Medical school can be brutal, and it’s making many of us suicidal
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After one does complete residency, it does seem to get a lot easier based on observing some of her friends that didn't do fellowships, especially if the person takes a more clinical job. But after all of that effort, a lot of people become attending physicians where they are putting in just as many hours, if not more, because it is more prestigious. Those are the people that run the teaching hospitals, so it feels like there is a lot of "I survived and it made me a better physician, you can too" mentality.
Looking back on medical school, she can't believe how ridiculously easy it was and how much free time she had.
[1] where "comparatively relaxed" still means "she works harder than anyone I know in tech".
Unless they get paid by the hour, I see no reason to continue to participate in such a system. Still, it should not be allowed when lives are at stake.
For some contrast though, before everyone cries out "save the med students, they have it harder than any one should endure"... remember there are other jobs with far greater risks, hours, and far less pay. Ever been deployed in a military unit during wartime? I've wished there was a window to jump out of several times, or that a pager beeping was the scariest thing to fear while trying to sleep - and that was in recent engagements, it was far worse for the generation before us during wartime - doctors not so much.
Once you're an attending, yes. My wife, however, is still a resident. She's doing this for $50k/year.
Just because a worse job might exist is not a justification to continue---logic and all that.
It's worth noting that there have been several studies over the years investigating whether reduced hours produce better outcomes; they don't seem to. Shorter hours means more shift changes and patient handoffs, which is the source of more errors than tired residents. Also, keep in made that getting the same experience in a specialized field like neurosurgery with fewer hours per week would require extending the training program even further. It's already seven years beyond medical school, often with a one year fellowship after residency. Extending it another few years isn't really a viable option unless we significantly increase the autonomy and salary that residents receive.
Sorry, I don't buy it.
In many hospitals doctors are paid hourly, so shorter shifts wouldn't cost the hospital money.
You'll have to significantly increase resident salaries, and allow residents to move between hospitals to deal with life events. This isn't impossible, but it's politically infeasable while everyone is talking about cutting medical costs (total pay to residents would need to go up ~10-fold for this to work out). It's a bad situation today, but there isn't a simple magic wand to fix it with minor changes.
While they had to work incredibly hard to get into medical school, and it's harder than it's ever been, I feel like anyone born in the 90s or later is going to be at a disadvantage, because the level of stress is not only much higher than before but many just aren't prepared for the stress.
<sarcasm>However, I think that because of this, medical schools will have to change. It's just too darn hard!</sarcasm>
Getting real though: med school is f'ing hard. Reading this did not surprise me, and if anything, I was surprised that the writer did not know what he was getting into when he got in. The things he is complaining about are the same things I've heard for decades.
Also- the Helen Keller comment, while disrespectful to those that are hearing and/or sight challenged, made me laugh.
The main difference between those going to med school and the 90s and now in my opinion is a mix of the expectations by students that the increase in level of difficulty should be comparable to the transition between high school and college, or college and graduate school. It's not, and it never was. High expectations have always been the rule.
However, for the past 25 years, there have been many more immigrants or children of immigrants that work their asses off competing harder and raising the bar.
The medical schools should not lower the bar to make it less stressful. Instead, we need more medical students to matriculate to P.A. programs and nursing programs, where they can do just as much good helping many of the same patients, sometimes making similar salaries. Eventually there will be more medical schools, which will help some. Or, maybe some of these doctors that feel that they had to go through too much can work their way up and teach so that they can give their students an easier individualized and sensitive education and see where that leads.
However, imo it should always be extremely difficult to get in and to succeed. That's the point. I don't think people should commit suicide. They should just quit.
As somebody who works with pathologists, I don't find the academic part of medicine more difficult then say physics - but the pay is substantially different. This artificial labor shortage is protected by the systematic failures discussed in many of the HN comments.
None of these things are defensible.
There are deep challenges with continuity of care. How does one person hand of treatment to another person?
Imagine you and I are both working on a project. There's only one computer, you use it from 6AM to 6PM, I use it from 6PM to 6AM. We can only work on one feature at a time. How do we coordinate that handoff every day? That alone sounds like a huge pain. With a doctor, everything can super time critical, and requires just as much depth of understanding. You may have a an understanding of something that i didn't understand in the handoff. building a project, we roll back my code talk some more and do better the next day. With doctors, maybe somebody dies.
