quitters

[Rabbit Hole]

I actually knew a guy that dreamed and achieved creating a practice out of a conversion van.... not in surgery mind you.

Was it profitable? Anyone wanna split a rusty old van and start a practice? I'll throw in a couple of coolers and Wilford Brimley for good measure. [Good eye Guile].

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[Guile]

I wish this was true, but it's not. Residents are very seldom given the training necessary to deal with the business side of surgery. This is a huge deficit in our training, and we spend the majority of our time in residency blissfully in the dark on topics like coding, investments, etc.

Most general surgery residents will end up in private practice, and most of them will be relatively clueless when they get there.

Man, have I been misled. Get a good (and honest) CPA and office manager, I guess? So do all residency graduates just have to eat it and join a practice where they will "give more than take" for several years because they don't have the business acumen to open a practice or start a practice with others?

 

[Winged Scapula]

Man, have I been misled. Get a good (and honest) CPA and office manager, I guess? So do all residency graduates just have to eat it and join a practice where they will "give more than take" for several years because they don't have the business acumen to open a practice or start a practice with others?

Having "walked the walk" I wholeheartedly agree with SLUser...this is especially true for those of us who trained in academic medical centers. Your faculty have little to no idea about jobs outside of academia and many of them haven't looked for a job in decades.

You will have some scattered comments about coding here and there, but in general, you do not learn anything important when it comes to coding, billing, and running a practice in residency. Even private practice rotations do not spend an adequate time on this. I learn something new every day that I never thought about in residency.

One reason people don't open up their own PP is that its hard and its not sustainable for a very very long time. Most of us don't have a spouse that can pay off our loans and help support us, while we're sitting around barely bringing in enough to pay the electricity bill. So joining an established practice sounds good. My partner started her own practice but she got a loan from a local hospital and had a husband with a good paying job, so she could ride out the dry months. So its not just about business acumen but the reality of getting on insurance contracts and waiting for reimbursement all the while you have expenses.

 

[JelloBrain]

You will have some scattered comments about coding here and there, but in general, you do not learn anything important when it comes to coding, billing, and running a practice in residency.

I have seen Coding and Practice Development & Management offered as sessions during AANS/CNS meetings. I was wondering if such seminars help and if similar ones are offered during annual surgical meetings (ACS?)

 

[Taurus]

I wish this was true, but it's not. Residents are very seldom given the training necessary to deal with the business side of surgery. This is a huge deficit in our training, and we spend the majority of our time in residency blissfully in the dark on topics like coding, investments, etc.

Most general surgery residents will end up in private practice, and most of them will be relatively clueless when they get there.

This may not be so true in the future. Because of the bundling provision, the health reform bill pushes physicians hard to become hospital employees. Here's a good recent NYT article on it. More Doctors Giving Up Private Practices If you are an employee, then knowing the business side of medicine is not as critical. We've entered a new era in medicine with Obamacare.

 

[Rabbit Hole]

This may not be so true in the future. Because of the bundling provision, the health reform bill pushes physicians hard to become hospital employees. Here's a good recent NYT article on it. More Doctors Giving Up Private Practices If you are an employee, then knowing the business side of medicine is not as critical. We've entered a new era in medicine with Obamacare.

Nice article, thanks for that.

I've been soliciting info from doctors in different specialties about private practice and the business side of medicine in general. From what I have gathered, there is a general sentiment that it's flat out easier to be an employee than to tread out into unknown waters of opening up their own business.

I'm at the point where I'm seriously considering NOT going into surgery and switching to the specialty my family members are in so that I can learn the "business" and take over the practice. The logistics would simply work out better in that scenario. I'm wary about what sort of impact this health care reform is going to have on my job outlook if I go into surgery and become totally dependent on Suits in the boardroom for my bread crumbs. I wouldn't mind going into either specialty but I like surgery more.. so it would be a little sad but I'd get over it.

I don't wanna spend most of my life living in a Worker's Paradise.

