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What They Don't Tell You Before Getting Into Medicine.


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Well into medicine now, I find myself regretting the day I ever decided that medicine would be my career. Many of my colleagues feel the same way, but I can only speak for myself. The reason for this post is not to deter anyone from entering medicine, but to hopefully have some people deeply consider their motives and desires for entering this profession before committing themselves. I honestly believe that I just didn't have nearly enough information when I chose medicine. Or perhaps I did, but my ideals may have forced me to persevere. Years from when I decided, I can't explain how I never saw this earlier. 

 

But it doesn't matter now. I've decided to leave the toxicity of this profession. I've decided to give up the ability to seriously help others, the respect, the income, and every other benefit medicine offers. I've decided to give it up and take my life back. My life is worth it. 

 

Maybe these next few points will fall on deaf ears, but perhaps not. However, I feel an obligation to tell you, the younger generation not yet committed to this life, as no one did for me. Please ignore the fact that this is my first post under this handle. I was once active on these boards, and many know my real life alias of my regular handle. Those people, I'm sure, will find out eventually. But it isn't the time yet.

Hear me out.

 

Medical school starts out like a dream come true. The parties, the 100 odd friends you basically get given to you, the camaraderie, and the apparent lack of difficulty of the subject matter. It sucks you in and consumes you. I thought I had it made. But then come the professionalism talks (repeated, over and over). They drilled it into us that we are absolutely privileged to be a part of this profession. They tell you about how we are held to a higher standard, how we must conduct ourselves to the public. At first, it all seems fine. Why the hell would I care? I've obviously conducted myself pretty decently up until this point in life. I didn't really feel privileged, though. I worked my ass off to get here. Early mornings, late nights, ignoring friends, rinse and repeat. I earned my seat.

 

But then they start to drill it into us even more, and the message becomes very clear: We, as people, are not important. Our feelings, marriages, kids are not important. What is important is our patients, full stop. And they make you believe them by telling horror stories of medical students gone by who made the slightest of mistakes, and are now flipping burgers in the hospital cafeteria. They accomplished their mission: they put the fear of God into us, made us walk on eggshells, and made it so we always remember our "privilege" if ever we second guess ourselves, or think about having one too many drinks at the bar for fear of doing something stupid while drunk. God forbid we let loose on a Friday night. But still we persevered.

 

I would be lying if I said the first two years of medical school taught me nothing. It taught me to care about the community and be involved in it, even if at the expense of my own personal life. I enjoyed being a part of it, and being of benefit to those less fortunate. That feeling kept me going.

 

And then clerkship started. Clerkship was hell. Plain and simple. Think of the entirety of clerkship as an audition. You need to be "on", every single day. You need to say "thank you" when someone sh*ts all over you. And believe me, they will. If you work with any preceptors over the age of 40, they will have grown up in a time that promoted shame-based learning. And, like domestic abuse, the cycle of abuse in medicine also self-perpetuates. I still remember the first time I was humiliated by an attending. It was in an operating room on my surgery rotation, and I was 6 questions into a "pimping" session (http://jama.jamanetwork.com/article.aspx?articleid=2474430). I got the 6th wrong. The preceptor made sure I knew I was an idiot. In front of everyone: circulating nurse, scrub nurse, resident, anesthetist, and, worst of all, an AWAKE patient under spinal anesthetic (to this day, I will never forget that the reason you remove both the head of the pancreas and the duodenum in a whipple procedure is that they share an arterial supply). This is common, so don't be surprised by it. You will be shamed on a daily basis, unless you are the lucky 10% of students whose attending isn't an absolute psychopath. Prepare yourself for it.

It will teach you to be tough, or it will break you down. Students regularly take a year or two off in the middle for various reasons, but mostly mental health issues related to school. 

You WILL be on call. 1 in 4 usually. 26 hours straight, still always "on". Auditioning. Always auditioning. 

You are still fighting for a career at this point. You do everything you can for a good comment on your "MSPR", basically a report card that CaRMS programs read when you are trying to apply for residency. Even one unfavourable comment can sink your battleship. Doesn't matter if you are applying for surgery and the bad comment is in peds. It will sink you. And even when you are a superstar, and do 80% of the attending's work for them, they may still write a generic one liner: "keen student, shows up on time". Might as well have just asked you to come in so they can slap you on the face directly.  So prepared to work hard and look "keen", even if you absolutely hate "well child" visits in outpatient pediatric clinics. Prepared to get sh*t on, and to respond with "Thank you, sir. Please sir, may I have another?". Any other response can cut your career short. And the MD without a residency is useless, unless your entire goal was to get "Dr" on your credit card (which I am aware, now, that you can just request that even if you DO flip burgers). 

