13 ms·

Medical school can be brutal, and it’s making many of us suicidal

113 points by snake117 10y ago

jseliger 10y ago
I wish more people knew and understood this. I didn't write about the suicide angle specifically, but I did write, "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school:" https://jakeseliger.com/2012/10/20/why-you-should-become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-school/ https://jakeseliger.com/2012/10/20/why-you-should-become-a-n..., which covers similar topics.
- Spooky23 10y ago
  Nurse practitioners and PAs have it made these days. Great pay and crazy flexibility and job prospects. My sister in law got annoyed about changes at her workplace with respect to scheduling. She griped about it in the break room, word got out and she had three unsolicited, real interview offers by the end of her shift. Her requirements were to get her kids on the bus and be home at 5PM. That's written into her employment contract, along with a significant raise and retention bonus.
jimmywanger 10y ago
I see parallels with medical school in tech hiring. They put the students through hell because that's what they had to go through, and they're rent seeking. In most other countries, doctors don't have an accreditation board. Most things are simple, and it doesn't require years of school to set a bone or put in some stitches, or even diagnose the flu or pneumonia. Similarly, you don't need a rockstar or ninja to write your CRUD app. Anybody who knows what he's doing will be able to do that, he doesn't need to be the best of the best, he just needs to be competent.
- ejstronge 10y ago
  Which are the countries where doctors don't have an accreditation board? The history of physicians controlling who is allowed to join their ranks goes back centuries, at the very least.
  - jimmywanger 10y ago
    In the US, medications are controlled through doctors. In most of Latin America (the countries I've been to), the pharmacists were the first source of triage. "Pooping too much? Here, take this pill. Oh wait, there's blood in there? You should probably go see somebody more informed."
    - ejstronge 10y ago
      This doesn't address the question of a country where physicians aren't trained/recognized by other physicians. Incidentally, the free availability of drugs in the way you described is being curtailed in Latin American countries.
- rifung 10y ago
  I have a friend in med school and his experience doesn't sound like tech hiring at all. From what I can tell, med school isn't hard because of rent seeking, but because there is frankly just a very large amount of things you have to learn in a short amount of time. They also have to work extremely long hours on certain rotations. I was shocked at how little sleep he could get on some days. On the other hand, he seems to not have experienced the bullying described in the article, so maybe that part of it is the rent seeking you describe. I do think that tech hiring is a little ridiculous at times, but if doctors mess up, people sometimes die. It would make much more sense for them to go through accreditation like engineers do, in my opinion of course.
  - dmoy 10y ago
    Agree with most bits, but the hours thing is ridiculous in med, in a very bad way. It doesn't have to be either... (Slowly changing for the better).
drcross 10y ago
Many people want the status associated with being a doctor (of course some are pushed that direction by parents and some also just want to help people). When you have an abundance of people trying to get into an industry the profession have the ability to only choose the absolute pinnacle of talent. It's the same with being a pilot. Many of them work long hours in shit conditions for years hoping to get a decent route. I have often had notions of throwing my career in to be a Doctor but the price you pay to climb to the top of the heap is not worth it, long hours, student loans, bad pay for the first decade, no social life, worry about malpractice, make it simply not worth the tradeoff for some status and job security.
- PhasmaFelis 10y ago
  How much longer until programming is the same way, now that we're pushing it to every kid and idolizing tech billionaires?
  - jrowley 10y ago
    The barrier to entry to becoming a programmer is significantly lower, so hopefully the pressure will never be as bad. But as a recent CS graduate I certainly feel a lot of stress about my skills or lack thereof. Coincidentally, my twin brother is applying to med schools right now (on the order of 40). I applied to exactly 2 jobs, got an offer and took it.
    - jimmaswell 10y ago
      The barrier to entry to call yourself a programmer or possibly make it through a Computer Science course is definitely lower, but there's potentially an immutable barrier to being a programmer regarding the ability to work with the kind of thinking required to do it, as mentioned in a comment I made elsewhere in this thread. I haven't heard the same said about becoming a doctor - I think it's considered something most people could do if they put in all the time and effort required. So, the barrier to programming might be either impassable or not there depending on who you are, while I'd assume the one to being a doctor would be difficult but doable for most people. So for those people who can't be a programmer, "difficult" would be easier than "not possible," so the barrier would be lower to be a doctor to them, while for someone with the predisposition for programming, programming would definitely be easier.
rifung 10y ago
> . Fortunately, others are speaking up as well. In online magazines and on NPR, medical students who have lived through suicide attempts, depression and other mental-health issues are standing up against this stigma. Medical schools are now training faculty to recognize risk factors for suicide and assuring students that seeking help isn’t a sign of weakness. I wonder whether and hope that mental illness will end up like homosexuality in the sense that people will no longer have to hide who they are. On the other hand, I suspect that would be a more difficult battle, especially when it comes to employment discrimination.
- cloudjacker 10y ago
  San Francisco is a sanctuary city for counterculture. As more counterculture becomes acceptable outside of sanctuary cities, more marginalized people remain or come to the sanctuary cities partly due the history of catering to marginalized people. I think that would be a decent way for you to see a possible outcome in that field too in order to create a conclusion.
  - Swizec 10y ago