I know it's a convoluted example. I imagine most stuff is routine and can be passed around safely. But it's only routine until it isn't, and there's no way to know up front. As much as developers hate being treated like cogs, it seems like it would make doctors lives quite a bit easier. Just seems like a super hard problem. And if you don't get it right people could die. So, like, that sucks.
Something really needs to be done about current crony capitalistic US medical industry.
I have a few physicians in my extended family and this mirrors what I've seen from them; I don't know how you'd get board certified neurosurgeons to take q3 trauma call in more rural areas for years on end other than ''here's a boatload of money''. It's masochistic work.
Capitalism, especially our current flavor of it, has plenty of problems, but I think it's important to separate the core principals (mostly free markets, pursuit of self interest) from the pollutants (loopholes, cronyism and special interests).
Citation required. I'd venture the US is more accurately described as a hybrid socialist / mercantilist regime than a capitalist regime.
PAs provide an instructive example, but there are many others of different sorts. Often, PA schools have stricter prerequisite experience requirements, and PA students often take the bulk of their courses with the MD students, and have maybe a semester less of courses, before clinical training. So the end effect is that a PA's actual experience is often the comparable to an MD's after a couple of years of practice. Hospitals and health care systems know this, and have been gradually replacing MDs in many areas with PAs because they're cheaper but provide similar care.
We can't afford to maintain this fiction that the only way to have something skillfully done is by the MD training model.
If there were twice as many doctors, the existing doctors probably wouldn't need to work 80 hours a week, and could likely cut down to 40 hours.
The other problem might be that doctors are paid extremely well in the U.S. compared to the rest of the world, and even compared to other rich first-world countries.
Proposals to expand residency run into the problem that it costs the government money. Residencies are funded at the federal level; teaching hospitals get a certain amount of money per resident to compensate for the effort required to train them. And the number of residencies funded per year has (I think?) been maintained at a pretty constant level compared for a long time, with so many new doctors per year per million people.
One option, I suppose, would be to allow self-funded residencies. Why should only the government's money be good enough? But that would probably be an option only for wealthy students, or those who are willing to go even further into debt.
Another option would be to replace residencies with something more like conventional apprenticeship. Is there any reason a new doctor has to learn the practical details of her trade at a hospital, rather than working under the supervision of an experienced doctor in private practice?
Of course, nothing like this is likely to happen. The whole medical industry is extensively regulated; those regulatory barriers are wide moats that ensure fat incomes and profits, which in turn create strong interest in keeping things as they are. Barring utter crisis, nothing is going to change.
Depending on your residency or fellowship program, it is not unusuall to sustain 80+ hours per week. And unlike nurses, you don't get to disconnect from work when you aren't in the hospital. There are pages to answer, notes to write, labs to review, and on and on...
The mental and emotional load is tremendous and there is no room for error. it's truly a miracle more people don't end up the subject of Morbidity and Mortality presentations from botched lines and pneumos.
The upside is that when I do a great job, it really is rewarding. The downside is telling families and patients I do not have much to offer, and their disease is too far gone. Anyway, don't go into medical school / surgery if you don't want to work hard. No one has a gun to your head. Physicians that pick the right profession for their personality / skill set are very happy.
PS my undergraduate degree was computer science
2.) The federal government controls the number of residency slots each year, through Medicare funding for residency programs. I don't pretend to know the details of how it works, but my impression is that to get more residents per year, you need to convince Congress that it's necessary.
3.) Classic chicken-and-egg problem. Any medical student can go into surgery if they want to, unless their performance up till that point is seriously below par. However, there are many other specialties that offer more attractive lifestyles. So to increase the number of students who choose to do surgery, you'd need to find a way of signaling to students that the life of a surgeon isn't all back-to-back divorces, microwave dinners, and 80-90hr work weeks.
#2 - If Congress were convinced of that, would that help lower medical costs for patients or possibly increase it? That's assuming without some sort of tax increase to pay for it.
#3 - I guess this why I've heard that dermatology is one of the most competitive fields to get into - good hours, not as much stress, and good pay.
