Things they don't tell you about medicine - an honest review from an MS4

[bruh]

I'm an MS4 who just finished clerkship. I've wanted to apply to a very competitive specialty since the beginning of med school but I'm having serious doubts about that now.

I used to frequent premed101 a lot as a premed and really appreciated some of the advice and help I got on here. I owe a lot of my knowledge during my premed journey to the likes of rmorelan and others who kept me informed. So, I wanted to return the favour in some form to the rest of you premeds. I want to share a few things that I wish I had known before I started medical school. I'll preface that this post may come off cynical, negative, or resentful but that truly isn't my intention to paint that picture. I just want to inform you in the most truthful and honest way before you get yourself into this field.

PART 1: Your AGE does matter

As someone who started med school in their late 20s, I was constantly told that age doesn't matter, and I should do the career that makes me the happiest. There is truth to that, because I still am happy I chose medicine and I wouldn't trade it for anything else. But, age DOES matter. I'm going to start residency in my early-30s and I always wanted to pursue a competitive surgical specialty. But my priorities in life are changing. Do I really want to spend the next 6-8 years of my life working 80+ hours a week making less than $10 per hours with 300K of debt? Do I really want to sacrifice the valuable time I spend with my family, friends, and self-care for a job?

This is something that you will start to to think about even if you don't right now - because your priorities in life will change as you age, and you need to develop the insight now to predict your later priorities. That kid in you who really wanted to be a top-notch surgeon is gonna want to settle down at some point, focus on family, friends, and kids. 

If you're interested in family medicine, then age really doesn't matter. FM residency is only 2 years (3 in a few years!) and warrants you a good lifestyle. 

 

PART 2: You will work harder than ever, and that's the easy part. The TOXIC CULTURE is the hard part.

I'll preface this point with the fact that I received outstanding or exceeds expectations evaluations on all of my clerkship rotations. So, working hard wasn't something I struggled with, and trust me you'll learn what working hard really is. You'll do 26h call shifts with no sleep every 4 days on some of your rotations. At my university, the culture is doing 1 in 3 26h call shifts if you really want to pursue the specialty. But that's really the easy part. All you have to do is guzzle down coffee like a junkie, stay awake, don't complain, and do your task. 

What has really surprised me isn't the work expectations, but the toxic culture and environment I'm immersed in. One of the best things I heard in all of clerkship was from an OB resident who told me "Medicine is a shit funnel. Shit rains down from the top, and you can either pass it down like a funnel, or you can be an umbrella and stop it". I've resonated with that statement so many times. The unfortunate truth is that you will always encounter shit funnels through your training. Sometimes, it's the nurse who's only enjoyment in life is belittling med students. Sometimes, it's the staff physician who had it really rough as a resident so they can't bare seeing you happy. 

I guess I've just learned that I value kindness more than I thought I would. You will experience kindness too, but unfortunately it's the unkind moments you'll remember more. I do think that the culture is slowly shifting in medicine. Most current residents and new attendings are kind, and truly are part of the change in the system. I hope that in the coming years, we will see the culture in medicine truly change for the better.

 

PART 3: Academic medicine will paint a POOR REALITY of medicine for you

You will spend most of your time in medicine in academic sites with academic physicians. This is inclusive of medical school and residency. This is even more pronounced if you are in a large metropolitan city like Toronto. You will live a reality that is niche, specific, and wholly different from all the different realities that exist in the field of medicine. Most people will not pursue academic medicine, and that is something that you don't really take in because you don't even know what community medicine is like. My best advice is to maximize your community medicine experience. The best decision I made in medical school was doing as many community sites as possible, and they have been some of the best experiences for me. 

Academic medicine is important too because it exposes you to more complex and difficult presentations, level 1 traumas, and superb teaching and research opportunities. Those are important too, but it comes with the caveat of often being more intense, busy, and alienating for med students. When you work in academic sites, you will get to do less as a medical student/junior resident and are more often the observer than doer. This also lends itself to a less welcoming environment for med students. You will see cool cases for sure, but all you can do is observe and learn, which is cool but likely inconsequential because most graduates don't do academic medicine anyways.

