Tuesday, January 11, 2011

The Mythical Bright Light

When I was in my second year of med school, I had kind of a sobering moment:

One of my classmates had a boyfriend who had recently graduated from residency in medicine and had a job in a private practice. Back then, that seemed like the bright light at the end of a long tunnel: someday I would finish med school, finish residency, and then the torture would be over!

Except my friend was complaining about how her boyfriend was working harder than he ever had before. As the newest person in the practice, he took call every holiday and was at the office late every night. She then went on to tell me that this was "typical" of first attending jobs.

I wanted to throw up. So not only did I now have to get through med school and get through residency, I now had to put in my dues in my first attending job for god knows how long? When the hell did it ever end?

When I was doing inpatient rotations in residency, I noticed that my attendings never left work before I did, and actually, were often there later than I was (except on call). I started to have a bad feeling that the bright light at the end of the tunnel was all a myth, and that by entering medicine, I had resigned myself to working hard for the rest of my life.

I do think that, in general, attending physicians work very hard. I know there's going to be some dermatologist who comments something like, "Hey, I work only two afternoons a week, I love my job, and I make half a million dollars a year!" And that's awesome for you, really, you bitch. But I think even physicians like myself, who work part-time and have fewer hours, work pretty hard while at work. And physicians who work full time in private practice generally work their asses off.

The bright light is not entirely a myth. At least as an attending, you earn more money and get to do something closer to the job you want to do. But then again, how many people end up with their dream job right out of training, especially in this economy? I think it's to be expected that you'll need to spend a few years putting in your dues. I think it's a myth to think that you just need to get through seven years of training and then you'll be on easy street. After all, there's a reason Physician ranked only 83 on CareerCast's list of the top 200 jobs of 2011 (I seriously thought we were going to be after the guy who cleans the urinals or something).

I guess my point is that if you think of medical training as something horrible you need to get through before you end up with some cushy, high paying job, maybe you should rethink medicine. I don't think it's a good idea to postpone your life until "the hard stuff" is over, because it might not be over as soon as you think. Or ever.

But as usual, I welcome dissenting opinions. Do you work your ass off as attending? Or did you get a cushy, high paying job straight out of residency?


  1. Well Fizzy, if it was fun, I guess they wouldn't call it "work," would they.

    I'm sorry you despised your training and are lukewarm about what you're doing now. I do think you're right that if you view attending-land as the light at the end of the tunnel, then perhaps you ought to rethink your decision to go into medicine.

    For me thus far in my training, there have definitely been ups and downs, but nothing nearly as hideous as my first two jobs out of college. Perhaps this perspective has helped me get through this. Overall I've been really happy I've done it, so far anyway. My hope is that being an attending will be at least as enjoyable / interesting as the training, and maybe even a little bit better.

  2. I think it's a good attitude to enjoy training for what it's worth and to live your life.

    For the record, I didn't despise my training. I despised my first three years of med school (who could hate 4th year?) and my internship. I didn't hate my PGY2-PGY4 years.

  3. I keep wondering when it will be over. It does feel like I was overworked in med school, now over worked in residency, with the prospect over being overworked in practice. I'm fine with work, just not with over work. There is no end is sight.

  4. Katherine: It was actually a disappointing discovery for me to learn that in many (most) fields of medicine, you just can't have a 9 to 5 type of job.

  5. Also, didn't you say at one point that you work 36 hours a week? I find that funny, bordering on hysterical that this is considered "part time."

  6. OMDG: Very true. I work 4 days a week, often 8:30 to 5:30 or thereabouts, so that adds up to 36 hours. I talked to a doc at the VA last year who said she got paid for 32 hours just to keep her actual hours under 40.

  7. Attendings still work hard...the trade-off is that they DO get paid substantially more and have an increased degree of flexibility in their schedules.

    My fiancee finished residency in 2007, and it has certainly been way easier for him to have outside interests and free time since then. So, no bright light, but there are perks. And yes, from what I can tell, he does have his dream job (ER doctor) and we have no money worries.

  8. Wow, that's a little depressing when you're the med student just trying to survive your last semester before Step 1. Glad you added in that you should enjoy the now, that's something that I feel like people with goals often miss. We spend so much time thinking about tomorrow that we kind of forget that today is all we have. I actually wrote a blog about that right as I was coming up on the end of my first year (http://focusdoctor.blogspot.com/2010/05/present-and-future.html) and have really focused my energy on enjoying life outside of school since then.

