The Story Of Kathryn

[JohnGrisham]

People with mental illnesses are entire people.  Who have some shortfalls (as do we all) and also some strengths.  Who can be really excellent physicians and well suited to medicine.  Mental illness can be managed and people with mental illnesses can often function perfectly well.  And there is something to be said for understanding the experience of being ill from the inside out.  Not everybody with a mental illness can be a good physician - but neither can everybody WITHOUT one.

 

I feel angry and sad that you could say something so outrageously ignorant and stigmatizing.  And I hope that anybody reading your post who might struggle with mental illness and might be in medicine or thinking about medicine will recognize how messed up that is and not let it sway them.

 

Edited because I shouldn't let my temper get away from me.

You're too polite, good on you. 

 

That dentist is so far off base, that it is sad actually.  "Lets blame the individuals, for a very shitty and poorly constructed system." 

[GH0ST]

People with mental illnesses are entire people.  Who have some shortfalls (as do we all) and also some strengths.  Who can be really excellent physicians and well suited to medicine.  Mental illness can be managed and people with mental illnesses can often function perfectly well.  And there is something to be said for understanding the experience of being ill from the inside out.  Not everybody with a mental illness can be a good physician - but neither can everybody WITHOUT one.

 

I feel angry and sad that you could say something so outrageously ignorant and stigmatizing.  And I hope that anybody reading your post who might struggle with mental illness and might be in medicine or thinking about medicine will recognize how messed up that is and not let it sway them.

 

Edited because I shouldn't let my temper get away from me.

 

Thanks for spreading the good word. 

 

- G

[Arztin]

You're a health care professional, your job is to make people less depressed and anxious along with solving their problems.

 

So how is being anxious and depressed helpful in terms of treating patients? How can you make their lives better if you cant deal with your own mental illness?

 

If you can't deal with your own mental illness, then you shouldn't be in medicine. Pursue a different career.

 

No one wants an anxious person treating them, that's a scary feeling to have. I would expect my surgeon to calm me down before procedure, instead of being anxious.

 

This is really common sense stuff. Med school and residency should try to fail out anxious people to improve health care quality.

Are you a troll? Next post of such a kind, and I'll assume that you are.

I respect people's opinion but you do sound like a troll to me.

[567765]

People with mental illnesses are entire people.  Who have some shortfalls (as do we all) and also some strengths.  Who can be really excellent physicians and well suited to medicine.  Mental illness can be managed and people with mental illnesses can often function perfectly well.  And there is something to be said for understanding the experience of being ill from the inside out.  Not everybody with a mental illness can be a good physician - but neither can everybody WITHOUT one.

 

I feel angry and sad that you could say something so outrageously ignorant and stigmatizing.  And I hope that anybody reading your post who might struggle with mental illness and might be in medicine or thinking about medicine will recognize how messed up that is and not let it sway them.

 

Edited because I shouldn't let my temper get away from me.

 

As for the first highlighted part, the argument we are all not perfect is very weak one to make. This is a high status profession, that's what I thought.

As for the second highlighted part is just bunch of non-sense. Something that is of no value and is not backed by any example to be informative.

I'm not coming to this part of the Internet again, bunch of egoistic people everywhere, ridiculous. Even when giving advice, people get sensitive. Egoistic in a ridiculous way indeed.

[ellorie]

Good, don't.

 

God forbid I could know more about it than you. It's not like I work with this every day or anything.

[uwopremed]

An article that was published today by the NEJM about a person who committed suicide in medical school.

 

http://www.nejm.org/doi/full/10.1056/NEJMp1615141

Unfortunately, some people just can't handle medicine, and the stresses that come with it.  Most people that attempt or commit suicide usually have other issues at play.  Often they can't handle the loss of a relationship, and generally not cope with failure well.

 

While it is important to try to catch people before they commit suicide, or attempt self harm - it is still quite rare in general.  While suicides do occur, there has not been one successful one among Ontario medical students, of which there are close to 4000 at any given time, in several years.  And depression, while widely present, is also widely present in virtually all segments of society.  Mental health needs to be appreciated and treated - but calling everything an epidemic is ridiculous.  In virtually all arenas of life - things are better now than they ever have been.  I admit that there seems to be a lack of resilience in my generation (we largely never grew up with war, widespread poverty (or at least the levels of the past), high crime, disease or epidemics) - and I'm not sure how we can be toughened up in the way my parents' and grandparents' generations were.  Quite frankly, the first 2 years here have been great so far - and while i'm aware 3rd year is more challenging emotionally - it's also self limited to 1 year.  Remember - we all chose this career because it pays alot, is exciting, and has great prestige.  Of course there has to be some catch - at times it will be hard.

[older]

Lots of people will disagree that "in virtually all arenas of life things are better than they ever have been". Not to mention middle-class struggles in general, medical admissions are as competitive as never before, competition for residency getting more and more fierce, real wages are declining, and so is overall state of the health system strained to the limit by lackluster economy and governments' ineptitude.

 

It is not true that "some people just can't handle medicine" (that is, assuming they don't faint at the sight of blood or a syringe). But it is true that many have difficulties in coping with stress along the path leading to doctor's profession, and later in the course of their careers.

 

And while the term "epidemic"  is not  something one would use with relation to suicides of med students, it is arguably applicable to mental health issues in general population - with concentration in high-stress environments that include med schools and med profession. If stress cannot eliminated or reduced, it can be better managed,  and help can be made more available. This is essentially the message of this and other similar  articles.