My point is that med school didn't really show me what I want to do with my actual career. It made it confusing for picking a specialty because my experiences were specific to the sites I did my rotations in. You'll notice this when your classmates start having such vastly different experiences depending on the sites they were at.

 

PART 4: You will discover your TRUE IDENTITY in medicine

This is probably the most meaningful thing I learned in medical school. I have personally developed more than I ever had during my time in med school. The intensity of med school, the vast career options available to you, and the constantly changing environment continuously makes you re-evaluate your identity. You will make great friends in med school and develop close bonds. You will start focusing on other parts of your identity that you never even appreciated were part of you until med school. Suddenly, your only dream of just being a doctor becomes a lot more nuanced. You will realize how valuable your time with your family, friends, and yourself is. This applies to most people. 

For some people, they discover that medicine is really all that they dreamed up to be. Their passion of being a physician and treating patients becomes reinforced. They study, work, and research harder than everyone else, and don't need as much emphasis on other aspects of their social life. Those people will become neurosurgeons and cardiac surgeons. This is not something that you really take in until later. Most people start medicine tantalizing themselves with the idea of becoming some world-renowned doctor then they learn how much they value other parts of their identity - this applied to me and many many of my friends in medicine. 

 

BOTTOM LINE: All of the above will both help and confuse you in CHOOSING A SPECIALTY to pursue

The bottom line is that you will develop personally through medical school. You will experience so many things. Some you enjoy, some you loathe. You will make some amazing connections, but also some hurtful ones. These experiences will help narrow down how you want to live the rest of your life, but they will also confuse you if you're passionate about medicine AND your personal life. 

Residency is long, and for the surgical specialties, there is always stories of people who drop out, transfer, or are unhappy throughout. So, yes, there is a light at the end of this tunnel, but sometimes the tunnel is too dark and too long to be worth it. Don't think that just because you're a strong, resilient person, you are immune to the rigours of medicine. There are a lot of resilient, brilliant people in medicine, and all of us get tested in this journey.

If you think that you will be happy as a family physician, then you likely won't have as much of a quarter-life crisis as the ones who want surgical specialties. You just have to get through med school and a short residency which will warrant you a more relaxed and comfortable life. However, if you are someone like me who has always wanted to be a surgeon, your values and ideals will be challenged greatly, and you should know this now so that you are prepared for what lies ahead. Overall, I do not regret pursuing medicine, and wouldn't have it any other way. There are beautiful moments when I get to help a patient and make a difference. I just wish I knew more and was prepared for what lied ahead.

[Bobthebuilder]

The culture. This.

I'm 33. Started med school last year. Been a hospital pharmacist for 5 so I was immersed in this. Also, had been in the army reserve for around 9 years.

To me medicine and healthcare in general is probably as toxic as military culture. At least, in the Armed Forces they didn't try to hide their toxicity behind interviews supposed to select empathetic individuals or with hypocritical classes supposed to teach how to act with your peers while also allowing toxic surgeons to continue harassing anybody in their direct environnement. (I'm exaggerating...but barely)

I can take it. I got force fed toxicity by the army but I was surprised at the lack of kindness in this field. That's all. 

Bob

[bruh]

34 minutes ago, Bobthebuilder said:

The culture. This.

I'm 33. Started med school last year. Been a hospital pharmacist for 5 so I was immersed in this. Also, had been in the army reserve for around 9 years.

To me medicine and healthcare in general is probably as toxic as military culture. At least, in the Armed Forces they didn't try to hide their toxicity behind interviews supposed to select empathetic individuals or with hypocritical classes supposed to teach how to act with your peers while also allowing toxic surgeons to continue harassing anybody in their direct environnement. (I'm exaggerating...but barely)

I can take it. I got force fed toxicity by the army but I was surprised at the lack of kindness in this field. That's all. 

Bob

I've heard the military training analogy and can now really appreciate how it truly feels to experience it.

At least in military training the bonds you develop with your peers are unmatched to any other field, or so I've heard. 