    > San Francisco is a sanctuary city for counterculture. As long as your type of counterculture doesn't involve the perceived potential of underperforming. Then you're out. Because meritocracy and stuff. Mental illness is almost always perceived as "Oh shit, this person isn't gonna be a top performer"
- wyager 10y ago
  > especially when it comes to employment discrimination I mean, a lot of mental illnesses actually have a legitimate negative effect on one's ability to be a productive worker. It wouldn't really make sense to make it illegal to discriminate against people with e.g. severe learning disabilities who can't read or write.
  - rifung 10y ago
    > I mean, a lot of mental illnesses actually have a legitimate negative effect on one's ability to be a productive worker. Yes I completely agree. However, if a mentally ill person can perform their duties with reasonable accommodations as well as a person who isn't mentally ill , then that person shouldn't be discriminated against. Indeed, the Americans with Disabilities Act already covers people with depression and bipolar. If you could discriminate against people because they have something which legitimately negatively affects one's ability to be a productive worker, then companies would probably discriminate against hiring women too, because they might get pregnant and have to take time off. This is also illegal because while it's true that it might be less efficient for the company, it's still unethical.
smnplk 10y ago
"You are grounded until you become a doctor!" - One chinese dad to his young son.
cylinder 10y ago
The presence, or increase, of suicides does not mean that medical school is too "brutal." It could very well mean that young people are becoming worse at coping with stress. Or perhaps students feel more pressure because of their perceived consequences of their failures: basically no alternative career path that would provide the same standing as medicine, whereas in previous generations, med school dropouts could go on to dental / law / cushy corporate gig more easily. This could be one of the consequences of rising inequality. I'm not disputing anything here, just want to discuss this logically. I've been in graduate school, and it wasn't that hard, and yet some of my peers would freak out constantly. And some wouldn't. I will say that there's definitely a hazing culture across all professions in America that's completely unnecessary and inappropriate.
- sparky_z 10y ago
  "I will say that there's definitely a hazing culture across all professions in America that's completely unnecessary and inappropriate." I'm a structural engineer. I don't recall any sort of hazing culture, or even a single instance of hazing.
  - LeifCarrotson 10y ago
    Where did you do your internship, and what were you asked to do there? How many hours did you work and study while in school? Were you expected to work much longer hours as a junior employee to "work your way up the ranks? I think these are the sorts of elements of a hazing culture that GP is discussing. Not necessarily fraternity-prank style hazing.
    - cylinder 10y ago
      Yes, this is the type of hazing I am referring to. Call it "institutionalized hazing" rather than fraternity style hazing. The bar exam for lawyers is one good example of hazing. Most law grads who apply themselves will pass, it's just a form of hazing for new entrants. Other countries with common law have just as good, if not better, bars and they do not have postgraduate law degrees and bar exams to become admitted. I don't buy the "it reduces supply" either, because of the high pass rates, but even if it was used for this, it would simply be injustice. If you want to filter people out, do it before they waste three years and $150,000.
mhb 10y ago
A med school student's contemporaneous journal describing his time in med school: https://news.ycombinator.com/item?id=12680306 https://news.ycombinator.com/item?id=12680306
samfisher83 10y ago
If you get into med school especially if you are Asian means you are pretty competitive. You basically need a 3.8 GPA and about 31 to get into an average med school. If you get into a specialty you are making close to 250-300k+ starting. Obviously its going to be competitive. Its basic economics.
chriskanan 10y ago
My wife finished medical school a bit over 4 years ago. While she thought medical school was brutal, it was comparatively easy compared to the challenges she faced in residency (she did her prelim at UCLA-Harbor and is now at Boston Children's hospital doing pediatric neurology). 80+ hour work weeks are the norm, and sometimes she works 14 days straight and has a pager that beeps throughout the night that she must respond to before going in again in the morning. After one does complete residency, it does seem to get a lot easier based on observing some of her friends that didn't do fellowships, especially if the person takes a more clinical job. But after all of that effort, a lot of people become attending physicians where they are putting in just as many hours, if not more, because it is more prestigious. Those are the people that run the teaching hospitals, so it feels like there is a lot of "I survived and it made me a better physician, you can too" mentality.
- stephencanon 10y ago
  Yup. My wife is a neurosurgery resident. While she's on her research year right now, which is comparatively relaxed[1], prior to this she worked 5 years of 80+ hour weeks, including three stretches of 20+ consecutive days after another resident in her program left. Looking back on medical school, she can't believe how ridiculously easy it was and how much free time she had. [1] where "comparatively relaxed" still means "she works harder than anyone I know in tech".
  - mixmastamyk 10y ago
    To what end? It's well known the body has < 10 hours of high-level productivity in it per day. Unless they get paid by the hour, I see no reason to continue to participate in such a system. Still, it should not be allowed when lives are at stake.
    - module0000 10y ago
      Well, look at it from the patients point of view... if there isn't a doctor to available, because they took some time off after a 20+ day stint...where does that leave you(the patient)? It's a tough job, but they signed up for it, and the pay is very good by comparison to other jobs that have similarly long hours. For some contrast though, before everyone cries out "save the med students, they have it harder than any one should endure"... remember there are other jobs with far greater risks, hours, and far less pay. Ever been deployed in a military unit during wartime? I've wished there was a window to jump out of several times, or that a pager beeping was the scariest thing to fear while trying to sleep - and that was in recent engagements, it was far worse for the generation before us during wartime - doctors not so much.