 

So you've shouldered your way to the end, decided on a specialty (in what is not nearly enough time, as you have to arrange electives basically before you have exposure to most specialties), and sucked enough D to get some decent reference letters. Hopefully, at least. You don't get to see them.Then comes CaRMS time. Spending ridiculous amounts of time and money preparing personal letters, trying to convince every program in the country why you think theirs is the best, and why they should pick you. And then the waiting game, and you still might go unmatched, and be left without a job. Hopefully an unmatched student can come give you the personal experience of the agony of that experience, and enlighten you in that regard.

 

And then residency comes along. I won't repeat everything I said about clerkship. But a summary: it's clerkship on crack. More work, more hours (80+/week), more responsibility, more getting shit on. The one upside is you now give zero f*cks about what people think about you. You got your career, unless you are in the 80% of specialties where jobs are now scarce after residency, so you have to be well liked. HAH. It never ends. The nurses also don't treat you like absolute sh*t anymore. You now outrank them. Tangential side note: never believe the nurse's charting resp rate. They literally never count it, and always report it as 18 or 20. Because it's so hard to watch a guy's chest move for 20 seconds and multiply by 3. Oh well.

 

Finally, you are a royal college physician. Now you have to go interview for jobs, 13 years from when you graduated high school. If you picked ortho, or any of the other surgical specialties, be prepared to locum, or work somewhere you don't want to work. The old guys won't retire, and there's no OR time for the fresh new grads whose hands don't shake like a reluctant bride at the altar. And be prepared to deal with the endless politics of medicine. Everyone has a chip on their shoulder. Everyone. You still work a ton of hours, and still get treated like sh*t. Only this time, it's the patients that walk all over you. Dr Google always knows more than you, according to them. Every patient has a nurse friend that thinks you should manage their disease in a certain way. Good for them.

 

And don't you even think of trying to convince them that they are wrong. Come off as offensive in any way, and you will get a complaint to your respective college: our "self regulatory" body. They literally only exist to "protect the public" from us deadly doctors. Our motives must be so sinister. If ever you think a patient is batsh*t, bring a chaperone to the encounter so you can prove your side of things. And document, document, document. 
 

It all wears on you after a while. It wore the shit out of me, and continues to. There is a reason physicians have a suicide rate almost double** the general population. Our addiction rates are 20-25% compared to the 15-20% of the general population. Eating disorders, depression, anxiety, etc... You could argue this is because of the personalities that enter medicine are predisposed to mental health issues. Maybe. But medicine takes a tangible toll, and is solely responsible for at least some of the cases. This is not to mention the divorces, and being absent from the lives of your children. Your spouses and kids deserve you too, they deserve you more than your patients. Don't forget that they sacrifice in order for you to do this job. Interestingly, surgeons have the lowest addiction rates in medicine, but the highest divorce rates. Pick your poison.

 

If you know you can withstand all this, then all the power to you. People need us. We genuinely do good. We help people, and I would by lying if I said that I didn't get an enormous amount of satisfaction from this fact. 

 

But if you think that this road may cause you more trouble than it's worth, than I urge you to consider deeply your decision to pursue this career. For many, it is more trouble than it's worth. It was, for me. I just wish I realized it earlier, before I paid the high price in my personal and family life. No longer, though. 

 

After all this time, I have decided to walk away, to cut my losses and turn to something else. I've had a good run, but all good things come to an end. 

Again, I don't mean to purposely discourage people from medicine. I just want you to know the TRUTH so you can make an informed decision for yourself. The same informed decision we always say our patients should make. Why should we be any different, any less?

 

Regardless, good luck in your future endeavours. If you choose medicine, I hope that it gives you what you need each and every day. If you don't, no one will give you fault.

 

Consider dentistry, though.

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I've heard similar stories from a couple of newly graduated doctors about this process and it's crazy how much shit you have to deal with. One of my good friends told me "we work, research and study our butts off to apply and live this dream of getting accepted into medical school but we don't realize what comes next until we're thrown into it". Obviously, this is your story and people's experiences will be different but this is a good thing to put out there for future pre-meds. I salute you for turning to something else after the whole ride!

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This is exactly why I took my dental school offers over medical school offers. When I had to decide between the two, I talked to all my medical school friends/friends in residency and I could tell all of them had regrets choosing medicine as a career but no one had the courage to admit it. At the end it's "safe and respectable" career where you sacrifice your freedom for (Don't get me wrong there will always be people who enjoy it). OP I'm sorry to hear what you've gone through but that's decision you make in life. 

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I feel the same thing about pharmacy (and many of my friends also) but at a lower scale.

Exactly. Pharmacy and basically almost all other professions. 

