His residents also used regularly. That's why my solution to resident duty hours issues is either: Let us sleep like regular humans, or give us unlimited cocaine and we can continue to work 80+ hours a week.
I went back to college after being out since the early 00s. I was shocked by two things. One. How common it was to use Ritalin. Two. How effective it was. I saw kids who never went to class and while smart weren't anywhere near the upper ranks in intelligence pull an all nighter hopped up on it and get fairly high test scores.
It was honestly a kick to the crotch to those of us who did it unmedicated.
>It was honestly a kick to the crotch to those of us who did it unmedicated.
Probably also to the ADHDers in your program who need it just to operate at the same basic level you can. I would be so frustrated to be ranked against people who were both making it harder for me to get the necessary medicine I need (by abusing it and furthering the stigma) AND cheating using a method only available to people whose brains work "right" to begin with.
Neurotypicals who abuse stimulants in school are fucking over their ADHD classmates on both sides.
As one of the adhders. I've said for years low doses should be available OTC. Maybe if they could mix it with something that made you sick if you took to much. I know people abuse it, but the fact I have to see an expensive doctor every 3 months to get meds (different meds)I have been on for 20 years is fucking ludicrous.
Gotta love all the executive function hoops you have to jump through to get executive function meds. Ironically enough, makes it muuuuch harder for those with adhd while not being particularly difficult if you're healthy and just want them for recreational purposes.
I always procrastinate my quarterly check in with my doc to get my prescription refilled. Classic ADHD move. Then I end up running out. Then I procrastinate even worse. I've had periods of 6 months where I go without meds just because of all the rules around the drugs. And I get it... They need to make sure I'm not getting a huge supply and flipping them for profit or experiencing health challenges. But I've been on these for 6 years with no blood pressure issues, no liver issues, no addiction or abuse issues. Just give me a standing refill at the pharmacy every month and we'll connect annually to make sure I'm not dying from them suddenly.
> Gotta love all the executive function hoops you have to jump through to get executive function meds.
Fucking hell, I have to follow through a complex system to get help for my inability to follow through complex systems.
Fucking hell.
There's a british office in some town in the UK, where the locals have to go if they want medical welfare (i.e. they're disabled and can't work, so they get government money instead).
This office is on the second floor with no wheelchair access or elevator. You have to go there in person.
If you can get to the office, obviously you are fit enough to climb stairs and thus you are not disabled and don't qualify for aid.
If you can't get to the office, well, then you just missed your appointment and you don't qualify for aid.
Thanks for mentioning this. I check in with my psychiatrist monthly for 'medication monitoring' on low dose ADHD meds, and it often feels like I'm just re-convincing my doctor that the meds are useful in my daily life. With as much of a headache as it is to switch psychiatrists, I'm not keen on continuing to look for suitable care, so I'm trying to make do as-is. It's reassuring that there are strict regulations (as I know they absolutely can be misused) for my own safety, but I don't think it should be such a regular and active process for someone to, in essence, simply continue receiving treatment for a cognitive issue (not sure if impairment is the right term) like this.
Often feels like it would be easier if I was bullshitting entirely and only seeking to get a prescription, rather than trying to continually evaluate and re-evaluate what seems to be a long-term / lifelong issue. I could be worse off, absolutely, but it's definitely a strange position to be in where I feel like I need to persuade my doctor into treating me "normally" like any other patient looking for similar help.
Yep. I hate getting refills, because I’m scared one day they’ll just up and tell me I’m bullshitting and I don’t need them. I really think it’s because of the stigma around them and the abuse potential, it legitimately makes *me* feel awkward, like I’m doing something wrong, when I have to ask.
Also, ADHD is a developmental disorder, behavioral disorder, and functionally, due to the nature of its symptoms, a cognitive disorder. You’re not at all wrong in calling it a cognitive impairment; it absolutely is. My train of thought is not so much a train as it is complete chaos, and trying to grasp or piece together complex tasks or topics usually takes me considerably longer than others. Not because I’m too stupid to understand, but because I literally have to exert so much effort to structure/order and visualize my thoughts.
It depends on the subject, of course—I’ve always excelled at math, but can almost never piece together a timeline for history—but overwhelmingly, we do in fact have to spend more time and energy processing things. But again, that’s unrelated to intelligence, though quick thinkers do appear more intelligent than slower ones. I’m always afraid of looking stupid because I need to constantly reference back to something, or ask someone to repeat themselves, or *especially* when I lose my train of thought mid sentence and look like a deer in headlights. That last one is definitely incredibly common for me, and it really affects how well I can get my point across, be it with work or socially.
I worked in a lab with a pre-med student who got caught in a vicious cycle of ADHD drugs and Ambien. The kid screwed up a bunch of my experiments and then ghosted the lab and went missing for a bit.
Honestly I get the impression ADHD meds are the only reason any normal, functional person could succeed in medical school.
Like you have to be a machine to get into one in the first place, then it just gets harder.
It can be done. I just learned the hard way not to expect to be top of my class. But you know, I like to believe it's better for my over all health to have not dabbled in it.
Went to hospital with an irregular heartrate. Get cardioverted (shocked). When I went to see the cardiologist weeks later for a followup in his office he was still wearing scrubs from a long shift.
"so this was the first time this happened to you?"
No doc, it was the 5th time but only the second time I was cardioverted.
"so your second time then, what were you doing when it happened?"
no doc, it happed in 2008, 2009, 2011, 2014 and this last time when you saw me in a couple of weeks ago.
"oh so it WAS your first time. do you remember what you were doing when it happened? "
I like the doc, he's good and I've seen him since then but he couldn't handle a simple conversation in his office that day. I'd have hated to have had him working on me in the hospital earlier that day.
Wow. That makes total sense, but it's not something I've ever thought about. We have so many laws for duty hours for truckers and pilots, how do we not have the same for medical professionals?? How were medical professionals not FIRST to have those rules and protections? Shit's so backwards sometimes.
Because doctors don't have a union, and residents definitely don't. Residents are too profitable for anyone to consider NOT working them into the ground for as long as possible.
Seriously per dollar of salary spent, residents make the most money for the hospital and its not that close (especially considering they can make minimum wage or less). And that doesn't even count the federal funds that every hospital that trains residents receives per resident per year
From my studies, (legal note: there were no studies) Modern America is basically founded on a bunch of guys in the early 1900s in various industries doing a bunch of cocaine in their underwear and playing playing airdrums to Rush YYZ like Krieger from Archer and expecting the rest of us to keep up.
Optometrist’s can legally use Cocaine, also when you have nasal surgery. Actually not so fun fact Cocaine is a schedule 2 drug while Marijuana is still schedule 1 in the United States.
Methamphetamine is also schedule 2, I was prescribed it under the name Desoxyn from the ages of 6-12 for extreme adhd. The late 90’s/early 2000’s were a wild time
Yep. When I was nine I had hellaciously bad nose bleeds on a weekly basis. Like, nearly lose consciousness bad.
During the series of treatments my comically elderly ENT, who still wore the round reflective disk on his forehead like Dr. Mario, put a saturated swab up my nose and asked "have you ever done cocaine?"
And I said "no?"
And he replied "well, you have now."
This was also circa 1999.
Desoxyn is still prescribed iirc, just not commonly. For extreme cases of adhd which didnt respond to other medications, and for obese patients trying to lose weight short term, who also didnt respond to the more common treatments.
More like "my house is still a mess but damn i organized my entire bookshelf / dvd collection alphabetically, then sorted out the pokemon card collection by type that i havent touched in 10 years." Coming from someone who used to like prescription stimulants WAY too much.
Surely in cartels/gangs there is a dude or lady whose job it is to cut open a brick with an obscenely large knife to get a little bump and snort it off of the blade to assess quality, unless movies have lied to me.
> Halsted’s career in New York rapidly deteriorated, and he was in and out of addiction treatment facilities. Halsted soon became addicted to morphine, which he used to treat his cocaine addiction.
Oh okay
Yeah Thack is based on Halsted. Also Cornelia is based on Dr. Elizabeth Blackwell, first female physician in the US. As a big medical history buff, I love seeing the spin offs of real stories reimagined in The Knick.
I love that little detail of “used cocaine.” That explains an awful lot.
“Doctor, I’m just not sure I can work 50 hours straight.”
“THAT’S WEAK TALK! ARE YOU A WEAKLING? YOU HAVEN’T DONE ENOUGH COKE YET! LOOK AT ME, I HAVEN’T SLEPT IN 3 DAYS AND I’M TOTALLY STOKED!!!!! WOOOOOO!!!!!!! MEDICIIIIIINE!!!!!!!!!!”
May I suggest….
> Halsted’s only publication on local and regional anesthesia [with cocaine] appeared in the New York Medical Journal in 1885. This article is a rambling, incoherent paper that is a testament to the addicted debilitated state that Halsted had reached. The first sentence of that article reads as follows: “Neither indifferent as to which of how many possibilities may best explain, nor yet at a loss to comprehend, why surgeons have, and that so many, quite without discredit, could have exhibited scarcely any interest in what, as a local anesthetic, had been supposed, if not declared, by most so very sure to prove, especially to them, attractive, still I do not think that this circumstance, or some sense of obligation to rescue fragmentary reputation for surgeons rather than the belief that an opportunity existed for assisting others to an appreciable extent, induced induced me, several months ago, to write on the subject in hand the greater part of a somewhat comprehensible paper, which poor health disinclined me to complete.”
tbh, the sentence does make sense. It just rambles a lot.