mmagin 10y ago
This is the important part, I think: "But one part of medical school culture has been especially hard to overcome: the stigma of mental illness. When they need help most, medical students in anguish rarely reach out. Students attribute this reluctance to seek care to fear of stigmatization by peers and to concerns over professional ramifications, particularly during applications for residency and licensing."
- LeifCarrotson 10y ago
  Interesting they say they attribute it to stigmatization and judgement. What I have observed among family in the medical industry is a reluctance to use the care they provide: not just Do-Not-Rescusitate orders but a tendency to just suffer through the sickness instead of seeking medication, and to let the illness take its course rather than seeking second opinions and treatment. Of course, these are with regards to physical ailments. Family has been much less public about mental issues. But I wonder if these same fears and proclivities also translate to mental health problems.
  - FireBeyond 10y ago
    "not just Do-Not-Rescusitate orders" makes a lot more sense when you realize things like the fact that survival-to-discharge ratios for CPR outside of Rochester MN and the Puget Sound are often dismal and out of the control of any one element (effective, timely and progressive pre-hospital care, early access to defibrillation, Cath labs and the like), and that as a whole, the general populace needs to realize that oftentimes, it -is- just better to let go. Too many "heroic efforts" are made for the family's sake, not the patients.
  - tcj_phx 10y ago
    > What I have observed among family in the medical industry is a reluctance to use the care they provide: not just Do-Not-Rescusitate orders but a tendency to just suffer through the sickness instead of seeking medication, and to let the illness take its course rather than seeking second opinions and treatment. Sometimes the treatment is worse than the disease. > Of course, these are with regards to physical ailments. Family has been much less public about mental issues. But I wonder if these same fears and proclivities also translate to mental health problems. Most mental health medications are palliative, and tend to make the underlying condition worse over time [1]. [1] https://www.madinamerica.com/anatomy-of-an-epidemic/ https://www.madinamerica.com/anatomy-of-an-epidemic/
ReallyAnonymous 10y ago
medical school is humbling and difficult. Being a physician is difficult. I finished medical school in 1996 - didn't find it ridiculously hard, but then again, studying a lot was what I did in my youth. Now, I'm 47 years old, and work about 90 hours a week as a surgeon - I laugh when people say that we make too much. All I know is that 25 years ago, you had to be in the top 10% of your class to become a surgeon. When I applied, it was top 20%. Now, it's basically if you graduate from medical school and want to be a surgeon, you can become one. General surgeons put in long hours for not that much glory - today I waited 2 hrs to drain an abscess that took me 10 minutes, so I got home at 6:30 pm. The upside is that when I do a great job, it really is rewarding. The downside is telling families and patients I do not have much to offer, and their disease is too far gone. Anyway, don't go into medical school / surgery if you don't want to work hard. No one has a gun to your head. Physicians that pick the right profession for their personality / skill set are very happy. PS my undergraduate degree was computer science
- agumonkey 10y ago
  What do you think about current day surgery and potential technological change in the field (robot driven, nanotech [not smart molecules, but increasingly simple interaction at sub micron scale], large data monitoring and analysis for prevention) ?
- lanius 10y ago
  Interesting, I assumed that the field would become more selective over time. Or is it because just getting accepted to medical school itself is already extremely competitive?
  - mahyarm 10y ago
    I have heard that getting into medical school is a lot harder than it used to be too. It might be the reason why it's easier to be a surgeon once your in. I'm not a doctor or a med student, so take that with a grain of salt.
  - stephencanon 10y ago
    The specialties with better quality of life (e.g. dermatology) have become increasingly competitive, drawing some of the top students away from the more masochistic fields.
paviva 10y ago
Compared to previous generations (and the change is quite steep -- I am talking about students today vs. students 5-10 years ago), a growing proportion of medical students have entitlement issues. Those issues are roughly two-fold : (1) feeling entitled to a "balanced" lifestyle; (2) feeling entitled to help people. The first one is obvious: student want to leave early, they don't understand that patients always come first, that, sometimes, you have no choice but to be sleep-deprived for days, and so on. The second one is a kind of "Mother Teresa Complex" when students experience uncontrolled anxiety and distress upon seeing a fully competent adult actively undermining his own care. I see it all the time when they try to talk a lung-cancer smoker into stopping for 30-40 minutes, come back almost crying that he's not interested, and can't believe that their "trying to help" means they are now late, and I'm not happy at all.
- alasdair_ 10y ago
  >"Mother Teresa Complex" Wouldn't this mean simply telling the patient that their suffering is "God's plan" and refusing to treat them, nor give them any pain medication?
  - paviva 10y ago
    Thus is hyperbole, of course -- hyperbole which serves to highlight that refusing to allow the patient to decide for himself, trying to force your own outlook "for his own good", is exactly the same as not giving pain medication because it's against some religious ethical code.
choward 10y ago
I just skimmed the article but is there any comparison of current suicide rates to previous suicide rates? If not, this article is pointless.
cm2187 10y ago
One thing that strikes me is that the medical profession is one of the only professions that hasn't industrialised. Basically one highly paid, highly trained doctor in front of every patient. It's a craft industry... It doesn't scale well, and it is very hard to maintain a consistent quality. Perhaps will AI change that...
- dnautics 10y ago
  ? Every patient is exposed to a surface area that comprises several doctors. Currently my father is hospitalized with a failing liver and kidneys. He sees a GI doc, a liver doc, a kidney doc, an anaesthesiologist, residents for each of these, an intensivist.