    Everything is what you make it. I know good and well if I don't pretend there is a bright light at the end of my tunnel that I will be needing a Beta Blocker before I'm 25....so I'm going to pretend I didn't read this and keep on seeing my light. :)

  9. Sarah: I think ER is one of those fields where if it's something you like, you're probably going to end up with a good lifestyle because it's shift work by definition.

    Danielle: Yeah, what I was trying to emphasize was that you shouldn't live for that bright light. I think I was much happier when I stopped just waiting for the bad stuff to be over and did things to make me happy in the moment (e.g. getting married, having a child, switching to another residency).

  10. Residency had its moments but for the most part, it was ok. Our inpatient months were bad (especially during the winter) but otherwise I didn't work more than 70 hours a week. As an attending, when I'm not on call, I work about 60 hours a week. While I wish I had more time to do things during the week (ie. go to the gym, read books) my weekends are generally free. I work as part of a big practice and I'm only on call 7 weekends and 9 weeks during the year (we do our call in three week blocks). Being an attending is way better. I'm working hard and somedays I'm at work long after the residents have gone home but I love my job so I don't care. You have to love it and have fun.

  11. I have finally made it to attending land after 7 years of training (med-peds rheumatology) and I basically love it. That's only true because I like what I do. I liked most of fellowship too, honestly, since it was interesting and mostly not crazy hours. I do think I work more now than in fellowship, but it's worth it to have some control over my life and to have a salary that I can support a family on. (I have the benefit of being married to a stay-at-home dad, who takes care of our 2-1/2 yr old daughter and 15 month old son, which is truly awesome, but it did make money pretty tight during fellowship!) I don't think it's a light at the end of the tunnel, exactly, but I feel like my medical career has gradually gotten better and better from the 3rd yr of med school until now, as I've been able to focus more and more on the kinds of things that interest me and that brought me into medicine to begin with.

  12. Totally depends on a) your particular job (not specialty; job), b) whether you enjoy your work. For me, being an attending rocks. I've been in the same job right out of residency. I think I am compensated well, have the flexibility I need, and love what I get to do.

    Sometimes, I can't believe I get paid to do this.

    It is absolutely the light at the end of the tunnel, at least for me. Worth every minute of my training (which occurred prior to the 80 hour work week...)

  13. It's great that everyone loves their jobs so much, but that wasn't entirely what I was asking. I was talking about the fact that physicians DO work hard, both in terms of work and and in terms of hours. How many attendings out there feel that they have a "light" job with lots of free time?

  14. If there is a "cushy" job as a physician, I haven't seen it.

    I am in full time private neurosurgical practice, and I do in fact work my ass off. I take night call one weekday every week and one out of 4 weekends (Friday 0700 - Monday 0700) covering 2 hospitals. I do between 500 and 650 cases per year on average.

    I agree that if you think it will get easier when you're done with residency, you need to rethink things. I had thought so, too; I had the impression that a new physician would find a nice practice, hang out a shingle, and live happily ever after. Ha!

    It doesn't get easier, it gets harder. But it changes significantly. The good things: You are your own boss, and you have tremendous control over your practice. Success or failure is largely up to you. You no longer have to do things the way your attending wants. You can choose the surgical techniques that work best for you. Your patients are *yours*. You also make a lot more money than you did as a resident.

    The bad things: You may make more money, but you also have a lot more bills. You have to worry about the business aspects of running a practice. Your responsibilities are much greater, to your patients, your employees, and your family. You have to deal with the politics of medicine and with partners (different from dealing with fellow residents). And you end up working more hours, especially now in the day of the 80 hour resident work week. You also now have to worry more about malpractice liability.

    Practice is very hard, much harder than residency. But I love my job, and the good things far outweigh the bad in my mind. Just the ability to make a real difference in the life of a patient makes it worth while.

    I have premed students shadow sometimes, and I always tell them that you shouldn't go into medicine if you want to get rich. You will only be happy in this profession if you really love what you are doing, period. If you don't love it, you won't last long term.

    I would not recommend that any medical student, resident, or physician postpone life outside medicine just on the assumption that it's going to get easier. It won't. You just have to get on with life and family and make it work.