To me, the worst outcome of all of this is that competent, amazing people who want to become surgeons are choosing to not pursue it because of the toxic culture. I know of many of my classmates who gave up on surgery solely because of this and now they're in a limbo of uncertainty about what to do with their life, or have chosen lifestyle specialties over their career ambitions because they lost the passion they had when they started medicine - sadly I may be one of those people come CaRMS time.

 

[Balsamico]

Thank you for the honest review! Stop thinking that enter medicine is a dream come true...sometimes it's a nitgtmare, I could experience that all my life with my 2 parents who are surgeons and not always happy with their choice...Still Im trying enter like crazy...so weird that pressure of medicine in doctors family without even having pressure from our parents, but just by the situation of our family.

[1D7]

3 hours ago, Bobthebuilder said:

The culture. This.

I'm 33. Started med school last year. Been a hospital pharmacist for 5 so I was immersed in this. Also, had been in the army reserve for around 9 years.

To me medicine and healthcare in general is probably as toxic as military culture. At least, in the Armed Forces they didn't try to hide their toxicity behind interviews supposed to select empathetic individuals or with hypocritical classes supposed to teach how to act with your peers while also allowing toxic surgeons to continue harassing anybody in their direct environnement. (I'm exaggerating...but barely)

Well to be fair, the reason they are instilling this in the new generation is because they can still be taught and molded. You're not going to easily change the attitudes of people past a few years into their career.

For someone who has some decent sense on how to behave with other people and on social media it is pointless, but these sorts of classes are for those who don't.

 

[1D7]

2 hours ago, bruh said:

To me, the worst outcome of all of this is that competent, amazing people who want to become surgeons are choosing to not pursue it because of the toxic culture. I know of many of my classmates who gave up on surgery solely because of this and now they're in a limbo of uncertainty about what to do with their life, or have chosen lifestyle specialties over their career ambitions because they lost the passion they had when they started medicine - sadly I may be one of those people come CaRMS time.

 

To some extent there is a desired self-selection in this environment. If you don't want it that deeply, you probably won't tolerate it when asked to do a full day of consults/clinic after 24 hr call. Despite this, if anything surgical specialty interest remains over represented in medical school. Pretty much every surgical specialty has filled after 2nd round to my memory, and the majority after the 1st round. I'm not defending it, but there's not any strong reason to change (if anything it will remain in status quo).

I agree with the general gist of your post.

[Bambi]

For CaRMS, I applied to a competitive surgical specialty, 40 interviewees for 3 spots. I was the least qualified interviewee and was selected due to my soft skills, i.e., collaborative team player, friendly, etc. as I was deemed to be a good fit, whereas not one of the may gunners with a seemingly better profile were accepted. Residency was extremely hard work. During residency, there was one particular member of staff who was threatening and suggested he could derail my career. This was a rather stupid move on his part. To solve this seemingly toxic issue, I made a strategic decision with a preemptive strike and I totally neutered him, and rather quickly! Otherwise, I did not experience a toxic culture and environment, quite to the contrary. I enjoy my practice in a community hospital, have a good work/life balance and the long journey was well worth it.  

[Bobthebuilder]

On 8/19/2023 at 2:48 PM, 1D7 said:

Well to be fair, the reason they are instilling this in the new generation is because they can still be taught and molded. You're not going to easily change the attitudes of people past a few years into their career.

For someone who has some decent sense on how to behave with other people and on social media it is pointless, but these sorts of classes are for those who don't.

 

I agree. I think you are right...but I've seen some weird shit from older attendings less so from younger ones. Like 2 years ago, a cardiologist tried breaking into hospital pharmacy and threw a fit cause pharmacist refused to provide him with a nitro pump for his fishing trip. (I'm biaised tho, pharmacist is a friend of mine). Like bruv, they were making em different back in the days. 