  - cm2187 10y ago
    I had more the generalist model in mind, as many small problems could certainly be dealt with in a more automated way. But the example of your father is illustrating my point. All these professionals each individually has to stay up to date on all the developments in their profession. And you hope they were not bottom of their class, barely making the exam. For complex medical problems, algorithms are unlikely to do it for many years. But to recognize common skin diseases for instance it is perhaps not so far fetched.
    - epmaybe 10y ago
      As a medical student, I bring the AI future up a lot. For some reason, my fellow students immediately assume I mean general AI, where it somehow assumes all roles of a physician. What I always try and explain to them is that there are definitely solvable problems in subsets of medicine like dermatology. Sure, it'll probably take 20 years before there's any traction, but there's no reason to completely dismiss the idea either.
- dragonwriter 10y ago
  Lots of medical work is done by non-doctor medical specialists (and non-spwcialist assistants) of various kinds with doctors in a supervisory (functionally, not necessarily in the personnel management sense) role. It certainly has "industrialized" in that sense. There are certain decisions that remain reserved to doctors which limit scalability, but that's also the case in other regulates professions, it's not unique to medicine.
ljk 10y ago
I wonder if the high salary is worth the mountain of debt on top of all this. Could part of reason why the education is so expensive due to the monopoly in all the tests med students have to take? http://endstep2cs.com/petition/ http://endstep2cs.com/petition/
- trgn 10y ago
  Of course it is. The size of medical school debt is about the size of a common mortgage. That's no burden at all for a deep six-figure salary. It's a total non-issue.
seanseanme 10y ago
I just finished residency and, based on my experiences, I have three points. 1) This situation seems analogous to the higher rate of suicide in very competitive colleges. Both feature putting people who did very well in the prior stage and then demanding a high level of content mastery in a short period of time. Interestingly, some places a pushing for a 3 year med school experience for primary care to reduce loan burden and get more productive years out of the training. I wonder how this will affect this pressure. 2) I wonder if discussing the harsh reality of medicine - charting, team management, things being beyond your control - rather than emphasizing the 'higher calling' and 'privilege to care' would dissuade those seeking prestige form entering medical school. I think it is a much greater service to have them figure out before school starts and not be saddled with 40-50k of debt that first year. 3) A big transition I always heard in med school was the difference of the trainees in that they value work/life balance much more than the titans of medicine in the past. How to rectify this priority with traditional medical school is a VERY interesting question.
naveen99 10y ago
> average acceptance rate for fall 2015 was 6.9 percent But most students apply to multiple schools. Actual acceptance rate is 40% across all demographics. https://www.aamc.org/download/321480/data/factstablea12.pdf https://www.aamc.org/download/321480/data/factstablea12.pdf Edit: also, 25% of the applicants are repeat applicants. So, first application acceptance rate is probably closer to 50%.
- cloverich 10y ago
  Though its worth mentioning that based on your grades, test scores, and even pre-med screening -- many students who want to be a doctor will never even apply.
glup 10y ago
My partner studies how and why mainstream hospitals are turning increasingly to complementary and alternative medicine (CAM). Interestingly, one reason is that many current doctors burnt out (because of the conditions described in the article and developed chronic and/or psychological conditions either in med school or practicing. These doctors (or soon-to-be-doctors) find that CAM offers better remedies for many chronic conditions, which the current biomedical stack really isn't optimized to handle. Then when they finish med school, they're in a privileged position to confer institutional legitimacy on CAM treatments. So in some sense, this brutality is changing medicine more generally.
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ukat 10y ago
I love the medical school analogy "drinking from a firehose" since a lot of the knowledge has to be frontloaded. This makes sense since making errors is less forgiving. software engineering might be closer to "drinking from a running facet.. forever". I know doctors have to keep learning but I always wondered if it was more or less than engineers after school.
elijahparker 10y ago
A company I used to work with makes a program [1] for monitoring medical student well-being over time to try to detect early warning signs as well as provide anonymized data for research [1] http://www.mededwebs.com/well-being-index http://www.mededwebs.com/well-being-index
naveen99 10y ago
> "I checked the medical licensing requirements in California to make sure I wouldn’t lose the ability to care for patients... Fears were unfounded." You should get help. But you can't be sure you will be allowed to practice medicine. The medical board will decide on an individual basis. For reference, texas medical board form for mental illness and self referral program: http://www.tmb.state.tx.us/dl/C5EAB589-0916-C88D-FF94-DE8D9623C5A4 http://www.tmb.state.tx.us/dl/C5EAB589-0916-C88D-FF94-DE8D96... Of course, if you don't self report, and practice anyway, and a patient complains, you might be facing criminal charges. First do no harm. Help yourself before you help others (seek mental help if you need it).
s_q_b 10y ago
My sister is currently finishing medical school at Penn. We talked about suicides in hospital and university settings. She had an interesting perspective on the problem. She said that it isn't the intensity of the work, the academic rigor, or even the emotional damage from constant exposure to death and disease. It's the sleep deprivation. There is a very large amount of evidence that one night of reduced sleep massively increases medical errors. Despite this knowledge, sleep deprivation remains this massochistic macho hazing ritual, which increases in severity through residency. It's dangerous and unnecessary. This article does a good job of capturing the chain of internal events that lead from exhaustion to burnout to severe depression and finally to suicidal ideation.
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113 points by snake117 10y ago

