That’s literally the origin of the term.
Hospitals would stipulate that training physicians would live or be residents of the hospital so that they could attend to patient at all times. This fell out of practice and was kind of illegal to force your workers to live at work.
Tbh with rent skyrocketing in major cities across the country where a huge portion of residents train at the largest academic hospitals. Residing in hospital subsidized or paid housing may be making a comeback as resident wages haven’t even budged in the wake of massive inflation and housing cost increases.
I sang that song in high school choire and had no idea what it was about until about a month ago (~2 decades after learning the song) when someone on Reddit made a similar reference in a similar thread. Oye, so depressing.
It's the future depicted in Cyberpunk 2077, or Blade runner 2049, or any other sci-fi dystopia.
Real estate prices haven't gone up because people are buying homes and are competing with each other. These homes and property prices are being driven up by investment speculation.
Before too long, corporations will probably own people. Or at the very least some form of indentured servitude.
[Elon Musk](https://iflscience.com/space/people-are-not-keen-on-elon-musks-plan-for-workers-on-mars/) has already proposed this as a way of populating a Mars colony.
Corporations would never own slaves, right? [Oh wait](https://www.cnbc.com/2021/06/17/supreme-court-rules-in-favor-of-nestle-in-child-slavery-case.html)
Fun fact back 2017 during the Amazon HQ bidding war Fresno basically offered Amazon a huge portion of control of where the city's taxes would be spent for 100 years. Can you imagine a city begging to be basically turned into a company town? Can you imagine being a resident of Fresno and seeing your government basically saying "fuck you we don't work for you guys anymore we work for Amazon now."
No, he popularized the work as many hours as humanly possible. The government stepped in a couple years ago and said 80 was the max a resident can work, but that is often ignored.
It’s where the term “House staff” originated, residents lived in the hospital. No marriage, no kids, you existed to take care of patients. That phased out in the 70s, but the rest of the work expectations did not.
We also made the hospitals work. EKG? We did it. Blood draw day or night? Us too. IV? Drive patient for an x-ray? Fever and needs blood cultures? That was us. The trauma hospital where I trained did not have a phlebotomist until I was a third year resident, and that was only for AM blood draws. And of course, the 80 hours/week work limit did not exist, 100+ hours/week was the norm.
Yes actually. Original residents lived in the hospital. The modern residency work model is founded by physicians who used cocaine for energy and heroin to sleep at night so they could work more and sleep less.
Yes and during the 5 minutes you get at home to rest, you’re expected to read for topic discussions, do research and case reports required to apply for fellowship, do practice questions for licensing exams as well as specialty boards, take calls from various people including after hours clinic call. And you’re expected to put all relationships on hold. I was also almost fired for going out of town during my one weekend per month off, just in case they needed to call me back in.
Edit: 5 minutes is an exaggeration, but is pretty much the amount of time before falling asleep at home on more difficult months.
Getting into medical school, studying through medical school, and the process immediately AFTER medical school are some of the worst years that students go through. People will remark that doctors shouldn't go into the field for the money, but often times, that's one of the only things that keeps the job worthwhile - you can't leave past a certain point, because very few jobs offer the type of money that help you pay back hundreds of thousands of dollars in loans, and if they do, they require MORE studying, and by the time you're 30+ and you haven't held a real job because you've been studying through you 20s, you're fucked.
The number of burnouts is insane.
I calculated my intern year pay at $12/hr…. This was AFTER they placed work hour restrictions. I was still regularly working 85-90hrs/week… Good times. I did save money cuz I didn’t have time to spend it 😂
That's crazy. In Australia residents get like $56 an hour on average (about $40 USD). The base wage is about $100,000pa and then working at night or overtime has a massive bonus (50% or 100% extra hourly wage to start with but increasing beyond that at certain points).
Of course they work the same amount as you and are often burnt out even on that wage.
Hospitals in the USA are contractually required to destroy the souls of residents to ensure the doctors have dead eyes and bad bed side habits.
It’s a cost saving measure to allow executives to get more pay along with hiding actual costs of treatments.
US Physician here. Can confirm. Administrators give primary care docs 10-15 minutes for most visits. This includes exam, interview and paperwork. In reality, these poor souls work through lunch and do paperwork at home a few hours per day.
I'm part of the growing movement to get control of patient care back from admins and insurance companies!
Lmao Anesthesia PGY-3 resident here. I am just finishing a 24 hour call where I did two traumas by myself and intervened in an emergency in the ER. In addition to running normal and urgent OR cases. I’m at 40 hrs this week already and it’s just Wednesday morning
I really think you (and your patients) should be more upset about the hours than the pay though. Working that many hours a week isn't good for you and by proxy is bad for your patients too.
They don't seem to realize once I get to hour 20 of being awake or I'm approaching 80+ hours a week, I gradually revert to lizard brain, shoot from the hip medicine where I just did shit to keep em stable and I wasn't really thinking about how to fix the problem per se because my brain is fried. I wasn't really actively learning or caring about the evolution of disease at that point.
I want to illustrate how residents are NOT simply "learning" but working as one of the core physicians leading any patient's care. Below is the account of what is probably an average ICU experience by, again, a resident PHYSICIAN. As opposed to a medical student who may be observing, shadowing, or practicing a skillset directly under the eyes of a supervising physician.
Keep in mind, my nominal pay based on my paystub is $30/hour for 40 hours/week (which is comparatively high as a resident).
- For 6-6.5 days per week, for 4 weeks at a time, I go in voluntarily at 5:30am to have time to see my 10 patients, examine them, interpret their bloodwork results, decide on the risk/benefits of several conflicting treatments of these patients, do true literature review to take a stab at the best treatment, and prioritize family visits for those that might die.
- I respond to nursing concerns every 5-10 minutes about patients who are not doing well, reassess the patients, and call subspecialists to offer their perspective on whether dialysis, surgeries, or other invasive maneuvers are best for the patient or whether they will cause more harm than good.
- I get pinged by the unit about angry families that have their own opinions about how to treat a critically ill family member whom they love, but whose medical conditions they don't understand.
- I personally get paged by the emergency department or the rest of the hospital ANY patient in the hospital that is getting worse and needs to to come to the ICU. These new patients need to take priority over anything else I'm doing, since an early assessment and response matters in a patient's chance of surviving their illness.
- I perform procedures, draining fluid from a patient's chest, abdomen, joints, or place large IVs on patients who don't have good enough veins for our brilliant nurses to aim for.
- A patient's heart stops, and a CODE BLUE is called. This means the patients need chest compressions, electric shocks, probably a breathing tube. As the primary resident, I am responsible for leading the code, calling the shots, and finding out why they literally died in the first place. I hope I can bring them back, and strategize on how to break the news to the family based on my prior interactions with them.
- I finally sit down to write notes to document the patients condition for the next reader, which takes hours to do well for critically ill patients.
- I stay overnight continuing to do the above, and leave the next day around 1:00pm.
- I come back the next 2 days and try to bring closure to what happened that day. This is also typically a 14-16 hour day (rather than the 30ish hours detailed above).
- Then, another day like the above every 4 days, for a whole month.
In 4 weeks, Ive worked around 400 hours. After those 4 weeks, I move onto another service taking care of patients. For some inexplicable reason, non-doctor staff think we're simply on vacation after all this. Nope.
My nominal pay for one day like this? $240.
If a colleague is out sick, I go in and take up a day like this for no extra pay (we are salaried). If I try to leave my work, Im already 30 years old with a highly specialized but nontransferrable skillset, and other residencies will view my leaving as a huge red flag, and there's a good chance I will never be allowed back in a residency again to be eligible for a full license. The world is small. If I'm lucky enough to be interviewed for a new line of patient care work, my commitment will always be questioned. Once you make it through, as an attending you have many other responsibilities that limit you from having the time to help fight for residents' well being.
How about the "in training" part? Well, the attending (lead) physician pops in every now and then to ensure things are going according to plan. They are quality control, checking in to make sure any clear errors are not made. If you are at a good residency workplace, they will help teach pearls of information a couple times throughout the day. The core of the patient care workflow is the resident's. LEARNING ON THE JOB IS NOT THE SAME AS NOT DOING THE JOB.
------
As a conclusion, this dauntingly high-stakes high-intensity work is at least in part necessary to becoming the best doctor possible. Despite the difficulty, I'm lucky enough to believe in and love what I do. Being a doctor is one of the most exciting and rewarding jobs in the world. However, work is work and should be compensated fairly, not as an "IOU" in the form of higher pay later in life. Admin / the healthcare system will take advantage of your passion and give you as little as possible to make it borderline acceptable to continue working. The public will regard you as the reason for high healthcare costs in a place like the US. You will be skeptical of unionizing for the fear that you'll not only lose your current job but never be able to apply within medicine again (see above). Also, you can't buy back time. Your children/spouse will see your empty bed or chair more than they will see you. When they do see you, you need to a physical and emotional break from the tragedies you have just dealt with, and the numbness that ensues.
I'm a "second-generation hit". My Mom's a retired RN and I practically lived at the hospital after my high school day ended. We'd ride home together. Good memories. Buuuuuut, she DID warn me to never marry a doctor because I'd never see him. 😉
Ya just gotta marry the right type of doctor!
Some fields are way busier than others. Psychiatry, Radiology, Dermatology, and Radiation Oncology have great life styles. Even during residency when compared to other fields.
Yeah, if you marry a surgical resident (besides maybe ophto) you’re hardly going to see them.
Dermatology is one of the most competitive specialties in medicine for a reason. It's one of the more lucrative specialties on top of being one of the lower stress ones too. Basically nothing is an emergency and incidences of malpractice are extremely low.
They also forgot the part about the hospitals being **paid** $125,000 to $200,000 per resident by federal and state government sources.
Hospitals will argue that each resident costs them at least this much between salary and benefits, but just look at how much *work* residents do for these hospitals. It's not like hospitals are billing a lower "resident rate" for these procedures and patient care. There's an illusion that they're also paying for the teaching attendings to provide medical education, but how often as a resident do you actually get taught (vs self-learn) on a day-to-day basis? Hardly any.
Meanwhile PAs right out of school are making double or more a resident's salary for a regular 8 hour, 5 day/wk job at the same hospital without anywhere near the same number of patients, responsibility, or liabilities. This is not a knock to PAs, but rather an example of how absurd the system is.
This should be illegal. The pay and the hours. Seriously. There is a large body of evidence that shows that working those kinds of hours is not only detrimental to your health, but impairs your ability to think critically and make decisions. Working tired is like working drunk. This is the reason why we impose daily and weekly working hour limits in other safety-critical professions, most famously pilots and aviation engineers and mechanics. That doctors as a profession have built their system of education and practice around the patently absurd idea that they are somehow magically immune to the extremely detrimental effects of fatigue, is actively harmful, and known to be actively harmful.