  15. Oh, and I failed to mention that when you first join a practice, there is generally a period of time during which you are a salaried employee before becoming eligible for partnership. This period varies from practice to practice; mine was 2 years. During that time, you generally make more money than a resident, but not nearly as much as a partner. In many practices, becoming a full partner requires a "buy-in," which may be small or may run into six figures. This also dims the mythical light a bit.

  16. Ugh, my thoughts are not very organized tonight. Sorry! I wanted to also comment about the myth of an attending having more "flexibility" in the schedule. I have found this not to be true personally. The pressure to keep the schedule on track increases exponentially as your practice gets busier. Taking an unplanned day off accordions the subsequent schedule in a miserable way. There is also pressure to keep referring physicians happy by accommodating urgent work-ins and by keeping the wait time for appointments to a reasonable period. Right now, for instance, I am stressing about restructuring my schedule for 2.5 days lost as a result of the southeastern snowstorm. I'm probably going to end up working some Saturdays and after hours for a week or two. Ugh.

    In a specialty not defined by shift work, the schedule is very inflexible!

  17. gcs15: Good to hear your perspective. Regarding the flexibility, I remember being shocked when an attending told me that attending-hood is the WORST time to have a baby, just because coverage is harder. In residency, you've got the whole program to cover for you. As an attending, there are often just a few people to cover, or perhaps just yourself. Just being sick for a day or two can involve some painful trades.

    Some people really do get lucky right out of training, but there are a bunch of new doctors I know right now who are not terribly happy with their first jobs.

  18. Um, pathology? Best secret in medicine? I love my first job out of training. Yes, I made partner last fall after three plus years, and have a big buy in, but I've got myself in a living situation where I am very comfortable financially (finally!). Despite the big snowstorm, I had to be there, and I am so thankful for my wonderful former nanny and her family, who are still there for me. When I am driving to the hospital in the snow before sun-up, they beat me up and made it to my house to care for my kids so I could get to work. Oops, I ran off track being thankful, sorry.

    Are there things I am frustrated about? Of course! Who isn't. The politics over laws and reimbursement - the so-called business side of things that gcs15 alluded to above - that can drive me insane. So much so at times that I have to remind myself why I am doing this at all - a busy call where I help a ton of patients (like New Year's weekend) or a wonderful weekend off with my kids helps me get off of my obsessive thoughts about the side of pathology I never really wanted to know about.

    I think residency and practice are both hard. Hell, so is med school. It's all tough, and very different. But if you truly enjoy what you are doing, even if you have to remind yourself of that every now and again, you'll pull through.

    I agree that it is difficult to define hours at a physician job outside of shift work. I investigated part-time pathology, and chose to stick it out through the years to partner instead, because every part-time pathologist I knew was frustrated with the fact that they were almost full time coming in to finish leftover cases and got no benefits or perks. One part-timer I saw was sneered and scoffed at, and treated as inferior, even though she was choosing to take less pay to start a family (she was also smarter than most of the people scoffing). So that road, at least in path, seemed worse to me.

  19. I'm glad to hear that the majority of women in medicine love their jobs.

  20. I think it depends on how you define "the light." I finished up in internal medicine in Aug of last year. The stress and workload of residency had pushed me to the edge mentally and physically. I was always worried about money and I was very angry that I was working so many hours for such little pay. Also, I had a baby at the beginning of my third year and was resentful that I wasn't spending as much time with her as I wanted. Honestly, I was starting to think I made a big, expensive mistake by going to medical school.

    So I was looking for relief and recovery. I found a wonderful job in a clinic with no hospital duties. Call is every 6weeks and is basically home call...if I think the patient needs to be seen I just direct him to the ER. I work 4 days a week, 8-5pm. I make more money now (although I have sacrificed some of my potential due to my limited responsibilities) and financial stability is no longer a worry. Interestingly, I feel that my workload has increased now that I don't have to check-out with attendings. I am astonished at how many patients I can see in a day!

    Most importantly, I am recovering and am starting to *like* what I do. In the past few months I have been able to stop the anti-depressant AND the PPI that were both started during my training. I feel that I have a stronger connection with my daughter now that I spend more time with her and I am not chronically tired.