 

There are absolutely issues in medicine, and yes you do sacrifice a lot more than in some fields to get there, but I think there's a particularly significant 'rose-colored glasses' phenomena that gets into the minds of premeds. There's this (totally false) idea that if you have the grades, then you 'should' go into medicine, and the idea that it defines 'success' for way, way too many people than will admit it. 

 

I don't know much yet, but I am not expecting the med school will be a one-way ticket to a perfect life. But having grown up with parents who work manual labor/retail, and hate every single day, working just as many hours a week as I will in the future-trying to earn enough money for essentials, honestly, I still feel unbelievably lucky that I get to do this. Medicine isn't perfect, but at the end of the day it is a job. Just like anything else. 

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I also believe medicine is not for everyone. At the end of the day most med students do get residency, do get a job and that is important, I do think people need to think more clearly before they enter this profession. Getting into medical school is probably the hardest part but it is also just the beginning, especially if you are thinking of academics and/or a long residency like surgery. At the same time, no one forces you down that path, you choose it if you enjoy it. Believe it or not, some people enjoy getting pimped, some people like the challenging environment and the intense atmosphere. The path you described of "hell in clerkship and residency all for no job in the end" made it seem like you were gunning for something competitive. At the same time, you would not have been subjected to those pressures had you gunned for something less competitive.  

 

If you are the type of person who wants an easier relaxing life where you can work part time and still make a great income, gunning for surgery is not going to be your thing and you will hate it. Forgive me if i'm wrong, keeping in mind i'm still in pre-clerkship but you sounded like someone who got into medical school thinking you made it and could relax now, wanted something competitive where you had to be "on" all the time and then were disappointed that those two goals were incongruent. 

 

There is no such thing as a free lunch. 

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Thank you for your honest post. It's not easy to speak up about these things.

 

I personally found clerkship and PGY1 to be generally less noxious than you describe - perhaps because of my chosen specialty - tough it certainly has its moments. But of course I am still very young and I don't know how things will look down the road.

 

I very much relate to your experience of worrying about doing anything in public and becoming basically a public figure while also being demonized in the media and by patients sometimes as a money hungry potential predator. That piece is probably the hardest and most demoralizing for me.

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I also believe medicine is not for everyone. At the end of the day most med students do get residency, do get a job and that is important, I do think people need to think more clearly before they enter this profession. Getting into medical school is probably the hardest part but it is also just the beginning, especially if you are thinking of academics and/or a long residency like surgery. At the same time, no one forces you down that path, you choose it if you enjoy it. Believe it or not, some people enjoy getting pimped, some people like the challenging environment and the intense atmosphere. The path you described of "hell in clerkship and residency all for no job in the end" made it seem like you were gunning for something competitive. At the same time, you would not have been subjected to those pressures had you gunned for something less competitive.  

 

If you are the type of person who wants an easier relaxing life where you can work part time and still make a great income, gunning for surgery is not going to be your thing and you will hate it. Forgive me if i'm wrong, keeping in mind i'm still in pre-clerkship but you sounded like someone who got into medical school thinking you made it and could relax now, wanted something competitive where you had to be "on" all the time and then were disappointed that those two goals were incongruent. 

 

There is no such thing as a free lunch. 

Hmm.

 

I think you may have missed the point of their post - what I got from it was that, of course medicine is hard and requires lots of hard work/dedication. Except what most people don't realize is the insane amount of unnecessary bureaucracy, unprofessional behaviour by superiors that goes unchecked, and sometimes toxic culture of the "Dedicate it all and to nothing else, or you are a "slacker"/"loser"" type etc.

 

While I agree there are definitely loads of people who probably didn't realize that the real world isn't all rainbows and ferries, and that medicine is no exception, you have to admit (And the literature here supports it), there are many aspects of medicine that are downright appalling and wouldn't fly in other sectors.  

 

There's a necessary evil of shitty work-life sometimes, that applies to all jobs, and then there is the unnecessary improprieties that accompany medicine and some medical students/residents/attending's are subject too.  I'm not saying everyone gets exposed to this crap, but many do...and like you said, some people don't mind parts of it, but many people (rightly so) do.   

 

I'm also not in clinical yet, but having talked to friends who just wrapped up 3rd year, the stories they have are a bit nauseating. Many had great experiences, and some not so much. Sure you can tough it out and push onwards, but these things can and do wear down on people. At least two preceptors have had repeated complaints against them, but given the rotation they run is essential and hard to find replacements, the faculty has to essentially just accept it as a necessary evil in order to get teaching for their students. They have however, agreed that for next year, they will pre-emptively warn students(in a professional context) about the preceptor, and to keep close tabs on them.

 

In most other industries, you'd fire someone like that so fast, and replace them. In some circumstances like this, it can be much more difficult to do in medicine, when they are providing a service for you (the students), regardless of their 1900's methodologies

 

Anyhoo, just felt that it wasn't probably fair to quickly dismiss the OP or make assumptions. 