They got the situation, they got me facin'
I can't live a normal life, I was raised by the strip
So I gotta be down with the hood team
Too much television watchin' got me chasin' dreams
I'm an educated fool with money on my mind
Got my ten in my hand and a gleam in my eye
I'm a loc'ed out gangsta, set-trippin banger
And my homies is down, so don't arouse my anger, fool
Death ain't nuthin but a heart beat away
I'm livin life do-or-die-a, what can I say?
I'm twenty-three now, but will I live to see twenty-fow'?
The way things are goin' I don't know

 

[SAvoodoo]

This may not be so true in the future. Because of the bundling provision, the health reform bill pushes physicians hard to become hospital employees. Here's a good recent NYT article on it. More Doctors Giving Up Private Practices If you are an employee, then knowing the business side of medicine is not as critical. We've entered a new era in medicine with Obamacare.

love or hate the bill, the article you posted blatantly states it's unrelated. literally the first sentance...not to mention it goes on to talk about '05 being the turning point, with a fancy graph for those of us who don't like reading (books are all words, no heart)

 

[jdh71]

Yeah he loved it too, although was a bit dismayed that I took 1/3 of the dose he took and he felt no effect.

It really was sort of scary in retrospect because I felt *so* good - alive, energetic, sexy - a superhero with none of the side effects of No-Doz: no shakes, no being awake but still feeling tired. It was like I imagine meth would be like.

.

 

[Smurfette]

You will have some scattered comments about coding here and there, but in general, you do not learn anything important when it comes to coding, billing, and running a practice in residency.

I have seen Coding and Practice Development & Management offered as sessions during AANS/CNS meetings. I was wondering if such seminars help and if similar ones are offered during annual surgical meetings (ACS?)

There are a few at ACS, but it certainly wouldn't be something that someone unfamiliar with how things work (i.e. most residents) could just jump into and comprehend fully. Also, it's not as though residents get time off to travel to ACS every year (those who do are usually local, presenting something or maybe are allowed to go as a chief resident).

 

[JelloBrain]

There are a few at ACS, but it certainly wouldn't be something that someone unfamiliar with how things work (i.e. most residents) could just jump into and comprehend fully. Also, it's not as though residents get time off to travel to ACS every year (those who do are usually local, presenting something or maybe are allowed to go as a chief resident).[/QUOTE]

Thanks Smurfette. I keep forgetting that once I start residency in USA I won't get to go to all the annual meetings I currently attend as a Postdoc presenting my research. Maybe I should just learn the coding thing at my next meeting. But then I am strictly for an Academic track (fingers crossed) for myself, so not sure how it'll help me.

 

[SocialistMD]

But then I am strictly for an Academic track (fingers crossed) for myself, so not sure how it'll help me.

Your salary (and/or employment) will still be tied to your billing. You have to demonstrate that you are at least pulling your salary, and proper documentation is an easy way to do this, especially if you are looking at trauma/acute care, where much of your patient management will be non-operative.

 

[JackADeli]

Your salary (and/or employment) will still be tied to your billing. You have to demonstrate that you are at least pulling your salary, and proper documentation is an easy way to do this, especially if you are looking at trauma/acute care, where much of your patient management will be non-operative.

I must agree. Numerous physicians "leave money on the table". there are significant nuances that have big financial implications. An FP physician told me that if he admitted a patient with "bad UTI/pyelonephritis" and called it bad UTI.... he got paid same as outpatient clinic visit UTI. He said he needed to specifically call it "sepsis from urinary source". There is similar jargon for pneumonias, acute blood loss anemia, etc.... To increase the reimbursement based on morbidities, you might need to classify exact type of renal insufficicency... something like "class 4 renal insufficiency". Or, acute on chronic congestive heart failure with ... must specify "pulmonary edema/EF = x", etc, etc, etc, etc....

Things like:
"admit for pneumonia" = loose money get paid outpat clinic visit rate
"admit for COPD exacerbation" = loose money get paid outpat clinic visit rate
etc....

There are numerous catch words & phrases that you must specify in your notes in order to upgrade the severity of illness. But, all that goes away once you have "respiratory failure with tracheostomy". There is no higher modifier of severity of illness once you got that one

 

[JackADeli]

Was it profitable?...

From what I heard, it was/it is.... he had a fax machine in the van, no office staff, no real overhead, vehicle and all was tax deductable, etc....

 

[notinkansas]

Back to the original point-

I am one who did quit.