[uwopremed]

Lots of people will disagree that "in virtually all arenas of life things are better than they ever have been". Not to mention middle-class struggles in general, medical admissions are as competitive as never before, competition for residency getting more and more fierce, real wages are declining, and so is overall state of the health system strained to the limit by lackluster economy and governments' ineptitude.

 

It is not true that "some people just can't handle medicine" (that is, assuming they don't faint at the sight of blood or a syringe). But it is true that many have difficulties in coping with stress along the path leading to doctor's profession, and later in the course of their careers.

 

And while the term "epidemic"  is not  something one would use with relation to suicides of med students, it is arguably applicable to mental health issues in general population - with concentration in high-stress environments that include med schools and med profession. If stress cannot eliminated or reduced, it can be better managed,  and help can be made more available. This is essentially the message of this and other similar  articles.

 

This frankly might be one of the most self indulgent posts I have ever seen.  And most of your 'facts' are wrong.

 

Medical school admissions are not more competitive than ever before at all.  In the 1990s, all of Ontario had only 532 medical spots.  There were about 3700 applicants, and the population of Ontario was about 11 million.  Today there are about 956 spots, with 6500 applicants.  In other words, the ratio is better now.  And to top it off, the population on Ontario is only 13.5 million (so not much higher).  The reason that things seem so competitive is a) you have no memory of the past, and grade inflation has completely ruined everything and made even mediocore students seem competitive or think they are smarter/more capable then they are.  In 1995, getting a 3.7 was impressive.  In 1975, getting a 3.5 was impressive.  Many bright students interested in medicine didn't even bother to apply in the 1980s/90s because they had GPAs south of 3.3.   Nowadays, in some programs, a 3.9 puts you in the bottom half, and everyone thinks their easily obtained 3.8 gives them a deserving chance.  This is also not to talk about the fact that padding resumes is so much easier:  travelling is much easier and safer, doing research is much easier (more journals, easy access to databases, easier to simply even send manuscripts or edit them), accessibility of advanced extracurriculars is easier.  

 

 

This Macleans article from this week helps explain a bit of the problem (and also outlines why morons like Trump can get elected, and why college students on the left are similarly clueless).  It's a problem on  both the left and the right.  http://www.macleans.ca/society/why-americans-have-come-to-worship-their-own-ignorance/   

 

The mental health epidemic thing is also a bit much.  On my FB feed over the last month, i've had posts talking about the mental health epidemic for:  paramedics, nurses, clerking lawyers, law students, pharmacists, police officers, and small time business owners.  In the end - every profession seems to have some sort of mental health epidemic - which in my mind means there are no epidemics.  Just the mental health challenges people have if their disposition and job are a bad mix.

 

Doctors have always had rough patches.  In 1986 my uncle remembers full out striking.  There were rough deals in the 1990s.  Actually, at this moment, MD salaries are near their peak (even with inflation) - but are tapering or modestly dripping.  The vast majority of students can still get into a speciality or residency - they just disproportionately want big cities and have a hard time accepting failure.  Despite the high non-match rate this year - the vast majority not only seemed to get their specialty, but also their location.  

 

I couldn't handle being a firefighter or soldier.  Some people end up being horrible CEOs or politicians.   Some people can't hack being a doctor.  To me - that's a pretty common sense statement.  I could never be a professional hockey player even though i wanted to when i was a little kid playing hockey.  I accept that.

 

The economy today is always thought to be much worse than the past.  It is not; unless you're dreaming of a house in Toronto or Vancouver (Canada joins the USA and UK in that regard - London and New York/San Fran have always been prohibitively expensive).  You can buy a great place in London, and there are actually a lot of decent jobs available in London/St Thomas in all fields at this moment.  The job environment for MDs is also pretty decent for the most part - with perhaps orthopedics the only one with a national problem.  For other specialties - it's more an issue of entitled people wanting to work in Toronto or Vancouver.  I think the biggest problem is that we can all see how others are doing much more than previous generations (i.e. Facebook).  So people always feel others are doing better than them  - and that makes them feel bad.  It's all relative.

 

Look, I have some metis ancestry - and can assure you that on that side - most of history has been pretty awful.  I had a great great grandparent brutally wounded in wwi (i have photos i inherited from great granddad) - and it was common back then.  None of them could afford university even though they were bright - they had to work on the farm as youn men.  Most didn't travel.  There was no OHIP, and little Welfare.  2017 is actually pretty damn good.  

[NLengr]

 The job environment for MDs is also pretty decent for the most part - with perhaps orthopedics the only one with a national problem.  For other specialties - it's more an issue of entitled people wanting to work in Toronto or Vancouver. 

I don't believe that's true. The job market issues are definitely more widespread than just ortho nationally. The RC also believes there is more widespread issues (Uro, ENT, Nephrology, Cardiac, neurosurg are all on the list just off the top of my head) hence the committee investigation into specialties with employment issues. It's not just a simple matter of all these other specialties wanting to only work in Toronto or Vancouver.

[uwopremed]

I don't believe that's true. The job market issues are definitely more widespread than just ortho nationally. The RC also believes there is more widespread issues (Uro, ENT, Nephrology, Cardiac, neurosurg are all on the list just off the top of my head) hence the committee investigation into specialties with employment issues. It's not just a simple matter of all these other specialties wanting to only work in Toronto or Vancouver.

