how and why. That's what make us special.
Click to expand...

It's been a long time since I fell in love with a medical student. :thumbup:
 
If only sepsis, MI, cancer, aortic dissection, bullet wounds, and motor vehicle accidents occurred between 9-5 M-F (no weekends) . . .
 
Agreed. It doesn't. I have much respect for you, jdh, however I'm going to bring up a few things...

There are nocturnists for those who like to work nights. There are those who like to work weekends, too. You can't fault those who do not wish to work their lives away for the sake of medicine, just how you can't save every patient. You just can't. It's not about enjoying the money. It's about LIVING YOUR LIFE. Entering medicine does not mean you signed your life over to it. Medicine is a career, but it is not my life. While jumping through the hoops of the pre-med/med school days, I've always heard that one should have a life outside of medicine, science, etc. They push "well-rounded" individuals. They want people to enjoy what they do, NOT be so one-dimensional that all they do is "eat, live, breathe" their career that they burn out, causing a lower quality of patient care.

There's different sides to this argument. I do agree we should go above and beyond for our patients, because if we don't, then who will? However, go above and beyond for your patients while you are working and they are under YOUR CARE. Nurses? PAs? It will be a sad day when primary care providers are nurses and PAs. However, that has more to do with those pursuing primary care specialties then later pursuing fellowships to become specialists. There, I said it. Don't blame those who wished to pursue a straight path to specialty medicine because they enjoyed it. As for the med student, your attitude is fine, if you keep it up. Good for you. Chances are you won't. Having a wife was a major strike against that. Overall, if you wish to remain a generalist and work long hours, go for it. I don't see any of you doing it. So, don't judge.
 
inspirationmd said:
VoiceOfReason,

Ok, I will try with some evidence this time. Here are some links to studies published recently in specialties spanning Family Medicine, Cardiothoracic Surgery, Gen Surg, Anesthesia and Neurosurg.

1)

http://www.ncbi.nlm.nih.gov/pubmed/19258094

This study looks at Cardiothoracic Surgery residents and examines Pre and Post Duty hour changes in operative experience. Concludes that "the overall volume of thoracic surgery cases was not significantly different after the implementation of the 80-hour work-week restriction. The total number of cardiac cases logged was substantially less during the same time period, and therefore as a result, the total number of cases performed after the implementation of the work-hour restrictions was also reduced. Although recent data have not shown an improvement in patient outcomes after restriction of resident work hours, we speculate that in a time of increasingly complex cases, reduction in resident case volumes caused by work-hour restrictions and decreasing cardiac cases might lead to inadequate operative experience."

2)
http://www.ncbi.nlm.nih.gov/pubmed/17989554

Anesthesia study that shows that while residents perceive a better sense of wellness overall that "it remains unclear if there has been an improvement in patient safety or quality of resident education." This is even though Anesthesia faculty have noticed an increase in their workloads and an increased need to hire additional staff.

3)
http://www.ncbi.nlm.nih.gov/pubmed/19927506

Gen Surg study that indicates that pre vs post duty hours there has been " a statistically significant decrease in the number of total chief cases...The significant decrease in the number of total chief cases demonstrates that the work hour restriction most affected the chief year operative experience. Further evaluation of resident participation in nonoperative facets may reveal additional deficiencies of surgical training under work hour restrictions."

4)
http://www.ncbi.nlm.nih.gov/pubmed/17549647

Family Medicine faculty felt that "residency education and patient care were not positively affected by duty hours" and "Twenty percent of faculty members are considering leaving academic medicine in relation to duty hours."

5)
http://www.ncbi.nlm.nih.gov/pubmed/19409028

Neurosurgeons believe possible further restrictions down to the 56 hour work week would cause problems. Also their written board certification exam scores experienced a statistically significant drop from 2002 to 2006 even though Step 1 scores remained roughly unchanged.

"Most chief residents and program directors believed the 80-hour workweek compromised resident training (96%) and decreased resident surgical experience (98%). Respondents also believed that the 80-hour workweek threatened patient safety (96% of program directors and 78% of chief residents) and access to quality care (82% of program directors and 87% of chief residents). When asked about the effects of a 56-hour workweek, all program directors and 98% of the chief residents indicated that resident training and surgical education would be further compromised. Most respondents (95% of program directors and 84% of chief residents) also believed that additional work-hour restrictions would jeopardize patient care."


Personally I was impressed that this much is out there in the literature given what I believe is political pressure to denounce resident hours as monstrous and a general travesty to patients even at the 80 hour per week threshold (which I believe is reasonable though I do not start residency for 2 more weeks). I will admit that my position was originally from my own observations on rotations and with consideration for my learning style but there is some evidence to support my position as well.

Again I am not saying that improvements in patient outcomes have not been noted since the drop from the 100-120 hour weeks but that if we continue dropping the work hours then its inevitable that we will eventually reach a point where our experience level during residency will be less than previous recent residency graduates and we will graduate as attendings not as well equipped to practice medicine. That is unless we do fellowships or other additional training (which you are already seeing in Gen Surg with minimally invasive fellowships according to some gen surg residents I know). Given how complex medicine continues to become in conjunction with the desire not to increase residency length some sort of reckoning is coming imo.
Click to expand...

:thumbup:

We are not only increasing our gaps in knowledge, but we are leaving a vacuum for others to fill. Overall it is bad for the profession. The new 16 hr intern work rule is stupid.
 
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