Sometimes i still can't believe it. As a medical student, I was considered hard core by my fellow students. Surgery seemed like the most natural place for me to everybody. My 3rd year rotation occurred before the 80 hr work week. We took call very much the same as the residents did. On the trauma part, the entire team took Q2 call, with a post call clinic one day a week. I loved it. I loved going to the OR and couldn't wait to be the one doing the cases.

Started residency at a different program. Slowly my enthusiasm waned. I learned I had a low tolerance for BS. The BS that bugged me wasn't within the department. It was the dumb stuff being imposed by the hospital, increasing every year (eg instead of simply ordering heparin, now there is a form that must be filled out). Patients seemed to become more demanding and unreasonable. As I moved up in residency my schedule was more like that of an attending. I was staying more often in the OR late. Then I'd have to round, and would encounter visiting family member (new to me) who would bombard me with questions (all these questions I've already answered for pt and primary family member). At 8 or 9 pm, after rounding in the am, being in the OR all day, when I'm tired, my back hurts, and I've wolfed down crappy food, I don't want to deal with this. I just want to go home.

Once the novelty of the OR was gone, I didn't love it enough to put up with all the BS. And I learned that I absolutely hate doing laparoscopic cases. The bad ergonomics made my back pain much worse, and I hate the frustration of it. I struggled with it more than my younger counterparts. The cost/benefit ratio no longer made sense to me. It was a difficult decision.

I'm female, and started medical school in my late 30's, so I guess you could say i had some predictive factors for attrition. At the end of the day, as with any specialty, you can't get a good feel for what it's really like until you've been in it for a while.

I still have a soft spot for all things surgical, and sometimes I miss the OR. I'm working a moonlighting type job now to pay down some debt before I retrain. I haven't decided yet what field, that is a process I'm working through right now.

 

[Guile]

^^ Thanks so much for sharing that with us. Really helpful perspective. Good luck with everything.

 

[ramblinwreckie]

California was a different ball of wax. Students were so coddled it was absurd. I worked briefly with MS3s who would scrub on plastics cases; they had 25+ hrs a week of protected "academic time", wore long coats, and instructed me to refer to them as "Doctor" in front of patients. Hell no.

seriously, i think that soft surgery clerkships are quite hurtful overall to med students. it definitely does not give them an accurate representation of what it would be like to be a surgery resident. here at UCSF, we never see the med students. they're usually off in lecture somewhere. for the six or so students on trauma each rotation, only one rounds daily with the team. that's absurd, in my opinion. at Duke, we worked >100 and were given an accurate representation of what it would be like to be a surgical intern. so, kids that did soft clerkships will be in for quite the surprise once they find out that gen surg is not what they thought it was (and, hence, more likely to drop out).

 

[PAgirl]

seriously, i think that soft surgery clerkships are quite hurtful overall to med students. it definitely does not give them an accurate representation of what it would be like to be a surgery resident. here at UCSF, we never see the med students. they're usually off in lecture somewhere. for the six or so students on trauma each rotation, only one rounds daily with the team. that's absurd, in my opinion. at Duke, we worked >100 and were given an accurate representation of what it would be like to be a surgical intern. so, kids that did soft clerkships will be in for quite the surprise once they find out that gen surg is not what they thought it was (and, hence, more likely to drop out).

I agree that easy surgery clerkships don't give students an accurate idea about what a surgery residency is like. However, when I was on my surgery rotation, I met a third year resident who was miserable and hated her life as a surgery resident and tried to convince me to do anesthesia or radiology instead of surgery, but she told me as a med student she worked about 100 hours a week on surgery. So I guess no matter how much you work as a student, you still can't know what it's like as a resident until you actually do it. Another example is the above poster. Just my two cents.

 

[EastCstBound]

I'm a third year probably applying in gen surg and I've been reading the boards a lot more lately. I dont agree at ALL with posters who believe putting med students through more hellish work hours is a good idea. I am in medical school to LEARN not to be scutted out for hours on end on the floors. Would a program rather a med student who spent a good amount of time learning about the decision making in surgery then observing it while they were still functional or one who didn't learn as much on surgery b/c they were constantly asked or required to be in the hospital doing things that were not high yield? If I were a PD I would want the former as long as they had demonstrated through other means and on other clerkships that they weren't afraid of hard work... I don't fear the crazy hours of surgery at all, but I sure do appreciate having time as a med student to digest why people are doing what they are doing so that when I'm in the same position in a year or two to come it'll come much easier and I'll know how to think about it... just saying.