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As someone that's on their 3rd (or is it 4th?) career change I can totally understand where you're coming from. I pursued several career options when I was younger, only to find out they weren't what I expected when I got into them. the mostly recent career I'm leaving has a high-stress, cutthroat environment where "shame-based" learning is the norm. It's definitely not for everyone.

 

All I can say is that your perspective on life changes from your early 20s into your 30s. If you're not happy, there are plenty of other things you can do with your life that are meaningful and will still make a difference. I wish you the best of luck!

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I also believe medicine is not for everyone. At the end of the day most med students do get residency, do get a job and that is important, I do think people need to think more clearly before they enter this profession. Getting into medical school is probably the hardest part but it is also just the beginning, especially if you are thinking of academics and/or a long residency like surgery. At the same time, no one forces you down that path, you choose it if you enjoy it. Believe it or not, some people enjoy getting pimped, some people like the challenging environment and the intense atmosphere. The path you described of "hell in clerkship and residency all for no job in the end" made it seem like you were gunning for something competitive. At the same time, you would not have been subjected to those pressures had you gunned for something less competitive.

 

If you are the type of person who wants an easier relaxing life where you can work part time and still make a great income, gunning for surgery is not going to be your thing and you will hate it. Forgive me if i'm wrong, keeping in mind i'm still in pre-clerkship but you sounded like someone who got into medical school thinking you made it and could relax now, wanted something competitive where you had to be "on" all the time and then were disappointed that those two goals were incongruent.

 

There is no such thing as a free lunch.

It's definitely worth remembering that the grass isn't necessarily greener elsewhere, but this attitude here, where someone is accused of being soft or wanting the easy life for speaking out about difficulties faced, needs to go, immediately. I can't express how angry these sorts of comments make me, shifting the blame to the individual rather than to our broken system. It is a huge contributor to the negative culture in medicine that practically stigmatizes having a life outside of medicine.

 

Some of the hardest working colleagues and mentors I know have regrets about their decision to enter medicine. It's a common feeling, even for those who seem to be handling the challenges of medicine in stride, or who are at the tops of their classes or fields. I've found it's not so much an overabundance of work that knocks people in medicine down, it's a lack of support, a lack of control over their own lives, and a lack of respect that do it. These are all attributes that can and should be fixed. But that's not going to happen if the go-to response from even a vocal minority is to blame the individual, forcing even more to suffer in silence lest they be judged...

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The posts couldn't have been more timely...it is mental health week until the 8th. As health care professionals or aspiring health care professionals, I think we really need to work on promoting the awareness of mental health at medical schools and within the medical associations. What is really sad to me is so many of us are community leaders, and one of the things I put in my application is that when I see something that is needed by the community or a change that needs to happen, I aim to be proactive about it. I know it's hard if this is the culture, it's just never easy fighting against a culture...but maybe instead of fighting it head on, it may be wiser to start integrating mental health awareness events and workshops into med school life. At least it would be a starting point. Just a thought. I am not there yet so I can't claim to know at all how it is, I am only going by what people are saying on this forum...but from what I gather from the comments, it seems there is a gap in mental health awareness that is being perpetuated indirectly through the culture.

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"But then they start to drill it into us even more, and the message becomes very clear: We, as people, are not important. Our feelings, marriages, kids are not important. What is important is our patients, full stop. And they make you believe them by telling horror stories of medical students gone by who made the slightest of mistakes, and are now flipping burgers in the hospital cafeteria. They accomplished their mission: they put the fear of God into us, made us walk on eggshells, and made it so we always remember our "privilege" if ever we second guess ourselves, or think about having one too many drinks at the bar for fear of doing something stupid while drunk. God forbid we let loose on a Friday night. But still we persevered.

 

I would be lying if I said the first two years of medical school taught me nothing. It taught me to care about the community and be involved in it, even if at the expense of my own personal life. I enjoyed being a part of it, and being of benefit to those less fortunate. That feeling kept me going.

 

And then clerkship started. Clerkship was hell. Plain and simple. Think of the entirety of clerkship as an audition. You need to be "on", every single day. You need to say "thank you" when someone sh*ts all over you. And believe me, they will. If you work with any preceptors over the age of 40, they will have grown up in a time that promoted shame-based learning. And, like domestic abuse, the cycle of abuse in medicine also self-perpetuates. I still remember the first time I was humiliated by an attending. It was in an operating room on my surgery rotation, and I was 6 questions into a "pimping" session (http://jama.jamanetw...ticleid=2474430). I got the 6th wrong. The preceptor made sure I knew I was an idiot. In front of everyone: circulating nurse, scrub nurse, resident, anesthetist, and, worst of all, an AWAKE patient under spinal anesthetic (to this day, I will never forget that the reason you remove both the head of the pancreas and the duodenum in a whipple procedure is that they share an arterial supply). This is common, so don't be surprised by it. You will be shamed on a daily basis, unless you are the lucky 10% of students whose attending isn't an absolute psychopath. Prepare yourself for it."