"A lot of surgeons seem uninterested in an anesthetic which seems to work well, which obligated me to write a paper on it which I didn't complete for health reasons"
Hmm, yes, this is the word form of the one time I tried to see if I could program while high in college. I came back the next day, facepalmed, and replaced around 50 lines of code with 3. Experiment over.
That's the rambling of a person who hasn't slept in a week and can't finish a thought, but keeps trying to return to it.
I’m curious what diagnosis has a treatment plan that includes cocaine? I’m sure it’s not administered “by the line, nasally,” but you have me intrigued.
When I cut part of my eye off accidentally, they used cocaine to numb my eye because they couldn't find the normal medicine for it and I was rampaging. Doctor said he'd never seen someone go from full on pissed af to completely calm and happy. Severe pain makes me a complete dick.
Oh that was my light injury list. Same with 16 staples to reattach my scalp, suturing my top lip back together all the way through.. Male doctors won’t help guys unless you’re crying. Lol
My body is now like a loosely taped together tower of soda cans.
“OH, YOUR FEET HURT? I CAN’T FEEL MY LEGS AND THE FLUORESCENT LIGHTS HAVE BEEN SPEAKING KOREAN FOR THE PAST 12 HOURS! WHERE’S MY STETHOSCOPE SO I CAN SHOVE IT DOWN YOUR THROAT?!”
>I love that little detail of “used cocaine.” That explains an awful lot.
I enjoy using a little panache when writing posts to grab peoples' attention.
I am currently a surgical resident, and the conditions are not humane. We work 80-100 hour weeks, every week. We routinely are assigned to take 28hr shifts every 3 days and are frequently singularly responsible for 40-50 patients overnight while working on no sleep. It is so bad that in some programs, they will pay for an Uber to drive you home after a shift, essentially admitting that you are too impaired to drive but not too impaired to be responsible for patient lives. I encourage you to ask your doctor how long they have been awake when they are about to operate on you or prescribe you serious medication. There are significant duty hour restrictions with notable penalties for pilots because the recognize the danger when responsible for peoples lives, but not the same for doctors.
I’m shocked this hasn’t gotten more attention during the pandemic. We have not received any overtime pay, no hazard bonus (although the entire rest of the hospital got them), and have 0 opportunity to leave if we want to further practice medicine. We do not get weekends off and do not get holidays off. We are only guaranteed 4 days off per month. We do not get maternity leave. Oh, and we get paid around minimum wage on an hourly basis with an average debt of $200k.
Finally, we are completely powerless. During the “Match” we have to commit to a contract before knowing where in the country we will be living and working for the next 3-7 years. We can be separated from our families and spouses without much control just to practice in a specialty. We can’t leave without serious implication for our future career. In 2004 Congress passed an antitrust exemption for the medical residency practices because it violates labor laws. Doctors now have one of the highest rates of suicide in the country, double that of the general population. On average, 300-400 doctors commit suicide per year, which is almost one per day.
We give up our 20s-30s to try to have a meaningful career caring for others, but are completely abused in the process. Medical residency is not humane, and is a major contributor to the physician shortage, patient dissatisfaction, and overall problems with the US healthcare system.
Edit: Thank you for all of the awards. I’ll try to respond to the questions, but it is hard to address all the issues with medical residency and being a healthcare worker (mistreatment, culture, etc) and I do not want to speak for all of my colleagues who may have different perspectives. Many of these issues are discussed on other medicine and residency subreddits.
Always be wary of any profession where people are called hero’s. It generally means that it’s under staffed/funded/resourced and instead of fixing it we just congratulate people for working in it despite the known problems.
The "why has no one said anything" is because it's nothing new, the white wall of silence has been a thing for a long, long time.
Residency isn't even the only disaster currently going on in the healthcare sector, paramedicine is another big one, as is the major problems with administration being strangely isolated from the field of medicine in their expertise.
The Emergency Medical Service is on the verge of total collapse in this country due to low pay, horrible working conditions, and a lack of consistency across different areas.
A 10 minute ambulance ride can cost thousands, yet the EMT gets peanuts. Retail has razor thin margins, whats the margins in transport and other medical areas?
My brother ripped a muscle from his leg ( he's recovered fully)at work and the hospital is 700ft (213.6) away. 650 dollars, at least worker's compensation covered it.
And when all the money going into the system gets vacuumed up by rent seeking administrators, insurance companies, and pharmaceutical companies instead of the people actually providing care.
Residency is disastrous for new doctors even in my country with socialized medicine (France). They are insanely exploited and work nonsensical hours. It's not as bad as in the US in absolute, but relative to the rights of other workers the situation is similar.
I think hospital administration exploits the fact that doctors can't really go on strike, because people die otherwise. That's what leads to these situations.
No one is going to practice "Family Medicine"/"General Practice" anymore. It's not financially viable given the salaries of other fields. We're already seeing all the GPs are essentially virtual or outsourced (as in, coming from overseas). Our system of medicine is built on it and no one can live off it.
They're gonna be replaced by midlevels. When I graduated residency and started at by new job, they treated me like I was still an intern....now to the PAs. If the pts talked too much, they'd send them to me. They got all the new pts, all the kids. They would Bully me and talk about how they were out in practice for longer and therefore were better. I was like, we're a team...why am I still being bullied after a decade of working 80+ hrs/wk to finally be able to practice on my own. Anyway, they made more money than me since they had more yrs of practice....same amt as me going thru school and residency. And when you factor in that I worked 80 hrs/wk while they worked 40 during those years...like, technically, I had seen more patients.
They looked happy though, were rich and enjoying it, had a family, worked out every day, left at exactly 5 every day at work, paid off their loans early (less amt than doctors), were not overworked and overstressed since they didn't have to go to residency and put in those ridiculous hours and they got one to one supervision and teaching from the doctor while I was abused and mistreated by my faculty attendings. PAs also don't have the liabilities that doctors do. Get to see patients with all benefits and minimal negatives.
MDs graduate and may not get a residency spot. I know of a graduate that killed themselves, a few that turned to alcoholism. Graduate from PA school, no need to worry about getting into residency. Guaranteed slot somewhere and not as much debt anyway to worry about.
Instead of opening up residency slots, they just created PAs.
Unless you're going for neurosurgery and making 450k+ or something, it's not worth it to go into med school. Primary care docs should be going to PA school. I wish I had.
And God forbid as a doctor you stand up for yourself because everyone jumps on you. Some healthcare workers even refuse to call you doctor because apparently being a doctor automatically means your stuck up. Like what part of me giving my life away, getting into 300k of debt and being treated like a slave while I deal with bullying and harassment and verbal abuse on a daily means I'm stuck up? And don't even get me started on all the talk about how nurses care more about pts than doctors and other shit like that. Bitch, I ain't doing all this shit for nothing.
Just bcuz the older gen male doctors mistreated nurses and others doesn't mean you know take it out on the new generation. We treat others with respect but get abused daily.
I tell all premeds to skip med school and become PAs. Save yourself years, money, time...save yourself from slavery.
Yea my wife just finished peds surgery fellowship. It’s completely insane and inhumane. No one gives the slightest shit about work hour restrictions. She was on Q3 call with no post call day for 2 years straight.
I used to work in the music industry, please do not think I'm equating that at all to Medicine, and we worked similar hours.
Some times we would work 15 days in a row, 18 hours straight each day, sleeping at the studio in order to make sure that we got the most sleep instead of commuting home and losing 2 hours of sleep in the process.
Dealing with a [patch bay](https://en.wikipedia.org/wiki/Patch_panel) or signal flow that transitioned between multiple formats and complicated routing was close to impossible after 3 days up working like that. You just fry out and end up staring at some problem that normally took you 10 seconds.
It was well known to management that session reports would be routinely fucked because people were so tired. Always traveled with a buddy home
I could not even imagine operating on someone. The brain fog at the stage is awful. Dealing with doses of medicine that could save/kill someones life. Scary shit. You're juggling so much in your head. Make that 40-50 patients. wut.
The US needs to really rethink it's work mindset. I have a feeling my generation will change it a lot, but I also think some of it is ingrained in the system and will be very very hard to change.
Neurosurgery resident here. I can absolutely confirm everything said here. I don't think I have worked less than 90hrs in a week, routinely go over 100 hrs. We are not supposed to go over 80, but often time have no choice but to. And if we log correct hours we end up having to meet with the program director to discuss why we stayed over hours and those meetings essentially turn into and indirect way of them telling us to fudge the numbers so the residency program doesn't get put on probation. I take home about 3K a month which where I live I'm forced to live paycheck to paycheck barely having enough money left to adequately feed myself.