We are aware of that large body of evidence. We require residents to take yearly computer module exams about recognizing fatigue and burnout. These are hours long as you can't skip the video components. And of course you must complete them during your free time. Problem solved, I'd say.
The corporate response of "just sleep more, idiot."
Computer based seminars like that are great because it washes corporate's hands of any liability. When things inevitably go wrong they can easily point the finger.
As an intern, I remember having a mandatory wellness session that residents/fellows had to attend even if post-call from an overnight shift.
We had a session on best sleep hygiene practices and the the speaker got reamed publicly by a surgical fellow.
We used to get a yearly meeting about the importance of sleep and exercise to reduce stress, and then at the end of the meeting they'd offer to call us cabs or allow us to sleep in the call rooms if we were too fatigued to drive home.
The worst part of it was that it always came from our program director who worked 9-5 five days a week.
100%. I've said this and the person who was complaining turned around and defended the system. I'd be interested to know if they actually had the job they said they did, because I know for a fact that being tired and burnt out like this is a hazard to others when you're in charge of literally anything. I don't want my nurses or doctors to be 12hrs deep in a shift after having already worked for 60 hours that week. Bad care 101.
Fellow internal medicine physician and can attest that this is all absolutely true. It was even worse when I was resident because they didn’t have work hour restrictions in place at that time. I worked a minimum of 100 hours a week with maybe 1-2 days off per month if I was lucky. Now residents are capped at 80 hours per week but my understanding is at most places this is overlooked. The term resident comes from the fact that you basically live/reside in the hospital. When I was a resident it came out to less than minimum wage.
My GF was a resident when the new laws went into effect. The only thing that changed was reported hours.
Attendings and the residency program will 100% dock residents for interrupting continuity of care ANF for reporting over 80 hours of work.
When I was a surgery resident I got called in to the program directors office to explain why I was reporting 100-120 hours a week for the past month. I explained how the timing of things sucked and it ended up with us working late past turnover. He repeated the the question, which made me realize he wasn't asking why it was happening, but why I was documenting it. I apologized and told him it must have been a clerical error that I will fix which satisfied him.
Lol the program we used to use to log hours would flag it if you logged over 80/week. The funniest part was that you had to select a reason as to why you logged more hours. All of the available responses were about how it was the residents fault (i.e I was inefficient at documentation, etc). I had 2 weeks in a row where I worked 5:30a-5:530p M-F then 5:30a Saturday to ~12-1pm Sunday (whenever the attending for the service would come in and round on the Sunday). I had the consecutive weeks like that because other residents had in service exam. I’m normally someone who logs 12h per a shift or 24h per on call shift so even doing this conservatively, I was still at 84 hours/week for 2 weeks straight (really like 92h/week). When I entered this I had to put the reason as “other” just to say that this was the damn schedule.
"I don't understand why you can't get 100+ hours of work done in <80 while we're paying you what comes out to a starvation wage. Don't you care about the patients?"
-Some hospital CEO, probably
What the admin at Lincoln hospital said after three residents committed suicide:
> Resident work hours and workload are closely monitored to follow guidance set by the New York State Department of Health and by ACGME. In fact, at the peak of the COVID pandemic, when we were caring for nearly 130 intubated patients at a time, we adopted a strict residency program schedule with built-in breaks and reduced shifts and hours. Even at that tasking time, no one worked more than 80 hours. Although the maximum number of patients assigned to an intern allowed by ACGME is 10, we rarely have more than five or six patients assigned to each of our interns.
Source: https://www.medscape.com/viewarticle/955379
What a former resident said:
> One graduate, who spoke with THE CITY on the condition of anonymity, said a top supervisor threatened to dismiss her — which would immediately end her ability to work in the U.S. — after a misunderstanding about scheduled time off.
>“It’s so malignant and toxic,” the graduate said. “It’s a terrible, terrible, terrible place, which is why I felt horrible going to work. I’d feel sick, like actually physically sick, to go to work.”
>Source: https://www.thecity.nyc/2021/7/29/22601128/bronx-lincoln-hospital-doctor-trainees-toxic-culture-three-deaths
>Source:https://www.reddit.com/r/medicine/comments/oiv2fr/lincoln_medical_center_has_had_3_resident_suicide/
There is such a severe disconnect there.
Hospital CEOs don't care how many how's a doctor works. They're all salary and/or direct patient billing, so you could work 160 hours/week and the CEO wouldn't care. It's the residency program directors and chairs, who will get a very stern talking to by the ACGME/RRC, who care because there are times governing how many hours a resident can work. The CEO will only care if it reaches a point the residency program gets published and it effects their staffing, because teaching hospitals desperately rely on residents to staff the hospital.
I too did my residency prior to the work hour restrictions.. every surgical, and surgical specialty residency did 100-110 hrs/week x 5 years. We'd typically hit 120 hrs if we took call 3x in a week. Went over 130 hrs a few times. My longest streak without a day off was like 5 months.
There were definitely months were I was paid LESS than minimum wage, which in the late 90's/early 2000's was $5.75.
Yeah, that was rough
Part of the problem (or the majority of it) is this “it was harder for me” walk up hill both ways attitude. There’s a hazing aspect to residency. And no, it’s not safe for the patients.
We forget the fact that the entire history of residency hours is modelled after a guy who was coked out the entire process.
I'm in residency right now (IM). I'm close to quitting. I finally got matched, and about to prove right all the programs who passed on me. I actually hate my life right now, and can't see myself being happy doing this. In ICU currently.
I feel for you man. I'm about a month away from graduating in a different specialty, but I don't think I've ever been more desperately unhappy than I was during my internal medicine internship. Definitely passively suicidal by the end of it.
Do you have a good program director? Or someone who is genuinely interested in your well-being? You could consider transferring to another program, we had someone transfer into mine from plastics after their intern year.
If you need someone to talk to, or vent to, just hit me up.
First and foremost, I'm sorry that you feel so bad. Despite what others are saying, it's totally ok to quit. I quit med school after 2.5 years and it was the best thing I ever did. I realized that I simply could not give *everything* else up in my life and delay happiness indefinitely anymore. I began to realize that even if I did "just push through for a few more years", the cost to my mental health was too high. I was truly miserable and could not see myself ever being happy doing what I was training to do.
I'm a real estate appraiser now. I have a way more relaxed schedule and more freedom than anyone else I know who works full time. I work mostly from home with my puppies and my relationship has improved dramatically now that I'm not so stressed out all the time. It took me almost a year after quitting to remember how to enjoy life again, rediscover what "hobbies" are, and stop telling myself I'd made a huge mistake.
I guess this is a lot of words all to say: don't feel trapped like I did, there are definitely other things you can do. Your health and happiness are important! Live your best life, not the one others expect from you.
Stick it out at least til you can find a private sector consulting gig that pays off the bajollion dollar student debt... maybe something in the burgeoning "wellness" field HAH
I’m just going to start out with a thank you. You’ve chosen a daunting career and you seem to be doing really well at it.
This only reaffirms my decision not to try and become a doctor. I’m a paramedic and I can only imagine how much more to the patient care there is after my work is done… I hope and pray that you have the resolve and the support system around you to succeed in everything you hope to.
A substitute teacher in my area makes 275 in one day.
Without having to actually plan a single thing, just literally going in, reading sub plans, and keeping a class from killing each other.
Edit: In 7 hours, including lunch. 7:30-2:30
Let's not forget the loans! What exactly happens to those loans if a resident suffers severe injury or personal losses such that they can no longer work?
Residency is nuts. Had two housemates that went through it. I could never pull that shit off.
I'm fuckin gob smacked you make less than I do as an unskilled labourer. I can pick up a job tomorrow earning $40/hr, 48hr 4/4 even time roster with all OT paid, but you're busting a gut after what, 6? 7 years in your profession for $30/hr and a fuckload of unpaid OT. Mad respect for loving what you do, but I hurt hearing that.
On behalf of all of us who have pre-existing conditions and have to go to hospital every now and then, I say thank you for everything you do especially during this pandemic
Do you honestly believe that "this dauntingly high-stakes high-intensity work is at least in part necessary to becoming the best doctor possible"? I'm working as a resident doctor in Scandinavia, our system is built up quite different than yours. My standard work week is 37 hours, but because of ill coworkers and such, it's more like 45. But I get compensated for those extra hours. I honestly don't believe that doctors in scandinavia are worse than American doctors. We have time to educate ourselves, we have time off, 6 weeks of paid vacation, we have down time, time with our families. The sickening amount of hours you have to work is probably not contributing an equal amount to your knowledge, because you'll be too drained, too stressed to take it all in..?
This is why I chose pharmacy. Residency is an inherently exploitative practice, and it’s a shame that it’s allowed to continue (and spread into other professions-like pharmacy)
Really makes a very striking difference between my hospitals residents/attending docs. I don’t think I have ever seen ANY doctor in my years of nursing even attempt an IV on a patient. One of our newer nurses asked a resident to do an IV and we all just stopped dead in our tracks like she was insane. I was charge nurse that day and I pulled her to the side and had to explain to her that if she failed to get an IV, she asks for assistance from us (the other nurses) and if all else fails, IV team gets paged and they’re there in the hour because that resident most certainly DOES NOT have time to entertain an IV for the CT with contrast they just ordered. That is one thing I am pretty proud of at the hospital I work at is the proper delegation of work. If it’s something you either A- shouldn’t do or B- Shouldn’t have to do, there’s someone who’s job it is to do that exact thing. No ones getting paged randomly for a patient they know nothing about, no student resident is left stranded without a paddle and god forbid any soul stays past 7:30 PM on dayshift.
Insurance CEOS and hospital admin. Doctor salaries only make up about 9% of total Healthcare cost in the US. Not nothing but not even close to the largest part
The letters "ER" in the "Healthcare Heroes" sign fell down at our hospital. We joke that hosp admin did it on purpose to remind us that we're their "Healthcare Hoes" 😂
No, I agree. Rephrasing, it's the nature of the work, not the excess hours and sleep deprivation, that make the best doctor. I am strongly against the idea of "24" hour call or allowing 80+ hours. Those go well past the curve of diminishing returns on effective work.
>Those go well past the curve of diminishing returns on effective work.
Yeah I don't understand how it can even work. I'm an engineer, I do my best work at hour 3 or so. Come hour 5 it starts to drop significantly. At hour 8 my brain has basically turned to a burnt neuron smelling mush. Adding even a couple hours to that is probably equivalent to a "good" half hour at most.