 

[SLUser11]

I'm a third year probably applying in gen surg and I've been reading the boards a lot more lately. I dont agree at ALL with posters who believe putting med students through more hellish work hours is a good idea. I am in medical school to LEARN not to be scutted out for hours on end on the floors. Would a program rather a med student who spent a good amount of time learning about the decision making in surgery then observing it while they were still functional or one who didn't learn as much on surgery b/c they were constantly asked or required to be in the hospital doing things that were not high yield? If I were a PD I would want the former as long as they had demonstrated through other means and on other clerkships that they weren't afraid of hard work... I don't fear the crazy hours of surgery at all, but I sure do appreciate having time as a med student to digest why people are doing what they are doing so that when I'm in the same position in a year or two to come it'll come much easier and I'll know how to think about it... just saying.

I think your definition of scutwork may be different than ours. If I hear the "we're here to learn" line one more time I'm going to puke. We know you're there to learn, and we're there to teach you. Read my recent post on the subject for a more extended expression of my opinion.

 

[Buzz Me]

While I agree that med students shouldn't be scutted out unnecessarily during their rotations - they ARE there to learn, after all - a balance between education and service is required, to some degree (though not to the same degree as residents). I dislike med students who will only go to the OR (unprepared, often), and refuse to round on patients, help with floor work, go to clinic, etc. And while I don't agree with ridiculously difficult rotations in terms of work and hours, I feel it behooves any medical student interested in surgery to go for the most difficult, arduous rotation possible at their med school. That's the only way to see any sort of glimpse as to what it's like being a resident, keeping in mind that you'll never really know until you hit internship.

Too often, brand new interns will quickly become disillusioned/beat down/disenchanted/burned out/bitter because being a resident wasn't anything like being a med student on surgery. Sure, you don't want to coddle the med students, but you don't want them to get the wrong idea that surgery is all warm and fuzzy and "not work since you love what you do."

I worry that the high attrition rate is partially due to interns and junior residents realizing the world of residency was completely different from what they'd expected.

 

[Rabbit Hole]

While I agree that med students shouldn't be scutted out unnecessarily during their rotations - they ARE there to learn, after all - a balance between education and service is required, to some degree (though not to the same degree as residents). I dislike med students who will only go to the OR (unprepared, often), and refuse to round on patients, help with floor work, go to clinic, etc. And while I don't agree with ridiculously difficult rotations in terms of work and hours, I feel it behooves any medical student interested in surgery to go for the most difficult, arduous rotation possible at their med school. That's the only way to see any sort of glimpse as to what it's like being a resident, keeping in mind that you'll never really know until you hit internship.

Too often, brand new interns will quickly become disillusioned/beat down/disenchanted/burned out/bitter because being a resident wasn't anything like being a med student on surgery. Sure, you don't want to coddle the med students, but you don't want them to get the wrong idea that surgery is all warm and fuzzy and "not work since you love what you do."

I worry that the high attrition rate is partially due to interns and junior residents realizing the world of residency was completely different from what they'd expected.

I think another factor that can be attributed to the high attrition rate is that for a lot of students, residency is literally their first job. J-O-B, job. I think it's safe to say that a good portion of medical students don't really have real work experience. It's one thing to volunteer and shadow and all that jazz.. but once you start working for a paycheck things get real. Bosses, coworkers, office politics, showing up to work on time. I think this is one of the many reasons why expectations don't meet reality.

 

[notinkansas]

I'm a third year probably applying in gen surg and I've been reading the boards a lot more lately. I dont agree at ALL with posters who believe putting med students through more hellish work hours is a good idea. I am in medical school to LEARN not to be scutted out for hours on end on the floors. Would a program rather a med student who spent a good amount of time learning about the decision making in surgery then observing it while they were still functional or one who didn't learn as much on surgery b/c they were constantly asked or required to be in the hospital doing things that were not high yield? If I were a PD I would want the former as long as they had demonstrated through other means and on other clerkships that they weren't afraid of hard work... I don't fear the crazy hours of surgery at all, but I sure do appreciate having time as a med student to digest why people are doing what they are doing so that when I'm in the same position in a year or two to come it'll come much easier and I'll know how to think about it... just saying.