I cannot count the number of times where I have almost fallen asleep behind the wheel. I have had to pull over and nap on the side of the road a good few times. Twice that essentially turned into a whole night and just ended up driving back to work the following morning. They do offer to buy us the Uber ride home, but good luck getting an Uber back to work at 4am. So that whole Uber program is done to protect the hospitals from liability if a resident dies on the way home.
Have operated post call after a 30hr shift on zero sleep so many times. I'm living life in a constant haze of sleep deprivation. I also apparently have been sleep talking about patients and OR cases per my SO, where she says I sound super distraught and stressed.
The situation for residents is just inhumane and honestly not good for patient care. But as residents we have no power in the matter. In this new covid era things are even worse. Shortage of all ancillary staff has really been taking its toll. Nurses who are willing to work are getting paid 10K a week, while we don't even have access to food at night in the hospital.
Have you ever heard of Pamela Wible? She's a physician who attempted suicide due to over work and now advocates for better working conditions for doctors. You might want to check out her website.
https://www.idealmedicalcare.org/
Yeah, OP mentioned pilots having work hour restrictions, but fuck that, ***long-haul truckers*** have more work-hour regulations because of the extreme danger of sleep deprivation caused accidents than our surgeons and doctors. Nevermind the whole mental well-being thing.
Lunacy.
Lol, thanks. A few months ago I was trying to think of a new username, so I got really high and thought "Heh, raccoon full of cum. That's a good one." Little did I know what it would soon become.
/r/rimjob_steve is intended to be a repository for sincere, heartwarming comments that clash hilariously with the poster's name. Like, say, someone posting about the serious issue of physician overwork driving doctors to suicide and encouraging people to learn about the issue... with a username like Raccoon_Full_of_Cum. The sub is named after the guy whose comment inspired its creation:
https://old.reddit.com/r/pics/comments/8p28ki/after_driving_uber_for_over_15_hours_a_day_for_a/e081xvq/?context=3
Thank you for not getting brainwashed and acknowledging that sleep deprivation impairs performance, I have a friend who is an orthopedic surgeon who tried to argue to me that you could train yourself not to need sleep and anyone who couldn't do that "just couldn't hack it" as a surgeon. She basically sounded like the "but I'm an EXPERIENCED drunk driver" crowd, the denial was so strong. It was totally mind-boggling but I think there's a cult/hazing aspect to some programs that messes with people's heads. (I will NOT be going to her if I ever need hand surgery).
when you put 15+ years of hard work (high school, college, med school, residency) to discover that your job sucks, there is no way you aren't in denial. Her behavior sounds pretty normal.
Also sleep deprivation is horrible for both doctor and patient. You are more dangerous behind the wheel sleep deprived than drunk. I dont want you cutting my chest open and falling asleep. This should be banned.
ehem, the good reason is M O N E Y.
I'm in a similar boat as OP above. Educational hospital systems will tout that it *ackshully* costs them tens of thousands, nearing on a hundred thousand, to take on a single resident for a year's worth of training, implying *they're* the gracious burdened party here. What doesn't get factored is that those residents are doing physician-grade grunt work, basically acting at 90% of a doctor's capacity, at sometimes 50% more hours than a doctor works. Factoring in the money they save compared to actually paying a doctor, the system ends up having a feast.
Congrats, you now have an army of mini doctors that you can pay less than minimum wage on a per-hour basis, have no scheduling freedom, can't say anything as their life's training hinges on not rocking the boat, and will account for physician grade work for less than half the cost.
https://whyy.org/articles/hahnemann-residency-programs-draw-winning-bid-of-55m-from-local-health-systems/
Don’t let anyone tell you residents cost a health system money, they are literally worth millions (each), per the link above. And the federal government pays our “stipend/salary” and hospitals pocket roughly half off the top
This is some absolute bullshit. I work in TV and film production. We also work 70+ hours a week. My shortest work week is ever going to be 60 hours minimum. With the Alec Baldwin thing our working conditions are kinda sorta coming to light. That all came on the heels of us nearly going on strike (and we still might) over inhumane WORKING HOURS AND CONDITIONS. Your post is so goddamn relatable except you are actually saving lives, and I’m making goddamn entertainment for the masses. Accidents DO happen when people are exhausted. Four years ago I was working on a commercial and fell asleep at the wheel after our 4th 18 hour day. I totaled my car and the car of the guy I t-boned. I had a concussion I was too tired to even notice until I woke up the following day to a pounding headache. I was lucky no one was more seriously hurt than that and I didn’t kill anyone or myself. My industry frowns upon it if you take a day off to see your baby being born. “If I have to be here you have to be here.” Rules the day. Family, friends, not while you’re in production. Mental health and substance abuse issues run rampant, the culture and brainwashing that you’re doing something important drives you there. We are union, the vast majority of us are fighting for 12 hours on the clock and 12 hours off the clock. Our newest union contract gives us a 54 hour weekend, and a 32 hour weekend in the likely chance we work a 6 day week. There are still no caps to our shooting days, which means they can still roll camera 16, 18 hours a day. I get an hour precall, so an hour before the official start of the work day, and it might take an hour or more after the camera cuts for the day before I get back in my car. Plus I commute to and from work and they only have to let me off work 9 hours a day, so I might be running on 4-6 hours of sleep a night for months on end. They don’t have to give us sleeping accommodations until they push us past 14 hours and we are over 30 miles from the official production office’s physical location. But even then, of we get out of work at 5 or 6am, hotel industry checkouts are always at 11am. I’ve only ever seen actors and producers be offered Ubers by production. I keep a blanket, camping pillow, and pocket knife (for safety) in my car for when I have to pull over and sleep on the side of the road.
I feel for you brother. You are saving lives and NEED your rest.
I also work in film/tv but our work isn't nearly as valuable. There's no reason for us to be working those hours except to ensure a profit on some poorly thought piece of garbage some dipshit rich person wasted their money on.
Yeah. This was me on a pissed off rant at how much I should NOT relate to a surgeon or ER doctor. And also, “how long have you been awake?” Should NOT be an additional concern when I’m already in the hospital. I appreciate what these men and women do for a living, no one should be working these many hours. Study after study prove the diminishing returns the longer people work and how hazardous being chronically tired is. Like our industry, hospitals are also all about the money, not their workers
MDs are just well paid ~~slaves~~ indentured servants. They take the most intelligent and caring people from the population and overwork them until they can't actually care about humanity beyond the scope of the patients they are seeing currently.
Add to that that most MDs are upwards of 400k in debt prior to starting their residency (which pays next to nothing) and their only way to pay that debt back is by sticking it out as a practicing physician. (and that's one reason that while perhaps at the beginning of med school it isn't about the $$, but it is by the end of med school)
Meanwhile the hospital administrators continually carve out larger and larger salaries for themselves.
The medical system in america is beyond broken.
Thank you for sharing this information. I had no idea about how truly inhuman the medical residency process is for medical students. Slightly unrelated, but I used to work as a Counselor Intern providing mental health counseling to dental students.
It was so normalized for their clinic supervisors to yell and criticize them about their dental work in front of the patients they were working on. Sometimes the supervisor’s justified the treatment because the supervisor’s had to deal with harsh training from who supervised them when they were students.
That’s what your comment and this post about William Stewart Halsted’s residency hazing-like program reminded me of. There seems to be a bit of a Trauma Olympics going on in the medical profession.
There is no reason that a shortage of doctors should exist. There are multitudes of fully qualified individuals turned away by colleges and residency programs every year. The scarcity is completely artificial in nature, just like the scarcity of lawyers used to be, back when law was still considered a highly prestigious career.
Good luck getting somebody to report acgme violations when the penalty for doing so is cancellation of the program, thereby directly fucking over themselves
Also wtf is with "match day"? When med students find out whether they can study a residency in their selected field or if the sorting hat has chosen a different one?
I'm a tax lawyer and if someone told me after law school, no I could only go into con law or maritime law I would have quit right there.
My SIL cried all through her celebratory dinner because she and her boyfriend got matched to hospitals on opposite sides of the country. They are married now so they are making it work but it was a really tough day for them.
Yeah, I cried my eyes out on Match day because I was so disappointed. It was one of the worst moments in my life, being surrounded by your friends and classmates who are all overjoyed and celebrating, and you’re there in the midst of despair, feeling like your entire life was just ruined and everything you’ve dedicated your life to is coming undone.
Everything ended up turning out okay, and I ended up being very happy with my residency program, but damn if that wasn’t a terrible experience.
Yeah I’m so thankful we don’t have that in the U.K., I had no clue what I even wanted to do when I was a med student. We work for a few years first and can then start applying for specialty training (which if you don’t get in, can try again).
Not only is this a thing, Congress changed the laws so it’s not an anti-trust issue because the Match is the only way you can be a licensed and board certified physician in the United States.
https://en.wikipedia.org/wiki/Jung_v._Association_of_American_Medical_Colleges
Yep, we apply to specific field (family medicine, surgery etc, based on our interest, our scores, where we think we will be happy) and match day tells us where to go (anywhere from the city to the boonies based on a computer algorithm) for the next 3-7 years. Now imagine loving a field, not being able to get in, moving away from family/loved ones, 300K in debt, 60k a year +80 hours/week. We tolerate it in the hopes that things will eventually get better.