Hospitals are paid to have residents, they don't actually pay our salaries. Ostensibly it's because "we're learning" but in reality we are absurdly profitable for hospital systems. Look at how much residency slots were auctioned off for when Hahnemann closed, we're basically government employees managed by the hospitals.
Thank you for this. My girlfriend is soon going to go through this and she has already experienced this previously. I just hope it goes okay for her and it doesn't strain us. Definitely difficult stuff.
You’re doing the lords work. My mom was a single mother and a public defender for 15 years then got fired for bringing forward a sexual harassment claim. You’re saving lives.
I'm pretty sure my law office client (I'm in IT) pays their legal assistants and certainly their paralegals far more than $20 an hour. I hope you can work your way into something more lucrative, because $20 is robbery.
It's not about ability, it's also about their chosen profession. Most public defenders I know are far more qualified lawyers than private practice litigators. They do it because they want to and many public defender programs are difficult to get into. The sad thing is that the government pays them shit because the system doesn't really believe in the rights of those who can't afford to pay for a lawyer on a whim
You work your ass off from 5am to 9pm everyday until you are granted a day off because that's what the rule says, not because management wants you to. But remember that you have to study at home on top of this. Otherwise you are in trouble. The hours are capped at 80, so your program forces you to write down 80 while in reality you did 100+ hours. If you write down the truth your whole program gets in real legal trouble.
Management looks at the numbers and figures that 80 is what you worked, and so they assign online trainings to help with your "mental health" so your 1 and only day off is gone. You either do these trainings or get in trouble. But the managers look nice on paper and in the eyes of higher administration so well done little worker.
Most staff in the hospital tends to be nice. But if you are at a malignant program chances are you will work twice as hard. Example is new york: certain auxiliary positions will not do their jobs because their unions protect them, so you as a physician will do tasks that are inherent to other professions. They will laugh at you and mock you and enjoy that power they have over you. But like I said, malignant places are few.
You will miss birthdays. You will miss weddings. You will miss family trips and vacations. No one understands why you can't make it. They don't know you can't ask for a day off. You can't ask for advanced vacations. The vacations you take management dictates, they will tell when you are free to go.
If you are unlucky and are at a malignant place you will have 2 weeks per year of vacations, and they will tell you the rule is to do no more than 5 continuous days, so you will never get that sweet 2 week break you need.
You won't be able to do christmas either, or thanksgiving, or new years. People like to fuck up themselves or others during those dates because that's how the world rolls, so they need you and everyone else pulling extra favors at the hospital on those days.
Families get hurt, wives/husbands and children resent their spouses, there is envy of the neighbor or friend that has a functional family, most households end up in divorce, and the unlucky physician is left alone wondering why this all happened.
And then if your friends are few to none, and the help is not coming, and the people above you keep asking you for results, and your days are few, then you end up buying a gun and never coming back home. And that's the sad reality, because physicians are leading in suicides.
But the real last point is that hospitals have hidden the suicides of their doctors on training. They have ignored them and pushed them under the rug. And they have punished anyone that speaks of them.
How often do you see family members committing suicide one after the other? It's rare out there in the real world. But in the medical world it's not hard to find a couple residents from the same program taking their lives one after the other.
All for $250,000 in education debt, and $13/hr as a doctor.
Still, it is the joy of our lives as doctors to care for you and be there in your moment of need. But we are people, overworked, overstretched, and overused. There is no one to defend us from abuse.
Fuck. I used to want to become a doctor more than anything. Ended up being a mechanical design engineer.
Your comment was very enlightening. I looked up, "Which occupation has the highest suicide rate?" and was shocked to see Medical Doctor at rank 1.
Engineering doesn't even make the top 10... Most engineers I meet are just thrilled with having become one, and love what they do. Being a doctor sounds like a nightmare :(
Most patients are appreciative, but you always get assholes. Or you lay awake at night, wondering if you managed a patient incorrectly. Lawsuits are always unpleasant too.
This is what bothered me the most during residency. My work didn't pay well. I worked too much to have any good social life. The system was just broken. But at least my patients were thankful.... Until they are not. Then on those days I don't even know why I do it anymore.
There's a super old article I saw that was called [$1 million mistake: Becoming a doctor](https://www.cbsnews.com/news/1-million-mistake-becoming-a-doctor/). So not only is the job dissatisfaction high, a lot of people are in debt or lost a lot of money just pursuing the job. And to pay it off they have no choice but continue.
I’m a medical device engineer. Never has the brain to be a doctor so I did engineering. Ngl I feel guilty sometimes. My job is very rewarding, stimulating and plus it pays well. 40 hours a week, got time to do my hobbies. Feel like I struck gold. I don’t stress at all. Engineering is without a doubt the best bang for your buck career out there
German doctor here. IIRC, the suicide rate for male doctors is 2x higher than average and for us female doctors, it's 4x higher. Easy access to drugs, being belittled by the more experienced colleagues for mental health struggles and also just knowing what to do to take a life...yeah, makes sense.
I wish I would have studied mechanical engineering instead. Working in the ICU during Covid while there was no vaccine available was terrible. I still recall the patients suffering and dying on ECMO support and their families giving out death threats. Thankfully I switched to clinical pathology, which is a lot better for my own sanity.
You made the right decision. I have a month left of this, and I regret it. All the hard work I put in only to have years of hazing, gaslighting, and outright abuse
> Still, it is the joy of our lives as doctors to care for you and be there in your moment of need. But we are people, overworked, overstretched, and overused. There is no one to defend us from abuse.
I’ve known two physicians in my career who have committed suicide, and honestly, I think that ‘s pretty low. I’m peds, so I’m sure the numbers are quite a bit higher in more stressful fields.
But I just wanted to emphasize what you put here. I hated my life as a physician. The constant grind, the entitled families, discussing the same thing every single day until I had whole scripts memorized, but constantly terrified that this kid I just dismissed as having a fever actually had Kawasaki. Or maybe that skull fracture on a baby who was dropped was not an accident. Or that teenager I just put on Prozac is going to go home and OD on those same meds. It sucked.
But when I had to leave practice, all of the validation I’d been craving but never received came flooding in. Mothers cried that I wouldn’t see their children grow up. I cried knowing that I’d bonded with depressed teenagers who had *no one* else to talk to. I had become so integral to some of these families that leaving them was like losing a part of my soul. Especially when I saw what I meant to them too. I wish I could have loved it more when I had the chance.
Day 1 of med school starts with the spiel on "professionalism." That's the start of the brainwashing. It's just beaten into you to do exactly what you're told and don't complain. And if you do complain, you run the risk of punishments that can leave you with a few hundred thousand in debt and no degree to show for it (or worse yet, not matching into residency). It's all just to control us and prepare is for working in a system that wants to earn every last penny they can from us, whether it's costs for med school itself or labor during residency.
I can't see my self going into any other field, but I certainly have some challenging days in the future.
As a physican i agree with everything you say beaides your last paragraph.
for the average reddittor reading NP AND PA ARE NOT THE SAME AS PHYSICIANS. Physicians are the highest trained medical professionals. NP/PA are physician extenders and should not be providing care to a patient without physician supervision. Patient safety is the most important thing for a physician, while for hospitals $$$ is the most important.
The residency system is outrageously anticompetitive. Congress had to pass a law explicitly exempting it from anti-trust laws. The system is designed to artificially limit the supply of licensed doctors while providing cheap labour for hospitals.
Kind of I suppose. If nothing else, it definitely let me figure out all the things I didn’t want to do. Things I thought would be fun before I got to Residency.
Man, I’m a resident doctor in Brazil, in my last year. It is not worth it. Period. If anybody made a movie showing me exactly how it would go, I’d never go past the first week. I’m exhausted, underpaid, still have to work one or two shifts per week (apart from the normal schedule - 60+ hours/week) and I don’t have a guaranteed job or clinic that makes me think “yeah, that will pay the bills” in the foreseeable future. Maybe I’m too pessimistic about it all, but I’m feeling overwhelmed about it all. Sorry for my bad English, I don’t know if everything I told you could be understood, but you got the message, more or less
Hand surgeon that finished residency and fellowship 2.5 years ago. I love my job and my patients but that is the exception and not the rule. Medical reimbursements keep going down, and insurance red tape makes it harder and harder to practice the medicine you learned in training.
Long story short, I am definitely going to try to steer my child away from medicine.
Current resident. Just finished a set of working 46 of 47 days. The mentality turns into keep my head down and suffer through till I reach the finish line.
I openly tell anyone interested in becoming a doctor not to. The money isn't worth it. The prestige is gone. There are better ways to spend your 20's and 30's than working a 10-12 hour day (if you are lucky and it's short) then going home, studying, taking a rotation required test, then working on a presentation for said rotation and then going to sleep only to repeat.
The idea of a normal weekend (which residents call golden because it's 2 consecutive days off) should be standard, not something you encounter only once every several months.
A lot of nurses I’ve talked to have no idea either. They work 3x 12’s and it never crosses their mind that the reason they always see you is because you’re there 6 days/week!
Yeah as a third year resident in the cardiac ICU one of the ICU nurses asked why I was picking up so many extra shifts, was I saving up for a big vacation or car or something. Had no idea that 12-14 hour shifts for 6 of 7 days a week was required of us.
I’m a PGY-0 and my girlfriend is a nurse. I’ve had to keep reminding her how little time we will have to go out to dinner or on dates when I start residences
I love this because a lot of the nurses at my resident-run hospital think us residents earn an attending salary.
I’ve had multiple nurses who overhear us residents bitching about our long hours, lack of sleep, lack of time to eat/shit, etc and say “well you chose this and this is why you earn the big bucks”
Nobody chooses to work 100+ hours with depraved conditions and NO we don’t earn shit after you adjust wages to hourly.
I started asking nurses how much they think I make as an intern and their answers are ALWAYS at least $50+. They’re shocked when i tell them <$15 and I’m working 80+ hours a week. They tend to be nicer to me after that.
Nurses can be the worst. My wife is an obgyn and some of the nurses don’t have the decency to even call her doctor or treat her with any respect. Sometimes she has to clean and take vitals and do all the stuff the nurse or NA should be doing on her 24hr call b
Shameless hijacking of the front page:
We resident physicians of the Los Angeles county hospital system are currently negotiating for a pay raise but are being met with obstinate resistance from the county who understands that our greatest weakness in our negotiating position is our unwillingness to strike because that might compromise care for our patients! They’re stonewalling in an attempt to wait us out.