 

 

Well, pretty much this ^^.  First off, thank you for your honesty OP it is oddly validating even though I am not in medicine.  I really don't have much to say other than I strongly resonate with the post as a healthcare professional having a very similar sounding experience and I commend you for writing this at all.  This is a perspective not many people, especially pre-meds, get to hear about. 

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This is common with a lot of other health professions. It's just the reality of the situation. Biggest tip for everyone it to actually LOOK IN to this, really see if its something they want to do for the rest of their lives. Dedicate time and energy to others while letting your mental health waste away.

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I also believe medicine is not for everyone. At the end of the day most med students do get residency, do get a job and that is important, I do think people need to think more clearly before they enter this profession. Getting into medical school is probably the hardest part but it is also just the beginning, especially if you are thinking of academics and/or a long residency like surgery. At the same time, no one forces you down that path, you choose it if you enjoy it. Believe it or not, some people enjoy getting pimped, some people like the challenging environment and the intense atmosphere. The path you described of "hell in clerkship and residency all for no job in the end" made it seem like you were gunning for something competitive. At the same time, you would not have been subjected to those pressures had you gunned for something less competitive.  

 

If you are the type of person who wants an easier relaxing life where you can work part time and still make a great income, gunning for surgery is not going to be your thing and you will hate it. Forgive me if i'm wrong, keeping in mind i'm still in pre-clerkship but you sounded like someone who got into medical school thinking you made it and could relax now, wanted something competitive where you had to be "on" all the time and then were disappointed that those two goals were incongruent. 

 

There is no such thing as a free lunch. 

 

I think you missed the point. But as an aside, you are right. I did go for a very competitive specialty (at the time, from what I hear it is no longer that way due to job prospects). And I got that specialty at my first choice location, and afterwards, the fellowship i wanted as well. And then I got the job I wanted. Rather, it was the job I thought I wanted. However, those pressures are there no matter how competitive the specialty is that you are going for, and most specialties are now competitive. From what I hear, even family medicine doesn't match some people these days. At the time I went through, you could do zero electives in FM, and still be guaranteed to match to it. But that isn't at all the point of my post. 

 

Regardless, I hope you keep your idealism through clerkship. I hope you get the luxury of, after a lot of time has passed, believing that getting into medical school was the hardest part. Getting into medical school is, often, the easiest part of this journey. 

 

You are right. There is no free lunch. The price myself and my colleagues have paid was very high indeed.

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Believe it or not, some people enjoy getting pimped, some people like the challenging environment and the intense atmosphere. 

This is not the same as what the OP and others are describing when they talk about shame-based learning. I'm all for intensity and challenge, but I have never met anyone who enjoyed SBL.

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It's definitely worth remembering that the grass isn't necessarily greener elsewhere, but this attitude here, where someone is accused of being soft or wanting the easy life for speaking out about difficulties faced, needs to go, immediately. I can't express how angry these sorts of comments make me, shifting the blame to the individual rather than to our broken system. It is a huge contributor to the negative culture in medicine that practically stigmatizes having a life outside of medicine.

 

Some of the hardest working colleagues and mentors I know have regrets about their decision to enter medicine. It's a common feeling, even for those who seem to be handling the challenges of medicine in stride, or who are at the tops of their classes or fields. I've found it's not so much an overabundance of work that knocks people in medicine down, it's a lack of support, a lack of control over their own lives, and a lack of respect that do it. These are all attributes that can and should be fixed. But that's not going to happen if the go-to response from even a vocal minority is to blame the individual, forcing even more to suffer in silence lest they be judged...

 

What I said looking back does sound harsh but I actually think the culture of medicine is changing. The point of view i'm talking about is from what I've experienced so far which is that stigma associated with choosing an "easier life" at least among medical students in my class is actually disappearing slowly but surely. In fact, competitive specialties are actively avoided because of the lifestyle. 

 

I think my words may have sounded harsh, but in our class the negative connotations of choosing an "easier life" are actually fading away. As students we haven't been exposed too much to our seniors yet since we are still in pre-clerkship and there definitely is still some stigma but it is not the same as it probably used to be. More and more people are choosing so called lifestyle specialties every year. 

 

What my overall point was, its important to know who you are as a person so that you can make those decisions. There are so many opportunities in medicine where you don't have to suffer the "worst of the medical culture". I don't believe it has to be this bad, my experiences while limited, so far have been very positive in the medical field. I just don't feel its right to denigrate all the physicians who actually do teach well and care and are nice to students.

