11 ms·

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 fa

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.
    - stephencanon 10y ago
      > the pay is very good by comparison to other jobs that have similarly long hours. Once you're an attending, yes. My wife, however, is still a resident. She's doing this for $50k/year.
    - mixmastamyk 10y ago
      Doctors could work shifts just like everyone else at the hospital. Just because a worse job might exist is not a justification to continue---logic and all that.
  - stephencanon 10y ago
    There's no other path to becoming a doctor in the US. You can choose to go into a specialty with more relaxed hours, but you need to go through residency no matter what. If you want to be a doctor, you put up with it, like the generations before you. A sufficient number of residents organizing could do something about it, but (a) no one has time to organize when they're working 90 hour weeks and (b) there's a significant Stockholm syndrome effect in play. It's worth noting that there have been several studies over the years investigating whether reduced hours produce better outcomes; they don't seem to. Shorter hours means more shift changes and patient handoffs, which is the source of more errors than tired residents. Also, keep in made that getting the same experience in a specialized field like neurosurgery with fewer hours per week would require extending the training program even further. It's already seven years beyond medical school, often with a one year fellowship after residency. Extending it another few years isn't really a viable option unless we significantly increase the autonomy and salary that residents receive.
    - mixmastamyk 10y ago
      You can only learn so much per day. It sounds like you are making excuses to ignore basic human rights (recognized post-industrial revolution) such as ~40 hour weeks in favor of indentured servitude. Appeals to "outcomes" do not supersede workers rights. Sorry, I don't buy it.
      - kahrkunne 10y ago
        Human lives supersede workers rights. If you don't like it don't go to medical school.
        dagw 10y ago
        That's a bullshit argument. If hospitals really cared about human lives, they would keep a staff level that ensured that patients would be seen by doctors that where rested and focused. People die because doctors and nurses who've been on their feet for the past 20 hours are unfocused make stupid mistakes and hospitals simply don't care because dealing with the occasional accidental death is cheaper than hiring more doctors, and we as a society let them get away with it.
catscratch 10y ago
The majority of today's US med school students admitted in 2016 were born in 1992. They grew up watching the silly kids and stupid parents sit-com world of Disney Channel and Nickelodeon while getting soccer trophies for showing up. They wasted a lot of time playing non-educational games rather than reading or working hard to accomplish real things. While they had to work incredibly hard to get into medical school, and it's harder than it's ever been, I feel like anyone born in the 90s or later is going to be at a disadvantage, because the level of stress is not only much higher than before but many just aren't prepared for the stress. <sarcasm>However, I think that because of this, medical schools will have to change. It's just too darn hard!</sarcasm> Getting real though: med school is f'ing hard. Reading this did not surprise me, and if anything, I was surprised that the writer did not know what he was getting into when he got in. The things he is complaining about are the same things I've heard for decades. Also- the Helen Keller comment, while disrespectful to those that are hearing and/or sight challenged, made me laugh.
- frozenport 10y ago
  I can't tell if this sarcastic, but I think its important to point out that much of the challenge and stress of US medical school is self inflicted by the current culture - and leads to bad health outcomes for patients.
  - catscratch 10y ago
    My point was that medical school culture hasn't changed. It's been brutal for years. The main difference between those going to med school and the 90s and now in my opinion is a mix of the expectations by students that the increase in level of difficulty should be comparable to the transition between high school and college, or college and graduate school. It's not, and it never was. High expectations have always been the rule. However, for the past 25 years, there have been many more immigrants or children of immigrants that work their asses off competing harder and raising the bar. The medical schools should not lower the bar to make it less stressful. Instead, we need more medical students to matriculate to P.A. programs and nursing programs, where they can do just as much good helping many of the same patients, sometimes making similar salaries. Eventually there will be more medical schools, which will help some. Or, maybe some of these doctors that feel that they had to go through too much can work their way up and teach so that they can give their students an easier individualized and sensitive education and see where that leads. However, imo it should always be extremely difficult to get in and to succeed. That's the point. I don't think people should commit suicide. They should just quit.
deelowe 10y ago
As a father whose young son had a compound fracture recently and had to wait in the ER for 3 hours to get it patched up by a grumpy, rushed, and tired ortho, this is horrifying. Something really needs to be done about current crony capitalistic US medical industry.
- pjlegato 10y ago
  I'm not sure that capitalism as such has much to do with the problem you describe, as anyone who ever went to a Soviet emergency room will be happy to tell you.
  - gnu8 10y ago
    The Soviet healthcare system suffered from underinvestment due to their command economy's focus on heavy industry and military production. The problem in the United States is the exact opposite: unproductive overinvestment due to the proliferation of waste, fraud, rent-seekers, and all other types of interests that rake a profit off the top without contributing anything to patient care. It seems like a false argument to claim that because a radically socialist regime provided inferior care, our radically capitalist regime is not the cause of our inferior care.
    - nugget 10y ago
      I believe pjlegato's point was that while idealism may attract many students into medicine, it's ultimately the profit motive that keeps them working 60+ hour weeks and taking call for decades. I have a few physicians in my extended family and this mirrors what I've seen from them; I don't know how you'd get board certified neurosurgeons to take q3 trauma call in more rural areas for years on end other than ''here's a boatload of money''. It's masochistic work. Capitalism, especially our current flavor of it, has plenty of problems, but I think it's important to separate the core principals (mostly free markets, pursuit of self interest) from the pollutants (loopholes, cronyism and special interests).
    - stevendhansen 10y ago
      "our radically capitalist regime" Citation required. I'd venture the US is more accurately described as a hybrid socialist / mercantilist regime than a capitalist regime.
frozenport 10y ago
The real problem is many residents make real decisions, and their judgement is often impaired by fatigue.
M_Grey 10y ago
And that... is why I politely, yet firmly instruct anyone rendering medical care to not let a resident within 10 feet of me. "This is a teaching hospital!" doesn't cut it when the means of teaching are so irresponsible.
- Alkomb 10y ago
  What if someone asks for directions to the nearest hospital? "We ask them politely, yet firmly to (ask someone else)."
ozi 10y ago
Yep. Unfortunately, medical school is only the beginning. Depending on your residency or fellowship program, it is not unusuall to sustain 80+ hours per week. And unlike nurses, you don't get to disconnect from work when you aren't in the hospital. There are pages to answer, notes to write, labs to review, and on and on... The mental and emotional load is tremendous and there is no room for error. it's truly a miracle more people don't end up the subject of Morbidity and Mortality presentations from botched lines and pneumos.