    I guess what I am trying to say is that my "light at the end of the tunnel" has definitely held up to my hopes and expectations...of course I was in a far different place at the end of residency than at the beginning of med school so my "light" has changed over the years.

  21. I think it really is a matter of expectations. As someone involved in training, I worry that the new work restrictions for residents will create false expectations for what life will be like when they are done. I don't have someone to check out to and the work does not get done unless I do it. That said, I sacrificed compensation to have a small niche of patients and at home call. I work some weekends but can usually finish in 1/2 day. Yes I work hard but fortunately I love what I do. I also had good mentorship about medical careers which I try to pay forward. It would be unbearable if I did not love what I do. Onc15

  22. I'm refrain from giving my feelings about use of the word "love" to describe a job.

    (I don't want to sound disgruntled because I do like my job very much at times and there are days when I feel so incredibly grateful for it. But love? I love my daughter and my husband. I love my parents. Not so much my job.)

    Anyway, I do think it's great that everyone has so much strong affection for their work, but I guarantee that's not entirely universal among doctors. Last night I was talking to a friend of mine whose husband hates his first job as an ophthal, and I have several friends who are miserable in private practice. I know lots of people who have bounced from job to job because they couldn't find one they liked. A doctor who recently joined our practice told me that leaving her last job was like escaping from a nightmare.

    So for those of you who love your jobs, try to also remember that you are *lucky* and many people don't have the same experience.

  23. Birds of the same feather flock together. Maybe people who love their jobs tend to find other people who feel the same way.

    And people who hate their jobs will unite with people who also hate their jobs.

  24. I definitely think I am lucky to love what I do. It gets me over the daily aggravations. I do tell premeds to evaluate carefully why they want to do medicine. Do not do it for the money or prestige( not enough of either). Do it if you have an affinity for the kind of work you will do and the environment you will be working in. Hopefully there will be a point at which it becomes an avocation rather than a job. I just slogged through 8 inches of snow and slippery roads to get to work but I feel energized about the day.

  25. Anon at 750 you hit it on the head! I generally try to avoid the people who hate their jobs.

  26. Unfortunately, I work with two physicians who desperately hate their jobs and talk daily about quitting. It makes me feel guilty (I have a different job). It's not always possible to avoid negativity.

  27. I agree that it is naive to expect that after residency, you won't work as hard and you'll have perfect control over everything. I also think that your quality of life as an attending will vary depending on what specialty you're in, where you live in, what your family situation is, what the economic situation is like, etc.

    That being said, I really enjoy my job and the end of residency really did turn out to be the light at the end of the tunnel for me. I cut my work hours back to 30 hours a week, work a 12 hour night shift once or twice a month, paid off my debt within one year of finishing residency, and I go away for about 4 months a year. I know I'm lucky and I am grateful everyday that things worked out so well.

  28. I have had a love/hate relationship with medicine for about 30+ years now. Making people feel better-love. Insurance companies, hospital politics, lawyers, entititled patients (and you get just as many if not more as an attending)-make it hard to remember the love part. It has allowed me to support my family and afforded a fairly comfortable lifestyle. If I'd known then what I know now, would I do it again? Nope.

  29. Fizzy, I am only at my first job out of residency/fellowship so I don't have much to contribute - not much to compare it with. I know as an FP I get paid less for the number of hours of I work than probably everyone else in medicine. Some days are great and I don't care - more days than not I am running my ass off between the hospital, OB, and the clinic and thinking how unfair life is - and maybe more money would help me not be bitter. So who knows.

    Can I add that I absolutely LOVE your posts and you can make a depressing post pretty hilarious. Not a bad talent. :-) I wish I worked with someone like you!!

  30. I think anyone, in medicine or not, is lucky to love their job. Remember that at least we are well paid, have some level of job satisfaction, etc. What about the shlub who did not have our choices? This is somewhat a discussion of the priveleged. While we may think we do not have choices about our work, we have a heck of a lot more control and choice than many.

  31. Anon @ 5:14: There's always someone who makes a "discussion of the privileged argument." Sorry, I don't buy that. If you're going to say that, we can't discuss anything. When my kid asks me if she should get a PhD or go to med school, am I supposed to say, "You are privileged to have this choice so I refuse to discuss it"?