However, this is a vestige of the old culture and is slowly but surely being replaced both by new rules and, generally speaking, a better culture.
I asked and he told me that was a fairly typical surgery day.
In software the long hours have specific reasons. For example we can't double throughput by doubling resources, and in startups the money is limited, etc
Yes. Bad management and artificial marketing deadlines. You can't double the throughput in some cases by doubling the resources. (in some you can) But you don't have to work in the kind of environment that expects it. I got pulled into the environment that expected long hours once. Then the manager got replaced - throughput stayed the same, people started leaving on time and were much more happy.
For example if a trusted management quality metric was reading "sucks", it would be easier to leverage change.
My counterargument is that 'culture' isn't fixed and there's no reason not to strive for better and give people a chance to have lives outside work.
Sorry, you and your industry should be ashamed of themselves for putting lives at risk. Mistakes from fatigue are a real thing. Maybe you are just cutting off bunions, but there still could be complications.
Why there's this dichotomy when there are clear examples of how to educate medical students 'right', I don't know. Maybe it's better for medical students like me to forget trying to go to class when there's poor quality teaching and try and learn it on my own. Or maybe in the grand scheme of things, it doesn't matter because the real education comes in residency.
My undergraduate degree was also in CS, did you ever feel like you wasted four years of your undergraduate education just to go into medicine later? I'm trying to position myself in such a way that I still get to use those sorts of skills after medical school, but I forget much of what I thought I knew, and the field changes constantly. L
My sister in law got annoyed about changes at her workplace with respect to scheduling. She griped about it in the break room, word got out and she had three unsolicited, real interview offers by the end of her shift.
Her requirements were to get her kids on the bus and be home at 5PM. That's written into her employment contract, along with a significant raise and retention bonus.
Perhaps will AI change that...
For complex medical problems, algorithms are unlikely to do it for many years. But to recognize common skin diseases for instance it is perhaps not so far fetched.
What I always try and explain to them is that there are definitely solvable problems in subsets of medicine like dermatology. Sure, it'll probably take 20 years before there's any traction, but there's no reason to completely dismiss the idea either.
There are certain decisions that remain reserved to doctors which limit scalability, but that's also the case in other regulates professions, it's not unique to medicine.
There are a lot of areas that I predict will be affected by tech.
Diagnosis will be made easier. At present for instance, many cancers are classified in a confusing and overlapping way. Radiologists might disappear in 50 years. Huge swathes of surgery will be automated away. I suspect psychiatry too will succumb.
The key thing doctors do is take responsibility for a patient. A recurrent neural network won't do that. Machine learning engineers won't/can't do that. Google certainly isn't going to do that. Doctors don't always or even often get it right, and they could always do a better job, but they are still the only ones really willing to take responsibility for a patient.
I'm not disputing anything here, just want to discuss this logically. I've been in graduate school, and it wasn't that hard, and yet some of my peers would freak out constantly. And some wouldn't.
I will say that there's definitely a hazing culture across all professions in America that's completely unnecessary and inappropriate.
I'm a structural engineer. I don't recall any sort of hazing culture, or even a single instance of hazing.
I think these are the sorts of elements of a hazing culture that GP is discussing. Not necessarily fraternity-prank style hazing.
I am curious, also, to these other countries that have better bars, can you cite some countries and studies that back up these allegations?
They put the students through hell because that's what they had to go through, and they're rent seeking.
In most other countries, doctors don't have an accreditation board. Most things are simple, and it doesn't require years of school to set a bone or put in some stitches, or even diagnose the flu or pneumonia.
Similarly, you don't need a rockstar or ninja to write your CRUD app. Anybody who knows what he's doing will be able to do that, he doesn't need to be the best of the best, he just needs to be competent.
In most of Latin America (the countries I've been to), the pharmacists were the first source of triage.
"Pooping too much? Here, take this pill. Oh wait, there's blood in there? You should probably go see somebody more informed."
Incidentally, the free availability of drugs in the way you described is being curtailed in Latin American countries.
On the other hand, he seems to not have experienced the bullying described in the article, so maybe that part of it is the rent seeking you describe.
I do think that tech hiring is a little ridiculous at times, but if doctors mess up, people sometimes die. It would make much more sense for them to go through accreditation like engineers do, in my opinion of course.