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.
  - stephencanon 10y ago
    > the pay is very good by comparison to other jobs that have similarly long hours. Once you're an attending, yes. My wife, however, is still a resident. She's doing this for $50k/year.
  - mixmastamyk 10y ago
    Doctors could work shifts just like everyone else at the hospital. Just because a worse job might exist is not a justification to continue---logic and all that.
- stephencanon 10y ago
  There's no other path to becoming a doctor in the US. You can choose to go into a specialty with more relaxed hours, but you need to go through residency no matter what. If you want to be a doctor, you put up with it, like the generations before you. A sufficient number of residents organizing could do something about it, but (a) no one has time to organize when they're working 90 hour weeks and (b) there's a significant Stockholm syndrome effect in play. It's worth noting that there have been several studies over the years investigating whether reduced hours produce better outcomes; they don't seem to. Shorter hours means more shift changes and patient handoffs, which is the source of more errors than tired residents. Also, keep in made that getting the same experience in a specialized field like neurosurgery with fewer hours per week would require extending the training program even further. It's already seven years beyond medical school, often with a one year fellowship after residency. Extending it another few years isn't really a viable option unless we significantly increase the autonomy and salary that residents receive.
  - mixmastamyk 10y ago
    You can only learn so much per day. It sounds like you are making excuses to ignore basic human rights (recognized post-industrial revolution) such as ~40 hour weeks in favor of indentured servitude. Appeals to "outcomes" do not supersede workers rights. Sorry, I don't buy it.
    - kahrkunne 10y ago
      Human lives supersede workers rights. If you don't like it don't go to medical school.
      - dagw 10y ago
        That's a bullshit argument. If hospitals really cared about human lives, they would keep a staff level that ensured that patients would be seen by doctors that where rested and focused. People die because doctors and nurses who've been on their feet for the past 20 hours are unfocused make stupid mistakes and hospitals simply don't care because dealing with the occasional accidental death is cheaper than hiring more doctors, and we as a society let them get away with it.