 

Urology and ENT have significant medical aspects to their practice - and can essentially set up shop anywhere.   In fact, there are some urologists and ents that practice doing only minor procedures like cystoscopies (that don't have to be public hospital based) or even primarily medical.  Of course it sucks to not have a full surgical practice.  Nephrology is a subspecialty of Internal - those guys can work.  Cardiac surgery I concede is tough - but it's a tiny specialty with a narrow focus (after interventional cardiology basically took tons of their work).  People going into Cardiac surgery know those issues.  Neurosurgery is similar to cardiac surgery - though opportunities in communities like TBay, Windsor, and Sudbury are often present.  For the vast majority of graduates of all specialties - jobs are available.  A truly unemployed specialist is rare.  A few that have been written about in the media almost always have a personality or performance issue that people behind the scenes know about.  

[JohnGrisham]

Urology and ENT have significant medical aspects to their practice - and can essentially set up shop anywhere.   In fact, there are some urologists and ents that practice doing only minor procedures like cystoscopies (that don't have to be public hospital based) or even primarily medical.  Of course it sucks to not have a full surgical practice.  Nephrology is a subspecialty of Internal - those guys can work.  Cardiac surgery I concede is tough - but it's a tiny specialty with a narrow focus (after interventional cardiology basically took tons of their work).  People going into Cardiac surgery know those issues.  Neurosurgery is similar to cardiac surgery - though opportunities in communities like TBay, Windsor, and Sudbury are often present.  For the vast majority of graduates of all specialties - jobs are available.  A truly unemployed specialist is rare.  A few that have been written about in the media almost always have a personality or performance issue that people behind the scenes know about.  

" ENT"

 

You clearly know more about ENT than the 3 preceptors i've had. 

 

All in all, looks like you have a better handle than those currently in the field, getting work in non-big centres. 

 

I agree, truly unemployed is rare, underemployed not so much.  

 

One thing to remember is, the more specialized you are - you need a patient population base. You can't be super rural, especially if you want to keep that skillset up...and not to mention have enough patients to warrant you there...and to make a good living.

[NLengr]

Urology and ENT have significant medical aspects to their practice - and can essentially set up shop anywhere. In fact, there are some urologists and ents that practice doing only minor procedures like cystoscopies (that don't have to be public hospital based) or even primarily medical. Of course it sucks to not have a full surgical practice. Nephrology is a subspecialty of Internal - those guys can work. Cardiac surgery I concede is tough - but it's a tiny specialty with a narrow focus (after interventional cardiology basically took tons of their work). People going into Cardiac surgery know those issues. Neurosurgery is similar to cardiac surgery - though opportunities in communities like TBay, Windsor, and Sudbury are often present. For the vast majority of graduates of all specialties - jobs are available. A truly unemployed specialist is rare. A few that have been written about in the media almost always have a personality or performance issue that people behind the scenes know about.

You are talking about accepting major underemployment for specialists, which shouldn't be considered acceptable to physicians or the public. Taxpayers paid a ton of money to train those people and doing office only practice as a surgeon or essentially restricting your work to general internal despite your subspecialty training is underemployment and a waste of taxpayer money (not to mention the waste of the physicians time and effort in training). It should not be considered acceptable.

 

This position is supported by the majority of these specialty's associations. It's supported by the RC.

 

Completely unsubstantiated opinion about the personality and performance issues by the way. I certainly have never seen any data reflecting this and it hasn't been my experience as a resident or staff.

[ralk]

Unfortunately, some people just can't handle medicine, and the stresses that come with it.  Most people that attempt or commit suicide usually have other issues at play.  Often they can't handle the loss of a relationship, and generally not cope with failure well.

 

While it is important to try to catch people before they commit suicide, or attempt self harm - it is still quite rare in general.  While suicides do occur, there has not been one successful one among Ontario medical students, of which there are close to 4000 at any given time, in several years.  And depression, while widely present, is also widely present in virtually all segments of society.  Mental health needs to be appreciated and treated - but calling everything an epidemic is ridiculous.  In virtually all arenas of life - things are better now than they ever have been.  I admit that there seems to be a lack of resilience in my generation (we largely never grew up with war, widespread poverty (or at least the levels of the past), high crime, disease or epidemics) - and I'm not sure how we can be toughened up in the way my parents' and grandparents' generations were.  Quite frankly, the first 2 years here have been great so far - and while i'm aware 3rd year is more challenging emotionally - it's also self limited to 1 year.  Remember - we all chose this career because it pays alot, is exciting, and has great prestige.  Of course there has to be some catch - at times it will be hard.

 

Ugh... no. On almost every point... no.

 

I'll agree that we use the word "epidemic" too often. Yet, mental health problems among medical students, residents, and physicians are well above that of the rest of the population, particularly once taking into account education, income, and gender. That this occurring among individuals with training to treat mental health issues only reinforces how absurd this situation is. Same goes for suicide rates. Yes, other professions also have increased mental health problems as noted in your other post, but if all professions had the same level of difficulties, we wouldn't see the spike in medicine in particular.

 

I get that you haven't had your Psych block yet, but your understanding of mental health problems seem incredibly superficial. If the problem was just that people can't handle medicine, this would be so much simpler to deal with. People who really can't handle medicine usually get held back or fail out, or just never make it into medical school in the first place. Everyone who got to their stage in medicine passed everything that came before. When you get into clerkship, 20% of your class will be experiencing burnout within a few months, all of whom will have achieved as much as you have, shown equal ability to be a physician.