    Liana: Wow, if I had 4 months of the year off, I might feel very different about my job! That is a pretty rare situation though.

    Mamadoc: Very well said. I "love" my job sometimes and sometimes... not so much. Or I love some aspects. It's given me a comfortable lifestyle at this point and I wouldn't want to do anything else at this point. But if I were 22 again, I think I might make a different choice.

    Anon at 4:21: Thanks :) I think you make a good point too.

  32. I've got to agree with anon at 5:14. I don't think that s/he is saying that we shouldn't discuss our choices or be discriminating about all the wonderful opportunities that we in medicine have to choose from, just that this is another layer of gratefulness that needs to be a part of anyone's thought process.

    I think that it's everyone's prerogative to make and discuss their choices. It's just that to a large extent a lot of us have been lucky (through being born in the US or Canada, in families that valued education, etc) and the average person just doesn't have the range of choices we have.

    I think that there should definitely be some implicit (or even explicit) graciousness about the fact that, on the whole, being a doctor is a pretty good gig. I don't see that in your posts.

    Though we may work a lot and it's very demanding at times, we make more money and have more choice and control over our lives than, say, a person working in a factory or a janitor or all of the unfortunate people out there looking for work in this economy.

    As a family med resident, I don't make what my colleagues in other specialties do and I'm sleep-deprived but I am sure happy that I will always have a job.

  33. I really like what Anon at 3:26 pm said and I wholeheartedly agree with her.

  34. Fizzy- I think you are fully within your rights to discuss and complain. But I have to agree with Anon 5:14 and Sarah that even on my worst days, I am grateful and happy to do what I do than, for example, fighting in Afghanistan or more mundanely snoplowing or street sweeping. But again, I love what I do and generally work with great people. I am blessed both at home and at work. I am sorry if you do not feel that way.

  35. Guys, if you're implying that all doctors should be "grateful they have jobs" because not everyone is afforded that opportunity, I kind of think that's a bunch of BS. A person can be profoundly unhappy as a doctor, and telling him/her they should be grateful they have a job is not only incredibly unhelpful, but is also not really true. Perhaps a person who is a doctor might be happier as a janitor. There are good reasons people become unhappy in medicine. Stop being so freaking sanctimonious.

  36. Fizzy, maybe you feel that way because you are surrounded by doctors who hate their job and are negative? Maybe they are influencing you negatively?

    And, it's important to be positive. I agree with most people here when they say that we are very lucky to have a profession, more so a medical profession as a physician. You can look at any situation and your mind can come up with the same amount of negative and positive things about it. In the end, you'll have 2 lists, with the same number of things. For each negative thing, there is a positive thing. It's up to you whether you want to go on in life focusing on either the negative list or the positive list.

  37. @ Old MD Girl - well if they are profoundly unhappy as a doctor, then they should quit the career. There are other wonderful careers that make a lot of people very happy.

    I don't think people are trying to be sanctimonious.

    I also think Fizzy has all the right to complain about negative things about her job. After all, it's a blog and that's, I think, the purpose of a blog. That being said, I think the problem here is that most female doctors on here go to find support on this blog to "share our war stories", to overcome the daily trials of being a doctor and a mother. And, although Fizzy has all the right to write any kind of posts she wants, it's probably not helping anybody else feel better about their daily lives, that's all.

  38. @OMDG: I disagree that people are being sanctimonious. I think they are just expressing a counterargument to the negative opinions. Some people happen to like what they do and they recognize that they chose to go to med school and chose their residency and are glad they did. Not everyone can be happy every day, but they can be content with their choices. Also you cannot deny that a smart woman with educational opportunities can do a lot of things besides medicine so if medicine makes you unhappy why not do something else? You are right that some may prefer being a janitor. Fine but most do not.

  39. For the record, I disagree with all the Anonymouses. ALL of you.

    I can't sort through all these anonymous people, so I'm just going to reply generally:

    1) Getting told that I should be grateful to have a good job is like telling your kid that they should eat their lima beans because other kids have no food. Does that work? Do kids like being told that? Would YOU like being told that? When you have bad back pain or a flu, do you want to be told that you should stop your whining because you don't have metastatic cancer? Because if that's okay, show me your blog and I'll be happy to do so for you. Yeah, I'm grateful for things in my life that are good. Do I honestly have to list these things every time I make a post? Please.