I wish more people knew and understood this. I didn't write about the suicide angle specifically, but I did write, "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school:" https://jakeseliger.com/2012/10/20/why-you-should-become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-school/ https://jakeseliger.com/2012/10/20/why-you-should-become-a-n..., which covers similar topics.

Spooky23 10y ago
Nurse practitioners and PAs have it made these days. Great pay and crazy flexibility and job prospects. My sister in law got annoyed about changes at her workplace with respect to scheduling. She griped about it in the break room, word got out and she had three unsolicited, real interview offers by the end of her shift. Her requirements were to get her kids on the bus and be home at 5PM. That's written into her employment contract, along with a significant raise and retention bonus.

jimmywanger 10y ago

I see parallels with medical school in tech hiring. They put the students through hell because that's what they had to go through, and they're rent seeking. In most other countries, doctors don't have an accreditation board. Most things are simple, and it doesn't require years of school to set a bone or put in some stitches, or even diagnose the flu or pneumonia. Similarly, you don't need a rockstar or ninja to write your CRUD app. Anybody who knows what he's doing will be able to do that, he doesn't need to be the best of the best, he just needs to be competent.

ejstronge 10y ago
Which are the countries where doctors don't have an accreditation board? The history of physicians controlling who is allowed to join their ranks goes back centuries, at the very least.
- jimmywanger 10y ago
  In the US, medications are controlled through doctors. In most of Latin America (the countries I've been to), the pharmacists were the first source of triage. "Pooping too much? Here, take this pill. Oh wait, there's blood in there? You should probably go see somebody more informed."
  - ejstronge 10y ago
    This doesn't address the question of a country where physicians aren't trained/recognized by other physicians. Incidentally, the free availability of drugs in the way you described is being curtailed in Latin American countries.
rifung 10y ago
I have a friend in med school and his experience doesn't sound like tech hiring at all. From what I can tell, med school isn't hard because of rent seeking, but because there is frankly just a very large amount of things you have to learn in a short amount of time. They also have to work extremely long hours on certain rotations. I was shocked at how little sleep he could get on some days. On the other hand, he seems to not have experienced the bullying described in the article, so maybe that part of it is the rent seeking you describe. I do think that tech hiring is a little ridiculous at times, but if doctors mess up, people sometimes die. It would make much more sense for them to go through accreditation like engineers do, in my opinion of course.
- dmoy 10y ago
  Agree with most bits, but the hours thing is ridiculous in med, in a very bad way. It doesn't have to be either... (Slowly changing for the better).

drcross 10y ago

Many people want the status associated with being a doctor (of course some are pushed that direction by parents and some also just want to help people). When you have an abundance of people trying to get into an industry the profession have the ability to only choose the absolute pinnacle of talent. It's the same with being a pilot. Many of them work long hours in shit conditions for years hoping to get a decent route. I have often had notions of throwing my career in to be a Doctor but the price you pay to climb to the top of the heap is not worth it, long hours, student loans, bad pay for the first decade, no social life, worry about malpractice, make it simply not worth the tradeoff for some status and job security.

PhasmaFelis 10y ago
How much longer until programming is the same way, now that we're pushing it to every kid and idolizing tech billionaires?
- jrowley 10y ago
  The barrier to entry to becoming a programmer is significantly lower, so hopefully the pressure will never be as bad. But as a recent CS graduate I certainly feel a lot of stress about my skills or lack thereof. Coincidentally, my twin brother is applying to med schools right now (on the order of 40). I applied to exactly 2 jobs, got an offer and took it.
  - jimmaswell 10y ago
    The barrier to entry to call yourself a programmer or possibly make it through a Computer Science course is definitely lower, but there's potentially an immutable barrier to being a programmer regarding the ability to work with the kind of thinking required to do it, as mentioned in a comment I made elsewhere in this thread. I haven't heard the same said about becoming a doctor - I think it's considered something most people could do if they put in all the time and effort required. So, the barrier to programming might be either impassable or not there depending on who you are, while I'd assume the one to being a doctor would be difficult but doable for most people. So for those people who can't be a programmer, "difficult" would be easier than "not possible," so the barrier would be lower to be a doctor to them, while for someone with the predisposition for programming, programming would definitely be easier.

rifung 10y ago

> . Fortunately, others are speaking up as well. In online magazines and on NPR, medical students who have lived through suicide attempts, depression and other mental-health issues are standing up against this stigma. Medical schools are now training faculty to recognize risk factors for suicide and assuring students that seeking help isn’t a sign of weakness. I wonder whether and hope that mental illness will end up like homosexuality in the sense that people will no longer have to hide who they are. On the other hand, I suspect that would be a more difficult battle, especially when it comes to employment discrimination.