 

Likewise, while coping ability can be related to mental health issues, they're not equivalent. Many people cope poorly without mental health issues. Many people who are coping well have mental health issues. Maladaptive behaviours don't require mental health problems, and while mental health problems can be the result of or related to poor coping strategies, inability to cope is not a precondition for mental health issues.

 

Just because things overall, in the world, are getting better does not excuse inaction on remaining problems, nor does it imply that current problems are due to a lack of resilience on the part of those currently struggling with mental health issues. Many schools, particularly in the US, have used tried-and-true resilience training to address mental health. It hasn't worked, because the problem isn't lack of resilience. Along those lines, the solution isn't to make medical school easier, just more humane. Heck, if anything, as part of a comprehensive approach to medical student well-being, I'd like to see standards raised, for everyone involved. You say that at times in medicine it will be hard - I wish that was true. If anything, medicine's been the easiest post-secondary educational experience I've had, and I've had a lot of it. I would have appreciated a real challenge somewhere along the line above the current approach of "learn everything poorly".

 

Lastly, no, we did not all choose medicine for money, excitement, and prestige. Maybe you did. I didn't. And you're not going to understand the problem of mental health in medicine if you assume everyone has the same narrow goals that you have.

[uwopremed]

Ugh... no. On almost every point... no.

 

I'll agree that we use the word "epidemic" too often. Yet, mental health problems among medical students, residents, and physicians are well above that of the rest of the population, particularly once taking into account education, income, and gender. That this occurring among individuals with training to treat mental health issues only reinforces how absurd this situation is. Same goes for suicide rates. Yes, other professions also have increased mental health problems as noted in your other post, but if all professions had the same level of difficulties, we wouldn't see the spike in medicine in particular.

 

I get that you haven't had your Psych block yet, but your understanding of mental health problems seem incredibly superficial. If the problem was just that people can't handle medicine, this would be so much simpler to deal with. People who really can't handle medicine usually get held back or fail out, or just never make it into medical school in the first place. Everyone who got to their stage in medicine passed everything that came before. When you get into clerkship, 20% of your class will be experiencing burnout within a few months, all of whom will have achieved as much as you have, shown equal ability to be a physician.

 

Likewise, while coping ability can be related to mental health issues, they're not equivalent. Many people cope poorly without mental health issues. Many people who are coping well have mental health issues. Maladaptive behaviours don't require mental health problems, and while mental health problems can be the result of or related to poor coping strategies, inability to cope is not a precondition for mental health issues.

 

Just because things overall, in the world, are getting better does not excuse inaction on remaining problems, nor does it imply that current problems are due to a lack of resilience on the part of those currently struggling with mental health issues. Many schools, particularly in the US, have used tried-and-true resilience training to address mental health. It hasn't worked, because the problem isn't lack of resilience. Along those lines, the solution isn't to make medical school easier, just more humane. Heck, if anything, as part of a comprehensive approach to medical student well-being, I'd like to see standards raised, for everyone involved. You say that at times in medicine it will be hard - I wish that was true. If anything, medicine's been the easiest post-secondary educational experience I've had, and I've had a lot of it. I would have appreciated a real challenge somewhere along the line above the current approach of "learn everything poorly".

 

Lastly, no, we did not all choose medicine for money, excitement, and prestige. Maybe you did. I didn't. And you're not going to understand the problem of mental health in medicine if you assume everyone has the same narrow goals that you have.

 

The biggest issue with you, and I find many others in medicine, is that they so strongly believe that they conditions are unique relative to others.  There have been multiple high profile suicides recently of paramedics.  These true first responders are the ones that first see families hysterical when someone is dead from a stroke or cardiac arrest, a SIDS child, or even a brutal murder or car accident victim. Even ER docs don't deal with that.  The issues police officers, or soldiers, or firefighters go through is often much more acute and personally dangerous than what an MD goes through.  So no - it is not unique.  Dealing with mental health issues is important - but this idea that the issues are unique to medicine is silly.  To top that off - we go through so much to get into medicine - the least the admission process can do is try to weed out those that have mental health issues that may not make them amendable to be a successful doctor.  It won't be perfect, of course, but it can be done.  Resilience is an important trait - and much of the issues we see go beyond the genuinely pathological general depression, manic-depressive, or personality disorders.  WE have perfectly healthy students that have not learned to deal with adversity.

 

Mental health problems are no where above the general population.   People in poor socio-economic situations are way worse off on average.  East of adelaide we are talking drug addictions at extremely high rates, extremely high rates of divorce, high rates of physical abuse.  Those things DO happen among physicians - but no where near the general population average.  IF you think that - you are simply believing the steroetypes doctors give themselves to feel good about themselves as martyrs.  Doctors are less likely to be divorced than almost any profession out there.  https://hms.harvard.edu/news/doctors-and-divorce .  Suicide rates are modestly above that of the general population (something like 24/100000 a year compared to 15/100000) - but it's still quite rare, and once again may have to do with the type of people that choose medicine rather than the profession itself.  The ABSOLUTE difference is small.  In regards to slightly higher depression rates among medical students; once again, you are dealing with a population that has a tendency to self diagnosis or self recognize and seek help (and be around people that can even pick these things up).  So the slight increase may very well be that.

 

I also want to emphasize - MD pay is still really really good.  http://news.nationalpost.com/health/leaked-report-offers-window-into-the-medical-one-percenters-and-growing-concern-over-md-pay-inequity?__lsa=fdb7-e9df  Note how THE AVERAGE radiologist billed 1.6 million a year.  While some do have higher overhead - those that work in hospitals in Alberta (at least half), have close to zero overhead. And remember - provincial tax is lower there, as there is no provincial sales tax.  While I would have thought that the Bentley dealership in Calgary tended to go to oil tycoons - apparently 30% of their sales are to doctors!  Of course, Ontario is much worse compared to Alberta when it comes to physician pay - but it is still fantastic on average.