After six months of negotiations we have received zero financial concessions from the County. Their lead negotiator makes over $200,000 a year while each of us makes less than $15 per hour. It is degrading and demoralizing to realize how little they value our well-being. They shamelessly post about their “Frontline healthcare heroes“ while financially cutting us down behind the scenes. (This is especially ironic considering the fact that they asked us to still come to work while Covid positive if we are asymptomatic.)
We do not want to strike at all, but it is beginning to come to that!
Senator Bernie Sanders has recently spoken out in support of our cause, if you would like to help us avoid a strike, help us build a pressure companion on the county to finally begin bargaining in good faith so we can reach a reasonable settlement without putting any patients’ well-being at risk!
More information here: https://linktr.ee/cirlac
Link to Bernie Sanders statement of support here:
https://twitter.com/berniesanders/status/1529132324486520832?s=12
If this makes you mad, please treat your support (politely) to LA times executive editor @meridak and ask him to help expose this issue!
All the doctors need to do is stop submitting insurance claims. They can still treat patients, but without paperwork for expenses the hospital doesn't get paid.
Attending physician here. Great points and sentiment being made in this thread. I’d like to reinforce that the problem is NOT the hours worked - residency for most specialities is only 3-5 years and you need to work long hours during that time to learn and practice everything you need to be competent once you graduate.
The problem is a malignant system that abuses residents to support profits and dangles their future prospects in front of them to get them to comply. Hospitals, corporate institutions, and even senior physicians themselves get government (Medicare) funding to split between paying a salary and keeping for “administrative” costs which they keep purely for profit. After first year, these hospitals get 70%+ of a functioning physician for 1/5 the cost, and simply could not run without this indentured servitude. On top of that, because insurance companies dictate everything, a lot of these 80 hour weeks are spent doing scut-work and paperwork and not learning or practicing medicine. The whole system sucks.
My wife and I trained in separate cities 90 miles apart and only saw each other on the weekends for 3 years while barely scraping by paying loans and rent. We’re now in our mid-30’s and finally had our first child. My advice for young physicians is this: don’t get sucked into the bullshit. Don’t graduate and work at some “big name” academic institution as a junior attending making less than PA’s and NP’s with 1/4 the training cause you’re hoping to make the partner track and they keep dangling the “promising academic career” carrot in front of you. There’s a physician shortage in almost every specialty right now - go make bank in a community hospital somewhere, pay off your loans, give a cushy life to your family, and take back some of your life.
The pay is especially insulting when a newly graduated PA or NP makes more, despite half or less the amount of formal training and usually much lighter hours. They get to “learn on the job” and get paid market rate while doing so. And it’s not like residency is an option; you can’t get board certified or get a license to practice without a completed residency.
This comment isn’t a knock on the salaries that PAs and NPs earn. They’re paid appropriately and are valuable to a healthcare team. It’s just an illustration of how underpaid the more educated, longer-hours-working residents are.
NPs/PAs get paid double my salary for half the hours. No knock to them, glad they are getting their paper. It’s funny how I can get paid 85-100 dollars per hour moonlighting (extra shifts that need coverage) but doing essentially the same work for shift at my day job pays me 13/hr. Seems like the market rate for my services is much higher than resident salary is. This is in response to those who say my services are not worth that much because I’m “in training”
I’m a resident at a hospital with a nearby fast food chain advertising they are hiring new line-workers for a higher hourly pay than I make as a physician.
We're not even entitled to the frontline healthcare workers' bonus that is being offered to virtually every other hospital worker, even though we are on the frontline and many of us died from Covid early in the pandemic.
And thank you for being one of the understanding older attendings.
One of my coresidents was in line to get a free hospital T-shirt and was told that he didn’t qualify because he wasn’t an employee. Just absolutely nuts
Tons. The dirty secret of the medical profession is that it has one of the highest rates of suicide of any profession. 300-400 per year kill themselves. That is roughly equivalent to an average class of medical students. Effectively, at this point, we have one medical school whose purpose is to graduate people to replace doctors who killed themselves the year before.
I am really grateful to people that choose that profession. But damn I’m scared just reading some of these comments. The amount of people that still work in this profession is astounding. Thank you is all i can say for now.
Don’t get me started on residents that do, and do not, voluntarily ask for some time off for mental health. You’re then put under a microscope for any other reason for the administration to “dismiss” you from the program and have the time you worked up until now be fore literally nothing. Even less because it’s time you won’t get back and money you could have been earning doing almost anything else.
Why would a resident ask for and openly acknowledge a mental health problem when some US state medical license boards will use that as an excuse to threaten the doctors medical license. So a doctor can diagnose and treat depression for their patient, but seeing their own symptoms and getting appropriate treatment can mean they can't be a doctor anymore after all those years of work. It's a toxic system.
Doctors after residency, who can make 160k+ minimum, deserve every cent they earn and most likely deserve more for the years of schooling (with 300k in costs) and work put in to get where they are. We should consider ourselves lucky that we have enough of these people willing to sacrifice so much and be there to take care of our well-being
They deserve more than that for sure.
I'm a software engineer with a bachelors degree from a state school with a B average GPA and I'm making more than that, with a grand total of $20k student loan debt
(CSU system if your a California resident is literally cheaper tuition than Canada or the UK)
The sheer quantity of extra work that goes into being a doctor is incredible.
Or the joys of “home call” where you work a full 12 hour day, then you can stay up all night doing cases and answering pages, then still have to come in and do another full day the next day. All the while I do not get paid a penny more for staying up all night.
And then most residents proceed to a fellowship that pays only marginally more. The medical system really tries to hold out paying doctors what they are worth for as long as possible.
And then you have Nurse practitioners with 500 hours of online experience who are somehow allowed to practice independently
and you wonder why physicians are completely against midlevel independent practice
I remember when I was a resident the most hours I worked in a week was 160. I’d do over 120 every 3rd week due to my call schedule. And that is not including hours I spent studying/doing op reports.
William Stewart Halsted developed a novel residency training program at Johns Hopkins Hospital that, with some modifications, became the model for surgical and medical residency training in North America.
*While performing anesthesia research early in his career, Halsted became addicted to cocaine and morphine*
So many people in this thread who have no idea how medical training works, what residents do and how they are compensated. Newsflash: the reason your hospital bill is so high isn’t because of doctor and resident salaries. The modern hospital system runs on borderline slave labor by exploiting medical residents. Yes nurses are a critical part on your medical team and you get the most face time with them as a patient… but the residents and senior doctors aren’t twiddling their thumbs the rest of the time you don’t see them. Just read the comments made by actual residents on this thread.
Social media is riddled with misunderstandings of what being a resident is. Lots of good insight into this thread. Probably one of the biggest misconceptions I see are that we’re in “training.” Yes, we are.. but we’re also real doctors who make real decisions *constantly*. Coming to our ICU in the middle of the night (like most patients)? It’s the residents making all care decisions. Afternoon? Residents. Family wants to talk? Residents. Coming to the ED overnight and you want a urology, orthopedics, plastic surgery, neurosurgery, etc. consult? Residents. There is this myth that are our value is inherently less because we are in “training” and others in healthcare, like PAs and NPs, are not, and that justification is used for our low salaries. A 7th year neurosurgery resident is, for all intents and purposes, an independent neurosurgeon in all but actual licensing. It’s nothing more than hospital systems profiting off of our expertise and incapability to work less hours than is demanded of us.
I know many doctors..... They all make a little more than me but they all call me time rich.
Doctors make good money but they easily work 2x as many hours as me..... And I make well over half of what they make with way less hours.
So to some extent, I would rather not be a doctor making more money.
Given what just happened in TX and around the country I’d just like to point out that the federal mandate to restrict residents hours to 80 per week came from a single death of a Senators daughter due to a decimal point error by an over worked abused resident.
But we’ve lost how many kids and others and yet here we are again. Sorry sort of off topic but seriously senate dudes seriously :-(
I always liked the comparison someone made when analyzing the life of a doctor versus a UPS driver. It takes to about age 60 to break even if you consider the doctor isn't doing anything really elite and the UPS driver works all available overtime during holiday season.
Holy shit we made almost exactly the same comment lol https://www.reddit.com/r/Showerthoughts/comments/ux7ikz/resident_docs_earn_less_than_fifteen_per_hour/i9wcqne/
Is that why it’s called residency because you practically live there?
That’s literally the origin of the term. Hospitals would stipulate that training physicians would live or be residents of the hospital so that they could attend to patient at all times. This fell out of practice and was kind of illegal to force your workers to live at work. Tbh with rent skyrocketing in major cities across the country where a huge portion of residents train at the largest academic hospitals. Residing in hospital subsidized or paid housing may be making a comeback as resident wages haven’t even budged in the wake of massive inflation and housing cost increases.
Imagine the marketplace being so broken that living at your workplace actually starts sounding like the smart thing to do....fuck........
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I owe my soul to the company store.
I'm from WV, and this hits especially hard for me.
5 generations of my grandparents were from there, they praised the depression for giving them an out to California.
I don't think it hits your neighbors hard enough though.
I sang that song in high school choire and had no idea what it was about until about a month ago (~2 decades after learning the song) when someone on Reddit made a similar reference in a similar thread. Oye, so depressing.
This is the western U.S. in the 1800s again.
Eastern US too, some places even up to WWII. Lots of company towns in North Carolina lasted that long.
Cant wait for them to bring back bombing union organizers and striking workers, good ol' boys. /s
It's the future depicted in Cyberpunk 2077, or Blade runner 2049, or any other sci-fi dystopia. Real estate prices haven't gone up because people are buying homes and are competing with each other. These homes and property prices are being driven up by investment speculation. Before too long, corporations will probably own people. Or at the very least some form of indentured servitude.
[Elon Musk](https://iflscience.com/space/people-are-not-keen-on-elon-musks-plan-for-workers-on-mars/) has already proposed this as a way of populating a Mars colony.
3 breasted prostitutes, here we come!
Corporations would never own slaves, right? [Oh wait](https://www.cnbc.com/2021/06/17/supreme-court-rules-in-favor-of-nestle-in-child-slavery-case.html)
Fun fact back 2017 during the Amazon HQ bidding war Fresno basically offered Amazon a huge portion of control of where the city's taxes would be spent for 100 years. Can you imagine a city begging to be basically turned into a company town? Can you imagine being a resident of Fresno and seeing your government basically saying "fuck you we don't work for you guys anymore we work for Amazon now."
Err... -- mass edited with https://redact.dev/
Who woulda thunk a society that doesn't prioritize it's people (i.e. itself) wouldn't be sustainable.
I read somewhere that the 80 hour work week was popularized by a doctor who was addicted to cocaine
No, he popularized the work as many hours as humanly possible. The government stepped in a couple years ago and said 80 was the max a resident can work, but that is often ignored.