So what, exactly do you consider scut work that you can't learn from?

There is a limit to what you can learn sitting on your butt being lectured at.

There was very little I wasn't willing to do as a medical student. Even if it was making phone calls during clinic to find out what was taking the requested films so long to arrive- we worked on a team model. Nobody on the team went home until all the work was done. There were lots of little things that the students could do to move things along. Some medical students would probably consider that scut. I think it was valuable to have the experience of being a team player.

When I started residency, it was at a program where the med students were coddled. I stood out as a star. Some of my fellow interns (graduates of that medical school) had never stayed up all night until the first night they took call as an intern. I was GLAD that I had stayed up all night on call enough as a med student. I was accustomed to staying up all night, so that wasn't a new experience for me. It allowed me to focus only on the new experience of being the doctor who was getting the calls and making the decisions (most of which I ran by a sr resident, but still....)

 

[SocialistMD]

Here is an interesting article from the ACS website (I apologize if it was posted on this thread before).

 

[Pickyournose]

I'm wary of quitting statistics because some of them were actually fired. Really nasty chairs will fire you. Somewhat nasty ones will let you quit.

 

[Pickyournose]

It isn't a good idea to prescribe yourself a scheduled controlled substance. ."

Don't do it!

The surgery program director of Texas Tech (first name starts with A, in case there's a different guy there now) was reprimanded by the Texas Medical Board for asking his residents to write him pain pills.

 

[thedrjojo]

it is such a fine balance and really, you won't satisfy anyone, some will think they are too coddled (I felt this way sometimes even though we have a pretty rigorous Clerkship/AI, and more thought the other students were being coddled) and some will think they are being scutted out too much, just being used, etc... I think it is the nature of the nerotic med student... In general, with all the newer JCO, coding, billing type of rules, the medical student CANT do as much as before... I just started my ER rotation, they implemented an EMR in the ER 1 week ago... the student went from the person who wrote the note, wrote all the orders (and just had attending/resident sign off on them), scans, and followed up on all of them (radiology dept also just started a policy that only physicians and PA's can get radiology reads) to essentially worthless individuals cause we can't do any of that on the EMR. In surgery, back in the day when attendings wouldn't ever scrub or even show up in the OR, med students would do so much more in the OR (although my home institution still does work like that on some services, so I have done more than most in the OR, but on my away I saw what this could look like first hand) So yeah, med students are being coddled, and in general probably want to do less than students of yester year, but it is not all their fault... the whole nature of medicine has really neutered the medical student and how useful we actually can be (except on my mundane and pseudo-scut work...)

 

[thedrjojo]

Here is an interesting article from the ACS website (I apologize if it was posted on this thread before).

interesting article... i was particularly struck by the "Generational Gap" section, talking about baby boomers vs Gen X, and the tips listed as bullet points:

Recognize that expecting life balance does not translate into poor work ethic.
Listen to their side of the story instead of simply telling residents this is the way it is.
Refrain from talking about the good old days.
Set clear expectations with regard to outcomes but let residents devise the strategy.
Aim for immediate gratification by building in short term rewards.
Provide frequent feedback.
Emphasize and model life balance

I think they are both helpful, and a bit condoscending, almost treating gen x like they are primadonas that must be coddled (which goes to the whole coddling med student discussion above) - aiming for immediate gratification, provide frequent feedback, refrain from talking about the good old days... but I am not technically a Gen X'er (1984)... I think it is also interesting that some Gen X'ers are starting to rise into the power positions at programs (PD's and assistant PD's) and to see how they may strike the balance better or relate to residents better (who are now quickly become next neg (what is the next generation called anyway?)

 

[JackADeli]

...Refrain from talking about the good old days...