[deeman101]

RE: toxic culture, I think you have to keep in mind that a) this job takes over way more of your life than many others and most often this was not anticipated, b) the education process selects for multi-talented individuals and then gradually strips them of most of their activities they find joy in over time, c) these are still very smart people with generally very good interpersonal skills (i.e. high insight, adept verbal/nonverbal expressive and receptive communication, etc....not necessarily friendly social skills but the kind that makes them passive aggressive pain in the butt). And because the job is overrepresented in their lives they take out their frustrations on those around them at work. Particularly those subordinate to them. 

That said, once I accepted and learned to look past people that are full of negative energy and are a waste of my time, I met many amazing people that I look forward to spending time with on the job. 

[bearded frog]

OP I think your opinions are helpful and valid, but this is extremely YMMV territory... and I think somewhat unique perhaps to surgical subspeciality gunners. You didn't specify where you did medical school, I did not counter much toxicity at all in my medical school (caveat: I am in a privileged majority population) or my residency, and I applied to a compeditive non-surgical specialty. I do agree that while age/maturity is not a factor for medical school or doing medical school itself, it should play a role in choosing a residency.

[premed72]

Overhearing a nurse say all med students are useless in the midst of post call rounding after a 24 hour banger hits different 

[robclem21]

8 hours ago, premed72 said:

Overhearing a nurse say all med students are useless in the midst of post call rounding after a 24 hour banger hits different 

The unique thing about being a medical student is that everybody outside of medicine (including other allied health professionals) truly do not know what it means to be a medical student. When most people think about medical students, they draw on their knowledge from their friends in undergrad who were the most smart, keen, motivated, eager, and intense students they knew. Others get their opinions from medical shows or other media where medical students often have capabilities that extend way beyond that of a real life medical student. Because of this, the value, experience, and expectations of medical students is shifted to the extreme where many think they should be able to do and understand everything a well experienced physician should do. Nearly all medical students are not able to meet this expectation and it leads to many in the field thinking medical students are "useless" or "stupid". There are many times where the efforts of medical students can be really useful (good information gathering, taking more time to talk to patients, reviewing and reporting vitals and lab work to the team), but often these goals don't align with nurses goals (which is to basically get orders, get the work done, and resolve patient issues immediately), and so comes off as being useless. Looking back at my own medical school experience and dealing with medical students now, the fact is it generally requires more work to have students around as all their work needs to be double checked, and they need more supervision, and generally can't do anything independently (and this is okay). The difference being that residents and physicians recognize that level of training whereas many nurses, etc. don't realize that medical students are VERY early in their training and are still learning. This is somehow viewed differently from nursing students who many nurses would never call "useless".

While I am not justifying these types of comments, and in any other workplace would be 100% inappropriate and likely reported to HR, there is an element of needing to develop a bit of thicker skin as a medical student. It is important to understand that these comments come from both a place of frustration, fatigue, lack of understanding of your role and skill set, and in some cases, poor interactions with previous medical students who might have been arrogant or rude to them. This also stems from years where many physicians have been rude to them and they are simply looking for "payback" over those who they have any element of control over.

The point being, while not necessarily appropriate, its important to know when its better to learn to brush off these comments and self-appreciate your own value and level of training. This does feed back into the idea that the culture of medicine is a bit toxic, but these interactions in my experience are the vast minority. Loud angry voices always stand out over quiet, kind ones. You just need to shift the mindset of which ones you focus on and ignore the rude people who hate their life.

Ultimately, everyone needs to try to be nicer in healthcare.

[p12345lu]

9 hours ago, robclem21 said:

This also stems from years where many physicians have been rude to them and they are simply looking for "payback" over those who they have any element of control over.

Kiss up, punch down. You pick on someone you know who can't fight back so that you can have a quick source of power that temporarily relieves your insecurities. I haven't had much experience being on the wards as I'm just entering clerkship but this would always happen in grad school where grad students would rip on pre-meds and med students for shit that even grad students are guilty of and yet receive no backlash. 

[deeman101]

21 hours ago, premed72 said:

Overhearing a nurse say all med students are useless in the midst of post call rounding after a 24 hour banger hits different 

They're just haters. And also misguided. My wife was in nursing school (now a GP) and on the first day her class was told they'll know more than a PGY1 by the time they graduate nursing school. It didn't turn out to be true.....