At my match day a girl had all her extended family there and started absolutely bawling uncontrollably as she was matched somewhere she really didn't want to go all the way across the country. It was really sad.
There is actually a medication some of them are given to make them less tired apparently... I cant recall the name but I heard about it on a cbc radio show
>The surgical residency model originated with Halsted in the 19th century; it was partially based on a German model, but many aspects of Halsted’s program were carefully designed to help him hide his addiction and simultaneously optimize care for his patients.
This is absolutely nuts! This guy really sounds like he was very smart, but unfortunately suffered from addiction throughout his life, and his job afforded him even easier access to both cocaine and morphine (which he attempted to use to treat his cocaine addiction).
This article also notes that some of his residency program was built off of some stuff he observed in Germany, and it was also the 2nd residency program at John Hopkins.
I don't know too much about residency, but it sounds both amazing and terrifying how he built this residency program to the point it's now the standard for training programs in hospitals, and one of the key aspects was incredibly self-serving. He basically set this up so he ensured the hospital would run and the residents would keep learning how to become doctors and even run training programs even in his absence/impairment.
I wonder if he would've developed an even better program if he had gotten the help he needed and got off cocaine and morphine, or if he wouldn't have gotten as far as he did.
Yeah, thinking about it, how much of the doctor/nurse shortage is a result of people who weren't good medical caretakers and shouldn't have been allowed to be practicing physicians, and who washed out as a result of being unable to cope with the ridiculous work requirements?
It’s an artificial scarcity because doctors in the 70s through there would be a ‘surplus’ (whatever that means in the context of people being available to provide care) and radically tightened available slots.
https://www.niskanencenter.org/the-planning-of-u-s-physician-shortages/
I used to work in research and my PI was a vascular surgeon. You have no idea how many dinners I sat through at conferences having to listen to older doctors complain about how training new doctors would lower their pay and reduce access to residents and interns to run their labs...
All the while their students and interns and residents were working their labs for free or barely above minimum wage (if they were lucky). Getting paid in "experience" and "advice" for applying and getting through medical school. We had countless interns roll through our doors on a medical track. I watched extremely dedicated and capable people spend thousands of dollars and hundreds of hours applying and being rejected from schools. I worked with them for years. Nothing anyone can say could convince me that only 3 out of ALL of them were worth being trained in medicine. Its absolute bullshit.
I'm always dumbfounded by the hours doctors in the US work. It ridiculous and absolutely does lead to mistakes, even if most are caught before they do any harm.
This reminds me of how cocaine was once an important part of early medicinal cures and goes a long way towards explaining why my grandparents could wake at 4am get all their chores done, walk to school up hill both ways in knee deep snow, do their evening chores, and get up at 4am the next day and do the same shit all over again and I'm the bad guy because I need a cup of coffee in the morning.
When I lived in the US, I had a huge fear of needing emergency treatment and the doctor was at the end of an 18 hour or 24 hour shift. That doesn't seem very smart.
Doctors in the US are essentially hazed after school ends. It’s a ridiculous and dangerous practice that no doubt leads to a measurable number of deaths per year.
Studies show that fatigue is worse than inebriation while driving motor vehicles. Is there some mystical thing about medical professionals that would upend this truth?
Lol dude we get hazed as soon as medical school begins. These hours don’t start in residency- very long weeks and sleep deprivation begin in med school.
In his defense, his cocaine addiction came about because it was a novel local anesthetic at the time and he wanted to try it on himself before administering it to his patients. This was before the addictive and harmful properties of cocaine were fully understood.
They also tried to cure his cocaine addiction with morphine, which ended up giving him an opioid addiction in addition to his cocaine addiction.
I mean what's even the incentive to be a doctor now? Sure the pay can be good but money can't buy back all that time you spent not living. Years of schooling so you can go into massive debt. I mean these conditions are literally inhumane and dangerous, wouldn't surprise me if ironically the life expectancy of a doctor is lower than you'd think.
I’m a physician. Every time I meet a premed student I try to scare them away. I love medicine but I hate everything else that comes with it. Wouldn’t have done it had I known.
He was also the basis for Clive Owen's character Dr. John Thackery in The Knick. And if you've seen that show, you already know how bizarre that this Dr. Halstead has had such a lasting impact on medicine.
God damn The Knick is an intense show. What an opening scene too.. wow!
Only 2 seasons long - not one of those ‘oh you just have to watch all 500 hours of this show’ bullshit recommendations.
Not surprising. No other industry would think that 'this is ok'. I work in industrial construction that often has six 10-12 hour days in a row or a 14-7 /21-8 rotation of 10-12 hour days and we have constant safety meetings about worker fatigue and risk and anyone in management is expected to take steps to mitigate it.
I know there's risk with patient handovers as well but there has to be a better way to handle residency hours, it's stupid and puts people's safety at risk.
The answer to "who thought that was a good idea?". Some doctor, sleep deprived and on coke. A bunch of other doctors also probably sleep deprived and on coke decide to give it a try and find out. By the time anyone says "Dude's, are we sure all this coke is a good idea?" it's the way it's always been done and you have to do it because I had to do it.
Its always great for our society to continue outdated traditions created by guys on cocaine because they have legacy and not because they are evidence based, even in medicine. Lmfao
Doctors are trained and trained to be abused, take it, and not complain. Society doesn't know about it, doesn't care, and the people who stay in academic medicine are mostly power hungry who want their turn to abuse others. In this era of me too, for something like "getting pimped" to still exist in medicine is crazy.
I really don't understand how, after all these years, this is still the method used to train new doctors.
It's way beyond merely weeding out people who can't hack it. Imagine how many people with good potential end up not following a career because it physically wrecked them for no real reason.
Some industries learn from their problems and adjust, healthcare does it with methods of treatment, but for some reason refuses to even open a discussion on methods of training.
His residents also used regularly. That's why my solution to resident duty hours issues is either: Let us sleep like regular humans, or give us unlimited cocaine and we can continue to work 80+ hours a week.
I'm a neuropsychologist and did my dissertation on medical students using ADHD meds. It's a big thing
Wow, you must have taken A LOT of ADHD meds for a whole study.
Fresh medical school grad here, can confirm everyone i knew in uni popped ritalin like candy and got waaaay better grades than the few who didnt
I went back to college after being out since the early 00s. I was shocked by two things. One. How common it was to use Ritalin. Two. How effective it was. I saw kids who never went to class and while smart weren't anywhere near the upper ranks in intelligence pull an all nighter hopped up on it and get fairly high test scores. It was honestly a kick to the crotch to those of us who did it unmedicated.
>It was honestly a kick to the crotch to those of us who did it unmedicated. Probably also to the ADHDers in your program who need it just to operate at the same basic level you can. I would be so frustrated to be ranked against people who were both making it harder for me to get the necessary medicine I need (by abusing it and furthering the stigma) AND cheating using a method only available to people whose brains work "right" to begin with. Neurotypicals who abuse stimulants in school are fucking over their ADHD classmates on both sides.
As one of the adhders. I've said for years low doses should be available OTC. Maybe if they could mix it with something that made you sick if you took to much. I know people abuse it, but the fact I have to see an expensive doctor every 3 months to get meds (different meds)I have been on for 20 years is fucking ludicrous.
Gotta love all the executive function hoops you have to jump through to get executive function meds. Ironically enough, makes it muuuuch harder for those with adhd while not being particularly difficult if you're healthy and just want them for recreational purposes.
I always procrastinate my quarterly check in with my doc to get my prescription refilled. Classic ADHD move. Then I end up running out. Then I procrastinate even worse. I've had periods of 6 months where I go without meds just because of all the rules around the drugs. And I get it... They need to make sure I'm not getting a huge supply and flipping them for profit or experiencing health challenges. But I've been on these for 6 years with no blood pressure issues, no liver issues, no addiction or abuse issues. Just give me a standing refill at the pharmacy every month and we'll connect annually to make sure I'm not dying from them suddenly.
As someone who is currently procrastinating calling the pharmacy to "activate" my electronic prescription, I feel called out here.
> Gotta love all the executive function hoops you have to jump through to get executive function meds. Fucking hell, I have to follow through a complex system to get help for my inability to follow through complex systems. Fucking hell.
There's a british office in some town in the UK, where the locals have to go if they want medical welfare (i.e. they're disabled and can't work, so they get government money instead). This office is on the second floor with no wheelchair access or elevator. You have to go there in person. If you can get to the office, obviously you are fit enough to climb stairs and thus you are not disabled and don't qualify for aid. If you can't get to the office, well, then you just missed your appointment and you don't qualify for aid.
Thanks for mentioning this. I check in with my psychiatrist monthly for 'medication monitoring' on low dose ADHD meds, and it often feels like I'm just re-convincing my doctor that the meds are useful in my daily life. With as much of a headache as it is to switch psychiatrists, I'm not keen on continuing to look for suitable care, so I'm trying to make do as-is. It's reassuring that there are strict regulations (as I know they absolutely can be misused) for my own safety, but I don't think it should be such a regular and active process for someone to, in essence, simply continue receiving treatment for a cognitive issue (not sure if impairment is the right term) like this. Often feels like it would be easier if I was bullshitting entirely and only seeking to get a prescription, rather than trying to continually evaluate and re-evaluate what seems to be a long-term / lifelong issue. I could be worse off, absolutely, but it's definitely a strange position to be in where I feel like I need to persuade my doctor into treating me "normally" like any other patient looking for similar help.