Just one example of the post. I think it is a matter of how you preceive/interpret it and in what context. I have heard too many attendings speak to the good old days. It is not that I do not want to learn from them. It is that these trips down memory lane are more often then not intended to convince me/residents how inadequate we are and how inadequate our training is.

On the other hand, I have had a few senior mentors go down memory lane. They explained how they really had no real "text book" of knowledge as we do now. They explained they worked many useless long hours without any real efficiency... because they had all week to get the job done or until the patient died. They explained how the idea of modern trauma/critical care and the volumes of knowledge did not exist. They proceed to speak to how there is such a great volume of knowledge we/residents must now learn to provide good care, such that wasting time for endless hours without reading is unreasonable.... that the good old days were not so good.

 

[Apollyon]

....that the good old days were not so good.

"....and tomorrow ain't as bad as it seems!"

 

[SocialistMD]

what is the next generation called anyway?

They are the "Millennials," aka "Generation Mi."

 

[SplenoMegastar]

They are the "Millennials," aka "Generation Mi."

Isn't there a Gen Y in there somewhere?

 

[SocialistMD]

Isn't there a Gen Y in there somewhere?

They are one in the same.

 

[Untraditional]

If I can jump in here, then, how old is too old to pursue a career as a surgeon? If you get your MD at age 25 vs age 30 vs age 35 does it make a difference? How and why?

And unrelatedly can someone describe the circumstances under which a surg resident would be fired? Gross negligence? Shaky hands? Nervousness?

 

[Guile]

If I can jump in here, then, how old is too old to pursue a career as a surgeon? If you get your MD at age 25 vs age 30 vs age 35 does it make a difference? How and why?

And unrelatedly can someone describe the circumstances under which a surg resident would be fired? Gross negligence? Shaky hands? Nervousness?

Hopefully njbmd will chime in here soon. IIRC she started her surgery residency at or after 50. She had no problems matching and is now enjoying a career in academic vascular surgery.

 

[Jolie South]

I understand where yall are coming from with the "need to work residency-like hours to decide if you can handle GS training." However, a lot of students that rotate through surgery won't go into it. Isn't it better to have a balance of ward/OR work and study time to really get the basic surgical knowledge that the clerkship purports to impart for those folks?

I'm interested in surgery and I have no problem working the hours I'm told to work and doing the work that needs to get done, but at the same time my evals aren't the entirety of my grade and I can't learn everything on the wards anyways. I feel like I need some minimal study time right now as well so that when I go to the OR or my patient has a complication I can understand what's going on and come up with an intelligent thought about a treatment plan. If I need to do a sub-I, isn't that a better time to put me through the rigors of what it's like? I have no delusions about the workload or lifestyle as it is.

Maybe I'm just a naive clinical student. . .

 

[notinkansas]

If I can jump in here, then, how old is too old to pursue a career as a surgeon? If you get your MD at age 25 vs age 30 vs age 35 does it make a difference? How and why?

And unrelatedly can someone describe the circumstances under which a surg resident would be fired? Gross negligence? Shaky hands? Nervousness?

I matched into my GS program after age 40. The fact that I wound up not liking it and bailing out was not related to my age.

In order to get fired (generally from any residency) you have to be pretty bad. Things like an established pattern of very bad judgement, or a one time very stupid act (like taking a photo of the HOT ROD tattoo on a pts penis) are pretty much the only things that will get you fired. I would take the stories that you see posted on SDN that somebody go fired because everybody in their program was "out to get them" with a grain of salt.

 

[Guile]

or a one time very stupid act (like taking a photo of the HOT ROD tattoo on a pts penis)

Did that guy really get fired? I thought for sure he would just have to do some sensitivity training, apologize, etc. I know I've seen residents take photos of tattoos in the OR before (trauma patients inevitably have some interesting ones) but none of these were genitalia tattoos...

 

[Rabbit Hole]

Did that guy really get fired? I thought for sure he would just have to do some sensitivity training, apologize, etc. I know I've seen residents take photos of tattoos in the OR before (trauma patients inevitably have some interesting ones) but none of these were genitalia tattoos...

It's not exactly clear but he either got fired or resigned. The stupid b*tch who went straight to the newspapers instead of reporting it to the hospital obviously had it out for him.