 

I dealt with 35+ year experienced nurses that unfortunately did not know nearly as much as they thought they did and had to play 3D chess on them to manage patients properly. But to be fair I've dealt with other nurses that were actually smarter than most residents they deal with but always were respectful. In fact they'd do the 3D chess thing back on those residents to get them to do the right thing. I asked one of them not to retire until I was done residency, lol. She retired 3 months after I finished after 44 years.

[bruh]

On 8/24/2023 at 5:57 AM, robclem21 said:

Loud angry voices always stand out over quiet, kind ones. You just need to shift the mindset of which ones you focus on and ignore the rude people who hate their life.

Ultimately, everyone needs to try to be nicer in healthcare.

While I agree it is very important to have thick skin and ignore all the negativity, that one loud angry voice is the one that fosters a negative environment not just for the med student but everyone involved in the OR, including the staff surgeon. The other day I was in the OR, and while watching the surgery and not doing much, I figured I'd just reflect on the atmosphere. The circulating nurse was a truly terrifying presence. Every other nurse was a slave running around, nodding and bowing to her while getting yelled at and spoke to like they're lesser human beings. The residents got sighs and eye rolls from her, and the staff surgeon got passive aggressive comments. Everyone was tense, everyone spoke and moved in calculated ways, thinking if they will be punished for it. What a miserable environment...

I just wanted to break out of character for a moment and ask the nurse "why do you have so much anger and resentment? Why do you have such a persistent frown on your face? have you never experienced love and kindness in your life?".

Granted, this only happened in that OR and the rest of the days were more positive experiences. But the job as a surgeon is already tough, the hours are already long and there is already so much you're responsible for. The only thing we do have a control of is our attitude, manners, and the way we treat other people. It's disappointing to see so much toxicity in our field, and all we do is stay "strong and have thick skin" when in reality I don't think that make us any happier in life - I'm not surprised to see that many strong, resilient residents are unhappy in surgery. 

[bruh]

On 8/23/2023 at 10:39 PM, bearded frog said:

OP I think your opinions are helpful and valid, but this is extremely YMMV territory... and I think somewhat unique perhaps to surgical subspeciality gunners. You didn't specify where you did medical school, I did not counter much toxicity at all in my medical school (caveat: I am in a privileged majority population) or my residency, and I applied to a compeditive non-surgical specialty. I do agree that while age/maturity is not a factor for medical school or doing medical school itself, it should play a role in choosing a residency.

I definitely may have had a bias as someone interested in an intense surgical specialty. Also, I did most of my rotations in notoriously busy level 1 trauma sites known to have very intense environments.  Those factors definitely played a huge part in my perception of the field, which is definitely disappointing because it makes me question my choices. Maybe training in other cities, or different sites is different, but how am I going to get exposure to that unless I commit my elective time to those experiences? 

I will say, however, that my experience in peds, psych, and IM was vastly different. There is so much more kindness and positivity in those specialties than you find in surgery.

[robclem21]

4 hours ago, bruh said:

While I agree it is very important to have thick skin and ignore all the negativity, that one loud angry voice is the one that fosters a negative environment not just for the med student but everyone involved in the OR, including the staff surgeon. The other day I was in the OR, and while watching the surgery and not doing much, I figured I'd just reflect on the atmosphere. The circulating nurse was a truly terrifying presence. Every other nurse was a slave running around, nodding and bowing to her while getting yelled at and spoke to like they're lesser human beings. The residents got sighs and eye rolls from her, and the staff surgeon got passive aggressive comments. Everyone was tense, everyone spoke and moved in calculated ways, thinking if they will be punished for it. What a miserable environment...

I just wanted to break out of character for a moment and ask the nurse "why do you have so much anger and resentment? Why do you have such a persistent frown on your face? have you never experienced love and kindness in your life?".

Granted, this only happened in that OR and the rest of the days were more positive experiences. But the job as a surgeon is already tough, the hours are already long and there is already so much you're responsible for. The only thing we do have a control of is our attitude, manners, and the way we treat other people. It's disappointing to see so much toxicity in our field, and all we do is stay "strong and have thick skin" when in reality I don't think that make us any happier in life - I'm not surprised to see that many strong, resilient residents are unhappy in surgery. 