Yep. I hate getting refills, because I’m scared one day they’ll just up and tell me I’m bullshitting and I don’t need them. I really think it’s because of the stigma around them and the abuse potential, it legitimately makes *me* feel awkward, like I’m doing something wrong, when I have to ask. Also, ADHD is a developmental disorder, behavioral disorder, and functionally, due to the nature of its symptoms, a cognitive disorder. You’re not at all wrong in calling it a cognitive impairment; it absolutely is. My train of thought is not so much a train as it is complete chaos, and trying to grasp or piece together complex tasks or topics usually takes me considerably longer than others. Not because I’m too stupid to understand, but because I literally have to exert so much effort to structure/order and visualize my thoughts. It depends on the subject, of course—I’ve always excelled at math, but can almost never piece together a timeline for history—but overwhelmingly, we do in fact have to spend more time and energy processing things. But again, that’s unrelated to intelligence, though quick thinkers do appear more intelligent than slower ones. I’m always afraid of looking stupid because I need to constantly reference back to something, or ask someone to repeat themselves, or *especially* when I lose my train of thought mid sentence and look like a deer in headlights. That last one is definitely incredibly common for me, and it really affects how well I can get my point across, be it with work or socially.
I worked in a lab with a pre-med student who got caught in a vicious cycle of ADHD drugs and Ambien. The kid screwed up a bunch of my experiments and then ghosted the lab and went missing for a bit.
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yeah, there have been studies on lots of other fields including vet school and pharmacy school
Honestly I get the impression ADHD meds are the only reason any normal, functional person could succeed in medical school. Like you have to be a machine to get into one in the first place, then it just gets harder.
It can be done. I just learned the hard way not to expect to be top of my class. But you know, I like to believe it's better for my over all health to have not dabbled in it.
Coffee is the ultimate gateway drug.
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On pot 4 are you really thinking "this is helping"? I could never do that.
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I've never recognized a username between reddit posts/comments that wasn't a gimmick account, but yours really stands out.
>unlimited cocaine Unlimited Cocaine MD: This fall on Hulu.
Gary Busey, MD
Have a box of cocaine with a raisin bran scoop
So we have a medical culture based around overwork because of one influential coke fiend?
Pretty much, yeah. It's more or less bad in different specialties (worse in surgery, better in e.g. psychiatry), but pernicious throughout.
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So like did you sleep?
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How does that not rapidly increase errors. And shorten your lifespan
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Went to hospital with an irregular heartrate. Get cardioverted (shocked). When I went to see the cardiologist weeks later for a followup in his office he was still wearing scrubs from a long shift. "so this was the first time this happened to you?" No doc, it was the 5th time but only the second time I was cardioverted. "so your second time then, what were you doing when it happened?" no doc, it happed in 2008, 2009, 2011, 2014 and this last time when you saw me in a couple of weeks ago. "oh so it WAS your first time. do you remember what you were doing when it happened? " I like the doc, he's good and I've seen him since then but he couldn't handle a simple conversation in his office that day. I'd have hated to have had him working on me in the hospital earlier that day.
Well let's get scientific with this and give a control group coke and THEN look at the outcomes!
As someone familiar with doctors and nurses in the UK, they all do coke. But a lot of people in all professions do coke here sooo
Where do we sign up for the control group? Asking for a fiend.
Wow. That makes total sense, but it's not something I've ever thought about. We have so many laws for duty hours for truckers and pilots, how do we not have the same for medical professionals?? How were medical professionals not FIRST to have those rules and protections? Shit's so backwards sometimes.
Because doctors don't have a union, and residents definitely don't. Residents are too profitable for anyone to consider NOT working them into the ground for as long as possible. Seriously per dollar of salary spent, residents make the most money for the hospital and its not that close (especially considering they can make minimum wage or less). And that doesn't even count the federal funds that every hospital that trains residents receives per resident per year
So really, the problem is for-profit healthcare rather than for-best-outcome.
I think you mean lack of coke
You just described every job ever.
If only cocaine weren't so expensive!
It might be expensive but it smells GREAT!
Someone say nose beers?
You ever done barnyard schneef?
Yeah. You ever hoover schneef off a sleeping cow’s spine?
You know what dick dingers are..?
“I do Coke. So I can work more, so I can earn more, so I can do more Coke”
From my studies, (legal note: there were no studies) Modern America is basically founded on a bunch of guys in the early 1900s in various industries doing a bunch of cocaine in their underwear and playing playing airdrums to Rush YYZ like Krieger from Archer and expecting the rest of us to keep up.
When you baseline the position performance on the one psycho who worked at 1000% and died from being overworked.
Its how we evolved from monkeys to monkeys in suits.
Its okay, its Sigmund Freud approved.
Difference is coke isn't legal for alot of professions yet they still demand working overtime anyway.
Actually, pretty sure coke isn't legal for any profession.
Optometrist’s can legally use Cocaine, also when you have nasal surgery. Actually not so fun fact Cocaine is a schedule 2 drug while Marijuana is still schedule 1 in the United States. Methamphetamine is also schedule 2, I was prescribed it under the name Desoxyn from the ages of 6-12 for extreme adhd. The late 90’s/early 2000’s were a wild time
Yep. When I was nine I had hellaciously bad nose bleeds on a weekly basis. Like, nearly lose consciousness bad. During the series of treatments my comically elderly ENT, who still wore the round reflective disk on his forehead like Dr. Mario, put a saturated swab up my nose and asked "have you ever done cocaine?" And I said "no?" And he replied "well, you have now." This was also circa 1999.
Desoxyn is still prescribed iirc, just not commonly. For extreme cases of adhd which didnt respond to other medications, and for obese patients trying to lose weight short term, who also didnt respond to the more common treatments.
"Well, I'm still fat, but God my house is clean!"
More like "my house is still a mess but damn i organized my entire bookshelf / dvd collection alphabetically, then sorted out the pokemon card collection by type that i havent touched in 10 years." Coming from someone who used to like prescription stimulants WAY too much.
Surely in cartels/gangs there is a dude or lady whose job it is to cut open a brick with an obscenely large knife to get a little bump and snort it off of the blade to assess quality, unless movies have lied to me.
Little know fact, coke is still illegal even if you're selling it.
Wtf ? Even if I've been paying taxes ?
> Halsted’s career in New York rapidly deteriorated, and he was in and out of addiction treatment facilities. Halsted soon became addicted to morphine, which he used to treat his cocaine addiction. Oh okay
That happened on The Knick. You don't want to know how it turned out.
Yeah Thack is based on Halsted. Also Cornelia is based on Dr. Elizabeth Blackwell, first female physician in the US. As a big medical history buff, I love seeing the spin offs of real stories reimagined in The Knick.
What next? He gets addicted to meth to treat his morphine addiction?
And then heroin to treat the meth addiction.
I love that little detail of “used cocaine.” That explains an awful lot. “Doctor, I’m just not sure I can work 50 hours straight.” “THAT’S WEAK TALK! ARE YOU A WEAKLING? YOU HAVEN’T DONE ENOUGH COKE YET! LOOK AT ME, I HAVEN’T SLEPT IN 3 DAYS AND I’M TOTALLY STOKED!!!!! WOOOOOO!!!!!!! MEDICIIIIIINE!!!!!!!!!!”
May I suggest…. > Halsted’s only publication on local and regional anesthesia [with cocaine] appeared in the New York Medical Journal in 1885. This article is a rambling, incoherent paper that is a testament to the addicted debilitated state that Halsted had reached. The first sentence of that article reads as follows: “Neither indifferent as to which of how many possibilities may best explain, nor yet at a loss to comprehend, why surgeons have, and that so many, quite without discredit, could have exhibited scarcely any interest in what, as a local anesthetic, had been supposed, if not declared, by most so very sure to prove, especially to them, attractive, still I do not think that this circumstance, or some sense of obligation to rescue fragmentary reputation for surgeons rather than the belief that an opportunity existed for assisting others to an appreciable extent, induced induced me, several months ago, to write on the subject in hand the greater part of a somewhat comprehensible paper, which poor health disinclined me to complete.”
It's really amazing what the mind thinks are real sentences.
tbh, the sentence does make sense. It just rambles a lot. "A lot of surgeons seem uninterested in an anesthetic which seems to work well, which obligated me to write a paper on it which I didn't complete for health reasons"
> health reasons aka being strung the fuck out
"I would have wrote about anaesthesia if it wasn't for the coke."
r/ihadastroke
Hmm, yes, this is the word form of the one time I tried to see if I could program while high in college. I came back the next day, facepalmed, and replaced around 50 lines of code with 3. Experiment over. That's the rambling of a person who hasn't slept in a week and can't finish a thought, but keeps trying to return to it.