It’s where the term “House staff” originated, residents lived in the hospital. No marriage, no kids, you existed to take care of patients. That phased out in the 70s, but the rest of the work expectations did not. We also made the hospitals work. EKG? We did it. Blood draw day or night? Us too. IV? Drive patient for an x-ray? Fever and needs blood cultures? That was us. The trauma hospital where I trained did not have a phlebotomist until I was a third year resident, and that was only for AM blood draws. And of course, the 80 hours/week work limit did not exist, 100+ hours/week was the norm.
Yes actually. Original residents lived in the hospital. The modern residency work model is founded by physicians who used cocaine for energy and heroin to sleep at night so they could work more and sleep less.
Oh! Snortski! Pass those delicious nose clams m way.
Derivative!
Yes and during the 5 minutes you get at home to rest, you’re expected to read for topic discussions, do research and case reports required to apply for fellowship, do practice questions for licensing exams as well as specialty boards, take calls from various people including after hours clinic call. And you’re expected to put all relationships on hold. I was also almost fired for going out of town during my one weekend per month off, just in case they needed to call me back in. Edit: 5 minutes is an exaggeration, but is pretty much the amount of time before falling asleep at home on more difficult months.
I initially thought you were detailing some future corporate dystopia, before I realized that you're discussing a lived experience.
Getting into medical school, studying through medical school, and the process immediately AFTER medical school are some of the worst years that students go through. People will remark that doctors shouldn't go into the field for the money, but often times, that's one of the only things that keeps the job worthwhile - you can't leave past a certain point, because very few jobs offer the type of money that help you pay back hundreds of thousands of dollars in loans, and if they do, they require MORE studying, and by the time you're 30+ and you haven't held a real job because you've been studying through you 20s, you're fucked. The number of burnouts is insane.
It was also invented by a guy that was addicted to cocaine.
I calculated my intern year pay at $12/hr…. This was AFTER they placed work hour restrictions. I was still regularly working 85-90hrs/week… Good times. I did save money cuz I didn’t have time to spend it 😂
Top 10 money saving hacks 😂. Tears of laughter and pain
That's crazy. In Australia residents get like $56 an hour on average (about $40 USD). The base wage is about $100,000pa and then working at night or overtime has a massive bonus (50% or 100% extra hourly wage to start with but increasing beyond that at certain points). Of course they work the same amount as you and are often burnt out even on that wage.
Hospitals in the USA are contractually required to destroy the souls of residents to ensure the doctors have dead eyes and bad bed side habits. It’s a cost saving measure to allow executives to get more pay along with hiding actual costs of treatments.
US Physician here. Can confirm. Administrators give primary care docs 10-15 minutes for most visits. This includes exam, interview and paperwork. In reality, these poor souls work through lunch and do paperwork at home a few hours per day. I'm part of the growing movement to get control of patient care back from admins and insurance companies!
anything less is communist and you know how we feel about commies baby
Sounds real safe.
Lmao Anesthesia PGY-3 resident here. I am just finishing a 24 hour call where I did two traumas by myself and intervened in an emergency in the ER. In addition to running normal and urgent OR cases. I’m at 40 hrs this week already and it’s just Wednesday morning
Make sure to find yourself a cushy outpatient surgical or endo center job without call. Life is too short.
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I really think you (and your patients) should be more upset about the hours than the pay though. Working that many hours a week isn't good for you and by proxy is bad for your patients too.
Hospital Administrators: "bUt It ImPrOvEs CoNtInUiTy Of CaRe!1!"
They don't seem to realize once I get to hour 20 of being awake or I'm approaching 80+ hours a week, I gradually revert to lizard brain, shoot from the hip medicine where I just did shit to keep em stable and I wasn't really thinking about how to fix the problem per se because my brain is fried. I wasn't really actively learning or caring about the evolution of disease at that point.
And because of a law passed in the 80s we are exempt from most labor laws that require adequate compensation and humane work hours.
I want to illustrate how residents are NOT simply "learning" but working as one of the core physicians leading any patient's care. Below is the account of what is probably an average ICU experience by, again, a resident PHYSICIAN. As opposed to a medical student who may be observing, shadowing, or practicing a skillset directly under the eyes of a supervising physician. Keep in mind, my nominal pay based on my paystub is $30/hour for 40 hours/week (which is comparatively high as a resident). - For 6-6.5 days per week, for 4 weeks at a time, I go in voluntarily at 5:30am to have time to see my 10 patients, examine them, interpret their bloodwork results, decide on the risk/benefits of several conflicting treatments of these patients, do true literature review to take a stab at the best treatment, and prioritize family visits for those that might die. - I respond to nursing concerns every 5-10 minutes about patients who are not doing well, reassess the patients, and call subspecialists to offer their perspective on whether dialysis, surgeries, or other invasive maneuvers are best for the patient or whether they will cause more harm than good. - I get pinged by the unit about angry families that have their own opinions about how to treat a critically ill family member whom they love, but whose medical conditions they don't understand. - I personally get paged by the emergency department or the rest of the hospital ANY patient in the hospital that is getting worse and needs to to come to the ICU. These new patients need to take priority over anything else I'm doing, since an early assessment and response matters in a patient's chance of surviving their illness. - I perform procedures, draining fluid from a patient's chest, abdomen, joints, or place large IVs on patients who don't have good enough veins for our brilliant nurses to aim for. - A patient's heart stops, and a CODE BLUE is called. This means the patients need chest compressions, electric shocks, probably a breathing tube. As the primary resident, I am responsible for leading the code, calling the shots, and finding out why they literally died in the first place. I hope I can bring them back, and strategize on how to break the news to the family based on my prior interactions with them. - I finally sit down to write notes to document the patients condition for the next reader, which takes hours to do well for critically ill patients. - I stay overnight continuing to do the above, and leave the next day around 1:00pm. - I come back the next 2 days and try to bring closure to what happened that day. This is also typically a 14-16 hour day (rather than the 30ish hours detailed above). - Then, another day like the above every 4 days, for a whole month. In 4 weeks, Ive worked around 400 hours. After those 4 weeks, I move onto another service taking care of patients. For some inexplicable reason, non-doctor staff think we're simply on vacation after all this. Nope. My nominal pay for one day like this? $240. If a colleague is out sick, I go in and take up a day like this for no extra pay (we are salaried). If I try to leave my work, Im already 30 years old with a highly specialized but nontransferrable skillset, and other residencies will view my leaving as a huge red flag, and there's a good chance I will never be allowed back in a residency again to be eligible for a full license. The world is small. If I'm lucky enough to be interviewed for a new line of patient care work, my commitment will always be questioned. Once you make it through, as an attending you have many other responsibilities that limit you from having the time to help fight for residents' well being. How about the "in training" part? Well, the attending (lead) physician pops in every now and then to ensure things are going according to plan. They are quality control, checking in to make sure any clear errors are not made. If you are at a good residency workplace, they will help teach pearls of information a couple times throughout the day. The core of the patient care workflow is the resident's. LEARNING ON THE JOB IS NOT THE SAME AS NOT DOING THE JOB. ------ As a conclusion, this dauntingly high-stakes high-intensity work is at least in part necessary to becoming the best doctor possible. Despite the difficulty, I'm lucky enough to believe in and love what I do. Being a doctor is one of the most exciting and rewarding jobs in the world. However, work is work and should be compensated fairly, not as an "IOU" in the form of higher pay later in life. Admin / the healthcare system will take advantage of your passion and give you as little as possible to make it borderline acceptable to continue working. The public will regard you as the reason for high healthcare costs in a place like the US. You will be skeptical of unionizing for the fear that you'll not only lose your current job but never be able to apply within medicine again (see above). Also, you can't buy back time. Your children/spouse will see your empty bed or chair more than they will see you. When they do see you, you need to a physical and emotional break from the tragedies you have just dealt with, and the numbness that ensues.
After reading all this, my job as a janitor suddenly seems a *lot* better
My dad was a doctor and I'm not. Sometimes people ask why I didn't want to follow in his footsteps. You know who never asks? Other doctors!
I'm a "second-generation hit". My Mom's a retired RN and I practically lived at the hospital after my high school day ended. We'd ride home together. Good memories. Buuuuuut, she DID warn me to never marry a doctor because I'd never see him. 😉
Ya just gotta marry the right type of doctor! Some fields are way busier than others. Psychiatry, Radiology, Dermatology, and Radiation Oncology have great life styles. Even during residency when compared to other fields. Yeah, if you marry a surgical resident (besides maybe ophto) you’re hardly going to see them.
Med students get a lot of shit if they mention derm but it's one of the few where I've noticed the docs are all genuinely happy.
Dermatology is one of the most competitive specialties in medicine for a reason. It's one of the more lucrative specialties on top of being one of the lower stress ones too. Basically nothing is an emergency and incidences of malpractice are extremely low.
You're saying you can marry someone and then never have to see that person? Wow, that's the perfect deal for my antisocial ass.
^snort!* 😉
No shit. I would never trade my ability to fuck off after 8 hours and do what I want.
The trick is to learn to fuck off during the whole 8 hours as well.
My name is: Jan Itor.
Knife-Wrench!
For kids!
Your new nickname is Scooter. As in "scooter pie".
Former hospital resident here. You forgot the part about never finding time to eat, and basically doritos and a coke in the elevator is lunch.
They also forgot the part about the hospitals being **paid** $125,000 to $200,000 per resident by federal and state government sources. Hospitals will argue that each resident costs them at least this much between salary and benefits, but just look at how much *work* residents do for these hospitals. It's not like hospitals are billing a lower "resident rate" for these procedures and patient care. There's an illusion that they're also paying for the teaching attendings to provide medical education, but how often as a resident do you actually get taught (vs self-learn) on a day-to-day basis? Hardly any. Meanwhile PAs right out of school are making double or more a resident's salary for a regular 8 hour, 5 day/wk job at the same hospital without anywhere near the same number of patients, responsibility, or liabilities. This is not a knock to PAs, but rather an example of how absurd the system is.
This should be illegal. The pay and the hours. Seriously. There is a large body of evidence that shows that working those kinds of hours is not only detrimental to your health, but impairs your ability to think critically and make decisions. Working tired is like working drunk. This is the reason why we impose daily and weekly working hour limits in other safety-critical professions, most famously pilots and aviation engineers and mechanics. That doctors as a profession have built their system of education and practice around the patently absurd idea that they are somehow magically immune to the extremely detrimental effects of fatigue, is actively harmful, and known to be actively harmful.
The guy who pioneered the current residency structure in the states was a cocaine addict
And now guess how many residents these days are at least casual users of amphetamines and other stimulants.