I spend >99% of my clinical time in the operating room, and while there are definitely off-days where people are on edge, or in a bad mood, I can honestly say I have only experienced a situation as bad as the one you are describing on a handful of occasions in the past 10 years, and almost universally from a surgeon and never from a nurse. I have excellent relationships with the peri-operative staff and most of my negative experiences fall on a handful of individuals (surgeons, nurses, anesthesia, admin, etc.) who are well known by everyone to have that demeanour.

Aside from the fact the operating room can at times be a very high risk, high stress, high stakes environment, sometimes it just comes down to the fact that some people are miserable jerks. You'll find that in any field and not just medicine. It is more prevalent in medicine because of the long hours, negative patient outcomes, huge level of responsibility, angry, demanding patients and families, issues with family because of commitment to work, unhealthy sleep and eating habits, running a small business, etc. However, in this or any career where you plan to spend 30+ years, you cannot let a single person dictate your worth or your happiness. It simply isn't worth it. You have to find happiness in your career by being satisfied with the job you do, the difference you make in peoples lives, and the positive relationships you build.

Expect confrontation in surgery if it is what you want to do for the rest of your life. Over time you will learn how to handle it better and focus on things that matter.

[mohammad]

2 hours ago, robclem21 said:

I spend >99% of my clinical time in the operating room, and while there are definitely off-days where people are on edge, or in a bad mood, I can honestly say I have only experienced a situation as bad as the one you are describing on a handful of occasions in the past 10 years, and almost universally from a surgeon and never from a nurse. I have excellent relationships with the peri-operative staff and most of my negative experiences fall on a handful of individuals (surgeons, nurses, anesthesia, admin, etc.) who are well known by everyone to have that demeanour.

Aside from the fact the operating room can at times be a very high risk, high stress, high stakes environment, sometimes it just comes down to the fact that some people are miserable jerks. You'll find that in any field and not just medicine. It is more prevalent in medicine because of the long hours, negative patient outcomes, huge level of responsibility, angry, demanding patients and families, issues with family because of commitment to work, unhealthy sleep and eating habits, running a small business, etc. However, in this or any career where you plan to spend 30+ years, you cannot let a single person dictate your worth or your happiness. It simply isn't worth it. You have to find happiness in your career by being satisfied with the job you do, the difference you make in peoples lives, and the positive relationships you build.

Expect confrontation in surgery if it is what you want to do for the rest of your life. Over time you will learn how to handle it better and focus on things that matter.

I can't imagine the roles reversed. An attending doctor saying the nursing student was "useless" or "stupid". The double standard for medical students and residents vs allied health is unfair. The same can be said about expectation for attending to buy snacks and to treat everyone else to lunch. They want the best from doctors but will often step on and insult any medical trainee.

[hero147]

6 hours ago, bruh said:

I definitely may have had a bias as someone interested in an intense surgical specialty. Also, I did most of my rotations in notoriously busy level 1 trauma sites known to have very intense environments.  Those factors definitely played a huge part in my perception of the field, which is definitely disappointing because it makes me question my choices. Maybe training in other cities, or different sites is different, but how am I going to get exposure to that unless I commit my elective time to those experiences? 

I will say, however, that my experience in peds, psych, and IM was vastly different. There is so much more kindness and positivity in those specialties than you find in surgery.

It's also hard to compare. I hate to generalize, but the personality types are different. Surgeons are usually more direct and will tell you if they hate you. IM I find is more "talk about you behind your back" kind of thing. Everyone in IM has an idea of who they don't like in x/y/z specialty. 

Peds always seemed kind of fake to me. But then again, maybe everyone there really is bubbly at every hour of every day. Psyche I think has a healthy medium but it also attracts less of a gunner or type A personality than surgery or IM. 

Honestly, I have only seen one circulating nurse who was fuming over 5+ years of clinical medicine working in the OR. It's not common. Besides, the circulating nurse is the one usually taking orders from people. 