    2) I'm sorry if my post didn't make anyone feel better about their daily life. Would you like it better if I gushed on and on about how much I LOVE my job, how well behaved and a fantastic sleeper my kid is, how I lost all my baby weight two days after giving birth, and I just don't know what to do with all this money I have in the bank? Would that make everyone feel better about themselves? Frankly, I enjoy listening to people whine. Makes me feel better about myself.

    3) I think everyone is kind of missing the point. My point isn't that being an attending sucks ass. It was that if you're just looking at training as something you need to get through in order to have some cushy, easy, wonderful job as soon as residency is over, you may end up disappointed. You should enjoy training for what it's worth.

    4) I love it when people say, "You don't like medicine? Do something else!" It's SO patronizing to say that to someone who has put in a decade of hard training and has a quarter of a million dollars in debt and no way to pay it off without earning a physician's salary.

    5) OMDG: You rock as usual.

  40. "Guys, if you're implying that all doctors should be "grateful they have jobs" because not everyone is afforded that opportunity, I kind of think that's a bunch of BS."

    OMDG: I'm not implying it, I'm saying it outright. All doctors should be grateful they have jobs. GOOD jobs. Even the most poorly paid doctor makes 4 or 5 times the federal poverty level.

    My grandfather worked in a sock factory his whole life. He wept uncontrollably the day I got into medical school because he was so happy. He knew I would have the chance to make a good living for myself and my family and not have to scrape by like he did.

    I am grateful every day.

  41. Sarah: Fair enough, but next time you go to a restaurant and the food is terrible, you better not complain because YOU ARE PRIVILEGED TO EVEN HAVE FOOD. People in poverty sometimes don't, you know. So I hope you always acknowledge that.

    People are allowed to complain about stuff without constantly getting lectured. If you're feeling overworked, you're allowed to complain without having to add a disclaimer. Geez, why is everyone acting like my grandparents?

  42. Wow Fizzy if you don't like the heat get out of the kitchen. You asked for dissenting opinions; people who did not find residency intolerable and have the job they wanted. But what you really want is for people to agree that medicine is miserable. Maybe you feel your previous choices limit your ability to leave medicine but people do it every day. Other people like their jobs, what is wrong with that. Don't be grateful that you have a job- but do be grateful that as a result of your intelligence and hard work, you have many more choices than the ditch digger. That is a COMPLIMENT. Be gracious, it is much more attractive.BTW I waitressed during pre med and worked my way through med school, so I am grateful to my waitress in a restaurant because I know how hard she works. I penny pinched and lived on a shoe string a long time after med school and yes delayed my gratification and am happy I did so. I am lucky; I love my job and have had an easy time having my family. Just wanted that to counteract the "misery".

  43. Anon: I want to discuss. I just don't like it when people shut down the discussion completely by saying, "We can't talk about it because we should be grateful to just have jobs." Yeah, there are people who dig ditches and wait tables and I'm glad I don't do that. Are you happy now? Can we get back to the topic?

    Furthermore, I never asked who loved their job and who didn't. I asked who worked hard. I was pretty specific in my last paragraph. Nobody answered the question. You can work hard and still love what you do. My point was simply that if you're waiting to have a life becauase you think you're going to have a cushy job, that might be something you won't have as a doctor, especially in some specialties. Doctors work hard. Are they all miserable? I don't think so... a lot are happy. But I think they work harder than people in a lot of other fields.

    People infer things about me from my posts which are not true. Just because I wrote a post about how doctors work hard, everyone seems to infer that I'm disgruntled and miserable. I'm absolutely not. The truth is, I think I have a pretty great job. Really, I just want people starting out to have realistic expectations about the field so they don't end up miserable. But everyone seems to read exactly one random sentence of my post and reply to that sentence.

    I can't win, really. When I made a post about how I was grateful I had kids early, I was called judgmental and that I was showing off my good luck of having a family. Something about the way people reply to my posts switches on my bitch toggle. Maybe it's all the estrogen.

  44. Actually Fizzy several people answered your question about working hard and said yes they do but they like what they do which compensates. Maybe you have to be a workaholic. I usually get absorbed and don't notice the time at work. Are there days that I wish I had more time with my family, absolutely. But overall, I do not find my full time attending life bad(70 hours weekly on average) and enjoy it most days.