 

[Winged Scapula]

Did that guy really get fired? I thought for sure he would just have to do some sensitivity training, apologize, etc. I know I've seen residents take photos of tattoos in the OR before (trauma patients inevitably have some interesting ones) but none of these were genitalia tattoos...

Yep he definitely left Mayo; information about whether it was a "forced" resignation or firing has not been released for public knowledge.

Intraoperative photography is allowed as long as it is within the context of the planned surgery. Therefore, if you were doing genital surgery, a photo of a penis might be reasonably expected. However, a lap chole? Not so much.

A formal complaint was also made to the Az Medical Board which issued a Letter of Reprimand (available on line).

 

[Guile]

Yep he definitely left Mayo; information about whether it was a "forced" resignation or firing has not been released for public knowledge.

Intraoperative photography is allowed as long as it is within the context of the planned surgery. Therefore, if you were doing genital surgery, a photo of a penis might be reasonably expected. However, a lap chole? Not so much.

A formal complaint was also made to the Az Medical Board which issued a Letter of Reprimand (available on line).

Ouch. Losing your job (and chances of a future job) over a single poor decision like that is just awful. You work so hard all your life and lose everything in a moment of poor judgement.

 

[Winged Scapula]

Ouch. Losing your job (and chances of a future job) over a single poor decision like that is just awful. You work so hard all your life and lose everything in a moment of poor judgement.

Agreed (although you have to wonder if this really was a "moment" or a pattern of poor judgement). For a staff member to go to the newspaper rather than you or the department, makes me curious about previous issues (which can perhaps be personal and not professional).

 

[Winged Scapula]

I understand where yall are coming from with the "need to work residency-like hours to decide if you can handle GS training." However, a lot of students that rotate through surgery won't go into it. Isn't it better to have a balance of ward/OR work and study time to really get the basic surgical knowledge that the clerkship purports to impart for those folks?

That would seem perfectly reasonable if you approach medical education, especially the clinical years, as training a good generalist who will understand the needs and base knowledge of the core specialties.

That's what medical school is supposed to do - teach the non-surgeon to recognize surgical diseases, to have some understanding of when to consult (a la this thread), how its managed, to be able to explain to patients (in brief) the etiology of their disease and what the surgeon might do. The same is true for all specialties.

But what medical school has become is, in addition to the above, is a race to decide what your specialty should be. We have far too little time to figure these things out so many specialties have students do things that gives a more attractive insight into the field. In surgery, most students like the OR, like doing procedures; the OR is where you find the attendings. So spending time on the wards or at home studying for the Shelf doesn't help you assess whether you like (or can physically tolerate) the OR, or meet people who can teach you more about the field than the books can.

So I like the idea you have but its not the way things are designed. In addition, you aren't naive but you might not realize how much of that HUGE amount of medical knowledge you have right now is seeping out through the cracks. How little you will remember of each of your Core rotations once you get into a specialty. I had to try and remind myself of this everyday when my Ortho colleagues (who'd done a year of General Surgery) would forget to turn off IV fluids in patients who were eating (and would then fluid overload them), who wouldn't manage bowel function, etc. They had simply forgotten how, by not doing it everyday. Thus, while it sounds nice to teach a student not going into surgery about surgical disease by having them study more rather than standing for hours on end holding a retractor, IMHO at the end of the day the student who studied more is really not going to remember the level of detail as an IM resident or FP. But standing in the OR will teach them whether or not they can consider the field even while getting hand cramps and holding a dangerously full bladder.

I'm interested in surgery and I have no problem working the hours I'm told to work and doing the work that needs to get done, but at the same time my evals aren't the entirety of my grade and I can't learn everything on the wards anyways. I feel like I need some minimal study time right now as well so that when I go to the OR or my patient has a complication I can understand what's going on and come up with an intelligent thought about a treatment plan.

Agreed - if you are able to read before a case you get so much more about it.

If I need to do a sub-I, isn't that a better time to put me through the rigors of what it's like? I have no delusions about the workload or lifestyle as it is.

Yeah, I think that doing some call and working long hours is necessary as a 3rd year but the Sub-I really is where you should be acting like the intern, working the same hours and *still* trying to read (and seeing how difficult it can be).