[blah1234]

I've posted this before but I think we don't do a good job conveying what the medical training path is like to undergraduate students. I came into medicine as a second career after being another professional and I can say that residency was the hardest thing I've ever done. Although I really enjoy what I do now, I'm not sure I would do it over again knowing what I do now. I can safely say now that I probably would've been just as happy in my other profession and I would've been financially further ahead. The training asks for a lot, especially as you get older and have competing priorities.

I think medicine has a unfortunate combination of high student debt, long training time, extended working hours, relatively high stakes, and low pay during the training period. While I had to work long hours in my other profession, I at least made a good income during that time and working through the night was relatively rare. I think many students and staff feel resentment to medicine because the training is grueling without the carrots that other fields may have and it's very difficult to leave medicine once they realize they dislike it due to the heavy costs incurred during training. 

It's also very easy to imagine what your medical journey should be when you're a young student. However, people's priorities change as they get older (e.g., dating, illness, children, etc.) and the amount of sacrifice that the training can require can cause tensions in your personal life. I know a lot of people that have made significant personal sacrifices to complete their training and they still feel some bitterness years later. None of these challenges are unique to medicine but I don't think students are always aware how challenging the upcoming years could be in medicine. Things also don't become perfect when you become staff as many people can be unhappy with elements of their staff life such as practice location.

Overall, I think many people are satisfied with medicine as a career including myself. However, I know a lot of people that are not happy with their career choice. Many people can develop dissatisfaction with their careers regardless of the underlying field. I think medicine is just unfortunate that people find out their incompatibility when it becomes too late to leave. In addition, the medical training timeline is so long now compared to other professions that it can feel like you're trapped for a decade until you finish all your training. Now that we don't have a rotating internship, there's no easy off ramp for students. I wish there was a better way to help students understand their future but I'm not sure what that would be.

I would advise students to shadow healthcare professionals to get some semblance of the work environment. It's not perfect but I've met a surprisingly large amount of students that had no idea of the working environment like how many physicians worked through the night.

I would advise medical students to carefully think about their specialty choice. Often, clerkship is a easy version of residency and most students can push themselves hard for a month straight. Working difficult conditions for multiple years is a different story altogether. I've helped many residents with program transfers and one of the common themes is that they didn't realize how intense the multiple years of difficult training could be.

Finally, I would advise graduates to be financially responsible. It's very easy to believe you can work long & hard hours for the rest of your life, but the reality is that you probably can't. I've seen colleagues fall ill, or burn out when they were relatively young. It can be personally stressful if you are no longer able to work enough to manage your obligations. I think the stereotype that MDs are bad with money is quite true. Those financial troubles can also be the source of a lot of resentment in the field.

[bruh]

7 hours ago, robclem21 said:

I spend >99% of my clinical time in the operating room, and while there are definitely off-days where people are on edge, or in a bad mood, I can honestly say I have only experienced a situation as bad as the one you are describing on a handful of occasions in the past 10 years, and almost universally from a surgeon and never from a nurse. I have excellent relationships with the peri-operative staff and most of my negative experiences fall on a handful of individuals (surgeons, nurses, anesthesia, admin, etc.) who are well known by everyone to have that demeanour.

Aside from the fact the operating room can at times be a very high risk, high stress, high stakes environment, sometimes it just comes down to the fact that some people are miserable jerks. You'll find that in any field and not just medicine. It is more prevalent in medicine because of the long hours, negative patient outcomes, huge level of responsibility, angry, demanding patients and families, issues with family because of commitment to work, unhealthy sleep and eating habits, running a small business, etc. However, in this or any career where you plan to spend 30+ years, you cannot let a single person dictate your worth or your happiness. It simply isn't worth it. You have to find happiness in your career by being satisfied with the job you do, the difference you make in peoples lives, and the positive relationships you build.

Expect confrontation in surgery if it is what you want to do for the rest of your life. Over time you will learn how to handle it better and focus on things that matter.