Medicine is really hard. I have a condition that affects my lifestyle, I have to learn about it, the more I learn the better my outcome. I'm not studying medicine and only "have to" learn one little part. All the same it is not easy. It would be as though all someone had to do in their entire life was (something specific) but computer science is so hard that this is not easy.
I would say medicine is harder than computer science. DNA is 650 megabytes, not every underlying process is understood, drugs and their interractions have to be learned with tons of difficulty, even after you specialize you have to understand the entire system.
But then I read the rest of your comment, and I must say - perhaps it is true that there is room for someone to "diagnose pneumonia" or something. Doctors are expert systems: but perhaps there is room for lesser expertise.
(A small aside - it is certainly true that the long required training artificially reduces supply of doctors in the united states - however I think you are using an imprecise term "rent-seeking" and should pick a more specific term from economics since I think you are technically misusing it.)
I guess I should have mentioned my point first, which is that just like you don't need a star computer scientist to write an app for a restaurant, you don't need a doctor with all that training and theoretical knowledge to diagnose a sprained ankle.
I'm sorry about your condition, but that condition probably is fairly rare. How many of your other health issues couldn't be diagnosed by somebody with less training?
> however I think you are using an imprecise term "rent-seeking"
I don't see how I am. Can you please elucidate? You have to pass boards to practice medicine in the US, which requires a huge investment of time and money, and after you do that, you want to restrict supply so that you're in high demand. That way for the rest of your career you can coast on your laurels and keep collecting a paycheck.
You say that a "sprained ankle" is easy to diagnose -- but is it really? On the differential, how many other conditions manifest similarly? What complications can a trained doctor see, what questions do they know to ask?
In my interaction with the medical industry, in no case would I have been as well-served by a "lesser expert."
Regarding the term rent-seeking. This is quite a specific term, that means causing payment to be made for something that would be free. For example, if I opened an institute to monitor air quality and make recommendations, and managed to get the government to force everyone to pay an "air tax" for my endeavors -- this is "rent-seeking", since, of course, air can be enjoyed without paying for it.
From how I read your comment, you did not intend this usage. Rather, you meant to speak about the supply of trained doctors (not to speak about something that might be free otherwise), so it is more cartel-like behavior, at least as far as I read your argument.
I assume you still want the lesser experts we're discussing to be regulated legally, etc, and weren't comparing with "free" opinions such as if I ask an aunt about herbal medicines that have worked for her. If the latter, then, sure, I would say it is rent-seeking to start charging people to discuss herbal medicines for which discussion is otherwise free.
A few things I've personally witnessed: going to the doctor for a sick note, going to the doctor for routine travel immunizations, going to the doctor for a birth control prescription, going to an optometrist for routine eye correction prescriptions.
We're talking probabilities here. Most likely your illness is due to the most probable cause. And if it isn't, well, stuff happens.
From wikipedia: In economics and in public-choice theory, rent-seeking involves seeking to increase one's share of existing wealth without creating new wealth.
I believe that's what a lot of doctors do these days. After a weekend of tromping through the woods, I got a case of poison oak. I had to see a doctor and get a prescription for a steroid, because apparently it's a scheduled medication.
There is a lot of overlap between a cartel and rent-seeking though.
> In my interaction with the medical industry, in no case would I have been as well-served by a "lesser expert."
Is that only from your diabetic condition, or other issues? I think the question I'm raising is that maybe sometimes "it'll do" is just as good "he's elite, I'm lucky to have him".
> I assume you still want the lesser experts we're discussing to be regulated legally, etc
No. I think you should be able to hang out your shingle without government regulation.
> They put the students through hell because that's what they had to go through...
True. But the reason is that it toughens you up and winnows the wheat from the proverbial chaff. The forced marches through the wards at 2am in the morning prepare the budding doctor for the real world where he can be called upon as say, the sole doctor for miles in a rural area to attend to a mass casualty event.
>In most other countries, doctors don't have an accreditation board. ...
I do not know of any country that does not have an accreditation board. The difference between countries is the process of accreditation. Sometimes it is direct: the student takes centralized a board exam; sometimes indirect: the student takes a uni exam approved/supervised by the board.