cloudjacker 10y ago
San Francisco is a sanctuary city for counterculture. As more counterculture becomes acceptable outside of sanctuary cities, more marginalized people remain or come to the sanctuary cities partly due the history of catering to marginalized people. I think that would be a decent way for you to see a possible outcome in that field too in order to create a conclusion.
- Swizec 10y ago
  > San Francisco is a sanctuary city for counterculture. As long as your type of counterculture doesn't involve the perceived potential of underperforming. Then you're out. Because meritocracy and stuff. Mental illness is almost always perceived as "Oh shit, this person isn't gonna be a top performer"
wyager 10y ago
> especially when it comes to employment discrimination I mean, a lot of mental illnesses actually have a legitimate negative effect on one's ability to be a productive worker. It wouldn't really make sense to make it illegal to discriminate against people with e.g. severe learning disabilities who can't read or write.
- rifung 10y ago
  > I mean, a lot of mental illnesses actually have a legitimate negative effect on one's ability to be a productive worker. Yes I completely agree. However, if a mentally ill person can perform their duties with reasonable accommodations as well as a person who isn't mentally ill , then that person shouldn't be discriminated against. Indeed, the Americans with Disabilities Act already covers people with depression and bipolar. If you could discriminate against people because they have something which legitimately negatively affects one's ability to be a productive worker, then companies would probably discriminate against hiring women too, because they might get pregnant and have to take time off. This is also illegal because while it's true that it might be less efficient for the company, it's still unethical.

smnplk 10y ago

"You are grounded until you become a doctor!" - One chinese dad to his young son.

cylinder 10y ago

The presence, or increase, of suicides does not mean that medical school is too "brutal." It could very well mean that young people are becoming worse at coping with stress. Or perhaps students feel more pressure because of their perceived consequences of their failures: basically no alternative career path that would provide the same standing as medicine, whereas in previous generations, med school dropouts could go on to dental / law / cushy corporate gig more easily. This could be one of the consequences of rising inequality. I'm not disputing anything here, just want to discuss this logically. I've been in graduate school, and it wasn't that hard, and yet some of my peers would freak out constantly. And some wouldn't. I will say that there's definitely a hazing culture across all professions in America that's completely unnecessary and inappropriate.

sparky_z 10y ago
"I will say that there's definitely a hazing culture across all professions in America that's completely unnecessary and inappropriate." I'm a structural engineer. I don't recall any sort of hazing culture, or even a single instance of hazing.
- LeifCarrotson 10y ago
  Where did you do your internship, and what were you asked to do there? How many hours did you work and study while in school? Were you expected to work much longer hours as a junior employee to "work your way up the ranks? I think these are the sorts of elements of a hazing culture that GP is discussing. Not necessarily fraternity-prank style hazing.
  - cylinder 10y ago
    Yes, this is the type of hazing I am referring to. Call it "institutionalized hazing" rather than fraternity style hazing. The bar exam for lawyers is one good example of hazing. Most law grads who apply themselves will pass, it's just a form of hazing for new entrants. Other countries with common law have just as good, if not better, bars and they do not have postgraduate law degrees and bar exams to become admitted. I don't buy the "it reduces supply" either, because of the high pass rates, but even if it was used for this, it would simply be injustice. If you want to filter people out, do it before they waste three years and $150,000.

mhb 10y ago

A med school student's contemporaneous journal describing his time in med school: https://news.ycombinator.com/item?id=12680306 https://news.ycombinator.com/item?id=12680306

samfisher83 10y ago

If you get into med school especially if you are Asian means you are pretty competitive. You basically need a 3.8 GPA and about 31 to get into an average med school. If you get into a specialty you are making close to 250-300k+ starting. Obviously its going to be competitive. Its basic economics.

chriskanan 10y ago

My wife finished medical school a bit over 4 years ago. While she thought medical school was brutal, it was comparatively easy compared to the challenges she faced in residency (she did her prelim at UCLA-Harbor and is now at Boston Children's hospital doing pediatric neurology). 80+ hour work weeks are the norm, and sometimes she works 14 days straight and has a pager that beeps throughout the night that she must respond to before going in again in the morning. After one does complete residency, it does seem to get a lot easier based on observing some of her friends that didn't do fellowships, especially if the person takes a more clinical job. But after all of that effort, a lot of people become attending physicians where they are putting in just as many hours, if not more, because it is more prestigious. Those are the people that run the teaching hospitals, so it feels like there is a lot of "I survived and it made me a better physician, you can too" mentality.

stephencanon 10y ago
Yup. My wife is a neurosurgery resident. While she's on her research year right now, which is comparatively relaxed[1], prior to this she worked 5 years of 80+ hour weeks, including three stretches of 20+ consecutive days after another resident in her program left. Looking back on medical school, she can't believe how ridiculously easy it was and how much free time she had. [1] where "comparatively relaxed" still means "she works harder than anyone I know in tech".
- mixmastamyk 10y ago
  To what end? It's well known the body has < 10 hours of high-level productivity in it per day. Unless they get paid by the hour, I see no reason to continue to participate in such a system. Still, it should not be allowed when lives are at stake.
  - module0000 10y ago
    Well, look at it from the patients point of view... if there isn't a doctor to available, because they took some time off after a 20+ day stint...where does that leave you(the patient)? It's a tough job, but they signed up for it, and the pay is very good by comparison to other jobs that have similarly long hours. For some contrast though, before everyone cries out "save the med students, they have it harder than any one should endure"... remember there are other jobs with far greater risks, hours, and far less pay. Ever been deployed in a military unit during wartime? I've wished there was a window to jump out of several times, or that a pager beeping was the scariest thing to fear while trying to sleep - and that was in recent engagements, it was far worse for the generation before us during wartime - doctors not so much.

mmagin 10y ago

This is the important part, I think: "But one part of medical school culture has been especially hard to overcome: the stigma of mental illness. When they need help most, medical students in anguish rarely reach out. Students attribute this reluctance to seek care to fear of stigmatization by peers and to concerns over professional ramifications, particularly during applications for residency and licensing."