[indefatigable]

I also want to emphasize - MD pay is still really really good.  http://news.nationalpost.com/health/leaked-report-offers-window-into-the-medical-one-percenters-and-growing-concern-over-md-pay-inequity?__lsa=fdb7-e9df  Note how THE AVERAGE radiologist billed 1.6 million a year.  While some do have higher overhead - those that work in hospitals in Alberta (at least half), have close to zero overhead. And remember - provincial tax is lower there, as there is no provincial sales tax.  While I would have thought that the Bentley dealership in Calgary tended to go to oil tycoons - apparently 30% of their sales are to doctors!  Of course, Ontario is much worse compared to Alberta when it comes to physician pay - but it is still fantastic on average.

 

I'm not sure how much of this post is inflammatory, but to quote from the link (simply to give context to the post - not to engage in a broader discussion of pay):

 

 "But a spokesman for Alberta radiologists — the specialty pegged by the AMA report as earning the most in gross billings and third-most in net pay (in excess of $700,000) — says the document paints a misleading picture.  Diagnostic radiologists’ overhead is not 55 per cent as it states but more like 70 per cent, which would put their after-expenses income around the middle of the pack, says Dr. Rob Davies, president of the Alberta Society of Radiologists."

 

Regarding suicide (from medscape link) : "Of all occupations and professions, the medical profession consistently hovers near the top of occupations with the highest risk of death by suicide."

[older]

The post is inflammatory and lots of information is incorrect, but that's the style. Certainly stirs the pot and provokes interesting discussion.

[ralk]

The biggest issue with you, and I find many others in medicine, is that they so strongly believe that they conditions are unique relative to others.  There have been multiple high profile suicides recently of paramedics.  These true first responders are the ones that first see families hysterical when someone is dead from a stroke or cardiac arrest, a SIDS child, or even a brutal murder or car accident victim. Even ER docs don't deal with that.  The issues police officers, or soldiers, or firefighters go through is often much more acute and personally dangerous than what an MD goes through.  So no - it is not unique.  Dealing with mental health issues is important - but this idea that the issues are unique to medicine is silly.  To top that off - we go through so much to get into medicine - the least the admission process can do is try to weed out those that have mental health issues that may not make them amendable to be a successful doctor.  It won't be perfect, of course, but it can be done.  Resilience is an important trait - and much of the issues we see go beyond the genuinely pathological general depression, manic-depressive, or personality disorders.  WE have perfectly healthy students that have not learned to deal with adversity.

 

Mental health problems are no where above the general population.   People in poor socio-economic situations are way worse off on average.  East of adelaide we are talking drug addictions at extremely high rates, extremely high rates of divorce, high rates of physical abuse.  Those things DO happen among physicians - but no where near the general population average.  IF you think that - you are simply believing the steroetypes doctors give themselves to feel good about themselves as martyrs.  Doctors are less likely to be divorced than almost any profession out there.  https://hms.harvard.edu/news/doctors-and-divorce .  Suicide rates are modestly above that of the general population (something like 24/100000 a year compared to 15/100000) - but it's still quite rare, and once again may have to do with the type of people that choose medicine rather than the profession itself.  The ABSOLUTE difference is small.  In regards to slightly higher depression rates among medical students; once again, you are dealing with a population that has a tendency to self diagnosis or self recognize and seek help (and be around people that can even pick these things up).  So the slight increase may very well be that.

 

I also want to emphasize - MD pay is still really really good.  http://news.nationalpost.com/health/leaked-report-offers-window-into-the-medical-one-percenters-and-growing-concern-over-md-pay-inequity?__lsa=fdb7-e9df  Note how THE AVERAGE radiologist billed 1.6 million a year.  While some do have higher overhead - those that work in hospitals in Alberta (at least half), have close to zero overhead. And remember - provincial tax is lower there, as there is no provincial sales tax.  While I would have thought that the Bentley dealership in Calgary tended to go to oil tycoons - apparently 30% of their sales are to doctors!  Of course, Ontario is much worse compared to Alberta when it comes to physician pay - but it is still fantastic on average.

 

In no way did I say that what physicians face in terms of mental health problems are unique, nor even the most pressing problem in mental health. That's a strawman argument. Moreover, working to improve physician mental health in no way prevents efforts to improve mental health elsewhere - it's a false dichotomy. Saying there are other problems doesn't excuse inaction on this one.

 

I do care about physician mental health specifically for a number of reasons. First, we, as physicians and physicians-in-training, have a lot more control over the factors that contribute to mental health issues than we do for those in other professions. There's not much I can do for paramedics beyond seeing them as I would any other patient. I can't change their job or the conditions they work under. But there's plenty we can do for medical students, residents, and physicians. Medical training is almost entirely in the hands of physicians - we set the standards, the curriculum, and the structure of our medical education. Physicians are largely self-employed consultants in a self-regulating profession - working within a framework of course - but with the independence to set many of our own standards. And physicians are clearly part of the problem - medical students enter medical school with mental health problems fairly typical of those in the general population, but end up higher. We're responsible for that process and can change it for the better.

 

Second, unaddressed mental health issues can impact patient care in a negative and significant way. If we can improve physician mental health, it may have positive secondary benefits for patients, including those with their own mental health concerns.