 

[copes]

Back to the original point-

I am one who did quit.

Sometimes i still can't believe it. As a medical student, I was considered hard core by my fellow students. Surgery seemed like the most natural place for me to everybody. My 3rd year rotation occurred before the 80 hr work week. We took call very much the same as the residents did. On the trauma part, the entire team took Q2 call, with a post call clinic one day a week. I loved it. I loved going to the OR and couldn't wait to be the one doing the cases.

Started residency at a different program. Slowly my enthusiasm waned. I learned I had a low tolerance for BS. The BS that bugged me wasn't within the department. It was the dumb stuff being imposed by the hospital, increasing every year (eg instead of simply ordering heparin, now there is a form that must be filled out). Patients seemed to become more demanding and unreasonable. As I moved up in residency my schedule was more like that of an attending. I was staying more often in the OR late. Then I'd have to round, and would encounter visiting family member (new to me) who would bombard me with questions (all these questions I've already answered for pt and primary family member). At 8 or 9 pm, after rounding in the am, being in the OR all day, when I'm tired, my back hurts, and I've wolfed down crappy food, I don't want to deal with this. I just want to go home.

Once the novelty of the OR was gone, I didn't love it enough to put up with all the BS. And I learned that I absolutely hate doing laparoscopic cases. The bad ergonomics made my back pain much worse, and I hate the frustration of it. I struggled with it more than my younger counterparts. The cost/benefit ratio no longer made sense to me. It was a difficult decision.

I'm female, and started medical school in my late 30's, so I guess you could say i had some predictive factors for attrition. At the end of the day, as with any specialty, you can't get a good feel for what it's really like until you've been in it for a while.

I still have a soft spot for all things surgical, and sometimes I miss the OR. I'm working a moonlighting type job now to pay down some debt before I retrain. I haven't decided yet what field, that is a process I'm working through right now.

Thank you for sharing. Which fields are you looking at? I am a third year medical student considering surgery. Just curious as to what other specialties you would be interested in after going through surgery residency.

 

[ItsSurgicallyComplicated]

Quitting or not isn't about who is weak or who is strong but about fitting and priorities.
BlondeDocteur was a good resident and yet she choose to switch to pathology.

 

[LucidSplash]

Quitting or not isn't about who is weak or who is strong but about fitting and priorities.
BlondeDocteur was a good resident and yet she choose to switch to pathology.

Solid 6 year necrobump!

 

[HighPriest]

He can't quit this thread.

 

[Jolie South]

Solid 6 year necrobump!

It was weird reading the posts above from my young med school self.

 

[ACSurgeon]

Quitting or not isn't about who is weak or who is strong but about fitting and priorities.
BlondeDocteur was a good resident and yet she choose to switch to pathology.

True once you’re in it... ultimately everything is just a job, and your life outside work should be more meaningful. This doesn’t mean we should blindly encourage everyone to enter the most grueling of fields without giving them perspective and warning of how tough it is...

Finally, even though it’s just a job, I’m so glad that I love my job even when I’m having a 80 hour week or running on very little sleep!

 

[SLUser11]

He can't quit this thread.

I love this thread as well. The OP was very self-aware, and if you followed her longer journey through prelim year and pathology, it was very illustrative of the struggles female students (especially non-trads) face.

When it comes to predicting attrition, we don't do a great job, but there is a lot of outstanding recent literature on the topic. Here's a starting point from Heather Yeo: Yeo H[Author] attrition - PubMed - NCBI

In general, residents with more grit are less likely to quit. We can measure grit, but it's easy for people to answer the questions dishonestly in order to get a better score.

Grit scale: Angela Duckworth

On a side note, I stand by all of my comments from 8 years ago!

 

[ItsSurgicallyComplicated]

I partially agree. But grit is not everything, a person is not a mountain.

The most important predictor in my opinion, excluding glaring cases or poor fit, is lack of attending support or role figures.

People often forget that residency is a learning period. Hiding in the midst of all bs, the most important thing is learning.

If you are a resident that lands a spot with unsupportive staff , no one throws you a rope, soon and very easily you can become the bad resident, little defects spiral into something everybody talks about.

It is as simple as an attending being or not being invested in your training.