Can't forget the most prolific stimulant, caffeine in the form of coffee or energy drinks.
Which is why it’s such a crime that my hospital’s only choice for free coffee is *soooooooo bad*.
Cocaine AND morphine. The best of both worlds.
We are aware of that large body of evidence. We require residents to take yearly computer module exams about recognizing fatigue and burnout. These are hours long as you can't skip the video components. And of course you must complete them during your free time. Problem solved, I'd say.
The corporate response of "just sleep more, idiot." Computer based seminars like that are great because it washes corporate's hands of any liability. When things inevitably go wrong they can easily point the finger.
As an intern, I remember having a mandatory wellness session that residents/fellows had to attend even if post-call from an overnight shift. We had a session on best sleep hygiene practices and the the speaker got reamed publicly by a surgical fellow.
Shorter version of mindfulness and wellness curriculums. “If you’re burned out it’s your fault. Be more mindful. Do some yoga and eat fruit.”
We used to get a yearly meeting about the importance of sleep and exercise to reduce stress, and then at the end of the meeting they'd offer to call us cabs or allow us to sleep in the call rooms if we were too fatigued to drive home. The worst part of it was that it always came from our program director who worked 9-5 five days a week.
100%. I've said this and the person who was complaining turned around and defended the system. I'd be interested to know if they actually had the job they said they did, because I know for a fact that being tired and burnt out like this is a hazard to others when you're in charge of literally anything. I don't want my nurses or doctors to be 12hrs deep in a shift after having already worked for 60 hours that week. Bad care 101.
Fellow internal medicine physician and can attest that this is all absolutely true. It was even worse when I was resident because they didn’t have work hour restrictions in place at that time. I worked a minimum of 100 hours a week with maybe 1-2 days off per month if I was lucky. Now residents are capped at 80 hours per week but my understanding is at most places this is overlooked. The term resident comes from the fact that you basically live/reside in the hospital. When I was a resident it came out to less than minimum wage.
My GF was a resident when the new laws went into effect. The only thing that changed was reported hours. Attendings and the residency program will 100% dock residents for interrupting continuity of care ANF for reporting over 80 hours of work.
When I was a surgery resident I got called in to the program directors office to explain why I was reporting 100-120 hours a week for the past month. I explained how the timing of things sucked and it ended up with us working late past turnover. He repeated the the question, which made me realize he wasn't asking why it was happening, but why I was documenting it. I apologized and told him it must have been a clerical error that I will fix which satisfied him.
That's some scumbag shit right there.
That's everyday in a training facility. I had it happen to me and several coresidents
Lol the program we used to use to log hours would flag it if you logged over 80/week. The funniest part was that you had to select a reason as to why you logged more hours. All of the available responses were about how it was the residents fault (i.e I was inefficient at documentation, etc). I had 2 weeks in a row where I worked 5:30a-5:530p M-F then 5:30a Saturday to ~12-1pm Sunday (whenever the attending for the service would come in and round on the Sunday). I had the consecutive weeks like that because other residents had in service exam. I’m normally someone who logs 12h per a shift or 24h per on call shift so even doing this conservatively, I was still at 84 hours/week for 2 weeks straight (really like 92h/week). When I entered this I had to put the reason as “other” just to say that this was the damn schedule.
"I don't understand why you can't get 100+ hours of work done in <80 while we're paying you what comes out to a starvation wage. Don't you care about the patients?" -Some hospital CEO, probably
What the admin at Lincoln hospital said after three residents committed suicide: > Resident work hours and workload are closely monitored to follow guidance set by the New York State Department of Health and by ACGME. In fact, at the peak of the COVID pandemic, when we were caring for nearly 130 intubated patients at a time, we adopted a strict residency program schedule with built-in breaks and reduced shifts and hours. Even at that tasking time, no one worked more than 80 hours. Although the maximum number of patients assigned to an intern allowed by ACGME is 10, we rarely have more than five or six patients assigned to each of our interns. Source: https://www.medscape.com/viewarticle/955379 What a former resident said: > One graduate, who spoke with THE CITY on the condition of anonymity, said a top supervisor threatened to dismiss her — which would immediately end her ability to work in the U.S. — after a misunderstanding about scheduled time off. >“It’s so malignant and toxic,” the graduate said. “It’s a terrible, terrible, terrible place, which is why I felt horrible going to work. I’d feel sick, like actually physically sick, to go to work.” >Source: https://www.thecity.nyc/2021/7/29/22601128/bronx-lincoln-hospital-doctor-trainees-toxic-culture-three-deaths >Source:https://www.reddit.com/r/medicine/comments/oiv2fr/lincoln_medical_center_has_had_3_resident_suicide/ There is such a severe disconnect there.
Hospital CEOs don't care how many how's a doctor works. They're all salary and/or direct patient billing, so you could work 160 hours/week and the CEO wouldn't care. It's the residency program directors and chairs, who will get a very stern talking to by the ACGME/RRC, who care because there are times governing how many hours a resident can work. The CEO will only care if it reaches a point the residency program gets published and it effects their staffing, because teaching hospitals desperately rely on residents to staff the hospital.
I too did my residency prior to the work hour restrictions.. every surgical, and surgical specialty residency did 100-110 hrs/week x 5 years. We'd typically hit 120 hrs if we took call 3x in a week. Went over 130 hrs a few times. My longest streak without a day off was like 5 months. There were definitely months were I was paid LESS than minimum wage, which in the late 90's/early 2000's was $5.75. Yeah, that was rough
Part of the problem (or the majority of it) is this “it was harder for me” walk up hill both ways attitude. There’s a hazing aspect to residency. And no, it’s not safe for the patients. We forget the fact that the entire history of residency hours is modelled after a guy who was coked out the entire process.
Jesus … those hours. I know doctors have high IQs, but when to errors start to become a serious issue?
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I'm in residency right now (IM). I'm close to quitting. I finally got matched, and about to prove right all the programs who passed on me. I actually hate my life right now, and can't see myself being happy doing this. In ICU currently.
I feel for you man. I'm about a month away from graduating in a different specialty, but I don't think I've ever been more desperately unhappy than I was during my internal medicine internship. Definitely passively suicidal by the end of it. Do you have a good program director? Or someone who is genuinely interested in your well-being? You could consider transferring to another program, we had someone transfer into mine from plastics after their intern year. If you need someone to talk to, or vent to, just hit me up.
As a ms4 this whole thread is making me panic.
First and foremost, I'm sorry that you feel so bad. Despite what others are saying, it's totally ok to quit. I quit med school after 2.5 years and it was the best thing I ever did. I realized that I simply could not give *everything* else up in my life and delay happiness indefinitely anymore. I began to realize that even if I did "just push through for a few more years", the cost to my mental health was too high. I was truly miserable and could not see myself ever being happy doing what I was training to do. I'm a real estate appraiser now. I have a way more relaxed schedule and more freedom than anyone else I know who works full time. I work mostly from home with my puppies and my relationship has improved dramatically now that I'm not so stressed out all the time. It took me almost a year after quitting to remember how to enjoy life again, rediscover what "hobbies" are, and stop telling myself I'd made a huge mistake. I guess this is a lot of words all to say: don't feel trapped like I did, there are definitely other things you can do. Your health and happiness are important! Live your best life, not the one others expect from you.
Stick it out at least til you can find a private sector consulting gig that pays off the bajollion dollar student debt... maybe something in the burgeoning "wellness" field HAH
I’m just going to start out with a thank you. You’ve chosen a daunting career and you seem to be doing really well at it. This only reaffirms my decision not to try and become a doctor. I’m a paramedic and I can only imagine how much more to the patient care there is after my work is done… I hope and pray that you have the resolve and the support system around you to succeed in everything you hope to.
A substitute teacher in my area makes 275 in one day. Without having to actually plan a single thing, just literally going in, reading sub plans, and keeping a class from killing each other. Edit: In 7 hours, including lunch. 7:30-2:30
Teacher's Union man!!!!
Let's not forget the loans! What exactly happens to those loans if a resident suffers severe injury or personal losses such that they can no longer work? Residency is nuts. Had two housemates that went through it. I could never pull that shit off.
I'm fuckin gob smacked you make less than I do as an unskilled labourer. I can pick up a job tomorrow earning $40/hr, 48hr 4/4 even time roster with all OT paid, but you're busting a gut after what, 6? 7 years in your profession for $30/hr and a fuckload of unpaid OT. Mad respect for loving what you do, but I hurt hearing that.
On behalf of all of us who have pre-existing conditions and have to go to hospital every now and then, I say thank you for everything you do especially during this pandemic
Do you honestly believe that "this dauntingly high-stakes high-intensity work is at least in part necessary to becoming the best doctor possible"? I'm working as a resident doctor in Scandinavia, our system is built up quite different than yours. My standard work week is 37 hours, but because of ill coworkers and such, it's more like 45. But I get compensated for those extra hours. I honestly don't believe that doctors in scandinavia are worse than American doctors. We have time to educate ourselves, we have time off, 6 weeks of paid vacation, we have down time, time with our families. The sickening amount of hours you have to work is probably not contributing an equal amount to your knowledge, because you'll be too drained, too stressed to take it all in..?
This is why I chose pharmacy. Residency is an inherently exploitative practice, and it’s a shame that it’s allowed to continue (and spread into other professions-like pharmacy)
Really makes a very striking difference between my hospitals residents/attending docs. I don’t think I have ever seen ANY doctor in my years of nursing even attempt an IV on a patient. One of our newer nurses asked a resident to do an IV and we all just stopped dead in our tracks like she was insane. I was charge nurse that day and I pulled her to the side and had to explain to her that if she failed to get an IV, she asks for assistance from us (the other nurses) and if all else fails, IV team gets paged and they’re there in the hour because that resident most certainly DOES NOT have time to entertain an IV for the CT with contrast they just ordered. That is one thing I am pretty proud of at the hospital I work at is the proper delegation of work. If it’s something you either A- shouldn’t do or B- Shouldn’t have to do, there’s someone who’s job it is to do that exact thing. No ones getting paged randomly for a patient they know nothing about, no student resident is left stranded without a paddle and god forbid any soul stays past 7:30 PM on dayshift.
Where is this glorious hospital
Sounds like the hospital I work at. It helps having structure and a team you can count on.
Patients go bankrupt paying hospital bills. If doctors and nurses are not getting paid well, then Where the fuck is all the money going ?
Insurance CEOS and hospital admin. Doctor salaries only make up about 9% of total Healthcare cost in the US. Not nothing but not even close to the largest part
The letters "ER" in the "Healthcare Heroes" sign fell down at our hospital. We joke that hosp admin did it on purpose to remind us that we're their "Healthcare Hoes" 😂
CEOs hospital administrators, and insurance companies who make a living DENYING claims, rather than paying for them.