> it doesn't require years of school to set a bone or put in some stitches
Maybe. But it requires erudition and experience to anticipate that a poorly set bone can heal with complications(malunion, non-union,infection etc.) Fun fact: when Admiral Nelson was wounded in the battle of Santa Cruz de Tenerife in 1797 field surgeons had his arm amputated but mistakenly trapped his nerve in a ligature that caused him great pain until the mistake was corrected )
> it doesn't require years of school ...(to) diagnose the flu or pneumonia
That pov is exactly how people get misdiagnosed and killed (by quacks).
There are many different diseases that present alike and even subgroups of the same diseases that have different management regimes. While it may seem obvious for instance, that a patient has pneumonia, one would also do well to ask what kind of pneumonia he has, why he has it (immunocompromise?, zoonosis?) and what the alternatives could be( the differential diagnosis). More than once has "ordinary pneumonia" been found to be lung cancer. It takes years of post graduate training and practice to become proficient enough to identify different disease conditions and manage them with confidence.
Medical school hazing is not done because the seniors are sadists. Some aspects of the process could be improved but the rigor works and makes for good doctors.
When has that happened to you, or anybody you've known?
> There are many different diseases that present alike and even subgroups of the same diseases that have different management regimes.
Sure, how frequent is that?
My point is that we're training doctors like they have to be Navy Seals, equipped and prepared for every situation, whereas in real life, a grunt with 3 months paramedic training would be up for the task.
The scope of what a paramedic does and what a doctor does are totally different. The way medical care is organized capitalizes on each person's training: paramedics stabilize and transport patients; nurses carry out treatment plans; and doctors create treatment plans.
It sounds like you're saying, just because we don't always need to use an efficient algorithm all the time, we should never be trained to use efficient algorithms. This could make sense in the context of the next Rails app, but, when your life is at stake, the extra training matters.
> When has that happened to you, or anybody you've known?
In the state I grew up in, there were only three pediatric psychiatrists for multiple millions of citizens. If a doctor's training confers the ability to affect hundreds of children's lives, I definitely want them to be as knowledgeable of their area of practice as possible.
Are you kidding me? I practiced medicine until 8 months ago when I burned out and had to take a break. One of the cases I recall having on an offshore medical center, involved 4 victims who had suffered burns(in one case over 80% of his body surface area), on a night when I had 2 other patients on admission. It easily took my team of four 5 hours to stabilize the patients and have them evacuated by helicopter.
In 2014, the oil company we subcontracted for had an incident where over 90 people suffered acute food poisoning from eating dinner at the staff canteen. This was a bacillus cereus infection with vomitting and stooling. Dont attempt to imagine that number of sick patients. There were only 2 doctors and five nurses initially to manage the incident. I could tell you war stories all day so could many other doctors.
How was any aspect of your job improved by your years of medical school, your years of residency?
Would you rather have more less trained doctors, or fewer elite doctors in those circumstances?
People fail out of the profession at various levels. A classmate of mine fled in the second year during her first dissection of a cadavar, never to return, some make it to residncy then quit. Certainly we should be vigilant and catch students before they become suicidal. But really, the practice of medicine requires a certain temperament. Some people are built for it and others are not.
> Would you rather have more less trained doctors, or fewer elite doctors in those circumstances?*
Unfortunately there is no middle ground. A doctor is either capable or he/she is not. We simply cant train them halfway. There are countries that have carried out the experiment you propose and attempt to train doctors to 'adequate' levels. The results are not good.
But how often does that occur? And is it worth the economic cost of not having doctors available, or doctors overworked? Individual human life is cheap.
>A doctor is either capable or he/she is not. We simply cant train them halfway. There are countries that have carried out the experiment you propose and attempt to train doctors to 'adequate' levels.
Do you have a source? I'd be quite interested in reading it. And the phrase "either <x> is capable or either he/she is not" can be applied to any other profession.