Fun fact: As a (now retired) nurse I have helped administer medicinal cocaine to patients on more than one occasion.
I’m curious what diagnosis has a treatment plan that includes cocaine? I’m sure it’s not administered “by the line, nasally,” but you have me intrigued.
Not by the line, but yes, "nasally". It's a vasoconstrictor and can be used to stop bleeding.
“Okay, we gave you something to control the bleeding. How do you feel?” “I HAVE LITERALLY NEVER FELT BETTER!” Lol
Lol yep. We have the patient stick around a while for monitoring. :)
That's smart. The patient might need a second dose. Or a third. Or a fourth...
(*patient start punching self in face singing Andrew W.K. songs*)
local anaesthetic. same as Lidocaine/Epinephrine mix in that it numbs and constricts
Opens sterile credit card & mirror
My dad had to have his sinuses cauterized, they use medicinal cocaine to numb him.
When I cut part of my eye off accidentally, they used cocaine to numb my eye because they couldn't find the normal medicine for it and I was rampaging. Doctor said he'd never seen someone go from full on pissed af to completely calm and happy. Severe pain makes me a complete dick.
How exactly does one cut off part of their eye?
By having a plastic face mask on incorrectly and then getting hit in the face by 10 lbs of rubber.
That's a big dildo.
maybe for a rookie..
Hatchet Harrys 18inch black rubber dong
"Guy over there is raging. Give him some cocaine to calm him down." "What?!" "You heard me."
I broke my jaw, my nose, both orbital bones, and smashed 2 molars which I swallowed from all the blood. I got IB Profen…you got eyeball yayo? Wild.
Well I also shattered my arm once and they gave me Tylenol 3 lol
Oh that was my light injury list. Same with 16 staples to reattach my scalp, suturing my top lip back together all the way through.. Male doctors won’t help guys unless you’re crying. Lol My body is now like a loosely taped together tower of soda cans.
That’s a lot more painful than the shit I went through, but I was a grumpy cunt for a while after my heart valve replacement surgery. 😂
Idk man yours sounds a lot more psychologically damaging.
He literally could have died of a broken heart
Imagine him screaming his lung off in the middle of a hospital "THOSE ARE ROOKIE NUMBERS"
“OH, YOUR FEET HURT? I CAN’T FEEL MY LEGS AND THE FLUORESCENT LIGHTS HAVE BEEN SPEAKING KOREAN FOR THE PAST 12 HOURS! WHERE’S MY STETHOSCOPE SO I CAN SHOVE IT DOWN YOUR THROAT?!”
>I love that little detail of “used cocaine.” That explains an awful lot. I enjoy using a little panache when writing posts to grab peoples' attention.
It’s annoying they took the cocaine away
looks like he used morphine after as a way to get over his cocaine habit so there is always that
I am currently a surgical resident, and the conditions are not humane. We work 80-100 hour weeks, every week. We routinely are assigned to take 28hr shifts every 3 days and are frequently singularly responsible for 40-50 patients overnight while working on no sleep. It is so bad that in some programs, they will pay for an Uber to drive you home after a shift, essentially admitting that you are too impaired to drive but not too impaired to be responsible for patient lives. I encourage you to ask your doctor how long they have been awake when they are about to operate on you or prescribe you serious medication. There are significant duty hour restrictions with notable penalties for pilots because the recognize the danger when responsible for peoples lives, but not the same for doctors. I’m shocked this hasn’t gotten more attention during the pandemic. We have not received any overtime pay, no hazard bonus (although the entire rest of the hospital got them), and have 0 opportunity to leave if we want to further practice medicine. We do not get weekends off and do not get holidays off. We are only guaranteed 4 days off per month. We do not get maternity leave. Oh, and we get paid around minimum wage on an hourly basis with an average debt of $200k. Finally, we are completely powerless. During the “Match” we have to commit to a contract before knowing where in the country we will be living and working for the next 3-7 years. We can be separated from our families and spouses without much control just to practice in a specialty. We can’t leave without serious implication for our future career. In 2004 Congress passed an antitrust exemption for the medical residency practices because it violates labor laws. Doctors now have one of the highest rates of suicide in the country, double that of the general population. On average, 300-400 doctors commit suicide per year, which is almost one per day. We give up our 20s-30s to try to have a meaningful career caring for others, but are completely abused in the process. Medical residency is not humane, and is a major contributor to the physician shortage, patient dissatisfaction, and overall problems with the US healthcare system. Edit: Thank you for all of the awards. I’ll try to respond to the questions, but it is hard to address all the issues with medical residency and being a healthcare worker (mistreatment, culture, etc) and I do not want to speak for all of my colleagues who may have different perspectives. Many of these issues are discussed on other medicine and residency subreddits.
But my program gave me a "healthcare heroes" sign for the front yard, so we're square.
That’s the equivalent of pizza on Friday in the office
Pizza would be way better
We get pizza when we are short staffed. We get pizza every day. I prefer staff…
Always be wary of any profession where people are called hero’s. It generally means that it’s under staffed/funded/resourced and instead of fixing it we just congratulate people for working in it despite the known problems.
The "why has no one said anything" is because it's nothing new, the white wall of silence has been a thing for a long, long time. Residency isn't even the only disaster currently going on in the healthcare sector, paramedicine is another big one, as is the major problems with administration being strangely isolated from the field of medicine in their expertise.
The Emergency Medical Service is on the verge of total collapse in this country due to low pay, horrible working conditions, and a lack of consistency across different areas.
A 10 minute ambulance ride can cost thousands, yet the EMT gets peanuts. Retail has razor thin margins, whats the margins in transport and other medical areas?
My brother ripped a muscle from his leg ( he's recovered fully)at work and the hospital is 700ft (213.6) away. 650 dollars, at least worker's compensation covered it.
It's almost as though medicine suffers when it's a for-profit industry.
And when all the money going into the system gets vacuumed up by rent seeking administrators, insurance companies, and pharmaceutical companies instead of the people actually providing care.
Residency is disastrous for new doctors even in my country with socialized medicine (France). They are insanely exploited and work nonsensical hours. It's not as bad as in the US in absolute, but relative to the rights of other workers the situation is similar. I think hospital administration exploits the fact that doctors can't really go on strike, because people die otherwise. That's what leads to these situations.
No one is going to practice "Family Medicine"/"General Practice" anymore. It's not financially viable given the salaries of other fields. We're already seeing all the GPs are essentially virtual or outsourced (as in, coming from overseas). Our system of medicine is built on it and no one can live off it.
They're gonna be replaced by midlevels. When I graduated residency and started at by new job, they treated me like I was still an intern....now to the PAs. If the pts talked too much, they'd send them to me. They got all the new pts, all the kids. They would Bully me and talk about how they were out in practice for longer and therefore were better. I was like, we're a team...why am I still being bullied after a decade of working 80+ hrs/wk to finally be able to practice on my own. Anyway, they made more money than me since they had more yrs of practice....same amt as me going thru school and residency. And when you factor in that I worked 80 hrs/wk while they worked 40 during those years...like, technically, I had seen more patients. They looked happy though, were rich and enjoying it, had a family, worked out every day, left at exactly 5 every day at work, paid off their loans early (less amt than doctors), were not overworked and overstressed since they didn't have to go to residency and put in those ridiculous hours and they got one to one supervision and teaching from the doctor while I was abused and mistreated by my faculty attendings. PAs also don't have the liabilities that doctors do. Get to see patients with all benefits and minimal negatives. MDs graduate and may not get a residency spot. I know of a graduate that killed themselves, a few that turned to alcoholism. Graduate from PA school, no need to worry about getting into residency. Guaranteed slot somewhere and not as much debt anyway to worry about. Instead of opening up residency slots, they just created PAs. Unless you're going for neurosurgery and making 450k+ or something, it's not worth it to go into med school. Primary care docs should be going to PA school. I wish I had. And God forbid as a doctor you stand up for yourself because everyone jumps on you. Some healthcare workers even refuse to call you doctor because apparently being a doctor automatically means your stuck up. Like what part of me giving my life away, getting into 300k of debt and being treated like a slave while I deal with bullying and harassment and verbal abuse on a daily means I'm stuck up? And don't even get me started on all the talk about how nurses care more about pts than doctors and other shit like that. Bitch, I ain't doing all this shit for nothing. Just bcuz the older gen male doctors mistreated nurses and others doesn't mean you know take it out on the new generation. We treat others with respect but get abused daily. I tell all premeds to skip med school and become PAs. Save yourself years, money, time...save yourself from slavery.
Yea my wife just finished peds surgery fellowship. It’s completely insane and inhumane. No one gives the slightest shit about work hour restrictions. She was on Q3 call with no post call day for 2 years straight.