 

Finally, it's what should be a low-hanging fruit - if we can't manage mental health among those of us who we work with, share similar life circumstances, and common experiences, the chances of us gaining traction among those who live completely different lives seems pretty low. You're a walking example of this. From this and similar threads, you show little empathy for your own peers - is it any surprise that your post history is littered with unempathetic statements towards other groups? Even here, you present an attitude towards an area of London very typical of those who spend no time in that area - one of rampant drug use and abuse. Don't get me wrong, these are problems in that area, but as someone who spends and has spent a fair bit of time east of Adelaide, the region and the people who live there get far worse of a reputation than they deserve, a reputation which only makes thing worse.

 

Your assertion that mental health problems are "no where above the general population" is factually inaccurate. There are many studies and systemic reviews that indicate otherwise. The fact that physicians make a lot of money, relatively speaking, is only the more damning, as high income should be protective. Physicians and physicians-in-training should have lower rates of mental health concerns than the general population, yet have higher.

 

Again, your posts indicate a very superficial, and ultimately incorrect, understanding of mental health. Your comparison to other professions is particularly revealing, drawing contrasts with jobs where trauma - physical or psychological - as though trauma is the only factor in the development of job-related mental health problems. It certainly is a factor, but only one of many. Likewise, management of adversity is a factor, but only one. The assumption you make - and, admittedly, many other physicians do as well - is that mental health problems like depression, anxiety, and burnout, are due to an inability to handle events or others' expectations. If that was true, then it makes sense to blame students for their own lack of resilience, to focus on identifying those who might be more resilient, and to provide training on improving resilience. But that assumption is wrong. Mental health is extraordinarily multi-factorial. For medicine in particular, exposure to traumatic events and perceived high expectations are only part of what contributes to mental health issues among practitioners - and I would argue a small part that we couldn't change anyway. Medicine will always involve dealing with some incredibly difficult circumstances and we should have high expectations of physicians-in-training. Necessary parts of the job don't concern me as a problem. Where the problem lies is in the modifiable aspects - the long, mandatory hours; the lack of adequate training for practically every role a medical student or resident serves in; the general treatment of trainees by physicians; and the lack of continuity or support through all of this. And for this reason, I take full exception to your assertion that I'm buying into a martyr mentality, which I see often from physicians and abhor. Martyrs think they're sacrificing for the benefit of others. I think physicians and physicians-in-training are suffering with mental health problems for the benefit of no one.

[A-Stark]

Unfortunately, some people just can't handle medicine, and the stresses that come with it.  Most people that attempt or commit suicide usually have other issues at play.  Often they can't handle the loss of a relationship, and generally not cope with failure well.

 

[...]

 

Quite frankly, the first 2 years here have been great so far - and while i'm aware 3rd year is more challenging emotionally - it's also self limited to 1 year.  Remember - we all chose this career because it pays alot, is exciting, and has great prestige.  Of course there has to be some catch - at times it will be hard.

 

 

There is a need for resiliency and, above all, a healthy response to stress in medicine. That implies the need for a strong support network, but a historic culture of "be at work unless you're dying" and "don't complain because I used to do 1 in 2 call without post-call days" hardly helps. Medicine lifestyles - especially in training - put strains on relationships and any semblance of work-life balance. That doesn't mean it's impossible, but we do ourselves no service by relying on a few high stakes MCQ exams and an inflexible match that can punt people from one end of the country to the other with little recourse and sometimes fewer supports. 

 

Otherwise, clerkship was pretty much nothing compared to anything you go through as a resident. So, have fun with that. 

 

 

The mental health epidemic thing is also a bit much.  On my FB feed over the last month, i've had posts talking about the mental health epidemic for:  paramedics, nurses, clerking lawyers, law students, pharmacists, police officers, and small time business owners.  In the end - every profession seems to have some sort of mental health epidemic - which in my mind means there are no epidemics.  Just the mental health challenges people have if their disposition and job are a bad mix.

 

I don't know that there is an epidemic of Axis 1 mood disorders in any particular profession, but there must be a healthy system for teaching coping with stress. "Debriefing" is part of this, and I think we're probably better at this than in the past, but there is still room to get better. "Mental health" is indeed a bit of a catch-all term, and I think we can overstate the degree to which DSM-codable disorders are "epidemic" (perhaps "endemic" is more accurate). In any case, medicine is a wide enough profession that it can accommodate almost any sort of personality and "disposition". 

 

 

Urology and ENT have significant medical aspects to their practice - and can essentially set up shop anywhere.   In fact, there are some urologists and ents that practice doing only minor procedures like cystoscopies (that don't have to be public hospital based) or even primarily medical.  Of course it sucks to not have a full surgical practice.  Nephrology is a subspecialty of Internal - those guys can work.  Cardiac surgery I concede is tough - but it's a tiny specialty with a narrow focus (after interventional cardiology basically took tons of their work).  People going into Cardiac surgery know those issues.  Neurosurgery is similar to cardiac surgery - though opportunities in communities like TBay, Windsor, and Sudbury are often present.  For the vast majority of graduates of all specialties - jobs are available.  A truly unemployed specialist is rare.  A few that have been written about in the media almost always have a personality or performance issue that people behind the scenes know about.  

 

A urologist that doesn't perform TURPs, TURBTs, or ureteroscopies to say nothing of open procedures is no surgeon at all. More to the point, there are significant limits to what is possible without an OR and a spinal or GA. I suppose an ENT could stick to scoping in clinic, but it would be hard merely to diagnose and refer for bread and butter stuff like FESS or septoplasty or thyroidectomy. 