LeifCarrotson 10y ago
Interesting they say they attribute it to stigmatization and judgement. What I have observed among family in the medical industry is a reluctance to use the care they provide: not just Do-Not-Rescusitate orders but a tendency to just suffer through the sickness instead of seeking medication, and to let the illness take its course rather than seeking second opinions and treatment. Of course, these are with regards to physical ailments. Family has been much less public about mental issues. But I wonder if these same fears and proclivities also translate to mental health problems.
- FireBeyond 10y ago
  "not just Do-Not-Rescusitate orders" makes a lot more sense when you realize things like the fact that survival-to-discharge ratios for CPR outside of Rochester MN and the Puget Sound are often dismal and out of the control of any one element (effective, timely and progressive pre-hospital care, early access to defibrillation, Cath labs and the like), and that as a whole, the general populace needs to realize that oftentimes, it -is- just better to let go. Too many "heroic efforts" are made for the family's sake, not the patients.
- tcj_phx 10y ago
  > What I have observed among family in the medical industry is a reluctance to use the care they provide: not just Do-Not-Rescusitate orders but a tendency to just suffer through the sickness instead of seeking medication, and to let the illness take its course rather than seeking second opinions and treatment. Sometimes the treatment is worse than the disease. > Of course, these are with regards to physical ailments. Family has been much less public about mental issues. But I wonder if these same fears and proclivities also translate to mental health problems. Most mental health medications are palliative, and tend to make the underlying condition worse over time [1]. [1] https://www.madinamerica.com/anatomy-of-an-epidemic/ https://www.madinamerica.com/anatomy-of-an-epidemic/

ReallyAnonymous 10y ago

medical school is humbling and difficult. Being a physician is difficult. I finished medical school in 1996 - didn't find it ridiculously hard, but then again, studying a lot was what I did in my youth. Now, I'm 47 years old, and work about 90 hours a week as a surgeon - I laugh when people say that we make too much. All I know is that 25 years ago, you had to be in the top 10% of your class to become a surgeon. When I applied, it was top 20%. Now, it's basically if you graduate from medical school and want to be a surgeon, you can become one. General surgeons put in long hours for not that much glory - today I waited 2 hrs to drain an abscess that took me 10 minutes, so I got home at 6:30 pm. The upside is that when I do a great job, it really is rewarding. The downside is telling families and patients I do not have much to offer, and their disease is too far gone. Anyway, don't go into medical school / surgery if you don't want to work hard. No one has a gun to your head. Physicians that pick the right profession for their personality / skill set are very happy. PS my undergraduate degree was computer science

agumonkey 10y ago
What do you think about current day surgery and potential technological change in the field (robot driven, nanotech [not smart molecules, but increasingly simple interaction at sub micron scale], large data monitoring and analysis for prevention) ?
lanius 10y ago
Interesting, I assumed that the field would become more selective over time. Or is it because just getting accepted to medical school itself is already extremely competitive?
- mahyarm 10y ago
  I have heard that getting into medical school is a lot harder than it used to be too. It might be the reason why it's easier to be a surgeon once your in. I'm not a doctor or a med student, so take that with a grain of salt.
- stephencanon 10y ago
  The specialties with better quality of life (e.g. dermatology) have become increasingly competitive, drawing some of the top students away from the more masochistic fields.

paviva 10y ago

Compared to previous generations (and the change is quite steep -- I am talking about students today vs. students 5-10 years ago), a growing proportion of medical students have entitlement issues. Those issues are roughly two-fold : (1) feeling entitled to a "balanced" lifestyle; (2) feeling entitled to help people. The first one is obvious: student want to leave early, they don't understand that patients always come first, that, sometimes, you have no choice but to be sleep-deprived for days, and so on. The second one is a kind of "Mother Teresa Complex" when students experience uncontrolled anxiety and distress upon seeing a fully competent adult actively undermining his own care. I see it all the time when they try to talk a lung-cancer smoker into stopping for 30-40 minutes, come back almost crying that he's not interested, and can't believe that their "trying to help" means they are now late, and I'm not happy at all.

alasdair_ 10y ago
>"Mother Teresa Complex" Wouldn't this mean simply telling the patient that their suffering is "God's plan" and refusing to treat them, nor give them any pain medication?
- paviva 10y ago
  Thus is hyperbole, of course -- hyperbole which serves to highlight that refusing to allow the patient to decide for himself, trying to force your own outlook "for his own good", is exactly the same as not giving pain medication because it's against some religious ethical code.

choward 10y ago

I just skimmed the article but is there any comparison of current suicide rates to previous suicide rates? If not, this article is pointless.

cm2187 10y ago

One thing that strikes me is that the medical profession is one of the only professions that hasn't industrialised. Basically one highly paid, highly trained doctor in front of every patient. It's a craft industry... It doesn't scale well, and it is very hard to maintain a consistent quality. Perhaps will AI change that...