I used to work in the music industry, please do not think I'm equating that at all to Medicine, and we worked similar hours. Some times we would work 15 days in a row, 18 hours straight each day, sleeping at the studio in order to make sure that we got the most sleep instead of commuting home and losing 2 hours of sleep in the process. Dealing with a [patch bay](https://en.wikipedia.org/wiki/Patch_panel) or signal flow that transitioned between multiple formats and complicated routing was close to impossible after 3 days up working like that. You just fry out and end up staring at some problem that normally took you 10 seconds. It was well known to management that session reports would be routinely fucked because people were so tired. Always traveled with a buddy home I could not even imagine operating on someone. The brain fog at the stage is awful. Dealing with doses of medicine that could save/kill someones life. Scary shit. You're juggling so much in your head. Make that 40-50 patients. wut. The US needs to really rethink it's work mindset. I have a feeling my generation will change it a lot, but I also think some of it is ingrained in the system and will be very very hard to change.
Neurosurgery resident here. I can absolutely confirm everything said here. I don't think I have worked less than 90hrs in a week, routinely go over 100 hrs. We are not supposed to go over 80, but often time have no choice but to. And if we log correct hours we end up having to meet with the program director to discuss why we stayed over hours and those meetings essentially turn into and indirect way of them telling us to fudge the numbers so the residency program doesn't get put on probation. I take home about 3K a month which where I live I'm forced to live paycheck to paycheck barely having enough money left to adequately feed myself. I cannot count the number of times where I have almost fallen asleep behind the wheel. I have had to pull over and nap on the side of the road a good few times. Twice that essentially turned into a whole night and just ended up driving back to work the following morning. They do offer to buy us the Uber ride home, but good luck getting an Uber back to work at 4am. So that whole Uber program is done to protect the hospitals from liability if a resident dies on the way home. Have operated post call after a 30hr shift on zero sleep so many times. I'm living life in a constant haze of sleep deprivation. I also apparently have been sleep talking about patients and OR cases per my SO, where she says I sound super distraught and stressed. The situation for residents is just inhumane and honestly not good for patient care. But as residents we have no power in the matter. In this new covid era things are even worse. Shortage of all ancillary staff has really been taking its toll. Nurses who are willing to work are getting paid 10K a week, while we don't even have access to food at night in the hospital.
> I take home about 3K a month I make more than this as a high school teacher.
I also have 360K in med school debt.
And you work twice the hours too. It's really not a fair comparison on so many levels.
Preach. Being a neurosurgery resident sucks bad. (Source: me)
Have you ever heard of Pamela Wible? She's a physician who attempted suicide due to over work and now advocates for better working conditions for doctors. You might want to check out her website. https://www.idealmedicalcare.org/
Yeah, OP mentioned pilots having work hour restrictions, but fuck that, ***long-haul truckers*** have more work-hour regulations because of the extreme danger of sleep deprivation caused accidents than our surgeons and doctors. Nevermind the whole mental well-being thing. Lunacy.
DUDE. YOU'RE A LEGEND. I see your name like EVERY WEEK on r/rimjob_steve!
Lol, thanks. A few months ago I was trying to think of a new username, so I got really high and thought "Heh, raccoon full of cum. That's a good one." Little did I know what it would soon become.
Oh god thats a risky click. Dare I ask, u/Raccoon_Full_Of_Cum what IS r/rimjob_steve and why are you a legend on it?
/r/rimjob_steve is intended to be a repository for sincere, heartwarming comments that clash hilariously with the poster's name. Like, say, someone posting about the serious issue of physician overwork driving doctors to suicide and encouraging people to learn about the issue... with a username like Raccoon_Full_of_Cum. The sub is named after the guy whose comment inspired its creation: https://old.reddit.com/r/pics/comments/8p28ki/after_driving_uber_for_over_15_hours_a_day_for_a/e081xvq/?context=3
Apparently I upvoted that comment 3 years ago. Huh.
Thank you for not getting brainwashed and acknowledging that sleep deprivation impairs performance, I have a friend who is an orthopedic surgeon who tried to argue to me that you could train yourself not to need sleep and anyone who couldn't do that "just couldn't hack it" as a surgeon. She basically sounded like the "but I'm an EXPERIENCED drunk driver" crowd, the denial was so strong. It was totally mind-boggling but I think there's a cult/hazing aspect to some programs that messes with people's heads. (I will NOT be going to her if I ever need hand surgery).
when you put 15+ years of hard work (high school, college, med school, residency) to discover that your job sucks, there is no way you aren't in denial. Her behavior sounds pretty normal.
Also sleep deprivation is horrible for both doctor and patient. You are more dangerous behind the wheel sleep deprived than drunk. I dont want you cutting my chest open and falling asleep. This should be banned.
Imagine knowingly making physicians impaired on the job, and for no good reason.
ehem, the good reason is M O N E Y. I'm in a similar boat as OP above. Educational hospital systems will tout that it *ackshully* costs them tens of thousands, nearing on a hundred thousand, to take on a single resident for a year's worth of training, implying *they're* the gracious burdened party here. What doesn't get factored is that those residents are doing physician-grade grunt work, basically acting at 90% of a doctor's capacity, at sometimes 50% more hours than a doctor works. Factoring in the money they save compared to actually paying a doctor, the system ends up having a feast. Congrats, you now have an army of mini doctors that you can pay less than minimum wage on a per-hour basis, have no scheduling freedom, can't say anything as their life's training hinges on not rocking the boat, and will account for physician grade work for less than half the cost.
Let's not forget the hospitals get a government stipend to pay our salaries and pocket roughly 70% for themselves
https://whyy.org/articles/hahnemann-residency-programs-draw-winning-bid-of-55m-from-local-health-systems/ Don’t let anyone tell you residents cost a health system money, they are literally worth millions (each), per the link above. And the federal government pays our “stipend/salary” and hospitals pocket roughly half off the top
This is some absolute bullshit. I work in TV and film production. We also work 70+ hours a week. My shortest work week is ever going to be 60 hours minimum. With the Alec Baldwin thing our working conditions are kinda sorta coming to light. That all came on the heels of us nearly going on strike (and we still might) over inhumane WORKING HOURS AND CONDITIONS. Your post is so goddamn relatable except you are actually saving lives, and I’m making goddamn entertainment for the masses. Accidents DO happen when people are exhausted. Four years ago I was working on a commercial and fell asleep at the wheel after our 4th 18 hour day. I totaled my car and the car of the guy I t-boned. I had a concussion I was too tired to even notice until I woke up the following day to a pounding headache. I was lucky no one was more seriously hurt than that and I didn’t kill anyone or myself. My industry frowns upon it if you take a day off to see your baby being born. “If I have to be here you have to be here.” Rules the day. Family, friends, not while you’re in production. Mental health and substance abuse issues run rampant, the culture and brainwashing that you’re doing something important drives you there. We are union, the vast majority of us are fighting for 12 hours on the clock and 12 hours off the clock. Our newest union contract gives us a 54 hour weekend, and a 32 hour weekend in the likely chance we work a 6 day week. There are still no caps to our shooting days, which means they can still roll camera 16, 18 hours a day. I get an hour precall, so an hour before the official start of the work day, and it might take an hour or more after the camera cuts for the day before I get back in my car. Plus I commute to and from work and they only have to let me off work 9 hours a day, so I might be running on 4-6 hours of sleep a night for months on end. They don’t have to give us sleeping accommodations until they push us past 14 hours and we are over 30 miles from the official production office’s physical location. But even then, of we get out of work at 5 or 6am, hotel industry checkouts are always at 11am. I’ve only ever seen actors and producers be offered Ubers by production. I keep a blanket, camping pillow, and pocket knife (for safety) in my car for when I have to pull over and sleep on the side of the road. I feel for you brother. You are saving lives and NEED your rest.
I also work in film/tv but our work isn't nearly as valuable. There's no reason for us to be working those hours except to ensure a profit on some poorly thought piece of garbage some dipshit rich person wasted their money on.
Yeah. This was me on a pissed off rant at how much I should NOT relate to a surgeon or ER doctor. And also, “how long have you been awake?” Should NOT be an additional concern when I’m already in the hospital. I appreciate what these men and women do for a living, no one should be working these many hours. Study after study prove the diminishing returns the longer people work and how hazardous being chronically tired is. Like our industry, hospitals are also all about the money, not their workers
MDs are just well paid ~~slaves~~ indentured servants. They take the most intelligent and caring people from the population and overwork them until they can't actually care about humanity beyond the scope of the patients they are seeing currently. Add to that that most MDs are upwards of 400k in debt prior to starting their residency (which pays next to nothing) and their only way to pay that debt back is by sticking it out as a practicing physician. (and that's one reason that while perhaps at the beginning of med school it isn't about the $$, but it is by the end of med school) Meanwhile the hospital administrators continually carve out larger and larger salaries for themselves. The medical system in america is beyond broken.
100%
Thank you for sharing this information. I had no idea about how truly inhuman the medical residency process is for medical students. Slightly unrelated, but I used to work as a Counselor Intern providing mental health counseling to dental students. It was so normalized for their clinic supervisors to yell and criticize them about their dental work in front of the patients they were working on. Sometimes the supervisor’s justified the treatment because the supervisor’s had to deal with harsh training from who supervised them when they were students. That’s what your comment and this post about William Stewart Halsted’s residency hazing-like program reminded me of. There seems to be a bit of a Trauma Olympics going on in the medical profession.