 

Similarly a nephrologist without a dialysis unit is like an intensivist without an ICU. 

 

The biggest issue with you, and I find many others in medicine, is that they so strongly believe that they conditions are unique relative to others.  There have been multiple high profile suicides recently of paramedics.  These true first responders are the ones that first see families hysterical when someone is dead from a stroke or cardiac arrest, a SIDS child, or even a brutal murder or car accident victim. Even ER docs don't deal with that.  The issues police officers, or soldiers, or firefighters go through is often much more acute and personally dangerous than what an MD goes through.  So no - it is not unique.  Dealing with mental health issues is important - but this idea that the issues are unique to medicine is silly.  To top that off - we go through so much to get into medicine - the least the admission process can do is try to weed out those that have mental health issues that may not make them amendable to be a successful doctor.  It won't be perfect, of course, but it can be done.  Resilience is an important trait - and much of the issues we see go beyond the genuinely pathological general depression, manic-depressive, or personality disorders.  WE have perfectly healthy students that have not learned to deal with adversity.

 

I am not sure how you would propose that the admission process "weed out" those who have mental health issues. First, having any such "issues" does NOT under any circumstances imply not being "amendable (sic)" to be a "successful doctor". Second, plenty of people in medicine have dealt with adversity in their own lives - perhaps, I'd guess, even somewhat more than the norm. Resiliency is something learned from experience and reinforced with active debriefing and establishment and maintenance of social support networks. 

 

I can assure you that even not being a "first responder" you will see plenty of dead and/or actively dying people, possibly with accompanying "hysterical" families. 

 

Medicine will always involve dealing with some incredibly difficult circumstances and we should have high expectations of physicians-in-training. Necessary parts of the job don't concern me as a problem. Where the problem lies is in the modifiable aspects - the long, mandatory hours; the lack of adequate training for practically every role a medical student or resident serves in; the general treatment of trainees by physicians; and the lack of continuity or support through all of this. And for this reason, I take full exception to your assertion that I'm buying into a martyr mentality, which I see often from physicians and abhor. Martyrs think they're sacrificing for the benefit of others. I think physicians and physicians-in-training are suffering with mental health problems for the benefit of no one.

 

 

One of the major "soft" issues in residency eduction has been the successive drift away from closer "apprenticeship" relationships to the benchmarks of rotations and ITERs and - gag - competency by design. I don't think hours are really that much of an issue apart from a few specific specialties and circumstances. Lack of timely and constructive feedback is a not a trivial problem, though. 

[JohnGrisham]

Not to ask the obvious question, but is UWOpremed actually a med student now? Seen them around for a few years now, and wasn't sure if they actually got in. I sure hope they aren't this troll-like in real life. Otherwise, good luck come rotation.

[ralk]

One of the major "soft" issues in residency eduction has been the successive drift away from closer "apprenticeship" relationships to the benchmarks of rotations and ITERs and - gag - competency by design. I don't think hours are really that much of an issue apart from a few specific specialties and circumstances. Lack of timely and constructive feedback is a not a trivial problem, though. 

 

Totally agree that the drift away from an apprentice-like relationship in medicine is a problem and contributor. Continuity of teaching - especially at the medical student level - is horribly lacking and contributes strongly to isolation during the learning process. I don't think benchmarks and competency-based education are to blame though, at least as concepts. Having defined goals with clear benchmarks and a program ostensibly committed to helping you hit those benchmarks would be a positive for learner mental health. My pre-medical career in healthcare did just that in its clinical rotations, it didn't interfere with the apprentice-like approach, and worked just fine. From a practical perspective... the way programs - both medical schools and residency programs - seem to be approaching competency-based education is to take the bad parts of the old system and then combine it with the easy-to-implement but useless parts of competency-based education. So the apprenticeship connections get lost, but benchmarks end up being poorly defined and no support is really provided to achieve them. Not a great approach.

 

I do think the number of hours is still a factor. When people are working with interrupted sleep schedules and limited ability to recover and reset due to long work weeks on top of it, it's going to add to stress in a way that really can't be compensated for. There's no substitute for sleep when it comes to fatigue, and fatigue absolutely contributes to worsening mental health. I do think the long hours could be a lot more manageable, to the point where they might become acceptable, if a number of other factors fell into place. If residents were well-supported, had clear expectations, had more control over their workflow, etc., then long hours become a lot easier to handle. But, since I don't think those are likely to happen any time soon, and the push continues to be on residents and other learners taking care of their own well-being, then they need resources to do so, and the one resource that's significantly lacking for trainees is time. 

 

Not to ask the obvious question, but is UWOpremed actually a med student now? Seen them around for a few years now, and wasn't sure if they actually got in. I sure hope they aren't this troll-like in real life. Otherwise, good luck come rotation.

 

Apparently yes, they're a second year at Western.

[MountainAmoeba]

I honestly find this so incredibly rude.

 

"The biggest issue with you" you write.

 

What qualifies you to comment on what you perceive to be the largest "issue" someone has? Who invited you to do that?