 

I do think you have to choose wisely your specialty, but definitely the culture is changing and I don't think that this should really turn people off medicine entirely.  

 

And one point I was going to make but couldn't due to needing to go somewhere was that this kind of atmosphere is prevalent in many professions and this point does agree with what you said earlier ralk. I think medicine isn't much different from other high stress jobs like law, business or any corporate environment really where you can have a horrible boss or co-worker. In fact, some specialties where you can have your own clinic can be decidedly less stressful once you are an attending. Lastly, I just want to emphasize that the culture is changing and there is a difference between the 50+ attendings and the <50 attendings in attitude towards students however this is now more of a time issue. I have found amazing support from so many senior students, residents, attendings so far that give me hope in the system. 

 

 

Medicine is unique in that they try to make you a professional but that is also because as a profession we do have unique responsibilities and privileges that others don't. 

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What I said looking back does sound harsh but I actually think the culture of medicine is changing. The point of view i'm talking about is from what I've experienced so far which is that stigma associated with choosing an "easier life" at least among medical students in my class is actually disappearing slowly but surely. In fact, competitive specialties are actively avoided because of the lifestyle. 

 

I think my words may have sounded harsh, but in our class the negative connotations of choosing an "easier life" are actually fading away. As students we haven't been exposed too much to our seniors yet since we are still in pre-clerkship and there definitely is still some stigma but it is not the same as it probably used to be. More and more people are choosing so called lifestyle specialties every year. 

 

What my overall point was, its important to know who you are as a person so that you can make those decisions. There are so many opportunities in medicine where you don't have to suffer the "worst of the medical culture". I don't believe it has to be this bad, my experiences while limited, so far have been very positive in the medical field. I just don't feel its right to denigrate all the physicians who actually do teach well and care and are nice to students.

 

I do think you have to choose wisely your specialty, but definitely the culture is changing and I don't think that this should really turn people off medicine entirely.  

 

And one point I was going to make but couldn't due to needing to go somewhere was that this kind of atmosphere is prevalent in many professions and this point does agree with what you said earlier ralk. I think medicine isn't much different from other high stress jobs like law, business or any corporate environment really where you can have a horrible boss or co-worker. In fact, some specialties where you can have your own clinic can be decidedly less stressful once you are an attending. Lastly, I just want to emphasize that the culture is changing and there is a difference between the 50+ attendings and the <50 attendings in attitude towards students however this is now more of a time issue. I have found amazing support from so many senior students, residents, attendings so far that give me hope in the system. 

 

 

Medicine is unique in that they try to make you a professional but that is also because as a profession we do have unique responsibilities and privileges that others don't. 

 

I think you've missed my point. It's not your tone I'm objecting to, it's your message.

 

It doesn't matter what specialty they chose - the kind of things Regrettingitall described are unacceptable in any specialty.

 

It doesn't matter that other professions also experience harshness - mistreatment on the scale Regrettingitall describes is unacceptable in any profession. Plus, this isn't law or business, which are fundamentally antagonistic, top-down fields, this is medicine, where we're supposed to work together to help patients. There is zero benefit to treating each other terribly or expecting each other to endure hardships without complaint.

 

You are right, the culture is changing, slowly, but even that doesn't matter - the ones who are not changing are often able to continue on with impunity. Even if 90% of currently practicing physicians are fine - and I'd even agree that the percentage could be higher than that - that doesn't excuse the remaining 10% who are behaving inappropriately. And it's not just older individuals, my worst experiences have been with faculty and residents well under 50. There are systemic factors at play too - when our systems don't provide enough support, autonomy, or respect to learners and practitioners, it creates a terrible situation for those involved even if no one is actively causing harm. Apathy towards suffering is more a problem these days than outright abuse, but that doesn't make it any less concerning.

 

You talk about the choice that we all made to go into medicine, or to go into one particular field. It's true, we all consciously put ourselves on these paths. However, these are rarely fully-informed decisions. Medical students are frequently surprised by what they find in medical school, many residents are surprised by what's asked of them in residency, and attendings are often surprised by what their life is like once they finally land that coveted job. The OP, who has successfully been through it all, gives a compelling narrative of all three. And once you're far enough into each step, you often loose the choice to step away. Medical students get trapped by debt. Residents get trapped by a lack of transfer opportunities. Attendings get trapped by the job market. Even people who do everything they can to find out about the next step in the process get blindsided once they're on the other side and have no choice but to keep going forward. 