As someone currently in medical school, I'm going to have to agree w/ the previous comment that often "simple" cases are not so simple. For dealing with something as simple as diarrhea, you have to understand the anatomy of the GI tract, the physiology of nutrient absorption, pathophysiology of different diseases, important details about infectious causes (i.e. toxins, mech of transmission, etc.), labs, clinical presentation, associated phys/pathophys like neurological, immunological, and hematological features, associated symptoms, common patient histories, drugs and their mechanisms of actions, etc. etc. etc. The sheer volume of knowledge that you need to know and how everything fits together is something I hadn't realized before coming to med school. Plus, you have to learn clinical skills like how to take a patient history, do a physical exam, etc. all of which is only for treatment of diarrhea. Now imagine learning all of this for topics as wide ranging as all the different cancers, heart failure, emphysema, diabetes, all the different congenital defects, etc. You also have to know how to read radiology, how to intubate, draw blood, perform disease-specific tests, maybe learn how to do surgery, etc. Anyway, the point is it takes a lot of skills and concepts for a fully trained doctor to work up simple things.
You don't have to understand it. You can say "Hey, usually when you take this pill things get better" or "Just keep him hydrated with a water/salt/sugar mixture, and these things generally take care of themselves."
Human life is cheap. There are 7 billion of us. Why are we optimizing for the very few to reduce medical care for the masses?
I think this is the main point I and the other commenters are trying to explain. You do have to understand it. Imagine someone coming and telling you your software job is better done by overseas contractors - they're less efficient and cheaper so you naturally must be overpaid.
Except that ignores the many ways in which your training might make your higher cost worthwhile.
> Why are we optimizing for the very few to reduce medical care for the masses?
Are you implying there's a concerted effort to deny care? With the proliferation of nurse practitioners and physicians assistants, we're broadening the range of people who can take care of our population. Overseas, groups like Partners in Health are training community members to offer care in order to fill in gaps in health care availability.
Sorry to take this to its extreme, but I think you're proposing the idea of the marketplace finding the optimum amount of training for caregivers. As a point of opinion, this kind of system would be far more disadvantageous for society's less powerful than what we have now.
Go to your local urgent care or CVS doc in a box and you'll get a nurse practitioner who can help you out with routine stuff for low cost.
Seems like the issue is not a lot of doctors in the area. While we can't test this easily, wouldn't reducing the forced marches give more people incentive to join the profession? Then you have more doctors, better coverage and people scheduled to be on call for this.
Essentially, where's the balance between few superheroes who survived and a large number of doctors who are just pretty good.
> but the rigor works and makes for good doctors.
You're commenting on an article which talks about medical students being suicidal. And I know of 2 local doctors actually going through with that. That's not my definition of "good".
The thing is...when that fracture extends into the joint capsule, or is in multiple pieces and needs a surgical repair, you'll want the doctor around to manage that.
When that flu weakens your immune system and causes you to get a superimposed bacterial pneumonia, you'll want the doctor around to manage that.
The days when a doctor could make a living managing only simple problems are long gone, if they ever existed. These days, PAs and NPs handle the majority of healthcare's equivalent to CRUD applications, and physicians handle the complicated cases.
I have noticed that it's become popular on HN to refer to parts of the healthcare industry as "rent seeking," and while I agree to some extent, I haven't seen much evidence that doctors or medical schools themselves are rent seeking.
If we get a cold and need time off we need to visit a GP, this is rent seeking that could easily be handled by a non doctor for half the price.
As for the other points, that's just a matter of having escalation procedures. The current system has highly paid specialists doing front line technical support.
I'm not sure where you work, but I have never needed a doctor's note to get off work for a simple cold. That's a company policy issue, not the fault of the medical industry.
As I said, a lot of the front-line work is now handled by NPs and PAs. There are still physicians in primary care, but they spend much of their time handling the more complicated patients.
Every single prescription or referral to a specialist is a doctor's note.
that's what i think too, especially when students go through rounds in the hospital they get "pimped"[1] it's like hazing on top of rent seeking
[1] https://drottematic.wordpress.com/2009/11/30/pimping-in-medi...
So, the barrier to programming might be either impassable or not there depending on who you are, while I'd assume the one to being a doctor would be difficult but doable for most people. So for those people who can't be a programmer, "difficult" would be easier than "not possible," so the barrier would be lower to be a doctor to them, while for someone with the predisposition for programming, programming would definitely be easier.
One of a few articles on the subject: https://blog.codinghorror.com/separating-programming-sheep-f...