 

The biggest issue with you, and I find many others in medicine, is that they so strongly believe that they conditions are unique relative to others. There have been multiple high profile suicides recently of paramedics. These true first responders are the ones that first see families hysterical when someone is dead from a stroke or cardiac arrest, a SIDS child, or even a brutal murder or car accident victim. Even ER docs don't deal with that. The issues police officers, or soldiers, or firefighters go through is often much more acute and personally dangerous than what an MD goes through. So no - it is not unique. Dealing with mental health issues is important - but this idea that the issues are unique to medicine is silly. To top that off - we go through so much to get into medicine - the least the admission process can do is try to weed out those that have mental health issues that may not make them amendable to be a successful doctor. It won't be perfect, of course, but it can be done. Resilience is an important trait - and much of the issues we see go beyond the genuinely pathological general depression, manic-depressive, or personality disorders. WE have perfectly healthy students that have not learned to deal with adversity.

 

Mental health problems are no where above the general population. People in poor socio-economic situations are way worse off on average. East of adelaide we are talking drug addictions at extremely high rates, extremely high rates of divorce, high rates of physical abuse. Those things DO happen among physicians - but no where near the general population average. IF you think that - you are simply believing the steroetypes doctors give themselves to feel good about themselves as martyrs. Doctors are less likely to be divorced than almost any profession out there. https://hms.harvard.edu/news/doctors-and-divorce . Suicide rates are modestly above that of the general population (something like 24/100000 a year compared to 15/100000) - but it's still quite rare, and once again may have to do with the type of people that choose medicine rather than the profession itself. The ABSOLUTE difference is small. In regards to slightly higher depression rates among medical students; once again, you are dealing with a population that has a tendency to self diagnosis or self recognize and seek help (and be around people that can even pick these things up). So the slight increase may very well be that.

 

I also want to emphasize - MD pay is still really really good. http://news.nationalpost.com/health/leaked-report-offers-window-into-the-medical-one-percenters-and-growing-concern-over-md-pay-inequity?__lsa=fdb7-e9df Note how THE AVERAGE radiologist billed 1.6 million a year. While some do have higher overhead - those that work in hospitals in Alberta (at least half), have close to zero overhead. And remember - provincial tax is lower there, as there is no provincial sales tax. While I would have thought that the Bentley dealership in Calgary tended to go to oil tycoons - apparently 30% of their sales are to doctors! Of course, Ontario is much worse compared to Alberta when it comes to physician pay - but it is still fantastic on average.

[Sauna]

I honestly find you so incredibly rude.

 

"The biggest issue with you" you write.

 

I'm sorry what qualifies you to comment on what you perceive to the the largest "issue" someone has? Who invited you to do that? NOBODY.

 

Worldstarrrrrrr

[uwopremed]

I'm not sure how much of this post is inflammatory, but to quote from the link (simply to give context to the post - not to engage in a broader discussion of pay):

 

 "But a spokesman for Alberta radiologists — the specialty pegged by the AMA report as earning the most in gross billings and third-most in net pay (in excess of $700,000) — says the document paints a misleading picture.  Diagnostic radiologists’ overhead is not 55 per cent as it states but more like 70 per cent, which would put their after-expenses income around the middle of the pack, says Dr. Rob Davies, president of the Alberta Society of Radiologists."

 

Regarding suicide (from medscape link) : "Of all occupations and professions, the medical profession consistently hovers near the top of occupations with the highest risk of death by suicide."

 

Relying on a spokesman for the Alberta Radiologists to discuss average overhead, is like asking Sean Spicer to tell us the the true meaning behind whatever Trump tweets.  There is ZERO chance the average radiologist has 70% overhead in Alberta.  Almost half are in hospitals (so don't pay for anything except maybe a secretary), and out of hospital radiologists almost exclusively work in large groups, and are able to pool expenses.  Wouldn't trust what they say unless i see the tax returns! :-)  

 

In regards to everything else said above - I do think mental health is important.  I think the idea of a better longitudinal teaching for MD s with a mentor type person can remove the isolation of learning.  But I also think that quite frankly - medicine is a tough job - and people should think really hard before they choose to go into it.  In addition to compassion - one must also have a very thick skin.  Thankfully I have the thick skin, and I'm working on the compassion.

[ralk]

In regards to everything else said above - I do think mental health is important.  I think the idea of a better longitudinal teaching for MD s with a mentor type person can remove the isolation of learning.  But I also think that quite frankly - medicine is a tough job - and people should think really hard before they choose to go into it.  In addition to compassion - one must also have a very thick skin.  Thankfully I have the thick skin, and I'm working on the compassion.

 

Having a "thick skin" usually means being able to withstand criticism. As noted, many people who are dealing with mental health problems in medicine are quite successful, receiving far more praise than criticism. From my experience, compared to medical school, I've received far harsher critiques in just about every job or school setting I've been in. Heck, I've consistently asked for more criticism, as I find it lacking in medicine. So I'm a bit confused, how would a thicker skin help in medicine when it comes to mental health? And to take it further, how do you know that you have a thick skin, and why is that a positive thing?

[indefatigable]

 

In regards to everything else said above - I do think mental health is important.  I think the idea of a better longitudinal teaching for MD s with a mentor type person can remove the isolation of learning.  But I also think that quite frankly - medicine is a tough job - and people should think really hard before they choose to go into it.  In addition to compassion - one must also have a very thick skin.  Thankfully I have the thick skin, and I'm working on the compassion.

 

Increasing compassion, and empathy is not only desirable for a clinician (in my opinion), but also would help with the CanMeds clusters, specifically health advocate - a positive step.  There are numerous areas in London, like old East Village, that have communities that are neglected or have struggling populations.  East of Adelaide is an old stigma, and not justified.  It's not the South Side of Chicago, which in of itself is a broad stereotype.