catscratch 10y ago

The majority of today's US med school students admitted in 2016 were born in 1992. They grew up watching the silly kids and stupid parents sit-com world of Disney Channel and Nickelodeon while getting soccer trophies for showing up. They wasted a lot of time playing non-educational games rather than reading or working hard to accomplish real things. While they had to work incredibly hard to get into medical school, and it's harder than it's ever been, I feel like anyone born in the 90s or later is going to be at a disadvantage, because the level of stress is not only much higher than before but many just aren't prepared for the stress. <sarcasm>However, I think that because of this, medical schools will have to change. It's just too darn hard!</sarcasm> Getting real though: med school is f'ing hard. Reading this did not surprise me, and if anything, I was surprised that the writer did not know what he was getting into when he got in. The things he is complaining about are the same things I've heard for decades. Also- the Helen Keller comment, while disrespectful to those that are hearing and/or sight challenged, made me laugh.

frozenport 10y ago
I can't tell if this sarcastic, but I think its important to point out that much of the challenge and stress of US medical school is self inflicted by the current culture - and leads to bad health outcomes for patients.
- catscratch 10y ago
  My point was that medical school culture hasn't changed. It's been brutal for years. The main difference between those going to med school and the 90s and now in my opinion is a mix of the expectations by students that the increase in level of difficulty should be comparable to the transition between high school and college, or college and graduate school. It's not, and it never was. High expectations have always been the rule. However, for the past 25 years, there have been many more immigrants or children of immigrants that work their asses off competing harder and raising the bar. The medical schools should not lower the bar to make it less stressful. Instead, we need more medical students to matriculate to P.A. programs and nursing programs, where they can do just as much good helping many of the same patients, sometimes making similar salaries. Eventually there will be more medical schools, which will help some. Or, maybe some of these doctors that feel that they had to go through too much can work their way up and teach so that they can give their students an easier individualized and sensitive education and see where that leads. However, imo it should always be extremely difficult to get in and to succeed. That's the point. I don't think people should commit suicide. They should just quit.

deelowe 10y ago

As a father whose young son had a compound fracture recently and had to wait in the ER for 3 hours to get it patched up by a grumpy, rushed, and tired ortho, this is horrifying. Something really needs to be done about current crony capitalistic US medical industry.

pjlegato 10y ago
I'm not sure that capitalism as such has much to do with the problem you describe, as anyone who ever went to a Soviet emergency room will be happy to tell you.
- gnu8 10y ago
  The Soviet healthcare system suffered from underinvestment due to their command economy's focus on heavy industry and military production. The problem in the United States is the exact opposite: unproductive overinvestment due to the proliferation of waste, fraud, rent-seekers, and all other types of interests that rake a profit off the top without contributing anything to patient care. It seems like a false argument to claim that because a radically socialist regime provided inferior care, our radically capitalist regime is not the cause of our inferior care.
  - nugget 10y ago
    I believe pjlegato's point was that while idealism may attract many students into medicine, it's ultimately the profit motive that keeps them working 60+ hour weeks and taking call for decades. I have a few physicians in my extended family and this mirrors what I've seen from them; I don't know how you'd get board certified neurosurgeons to take q3 trauma call in more rural areas for years on end other than ''here's a boatload of money''. It's masochistic work. Capitalism, especially our current flavor of it, has plenty of problems, but I think it's important to separate the core principals (mostly free markets, pursuit of self interest) from the pollutants (loopholes, cronyism and special interests).
  - stevendhansen 10y ago
    "our radically capitalist regime" Citation required. I'd venture the US is more accurately described as a hybrid socialist / mercantilist regime than a capitalist regime.

frozenport 10y ago

The real problem is many residents make real decisions, and their judgement is often impaired by fatigue.

M_Grey 10y ago

And that... is why I politely, yet firmly instruct anyone rendering medical care to not let a resident within 10 feet of me. "This is a teaching hospital!" doesn't cut it when the means of teaching are so irresponsible.

Alkomb 10y ago
What if someone asks for directions to the nearest hospital? "We ask them politely, yet firmly to (ask someone else)."

ozi 10y ago

Yep. Unfortunately, medical school is only the beginning. Depending on your residency or fellowship program, it is not unusuall to sustain 80+ hours per week. And unlike nurses, you don't get to disconnect from work when you aren't in the hospital. There are pages to answer, notes to write, labs to review, and on and on... The mental and emotional load is tremendous and there is no room for error. it's truly a miracle more people don't end up the subject of Morbidity and Mortality presentations from botched lines and pneumos.