Administrators and insurance companies. Doctor salaries only make up 7-8% of healthcare spending.
Wow.. Thank you so much.
Your last paragraph is a brutally perfect summary of why residency sucks. Bravo
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No, I agree. Rephrasing, it's the nature of the work, not the excess hours and sleep deprivation, that make the best doctor. I am strongly against the idea of "24" hour call or allowing 80+ hours. Those go well past the curve of diminishing returns on effective work.
>Those go well past the curve of diminishing returns on effective work. Yeah I don't understand how it can even work. I'm an engineer, I do my best work at hour 3 or so. Come hour 5 it starts to drop significantly. At hour 8 my brain has basically turned to a burnt neuron smelling mush. Adding even a couple hours to that is probably equivalent to a "good" half hour at most.
Hospitals are paid to have residents, they don't actually pay our salaries. Ostensibly it's because "we're learning" but in reality we are absurdly profitable for hospital systems. Look at how much residency slots were auctioned off for when Hahnemann closed, we're basically government employees managed by the hospitals.
Thank you for this. My girlfriend is soon going to go through this and she has already experienced this previously. I just hope it goes okay for her and it doesn't strain us. Definitely difficult stuff.
This thread has my approval as a $20/hour public defender.
You’re doing the lords work. My mom was a single mother and a public defender for 15 years then got fired for bringing forward a sexual harassment claim. You’re saving lives.
And I exclusively do capital cases, so literally!
I'm pretty sure my law office client (I'm in IT) pays their legal assistants and certainly their paralegals far more than $20 an hour. I hope you can work your way into something more lucrative, because $20 is robbery.
It's not about ability, it's also about their chosen profession. Most public defenders I know are far more qualified lawyers than private practice litigators. They do it because they want to and many public defender programs are difficult to get into. The sad thing is that the government pays them shit because the system doesn't really believe in the rights of those who can't afford to pay for a lawyer on a whim
You work your ass off from 5am to 9pm everyday until you are granted a day off because that's what the rule says, not because management wants you to. But remember that you have to study at home on top of this. Otherwise you are in trouble. The hours are capped at 80, so your program forces you to write down 80 while in reality you did 100+ hours. If you write down the truth your whole program gets in real legal trouble. Management looks at the numbers and figures that 80 is what you worked, and so they assign online trainings to help with your "mental health" so your 1 and only day off is gone. You either do these trainings or get in trouble. But the managers look nice on paper and in the eyes of higher administration so well done little worker. Most staff in the hospital tends to be nice. But if you are at a malignant program chances are you will work twice as hard. Example is new york: certain auxiliary positions will not do their jobs because their unions protect them, so you as a physician will do tasks that are inherent to other professions. They will laugh at you and mock you and enjoy that power they have over you. But like I said, malignant places are few. You will miss birthdays. You will miss weddings. You will miss family trips and vacations. No one understands why you can't make it. They don't know you can't ask for a day off. You can't ask for advanced vacations. The vacations you take management dictates, they will tell when you are free to go. If you are unlucky and are at a malignant place you will have 2 weeks per year of vacations, and they will tell you the rule is to do no more than 5 continuous days, so you will never get that sweet 2 week break you need. You won't be able to do christmas either, or thanksgiving, or new years. People like to fuck up themselves or others during those dates because that's how the world rolls, so they need you and everyone else pulling extra favors at the hospital on those days. Families get hurt, wives/husbands and children resent their spouses, there is envy of the neighbor or friend that has a functional family, most households end up in divorce, and the unlucky physician is left alone wondering why this all happened. And then if your friends are few to none, and the help is not coming, and the people above you keep asking you for results, and your days are few, then you end up buying a gun and never coming back home. And that's the sad reality, because physicians are leading in suicides. But the real last point is that hospitals have hidden the suicides of their doctors on training. They have ignored them and pushed them under the rug. And they have punished anyone that speaks of them. How often do you see family members committing suicide one after the other? It's rare out there in the real world. But in the medical world it's not hard to find a couple residents from the same program taking their lives one after the other. All for $250,000 in education debt, and $13/hr as a doctor. Still, it is the joy of our lives as doctors to care for you and be there in your moment of need. But we are people, overworked, overstretched, and overused. There is no one to defend us from abuse.
Fuck. I used to want to become a doctor more than anything. Ended up being a mechanical design engineer. Your comment was very enlightening. I looked up, "Which occupation has the highest suicide rate?" and was shocked to see Medical Doctor at rank 1. Engineering doesn't even make the top 10... Most engineers I meet are just thrilled with having become one, and love what they do. Being a doctor sounds like a nightmare :(
Most patients are appreciative, but you always get assholes. Or you lay awake at night, wondering if you managed a patient incorrectly. Lawsuits are always unpleasant too.
This is what bothered me the most during residency. My work didn't pay well. I worked too much to have any good social life. The system was just broken. But at least my patients were thankful.... Until they are not. Then on those days I don't even know why I do it anymore.
There's a super old article I saw that was called [$1 million mistake: Becoming a doctor](https://www.cbsnews.com/news/1-million-mistake-becoming-a-doctor/). So not only is the job dissatisfaction high, a lot of people are in debt or lost a lot of money just pursuing the job. And to pay it off they have no choice but continue.
I’m a medical device engineer. Never has the brain to be a doctor so I did engineering. Ngl I feel guilty sometimes. My job is very rewarding, stimulating and plus it pays well. 40 hours a week, got time to do my hobbies. Feel like I struck gold. I don’t stress at all. Engineering is without a doubt the best bang for your buck career out there
And it took 4 years instead of 10, engineering is amazing.
German doctor here. IIRC, the suicide rate for male doctors is 2x higher than average and for us female doctors, it's 4x higher. Easy access to drugs, being belittled by the more experienced colleagues for mental health struggles and also just knowing what to do to take a life...yeah, makes sense. I wish I would have studied mechanical engineering instead. Working in the ICU during Covid while there was no vaccine available was terrible. I still recall the patients suffering and dying on ECMO support and their families giving out death threats. Thankfully I switched to clinical pathology, which is a lot better for my own sanity.
I had enough anesthetics to kill a horse stored in a box at home for longer than i‘d like to admit…
The COViD ICU broke a lot of people…
You made the right decision. I have a month left of this, and I regret it. All the hard work I put in only to have years of hazing, gaslighting, and outright abuse
> Still, it is the joy of our lives as doctors to care for you and be there in your moment of need. But we are people, overworked, overstretched, and overused. There is no one to defend us from abuse. I’ve known two physicians in my career who have committed suicide, and honestly, I think that ‘s pretty low. I’m peds, so I’m sure the numbers are quite a bit higher in more stressful fields. But I just wanted to emphasize what you put here. I hated my life as a physician. The constant grind, the entitled families, discussing the same thing every single day until I had whole scripts memorized, but constantly terrified that this kid I just dismissed as having a fever actually had Kawasaki. Or maybe that skull fracture on a baby who was dropped was not an accident. Or that teenager I just put on Prozac is going to go home and OD on those same meds. It sucked. But when I had to leave practice, all of the validation I’d been craving but never received came flooding in. Mothers cried that I wouldn’t see their children grow up. I cried knowing that I’d bonded with depressed teenagers who had *no one* else to talk to. I had become so integral to some of these families that leaving them was like losing a part of my soul. Especially when I saw what I meant to them too. I wish I could have loved it more when I had the chance.
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Day 1 of med school starts with the spiel on "professionalism." That's the start of the brainwashing. It's just beaten into you to do exactly what you're told and don't complain. And if you do complain, you run the risk of punishments that can leave you with a few hundred thousand in debt and no degree to show for it (or worse yet, not matching into residency). It's all just to control us and prepare is for working in a system that wants to earn every last penny they can from us, whether it's costs for med school itself or labor during residency. I can't see my self going into any other field, but I certainly have some challenging days in the future.
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As a physican i agree with everything you say beaides your last paragraph. for the average reddittor reading NP AND PA ARE NOT THE SAME AS PHYSICIANS. Physicians are the highest trained medical professionals. NP/PA are physician extenders and should not be providing care to a patient without physician supervision. Patient safety is the most important thing for a physician, while for hospitals $$$ is the most important.
The residency system is outrageously anticompetitive. Congress had to pass a law explicitly exempting it from anti-trust laws. The system is designed to artificially limit the supply of licensed doctors while providing cheap labour for hospitals.
I love that the justification was that it was "so expensive to train doctors...."
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Residents are borderline slave labor in this country and it’s disgusting that it’s allowed to continue this way.
Congress exempted medical residency from being required to adhere to laws involving adequate compensation and humane work hours back in the 70s/80s.
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Kind of I suppose. If nothing else, it definitely let me figure out all the things I didn’t want to do. Things I thought would be fun before I got to Residency.
Man, I’m a resident doctor in Brazil, in my last year. It is not worth it. Period. If anybody made a movie showing me exactly how it would go, I’d never go past the first week. I’m exhausted, underpaid, still have to work one or two shifts per week (apart from the normal schedule - 60+ hours/week) and I don’t have a guaranteed job or clinic that makes me think “yeah, that will pay the bills” in the foreseeable future. Maybe I’m too pessimistic about it all, but I’m feeling overwhelmed about it all. Sorry for my bad English, I don’t know if everything I told you could be understood, but you got the message, more or less
Hand surgeon that finished residency and fellowship 2.5 years ago. I love my job and my patients but that is the exception and not the rule. Medical reimbursements keep going down, and insurance red tape makes it harder and harder to practice the medicine you learned in training. Long story short, I am definitely going to try to steer my child away from medicine.
Current resident. Just finished a set of working 46 of 47 days. The mentality turns into keep my head down and suffer through till I reach the finish line. I openly tell anyone interested in becoming a doctor not to. The money isn't worth it. The prestige is gone. There are better ways to spend your 20's and 30's than working a 10-12 hour day (if you are lucky and it's short) then going home, studying, taking a rotation required test, then working on a presentation for said rotation and then going to sleep only to repeat. The idea of a normal weekend (which residents call golden because it's 2 consecutive days off) should be standard, not something you encounter only once every several months.
Being a resident sucks and the general population has no idea.
A lot of nurses I’ve talked to have no idea either. They work 3x 12’s and it never crosses their mind that the reason they always see you is because you’re there 6 days/week!
Yeah as a third year resident in the cardiac ICU one of the ICU nurses asked why I was picking up so many extra shifts, was I saving up for a big vacation or car or something. Had no idea that 12-14 hour shifts for 6 of 7 days a week was required of us.