 

My main point is that when people react to others' struggles like you did, by criticizing their decisions first and foremost, it reinforces the negative aspects of the medical culture. I'm glad you've had good experiences so far and hope those continue as you move forward, but I'm asking you - pleading with you - to adjust how you respond to those who have not had as positive an experience as you have. It is still so difficult for people in medicine to open up about their struggles. When these disclosures are met with criticism, it encourages everyone else who may be unhappy with their situation to continue to suffer in silence. That makes it so much harder to help these individuals, and to prevent others from going through similarly negative experiences. Even at your (our) early stage of training, your actions and attitudes help to shape the culture in medicine. Please, help move it in the right direction, away from blaming the victim and towards fixing the problems that caused the harm in the first place.

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Well into medicine now, I find myself regretting the day I ever decided that medicine would be my career. Many of my colleagues feel the same way, but I can only speak for myself. The reason for this post is not to deter anyone from entering medicine, but to hopefully have some people deeply consider their motives and desires for entering this profession before committing themselves. I honestly believe that I just didn't have nearly enough information when I chose medicine. Or perhaps I did, but my ideals may have forced me to persevere. Years from when I decided, I can't explain how I never saw this earlier. 

 

But it doesn't matter now. I've decided to leave the toxicity of this profession. I've decided to give up the ability to seriously help others, the respect, the income, and every other benefit medicine offers. I've decided to give it up and take my life back. My life is worth it. 

 

Maybe these next few points will fall on deaf ears, but perhaps not. However, I feel an obligation to tell you, the younger generation not yet committed to this life, as no one did for me. Please ignore the fact that this is my first post under this handle. I was once active on these boards, and many know my real life alias of my regular handle. Those people, I'm sure, will find out eventually. But it isn't the time yet.

Hear me out.

 

Medical school starts out like a dream come true. The parties, the 100 odd friends you basically get given to you, the camaraderie, and the apparent lack of difficulty of the subject matter. It sucks you in and consumes you. I thought I had it made. But then come the professionalism talks (repeated, over and over). They drilled it into us that we are absolutely privileged to be a part of this profession. They tell you about how we are held to a higher standard, how we must conduct ourselves to the public. At first, it all seems fine. Why the hell would I care? I've obviously conducted myself pretty decently up until this point in life. I didn't really feel privileged, though. I worked my ass off to get here. Early mornings, late nights, ignoring friends, rinse and repeat. I earned my seat.

 

But then they start to drill it into us even more, and the message becomes very clear: We, as people, are not important. Our feelings, marriages, kids are not important. What is important is our patients, full stop. And they make you believe them by telling horror stories of medical students gone by who made the slightest of mistakes, and are now flipping burgers in the hospital cafeteria. They accomplished their mission: they put the fear of God into us, made us walk on eggshells, and made it so we always remember our "privilege" if ever we second guess ourselves, or think about having one too many drinks at the bar for fear of doing something stupid while drunk. God forbid we let loose on a Friday night. But still we persevered.

 

I would be lying if I said the first two years of medical school taught me nothing. It taught me to care about the community and be involved in it, even if at the expense of my own personal life. I enjoyed being a part of it, and being of benefit to those less fortunate. That feeling kept me going.

 

And then clerkship started. Clerkship was hell. Plain and simple. Think of the entirety of clerkship as an audition. You need to be "on", every single day. You need to say "thank you" when someone sh*ts all over you. And believe me, they will. If you work with any preceptors over the age of 40, they will have grown up in a time that promoted shame-based learning. And, like domestic abuse, the cycle of abuse in medicine also self-perpetuates. I still remember the first time I was humiliated by an attending. It was in an operating room on my surgery rotation, and I was 6 questions into a "pimping" session (http://jama.jamanetwork.com/article.aspx?articleid=2474430). I got the 6th wrong. The preceptor made sure I knew I was an idiot. In front of everyone: circulating nurse, scrub nurse, resident, anesthetist, and, worst of all, an AWAKE patient under spinal anesthetic (to this day, I will never forget that the reason you remove both the head of the pancreas and the duodenum in a whipple procedure is that they share an arterial supply). This is common, so don't be surprised by it. You will be shamed on a daily basis, unless you are the lucky 10% of students whose attending isn't an absolute psychopath. Prepare yourself for it.

It will teach you to be tough, or it will break you down. Students regularly take a year or two off in the middle for various reasons, but mostly mental health issues related to school. 

You WILL be on call. 1 in 4 usually. 26 hours straight, still always "on". Auditioning. Always auditioning. 