I've personally found it to hold in a few instances where I've been able to observe different people trying to learn programming - they seem to either understand it right away or not really get it. A Computer Science professor of mine said this same thing once - he said "it's an aptitude."
http://retractionwatch.com/2014/07/18/the-camel-doesnt-have-...
I've been an adjunct instructor at a local university, and they hire industry people because they don't have enough grad students who can teach or don't speak English sufficiently to teach. The kids are great and can do anything, but they are stuck in a brain dead curriculum that's designed to haze them out before their junior year.
Her whole life was geared towards her becoming a doctor. Things like volunteering purely to make your med school application look strong. Bunch of my Indian friends are doctors from pure Inertia, not due to any particular passion of medicine.
But most students apply to multiple schools. Actual acceptance rate is 40% across all demographics. https://www.aamc.org/download/321480/data/factstablea12.pdf
Edit: also, 25% of the applicants are repeat applicants. So, first application acceptance rate is probably closer to 50%.
1) This situation seems analogous to the higher rate of suicide in very competitive colleges. Both feature putting people who did very well in the prior stage and then demanding a high level of content mastery in a short period of time. Interestingly, some places a pushing for a 3 year med school experience for primary care to reduce loan burden and get more productive years out of the training. I wonder how this will affect this pressure.
2) I wonder if discussing the harsh reality of medicine - charting, team management, things being beyond your control - rather than emphasizing the 'higher calling' and 'privilege to care' would dissuade those seeking prestige form entering medical school. I think it is a much greater service to have them figure out before school starts and not be saddled with 40-50k of debt that first year.
3) A big transition I always heard in med school was the difference of the trainees in that they value work/life balance much more than the titans of medicine in the past. How to rectify this priority with traditional medical school is a VERY interesting question.
I wonder whether and hope that mental illness will end up like homosexuality in the sense that people will no longer have to hide who they are. On the other hand, I suspect that would be a more difficult battle, especially when it comes to employment discrimination.
I think that would be a decent way for you to see a possible outcome in that field too in order to create a conclusion.
As long as your type of counterculture doesn't involve the perceived potential of underperforming. Then you're out. Because meritocracy and stuff.
Mental illness is almost always perceived as "Oh shit, this person isn't gonna be a top performer"
I mean, a lot of mental illnesses actually have a legitimate negative effect on one's ability to be a productive worker. It wouldn't really make sense to make it illegal to discriminate against people with e.g. severe learning disabilities who can't read or write.
Yes I completely agree. However, if a mentally ill person can perform their duties with reasonable accommodations as well as a person who isn't mentally ill , then that person shouldn't be discriminated against.
Indeed, the Americans with Disabilities Act already covers people with depression and bipolar.
If you could discriminate against people because they have something which legitimately negatively affects one's ability to be a productive worker, then companies would probably discriminate against hiring women too, because they might get pregnant and have to take time off. This is also illegal because while it's true that it might be less efficient for the company, it's still unethical.
Not sure I agree with you there. Personally, I think all business interactions should be voluntary; anything else is slavery with a few palliative layers of abstraction thrown in.
In the particular example you gave, that's just foisting part of the cost of reproduction (risk of productivity loss) onto some innocent third parties.
I see both sides of the argument, and I see why protecting the convenience of reproduction is important from a practical genetic/memetic standpoint, but I wouldn't go so far as to call it "ethical".
Hey I appreciate the alternative perspective.
However, at least from what you just said, I'm not convinced you do see both sides. Or maybe there's a third side..?
I actually personally do not care whatsoever about the cost of reproduction. If anything I would be happy if we reproduced less. Still, I support not being able to discriminate against women because doing otherwise supports gender inequality. It's unethical to punish a person just because they are female.
Whenever you prevent people from rationally using this kind of information in economic decisions, you are hurting more than you are helping. In the car insurance case, if insurance companies were unable to charge more for the more risky young men, this would mean that young women were unfairly subsidizing the risk of young men. So there's no net gain, and there's a bit of a cost associated with the fact that the market is no longer able to accurately transmit price information, which would have done useful things like encouraging the development of safer car technology, encourage statistically risky driver demographics to bike or take public transport rather than drive, etc.