  45. Einstein really was a genius. It really is all relative.

    Fizzy..as you know, I am a fan.
    I know you are grateful for the good things in your life and like reading your reflections on the not so good things.

    An Australian International aid worker, Phoebe Fraser, reflected in her book (I can't remember the name, something to do with a flower) that when she delivered aid in famine affected areas in Africa the pack included protein biscuts,
    In Eastern Europe the package includes cheese. She wondered if it was fair initially but then realised that cheese was on the daily menu in Eastern Europe and had been "lost"

    Also I worked once with a GP in a country town who had moved from South Africa to escape some horrid conditions. He refused to acknowledge any form of depression, particularly Post natal depression because these people should go to South Africa and then they'd have a real reason to be depressed.

    Of course Doctors can be deeply unhappy and not feel "privileged". Doctors can be hugely overworked, dealing with human sufferring, sleep deprived, and many other trials and challenges. And they weren't handed their jobs on a platter...they worked bloody hard for them.

    Not all doctors come from families with money who value education either. That intimation is a fallacy.

    Basically the idea that Doctors should be happy with their lot in life, simply because they are doctors is rubbish

    Male Doctors are 3 times more likely than the general population to suicide, Female Doctors 7 times (Australian data). Surely it is a good idea to explore the challenges facing our profession that may lead to these figures??

    Keep on blogging Dr Fizzy! Love the places your posts take us.

  46. I don't think it was about the point of your post, Fizzy. I think it's about the underlying tone - it seems sort of bitter and unhappy.

    We all agree that working as an attending is not the blinding bright light in the tunnel. There's still hard work involved even when you are at the top/best point in your career. But, I think it's the way you said it. Of course, this IS the internet and things can come off sounding differently and "offensive".

    Also, I love readings your posts, too. But, I think I see where other people are coming from.

  47. For the record, I didn't pick up on any bitterness in this post (maybe in the past, but not here). You're just saying that when you get to attending-land, the long hours and hard work may well continue, and if you're hoping that won't be the case because you're miserable in med school, then you might be in for a wake up call. That's all.

  48. @Bekkles

    No one is stating that being a physician is a cakewalk. However, with any group there is a bell curve. The range of comments reveal that. We all have a right to complain but please also acknowledge that some people do jave the life they want. There are people unhappy in every profession. Where docs get into trouble is thinking they cannot do anything else because of the investment they put in. If it really means misery for the rest of your life, you would still be a doc?

  49. I really value the honesty of your posts, Fizzy, and want to thank you for your courage in sharing the sometimes brutal truth about the reality of medicine.

    I'm a mother who is graduating pre-med this May, and sat out on last year's application cycle to medical school due to concerns about the sacrifice that would be involved and how it would affect my family.

    This being said, I am deeply appreciative of hearing both sides of the story about the life of a physician, and the journey to get there, and this is why I'm so glad that you are a contributing member here.

    As far as the continual debate goes, I will say that I wonder if there are some people being defensive because they feel threatened by the fact that you might be exposing them. They may feel like you do, for example, deep down inside, but are afraid to admit that they've sacrificed so much to get to this place that doesn't make them as happy as they thought it would, or isn't what they thought it would be. I'm sure this isn't the case with everyone who has an opinion opposite of yours, or argues against your posts, but you do have to wonder if it doesn't explain at least some of the snarling.

    However, I want to say thanks to all who do post the positive comments. I know there are some out there who truly love their roles as physicians and have found joy in the work, despite the demands. To hear these encouraging words is reaffirming and inspiring. I hope that they are genuine, and that I might one day be able to echo them.

  50. @bekkles and Fizzy

    I do not think people want to cut off debate about the hard work. They just wanted to show that they (the individuals) were happy despite the work. Maybe they did not feel med school was a trial requiring a "bright light." Maybe some of them do not mind the work. I would argue that lawyers work pretty hard in the standard setting as do people in the corporate world. Some people without our education have to work two jobs. The world is full of hard work. The question for me(and if you like you can answer) is does the profession reward you for that work. In money, respect, satisfaction,intellectual stimulation. I had choices but this is what I really wanted to do and most days the work does not bother me.but you are right, I do sometimes work harder now than in residency.