You are still fighting for a career at this point. You do everything you can for a good comment on your "MSPR", basically a report card that CaRMS programs read when you are trying to apply for residency. Even one unfavourable comment can sink your battleship. Doesn't matter if you are applying for surgery and the bad comment is in peds. It will sink you. And even when you are a superstar, and do 80% of the attending's work for them, they may still write a generic one liner: "keen student, shows up on time". Might as well have just asked you to come in so they can slap you on the face directly.  So prepared to work hard and look "keen", even if you absolutely hate "well child" visits in outpatient pediatric clinics. Prepared to get sh*t on, and to respond with "Thank you, sir. Please sir, may I have another?". Any other response can cut your career short. And the MD without a residency is useless, unless your entire goal was to get "Dr" on your credit card (which I am aware, now, that you can just request that even if you DO flip burgers). 

 

So you've shouldered your way to the end, decided on a specialty (in what is not nearly enough time, as you have to arrange electives basically before you have exposure to most specialties), and sucked enough D to get some decent reference letters. Hopefully, at least. You don't get to see them.Then comes CaRMS time. Spending ridiculous amounts of time and money preparing personal letters, trying to convince every program in the country why you think theirs is the best, and why they should pick you. And then the waiting game, and you still might go unmatched, and be left without a job. Hopefully an unmatched student can come give you the personal experience of the agony of that experience, and enlighten you in that regard.

 

And then residency comes along. I won't repeat everything I said about clerkship. But a summary: it's clerkship on crack. More work, more hours (80+/week), more responsibility, more getting shit on. The one upside is you now give zero f*cks about what people think about you. You got your career, unless you are in the 80% of specialties where jobs are now scarce after residency, so you have to be well liked. HAH. It never ends. The nurses also don't treat you like absolute sh*t anymore. You now outrank them. Tangential side note: never believe the nurse's charting resp rate. They literally never count it, and always report it as 18 or 20. Because it's so hard to watch a guy's chest move for 20 seconds and multiply by 3. Oh well.

 

Finally, you are a royal college physician. Now you have to go interview for jobs, 13 years from when you graduated high school. If you picked ortho, or any of the other surgical specialties, be prepared to locum, or work somewhere you don't want to work. The old guys won't retire, and there's no OR time for the fresh new grads whose hands don't shake like a reluctant bride at the altar. And be prepared to deal with the endless politics of medicine. Everyone has a chip on their shoulder. Everyone. You still work a ton of hours, and still get treated like sh*t. Only this time, it's the patients that walk all over you. Dr Google always knows more than you, according to them. Every patient has a nurse friend that thinks you should manage their disease in a certain way. Good for them.

 

And don't you even think of trying to convince them that they are wrong. Come off as offensive in any way, and you will get a complaint to your respective college: our "self regulatory" body. They literally only exist to "protect the public" from us deadly doctors. Our motives must be so sinister. If ever you think a patient is batsh*t, bring a chaperone to the encounter so you can prove your side of things. And document, document, document. 

 

It all wears on you after a while. It wore the shit out of me, and continues to. There is a reason physicians have a suicide rate almost double** the general population. Our addiction rates are 20-25% compared to the 15-20% of the general population. Eating disorders, depression, anxiety, etc... You could argue this is because of the personalities that enter medicine are predisposed to mental health issues. Maybe. But medicine takes a tangible toll, and is solely responsible for at least some of the cases. This is not to mention the divorces, and being absent from the lives of your children. Your spouses and kids deserve you too, they deserve you more than your patients. Don't forget that they sacrifice in order for you to do this job. Interestingly, surgeons have the lowest addiction rates in medicine, but the highest divorce rates. Pick your poison.

 

If you know you can withstand all this, then all the power to you. People need us. We genuinely do good. We help people, and I would by lying if I said that I didn't get an enormous amount of satisfaction from this fact. 

 

But if you think that this road may cause you more trouble than it's worth, than I urge you to consider deeply your decision to pursue this career. For many, it is more trouble than it's worth. It was, for me. I just wish I realized it earlier, before I paid the high price in my personal and family life. No longer, though. 

 

After all this time, I have decided to walk away, to cut my losses and turn to something else. I've had a good run, but all good things come to an end. 

 

Again, I don't mean to purposely discourage people from medicine. I just want you to know the TRUTH so you can make an informed decision for yourself. The same informed decision we always say our patients should make. Why should we be any different, any less?

 

Regardless, good luck in your future endeavours. If you choose medicine, I hope that it gives you what you need each and every day. If you don't, no one will give you fault.

 

Consider dentistry, though.

This is pretty much the best post ever a premed can read. @ premeds, please do not turn a blind eye or ignore this post. I definitely wish someone told me all this before starting med school. I am not a clerk yet (we did have quite a few weeks of clinical exposure by now at McGill) and I've already experienced myself, or heard from my peers many of the things you said. 

At this point at my school (I guess pretty much everywhere), being Med 2 students, at least half the class is stressing out about CARMS, research, and electives.

 

@ OP, whatever you do now, good luck to you and I sincerely wish you to find greener pastures!

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