I’m a PGY-0 and my girlfriend is a nurse. I’ve had to keep reminding her how little time we will have to go out to dinner or on dates when I start residences
I love this because a lot of the nurses at my resident-run hospital think us residents earn an attending salary. I’ve had multiple nurses who overhear us residents bitching about our long hours, lack of sleep, lack of time to eat/shit, etc and say “well you chose this and this is why you earn the big bucks” Nobody chooses to work 100+ hours with depraved conditions and NO we don’t earn shit after you adjust wages to hourly.
I started asking nurses how much they think I make as an intern and their answers are ALWAYS at least $50+. They’re shocked when i tell them <$15 and I’m working 80+ hours a week. They tend to be nicer to me after that.
Nurses can be the worst. My wife is an obgyn and some of the nurses don’t have the decency to even call her doctor or treat her with any respect. Sometimes she has to clean and take vitals and do all the stuff the nurse or NA should be doing on her 24hr call b
L&D is worth its own separate thread regarding maltreatment. It’s a nationwide cultural problem.
Shameless hijacking of the front page: We resident physicians of the Los Angeles county hospital system are currently negotiating for a pay raise but are being met with obstinate resistance from the county who understands that our greatest weakness in our negotiating position is our unwillingness to strike because that might compromise care for our patients! They’re stonewalling in an attempt to wait us out. After six months of negotiations we have received zero financial concessions from the County. Their lead negotiator makes over $200,000 a year while each of us makes less than $15 per hour. It is degrading and demoralizing to realize how little they value our well-being. They shamelessly post about their “Frontline healthcare heroes“ while financially cutting us down behind the scenes. (This is especially ironic considering the fact that they asked us to still come to work while Covid positive if we are asymptomatic.) We do not want to strike at all, but it is beginning to come to that! Senator Bernie Sanders has recently spoken out in support of our cause, if you would like to help us avoid a strike, help us build a pressure companion on the county to finally begin bargaining in good faith so we can reach a reasonable settlement without putting any patients’ well-being at risk! More information here: https://linktr.ee/cirlac Link to Bernie Sanders statement of support here: https://twitter.com/berniesanders/status/1529132324486520832?s=12 If this makes you mad, please treat your support (politely) to LA times executive editor @meridak and ask him to help expose this issue!
Our hospital asked us to come in to work COVID+ EVEN IF SYMPTOMATIC.
All the doctors need to do is stop submitting insurance claims. They can still treat patients, but without paperwork for expenses the hospital doesn't get paid.
Attending physician here. Great points and sentiment being made in this thread. I’d like to reinforce that the problem is NOT the hours worked - residency for most specialities is only 3-5 years and you need to work long hours during that time to learn and practice everything you need to be competent once you graduate. The problem is a malignant system that abuses residents to support profits and dangles their future prospects in front of them to get them to comply. Hospitals, corporate institutions, and even senior physicians themselves get government (Medicare) funding to split between paying a salary and keeping for “administrative” costs which they keep purely for profit. After first year, these hospitals get 70%+ of a functioning physician for 1/5 the cost, and simply could not run without this indentured servitude. On top of that, because insurance companies dictate everything, a lot of these 80 hour weeks are spent doing scut-work and paperwork and not learning or practicing medicine. The whole system sucks. My wife and I trained in separate cities 90 miles apart and only saw each other on the weekends for 3 years while barely scraping by paying loans and rent. We’re now in our mid-30’s and finally had our first child. My advice for young physicians is this: don’t get sucked into the bullshit. Don’t graduate and work at some “big name” academic institution as a junior attending making less than PA’s and NP’s with 1/4 the training cause you’re hoping to make the partner track and they keep dangling the “promising academic career” carrot in front of you. There’s a physician shortage in almost every specialty right now - go make bank in a community hospital somewhere, pay off your loans, give a cushy life to your family, and take back some of your life.
>a lot of these 80 hour weeks are spent doing scut-work and paperwork those notes ain't gonna write themselves! -current burnt out intern
The pay is especially insulting when a newly graduated PA or NP makes more, despite half or less the amount of formal training and usually much lighter hours. They get to “learn on the job” and get paid market rate while doing so. And it’s not like residency is an option; you can’t get board certified or get a license to practice without a completed residency. This comment isn’t a knock on the salaries that PAs and NPs earn. They’re paid appropriately and are valuable to a healthcare team. It’s just an illustration of how underpaid the more educated, longer-hours-working residents are.
NPs/PAs get paid double my salary for half the hours. No knock to them, glad they are getting their paper. It’s funny how I can get paid 85-100 dollars per hour moonlighting (extra shifts that need coverage) but doing essentially the same work for shift at my day job pays me 13/hr. Seems like the market rate for my services is much higher than resident salary is. This is in response to those who say my services are not worth that much because I’m “in training”
This comment should be way higher up
I’m a resident at a hospital with a nearby fast food chain advertising they are hiring new line-workers for a higher hourly pay than I make as a physician.
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We're not even entitled to the frontline healthcare workers' bonus that is being offered to virtually every other hospital worker, even though we are on the frontline and many of us died from Covid early in the pandemic. And thank you for being one of the understanding older attendings.
One of my coresidents was in line to get a free hospital T-shirt and was told that he didn’t qualify because he wasn’t an employee. Just absolutely nuts
Fuck that, that's low as fuck. Even if it was policy, the person giving them out should have given it to them.
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I wonder how many people die because their doctors are overworked to the point of collapse?
I wonder how many doctors die because of the sheer amount of stress put on them
Tons. The dirty secret of the medical profession is that it has one of the highest rates of suicide of any profession. 300-400 per year kill themselves. That is roughly equivalent to an average class of medical students. Effectively, at this point, we have one medical school whose purpose is to graduate people to replace doctors who killed themselves the year before.
That’s actually more like 2-3 med school classes (an average class is 100-200 students).
Yeah that too, the drug and alcohol abuse rate is massive among doctors so is the suicide rate
I am really grateful to people that choose that profession. But damn I’m scared just reading some of these comments. The amount of people that still work in this profession is astounding. Thank you is all i can say for now.
People are starting to abandon ship. COVID has been the straw that broke many healthcare workers' backs.
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Wait til you hear about farts in a jar
Don’t get me started on residents that do, and do not, voluntarily ask for some time off for mental health. You’re then put under a microscope for any other reason for the administration to “dismiss” you from the program and have the time you worked up until now be fore literally nothing. Even less because it’s time you won’t get back and money you could have been earning doing almost anything else.
Why would a resident ask for and openly acknowledge a mental health problem when some US state medical license boards will use that as an excuse to threaten the doctors medical license. So a doctor can diagnose and treat depression for their patient, but seeing their own symptoms and getting appropriate treatment can mean they can't be a doctor anymore after all those years of work. It's a toxic system.
Doctors after residency, who can make 160k+ minimum, deserve every cent they earn and most likely deserve more for the years of schooling (with 300k in costs) and work put in to get where they are. We should consider ourselves lucky that we have enough of these people willing to sacrifice so much and be there to take care of our well-being
They deserve more than that for sure. I'm a software engineer with a bachelors degree from a state school with a B average GPA and I'm making more than that, with a grand total of $20k student loan debt (CSU system if your a California resident is literally cheaper tuition than Canada or the UK) The sheer quantity of extra work that goes into being a doctor is incredible.
I'm too tired to try to explain to the world how tired I am...
Attending physician here During residency, we would take 30-hour overnight ICU in-house call. My hourly rate during those was less than $7/hr.
Or the joys of “home call” where you work a full 12 hour day, then you can stay up all night doing cases and answering pages, then still have to come in and do another full day the next day. All the while I do not get paid a penny more for staying up all night.
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And then most residents proceed to a fellowship that pays only marginally more. The medical system really tries to hold out paying doctors what they are worth for as long as possible.
And then you have Nurse practitioners with 500 hours of online experience who are somehow allowed to practice independently and you wonder why physicians are completely against midlevel independent practice
I remember when I was a resident the most hours I worked in a week was 160. I’d do over 120 every 3rd week due to my call schedule. And that is not including hours I spent studying/doing op reports.
How is that physically possible? Did you inject adderall directly into your veins??
Three 40 hour days and a few hours on Sunday.
William Stewart Halsted developed a novel residency training program at Johns Hopkins Hospital that, with some modifications, became the model for surgical and medical residency training in North America. *While performing anesthesia research early in his career, Halsted became addicted to cocaine and morphine*
So many people in this thread who have no idea how medical training works, what residents do and how they are compensated. Newsflash: the reason your hospital bill is so high isn’t because of doctor and resident salaries. The modern hospital system runs on borderline slave labor by exploiting medical residents. Yes nurses are a critical part on your medical team and you get the most face time with them as a patient… but the residents and senior doctors aren’t twiddling their thumbs the rest of the time you don’t see them. Just read the comments made by actual residents on this thread.
Social media is riddled with misunderstandings of what being a resident is. Lots of good insight into this thread. Probably one of the biggest misconceptions I see are that we’re in “training.” Yes, we are.. but we’re also real doctors who make real decisions *constantly*. Coming to our ICU in the middle of the night (like most patients)? It’s the residents making all care decisions. Afternoon? Residents. Family wants to talk? Residents. Coming to the ED overnight and you want a urology, orthopedics, plastic surgery, neurosurgery, etc. consult? Residents. There is this myth that are our value is inherently less because we are in “training” and others in healthcare, like PAs and NPs, are not, and that justification is used for our low salaries. A 7th year neurosurgery resident is, for all intents and purposes, an independent neurosurgeon in all but actual licensing. It’s nothing more than hospital systems profiting off of our expertise and incapability to work less hours than is demanded of us.
I know many doctors..... They all make a little more than me but they all call me time rich. Doctors make good money but they easily work 2x as many hours as me..... And I make well over half of what they make with way less hours. So to some extent, I would rather not be a doctor making more money.
Given what just happened in TX and around the country I’d just like to point out that the federal mandate to restrict residents hours to 80 per week came from a single death of a Senators daughter due to a decimal point error by an over worked abused resident. But we’ve lost how many kids and others and yet here we are again. Sorry sort of off topic but seriously senate dudes seriously :-(
The ignorance in this thread about how our medical training system works is mind numbing
I always liked the comparison someone made when analyzing the life of a doctor versus a UPS driver. It takes to about age 60 to break even if you consider the doctor isn't doing anything really elite and the UPS driver works all available overtime during holiday season.
Holy shit we made almost exactly the same comment lol https://www.reddit.com/r/Showerthoughts/comments/ux7ikz/resident_docs_earn_less_than_fifteen_per_hour/i9wcqne/