  51. Anon at 8:16: If you work 70 hours a week and are happy, that's awesome. I absolutely could not be happy with those hours. I'm sure some people would be fine with it, but plenty of people who go into medicine don't want to work that hard.

    Bekkles: True, unhappiness is an unpredictable thing. Postnatal depression used to baffle me because I couldn't figure out how anyone could be depressed when they were lucky enough to have a perfect little baby at home. (I get it now.) Just because you have a good salary, that doesn't mean you can't be totally dissatisfied with the work you're doing... either the work itself or the hours.

    Chacy: This post was probably aimed most at people like you. I didn't write it to discourage premeds from becoming doctors, simply to know what they're getting into before starting so they don't end up disappointed or depressed. When I was a sub-intern, my intern had a 7 year old son and she was the most unhappy person I ever saw. She used to cry all the time about what a horrible mistake she made going into medicine and how she missed her son so much. I think she went to med school, thinking about the future, about some great career she'd have someday (maybe), but then she was totally miserable in the present. I think it's terrible to live that way.... I know, because I *did* live that way for a while.

    Final Anon: Like I said above, some people like working hard under stressful conditions. Some people thrive on it. Some people deteriorate. For a person with good grades in college, there are lots of career options that pay well and are less work and low stress (see the link I posted). Since we do have that choice, it's worth considering. It's not like we're choosing between medicine and ditch digging.

  52. Unrelated comment: I love this blog.

    I'm your average college student seriously pondering whether I want to submerge myself into the huge commitment of med school, residency, etc. I stumbled on this blog a couple of years ago and I've kept up with it just because the women are so real and relatable. If anything, its made me see that being a physician is a worthy goal but it shouldn't completely define me.

    Fizzy, your blogs are great because they're so honest. They make me laugh (and I love the cartoons by the way) and through your blogs I can kind of see...work can suck sometimes. But really, everyone's work sucks too. You've really brought me back to earth (esp. this post. sometimes all that's ahead can be overwhelming and its hard not to look forward to the bright light...but I should definitely try and spend more time enjoying life as it is now. crazy pre-med life or not.) and if anything you've convinced me I really do want to be a doctor. This is one of the only blogs that's not like "MED SCHOOL IS SOOOO HARD" or "BEING A DOCTOR IS SO REWARDING!" and I love it. Sometimes the middle road is just the way to go.

    Thanks again for the insight :)

  53. I can't decide if I agree or disagree with this post. Well, I really can't do wither bc I'm an m1, so I guess I mean I can't decide if I like it or not. I also don't know if people are using the phrases "work hard" and "work long hours" interchangably.
    I do think that your point about not postponing your life is good- for everyone, not just mim's. I have a son who is about to be one- our plan was to wait until after training to have kids, God decided otherwise, and I have been grateful for the way things turned out every day since he was born. My m2 buddy has several children. When I asked her how her relationship was with them, she replied "I never see them". I'm currently doing the same thing she was when she "never saw them" and I'm only away from my son on average about three or four hours a day (I study after he's in bed), plus I have every weekend and the summer to spend uninterrupted with him. I often wonder how two women can have such very different realities during the same experience (m1 year). I think it's all about priorities, focus, and trust.
    I look ahead to the tougher times (m3 year, intern year, etc) and I sometimes wonder how it will all work out. But I wondered that about this year too, And I'm enjoying my life every day. I think a little creativity, some help from family or friends, and the ability to, as my friend says, "rid your life of bs" goes a long way.
    I do agree with so many women who've said if you're not happy, leave (not that you're saying that fizzy, but just to women in general). I can say that with a sliver of understanding bc I left a job for which I'd spent four years of training, 4.5 years of practice, and tens of thousands of dollars of loans on to come to med school. I think life is ao short and families are so important, if you can't enjoy them during school, training, or practice it IS NOT WORTH IT.
    (write me off as a naive m1 if you want, I understand. But I guarantee my priorities won't change.)

  54. @barefoot moses
    There will be days when you question your decision. What has pulled me through those days is good support at home, good friends and fortunately a love of what I do. Life is too short to be hating what you do. Maybe that is not what Fizzy is saying but the tone in the blog did not express any enjoyment of the schooling or training.Yes you will work hard and not only in training.just try to find the joy in it or it will not be worth it.


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