I'm very happy to hear that you almost never experience days where people are in a bad mood or on edge, but that has not been my experience or my colleagues who I am close to. I am not exaggerating when I say at least twice a week I encounter a miserable OR atmosphere. I'm not a whiny soft little kid to think any time someone is being direct they're being jerks. I think some people get acclimated to the assholes in the OR. Even I think I'm getting used to it. Also, I see the staff surgeons sometimes befriend the tough nurses so they can be on their side and not deal with their BS. I've also seen complete denial and shrugs from those who are toxic themselves. If you asked the moronic jerk whether they think there is toxicity in the workplace they'd just look at you with disgust and tell you "what?? no, I have no idea what you're talking about". I have had friends of mine bring up these issues to their senior residents or staff and were fully dismissed as hearsay/false news. 

My point is it's not a good idea to downplay the fact that there is a lot of toxicity, unhealthy, unkind behaviour in surgery. Maybe I'm living in a different reality, which I might be because I did most of my surgery and sub surgery rotations in a level 1 trauma centre with notoriously intense staff. But my experience is absolutely real - for me and many of my classmates toxicity in surgery has not been rare at all. But you are in Mac, which I have heard has really good healthy culture even in surgery, so it's possible that there truly is a huge divide in our experiences. 

[deeman101]

23 hours ago, bruh said:

I'm very happy to hear that you almost never experience days ....

Bad working environment is for the most part independent of specialty and level of care of the hospital. It's the people that make or break a working environment. Level 1 trauma center or not....by the way almost every medical school is based around a level 1 trauma center. Hamilton included. I've worked in three level 1 trauma services in Canada and at worst the bad vibes in the worst of them was annoying but ignorable. My absolute most insufferable toxic culture experiences has actually been in family medicine rotations in medical school and residency. Not from my genSx, uro, N.Sx rotations. Or even when I did an elective in anesthesia, where you might be looked down on by your surgical colleagues your entire career.

Your experience is valid and your grievances with your situation can be real, but projecting it on others and taking issue with their more positive experiences is not constructive. If it really bugs you, then develop your leadership skills because often the culture is set from the top and one day you might be in a position to do that yourself. 

 

[Edict]

On 8/28/2023 at 4:58 AM, bruh said:

I'm very happy to hear that you almost never experience days where people are in a bad mood or on edge, but that has not been my experience or my colleagues who I am close to. I am not exaggerating when I say at least twice a week I encounter a miserable OR atmosphere. I'm not a whiny soft little kid to think any time someone is being direct they're being jerks. I think some people get acclimated to the assholes in the OR. Even I think I'm getting used to it. Also, I see the staff surgeons sometimes befriend the tough nurses so they can be on their side and not deal with their BS. I've also seen complete denial and shrugs from those who are toxic themselves. If you asked the moronic jerk whether they think there is toxicity in the workplace they'd just look at you with disgust and tell you "what?? no, I have no idea what you're talking about". I have had friends of mine bring up these issues to their senior residents or staff and were fully dismissed as hearsay/false news. 

My point is it's not a good idea to downplay the fact that there is a lot of toxicity, unhealthy, unkind behaviour in surgery. Maybe I'm living in a different reality, which I might be because I did most of my surgery and sub surgery rotations in a level 1 trauma centre with notoriously intense staff. But my experience is absolutely real - for me and many of my classmates toxicity in surgery has not been rare at all. But you are in Mac, which I have heard has really good healthy culture even in surgery, so it's possible that there truly is a huge divide in our experiences. 

Part of it is the nature of the work we do though. The amount of time it takes to train a surgeon, anesthesia and OR nurses is high enough that you can't replace them easily, and the high stress, intense, emergency nature of the work for a lot of surgery (not all) does mean that you need those types of personalities who can thrive. Those personalities are going to be perfectionist and demanding, it goes with the job. 

I think you will get used to it overtime, we all have to get used to the system to stay in it, very few people fit the system perfectly from day one. 

[Arztin]

I'll just add one more thing.

If you think getting in med school (or being a MD) will make you happy - nope it doesn't.

[IMislove]

2 hours ago, JohnHopp said:

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This is the way