dnautics 10y ago
? Every patient is exposed to a surface area that comprises several doctors. Currently my father is hospitalized with a failing liver and kidneys. He sees a GI doc, a liver doc, a kidney doc, an anaesthesiologist, residents for each of these, an intensivist.
- cm2187 10y ago
  I had more the generalist model in mind, as many small problems could certainly be dealt with in a more automated way. But the example of your father is illustrating my point. All these professionals each individually has to stay up to date on all the developments in their profession. And you hope they were not bottom of their class, barely making the exam. For complex medical problems, algorithms are unlikely to do it for many years. But to recognize common skin diseases for instance it is perhaps not so far fetched.
  - epmaybe 10y ago
    As a medical student, I bring the AI future up a lot. For some reason, my fellow students immediately assume I mean general AI, where it somehow assumes all roles of a physician. What I always try and explain to them is that there are definitely solvable problems in subsets of medicine like dermatology. Sure, it'll probably take 20 years before there's any traction, but there's no reason to completely dismiss the idea either.
dragonwriter 10y ago
Lots of medical work is done by non-doctor medical specialists (and non-spwcialist assistants) of various kinds with doctors in a supervisory (functionally, not necessarily in the personnel management sense) role. It certainly has "industrialized" in that sense. There are certain decisions that remain reserved to doctors which limit scalability, but that's also the case in other regulates professions, it's not unique to medicine.

ljk 10y ago

I wonder if the high salary is worth the mountain of debt on top of all this. Could part of reason why the education is so expensive due to the monopoly in all the tests med students have to take? http://endstep2cs.com/petition/ http://endstep2cs.com/petition/

trgn 10y ago
Of course it is. The size of medical school debt is about the size of a common mortgage. That's no burden at all for a deep six-figure salary. It's a total non-issue.

seanseanme 10y ago

I just finished residency and, based on my experiences, I have three points. 1) This situation seems analogous to the higher rate of suicide in very competitive colleges. Both feature putting people who did very well in the prior stage and then demanding a high level of content mastery in a short period of time. Interestingly, some places a pushing for a 3 year med school experience for primary care to reduce loan burden and get more productive years out of the training. I wonder how this will affect this pressure. 2) I wonder if discussing the harsh reality of medicine - charting, team management, things being beyond your control - rather than emphasizing the 'higher calling' and 'privilege to care' would dissuade those seeking prestige form entering medical school. I think it is a much greater service to have them figure out before school starts and not be saddled with 40-50k of debt that first year. 3) A big transition I always heard in med school was the difference of the trainees in that they value work/life balance much more than the titans of medicine in the past. How to rectify this priority with traditional medical school is a VERY interesting question.

naveen99 10y ago

> average acceptance rate for fall 2015 was 6.9 percent But most students apply to multiple schools. Actual acceptance rate is 40% across all demographics. https://www.aamc.org/download/321480/data/factstablea12.pdf https://www.aamc.org/download/321480/data/factstablea12.pdf Edit: also, 25% of the applicants are repeat applicants. So, first application acceptance rate is probably closer to 50%.

cloverich 10y ago
Though its worth mentioning that based on your grades, test scores, and even pre-med screening -- many students who want to be a doctor will never even apply.

glup 10y ago

My partner studies how and why mainstream hospitals are turning increasingly to complementary and alternative medicine (CAM). Interestingly, one reason is that many current doctors burnt out (because of the conditions described in the article and developed chronic and/or psychological conditions either in med school or practicing. These doctors (or soon-to-be-doctors) find that CAM offers better remedies for many chronic conditions, which the current biomedical stack really isn't optimized to handle. Then when they finish med school, they're in a privileged position to confer institutional legitimacy on CAM treatments. So in some sense, this brutality is changing medicine more generally.

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ukat 10y ago

I love the medical school analogy "drinking from a firehose" since a lot of the knowledge has to be frontloaded. This makes sense since making errors is less forgiving. software engineering might be closer to "drinking from a running facet.. forever". I know doctors have to keep learning but I always wondered if it was more or less than engineers after school.

elijahparker 10y ago

A company I used to work with makes a program [1] for monitoring medical student well-being over time to try to detect early warning signs as well as provide anonymized data for research [1] http://www.mededwebs.com/well-being-index http://www.mededwebs.com/well-being-index

naveen99 10y ago

> "I checked the medical licensing requirements in California to make sure I wouldn’t lose the ability to care for patients... Fears were unfounded." You should get help. But you can't be sure you will be allowed to practice medicine. The medical board will decide on an individual basis. For reference, texas medical board form for mental illness and self referral program: http://www.tmb.state.tx.us/dl/C5EAB589-0916-C88D-FF94-DE8D9623C5A4 http://www.tmb.state.tx.us/dl/C5EAB589-0916-C88D-FF94-DE8D96... Of course, if you don't self report, and practice anyway, and a patient complains, you might be facing criminal charges. First do no harm. Help yourself before you help others (seek mental help if you need it).

s_q_b 10y ago

My sister is currently finishing medical school at Penn. We talked about suicides in hospital and university settings. She had an interesting perspective on the problem. She said that it isn't the intensity of the work, the academic rigor, or even the emotional damage from constant exposure to death and disease. It's the sleep deprivation. There is a very large amount of evidence that one night of reduced sleep massively increases medical errors. Despite this knowledge, sleep deprivation remains this massochistic macho hazing ritual, which increases in severity through residency. It's dangerous and unnecessary. This article does a good job of capturing the chain of internal events that lead from exhaustion to burnout to severe depression and finally to suicidal ideation.

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