Perhaps the latter is the intention but as far as I can tell it does not prevent the former from happening.
> Whatever nice ideals we have about gender equality, there are often practical statistical differences between genders, and it's OK to recognize and use that information.
I suppose this is our fundamental disagreement then.
I recognize that there may be additional costs or burdens to businesses and even other consumers if companies are forced to ignore statistically relevant details in the name of equality. However, this is a price I am willing to pay to live in what I consider a civilized society.
In a way this thinking even prevents social mobility. After all, if you are poor, it's less likely you would have a good education or upbringing, so is it okay for companies to discriminate against the poor? Feel free to accuse me of being an idealist, but I would rather we strive to live in a society where people are judged for who they are and not their race, sex, or other things which are completely out of their control.
"But one part of medical school culture has been especially hard to overcome: the stigma of mental illness. When they need help most, medical students in anguish rarely reach out. Students attribute this reluctance to seek care to fear of stigmatization by peers and to concerns over professional ramifications, particularly during applications for residency and licensing."
What I have observed among family in the medical industry is a reluctance to use the care they provide: not just Do-Not-Rescusitate orders but a tendency to just suffer through the sickness instead of seeking medication, and to let the illness take its course rather than seeking second opinions and treatment.
Of course, these are with regards to physical ailments. Family has been much less public about mental issues. But I wonder if these same fears and proclivities also translate to mental health problems.
Sometimes the treatment is worse than the disease.
> Of course, these are with regards to physical ailments. Family has been much less public about mental issues. But I wonder if these same fears and proclivities also translate to mental health problems.
Most mental health medications are palliative, and tend to make the underlying condition worse over time [1].
As a PhD student in a medical research program, I have talked to several others who face these same problems. I experience it in my own thoughts as well. 4 years in, I have no social life, never meet anyone, don't really have the drive to do anything outside of work anymore, etc... I never remembered being like this from my previous jobs, but overall, I genuinely feel sad that the things I look forward to most may never happen; A wife, kids, projects to do in my own house... Having always worked intense, physical jobs (at essentially minimum wage), I set out to get a much better job, benefit the lives of others, and ensure that I could comfortably support my goals in the future. In the process, I have completely lost who I was, let friendships fall apart, and feel the opportunities to mend them slip through my fingers.
Those issues are roughly two-fold : (1) feeling entitled to a "balanced" lifestyle; (2) feeling entitled to help people. The first one is obvious: student want to leave early, they don't understand that patients always come first, that, sometimes, you have no choice but to be sleep-deprived for days, and so on.
The second one is a kind of "Mother Teresa Complex" when students experience uncontrolled anxiety and distress upon seeing a fully competent adult actively undermining his own care. I see it all the time when they try to talk a lung-cancer smoker into stopping for 30-40 minutes, come back almost crying that he's not interested, and can't believe that their "trying to help" means they are now late, and I'm not happy at all.
Wouldn't this mean simply telling the patient that their suffering is "God's plan" and refusing to treat them, nor give them any pain medication?
You should get help. But you can't be sure you will be allowed to practice medicine. The medical board will decide on an individual basis. For reference, texas medical board form for mental illness and self referral program: http://www.tmb.state.tx.us/dl/C5EAB589-0916-C88D-FF94-DE8D96...
Of course, if you don't self report, and practice anyway, and a patient complains, you might be facing criminal charges.
First do no harm. Help yourself before you help others (seek mental help if you need it).
She had an interesting perspective on the problem. She said that it isn't the intensity of the work, the academic rigor, or even the emotional damage from constant exposure to death and disease.
It's the sleep deprivation.
There is a very large amount of evidence that one night of reduced sleep massively increases medical errors. Despite this knowledge, sleep deprivation remains this massochistic macho hazing ritual, which increases in severity through residency.
It's dangerous and unnecessary.
This article does a good job of capturing the chain of internal events that lead from exhaustion to burnout to severe depression and finally to suicidal ideation.
software engineering might be closer to "drinking from a running facet.. forever". I know doctors have to keep learning but I always wondered if it was more or less than engineers after school.
Could part of reason why the education is so expensive due to the monopoly in all the tests med students have to take? http://endstep2cs.com/petition/