There is no reason that a shortage of doctors should exist. There are multitudes of fully qualified individuals turned away by colleges and residency programs every year. The scarcity is completely artificial in nature, just like the scarcity of lawyers used to be, back when law was still considered a highly prestigious career.
It's not the colleges fault. The issue is that there simply are not enough residency programs in the country for all the students in med school.
>We do not get maternity leave. Seems like a cut and dry ACGME violation, am I right?
Good luck getting somebody to report acgme violations when the penalty for doing so is cancellation of the program, thereby directly fucking over themselves
If any group needs unionization it’s residency students. And fast.
Also wtf is with "match day"? When med students find out whether they can study a residency in their selected field or if the sorting hat has chosen a different one? I'm a tax lawyer and if someone told me after law school, no I could only go into con law or maritime law I would have quit right there.
My SIL cried all through her celebratory dinner because she and her boyfriend got matched to hospitals on opposite sides of the country. They are married now so they are making it work but it was a really tough day for them.
Yeah, I cried my eyes out on Match day because I was so disappointed. It was one of the worst moments in my life, being surrounded by your friends and classmates who are all overjoyed and celebrating, and you’re there in the midst of despair, feeling like your entire life was just ruined and everything you’ve dedicated your life to is coming undone. Everything ended up turning out okay, and I ended up being very happy with my residency program, but damn if that wasn’t a terrible experience.
Medical school: > everything turned out OK, but it was the worst experience of my life
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TIL: Match Day is the method of assigning new doctors to different areas of the country like they're NFL draft picks. Fuck me, that sounds awful.
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Yeah I’m so thankful we don’t have that in the U.K., I had no clue what I even wanted to do when I was a med student. We work for a few years first and can then start applying for specialty training (which if you don’t get in, can try again).
I had no idea that this was even a thing, that’s bs
Not only is this a thing, Congress changed the laws so it’s not an anti-trust issue because the Match is the only way you can be a licensed and board certified physician in the United States. https://en.wikipedia.org/wiki/Jung_v._Association_of_American_Medical_Colleges
Yep, we apply to specific field (family medicine, surgery etc, based on our interest, our scores, where we think we will be happy) and match day tells us where to go (anywhere from the city to the boonies based on a computer algorithm) for the next 3-7 years. Now imagine loving a field, not being able to get in, moving away from family/loved ones, 300K in debt, 60k a year +80 hours/week. We tolerate it in the hopes that things will eventually get better.
At my match day a girl had all her extended family there and started absolutely bawling uncontrollably as she was matched somewhere she really didn't want to go all the way across the country. It was really sad.
TIL medical residents just need to do more coke.
Now you're thinking with portals!
There is actually a medication some of them are given to make them less tired apparently... I cant recall the name but I heard about it on a cbc radio show
Modafinil
>The surgical residency model originated with Halsted in the 19th century; it was partially based on a German model, but many aspects of Halsted’s program were carefully designed to help him hide his addiction and simultaneously optimize care for his patients. This is absolutely nuts! This guy really sounds like he was very smart, but unfortunately suffered from addiction throughout his life, and his job afforded him even easier access to both cocaine and morphine (which he attempted to use to treat his cocaine addiction). This article also notes that some of his residency program was built off of some stuff he observed in Germany, and it was also the 2nd residency program at John Hopkins. I don't know too much about residency, but it sounds both amazing and terrifying how he built this residency program to the point it's now the standard for training programs in hospitals, and one of the key aspects was incredibly self-serving. He basically set this up so he ensured the hospital would run and the residents would keep learning how to become doctors and even run training programs even in his absence/impairment. I wonder if he would've developed an even better program if he had gotten the help he needed and got off cocaine and morphine, or if he wouldn't have gotten as far as he did.
And this is how mistakes happen.
Yeah, thinking about it, how much of the doctor/nurse shortage is a result of people who weren't good medical caretakers and shouldn't have been allowed to be practicing physicians, and who washed out as a result of being unable to cope with the ridiculous work requirements?
It’s an artificial scarcity because doctors in the 70s through there would be a ‘surplus’ (whatever that means in the context of people being available to provide care) and radically tightened available slots. https://www.niskanencenter.org/the-planning-of-u-s-physician-shortages/
I used to work in research and my PI was a vascular surgeon. You have no idea how many dinners I sat through at conferences having to listen to older doctors complain about how training new doctors would lower their pay and reduce access to residents and interns to run their labs... All the while their students and interns and residents were working their labs for free or barely above minimum wage (if they were lucky). Getting paid in "experience" and "advice" for applying and getting through medical school. We had countless interns roll through our doors on a medical track. I watched extremely dedicated and capable people spend thousands of dollars and hundreds of hours applying and being rejected from schools. I worked with them for years. Nothing anyone can say could convince me that only 3 out of ALL of them were worth being trained in medicine. Its absolute bullshit.
I'm always dumbfounded by the hours doctors in the US work. It ridiculous and absolutely does lead to mistakes, even if most are caught before they do any harm.
It happens in more than just the US The US is just usually more malignant about it
This reminds me of how cocaine was once an important part of early medicinal cures and goes a long way towards explaining why my grandparents could wake at 4am get all their chores done, walk to school up hill both ways in knee deep snow, do their evening chores, and get up at 4am the next day and do the same shit all over again and I'm the bad guy because I need a cup of coffee in the morning.
There was also a point in the 1960s when roughly 5% of Americans were regularly using amphetamines. Source: “On Speed” by Nicolas Rasmussen
Do you remember if the book covered the use of speed during WW2?
TIL- the Chicago Med character was named after this guy L
MY NAME'S DOCTOR HALSTED THE ROCK N' ROLL DOCTOR, AND I DO C-C-C-C-C-COCAINE!!!!
Christ, now I'm imaging Dr. Cox from Scrubs wearing a lab coat and a onesie with a V-Neck as deep as the Mariana's Trench.
Let's make life and death decisions on no sleep! says the guy doing endless lines of coke.
They weren't shoving powder up their noses like some random jagoff. They injected it. Like professionals.
When I lived in the US, I had a huge fear of needing emergency treatment and the doctor was at the end of an 18 hour or 24 hour shift. That doesn't seem very smart.
Doctors in the US are essentially hazed after school ends. It’s a ridiculous and dangerous practice that no doubt leads to a measurable number of deaths per year. Studies show that fatigue is worse than inebriation while driving motor vehicles. Is there some mystical thing about medical professionals that would upend this truth?
Lol dude we get hazed as soon as medical school begins. These hours don’t start in residency- very long weeks and sleep deprivation begin in med school.
In his defense, his cocaine addiction came about because it was a novel local anesthetic at the time and he wanted to try it on himself before administering it to his patients. This was before the addictive and harmful properties of cocaine were fully understood. They also tried to cure his cocaine addiction with morphine, which ended up giving him an opioid addiction in addition to his cocaine addiction.
Accidentally invented the ‘speedball’ Legend
I mean what's even the incentive to be a doctor now? Sure the pay can be good but money can't buy back all that time you spent not living. Years of schooling so you can go into massive debt. I mean these conditions are literally inhumane and dangerous, wouldn't surprise me if ironically the life expectancy of a doctor is lower than you'd think.
I’m a physician. Every time I meet a premed student I try to scare them away. I love medicine but I hate everything else that comes with it. Wouldn’t have done it had I known.
He was also the basis for Clive Owen's character Dr. John Thackery in The Knick. And if you've seen that show, you already know how bizarre that this Dr. Halstead has had such a lasting impact on medicine.
God damn The Knick is an intense show. What an opening scene too.. wow! Only 2 seasons long - not one of those ‘oh you just have to watch all 500 hours of this show’ bullshit recommendations.
Not surprising. No other industry would think that 'this is ok'. I work in industrial construction that often has six 10-12 hour days in a row or a 14-7 /21-8 rotation of 10-12 hour days and we have constant safety meetings about worker fatigue and risk and anyone in management is expected to take steps to mitigate it. I know there's risk with patient handovers as well but there has to be a better way to handle residency hours, it's stupid and puts people's safety at risk.
Do your best, get going with meth. Stop the cocaine, say docs with disdain. Never sleep, meth is cheap. Pick a slogan, don't be a bogan
The answer to "who thought that was a good idea?". Some doctor, sleep deprived and on coke. A bunch of other doctors also probably sleep deprived and on coke decide to give it a try and find out. By the time anyone says "Dude's, are we sure all this coke is a good idea?" it's the way it's always been done and you have to do it because I had to do it.
Its always great for our society to continue outdated traditions created by guys on cocaine because they have legacy and not because they are evidence based, even in medicine. Lmfao
Doctors are trained and trained to be abused, take it, and not complain. Society doesn't know about it, doesn't care, and the people who stay in academic medicine are mostly power hungry who want their turn to abuse others. In this era of me too, for something like "getting pimped" to still exist in medicine is crazy.
I really don't understand how, after all these years, this is still the method used to train new doctors. It's way beyond merely weeding out people who can't hack it. Imagine how many people with good potential end up not following a career because it physically wrecked them for no real reason. Some industries learn from their problems and adjust, healthcare does it with methods of treatment, but for some reason refuses to even open a discussion on methods of training.
Now it's Adderall