It’s official, I have become “That Doctor.”
You know, the guy who told them that their father only had three months to live and here he is, six months later, being wheeled in by his triumphant family. I mean, he looks almost the same as when I saw him the last time, maybe a little more cadaverish, perhaps a little less animated than I remember but still clinging gamely to life as only the terminally ill can. And I’m not disappointed in the slightest because he is a fine fellow and the family could not be more pleasant or good humored, a real pleasure to have in the department.
But to set the record straight, I did not say their father had three months to live. I said that the oncologist believed that their father had less than three months to live. But it doesn’t matter. I am now “That Doctor,” the guy who their father has outsmarted and outlasted and they are not shy to remind me of this, a remonstration that I take in the same good spirit it is given. Because I don’t mind. I have arrived. The family is profoundly grateful to all of us for our efforts on behalf of their father and I am flattered to be regarded as a wise physician who was never-the-less outwitted by their crafty old dad.
You should see my private email. I have a fan club of sorts who think I am the very Devil and are very defensive about the current state of residency training. They take particular umbrage to my often stated opinion that academic hospitals view residents as nothing more than cheap labor and extract much more value out of them than they end up paying in salary and benefits. My critics insist that even with the large sum of money paid to the hospital by the government for each resident (an average of $100,000 per year), if you take into account the overhead, the increased liability, and the inefficiencies that are unavoidable in teaching residents the hospital actually loses money and is doing us a favor by letting us tag along.
For my part, because I can add, subtract, multiply, and even have some facility with multiplication’s tricky cousin, long division, I have a pretty good idea how much we are actually worth to the hospital. My critics usually have no idea of this themselves and even the fact that the hospital receives federal money for residents is often a revelation.
But I can end the debate with two words:
Was there ever a bigger scam than this? Here you have a collection of disposable residents to whom is owed even less, if possible, than to categorical residents. They’ll be gone in a year, some to their real training that required a preliminary year and some to programs into which they match after another go at ERAS. Consequently, their education is viewed with profound indifference by their employer whose only goal is to extract as much medical labor out of them as possible.
I complain about residency but I have it easy compared to those sorry individuals. I once met a preliminary surgery intern who along with another preliminary intern was in the middle of three months of Q2 call. This means, for those who don’t know, that he alternated 24-hour shifts with his fellow serf.
“But Panda, that’s not that bad,” you say, “He gets every other day off.”
Maybe in a perfect world, one where call was actually call and not an extension of the work day, this would be true but the two interns in question essentially missed sleep every other night, went home exhausted, and came in the next morning as if nothing had happened. It is not like working as a fireman, for example, where you may be at the station but if nothing is going on you can eat, sleep, or just hang out. It was a day of the usual rounding, admitting, and scut which only intensified when everyone else went home.
The fact that they also had to stay a few hours extra past the nominal changing of the guard is of no concern to most people who, as they work at normal jobs, are somewhat cavalier about an hour or two. But this little chunk of time is precious to an intern. Be that as it may, this abbreviated day counted as their day off and their hospital could no doubt point proudly to their compliance with the ACGME work hour rules.
Think about it. If you work Q2, you will work approxmately 96 hours on one week and 72 on the next which, with some creative lying about hours which all surgical residents are strongly encouraged to do, can almost be called 80 hours per week averaged over four weeks with at least one full day off every week and at least ten hours between duty periods. It’s diabolical. Their program, smarting from the ACGME’s smackdown devised a way to work the crap out of the help while following the letter, if not the spirit, of the law.
Is it Too Popular?
Emergency Medicine, once a sleepy little-respected specialty which was regarded as something somebody did if they couldn’t do anything else, has enjoyed a tremendous increase in popularity among American medical students to the point that it is now as competitive as some of the surgical specialties. I think it is lifestyle, more than anything else, that is driving this.
Medical students rotate through the specialties and begin to realize that most of medicine, far from being the glamourous career of which they dreamed, is a grind, a slow slog, or a medical Bataan death march. Then they do a month in the Emergency Department where, while also not exactly what they expected, they see a world where the pace is faster, the decisions are quicker and, wonderous to behold, the hours are regular and you can forget about work when you go home as there is nothing to follow up.
It also feels more like real medicine because, unlike most other specialties where the patients all have baggage from half a hundred previous admissions and hundreds of pages of advice from the small squad of doctors who follow them, it is possible to see a patient who is completely terra incognito and upon whose body no physician has yet planted a flag.
So Emergency Medicine has a tremendous appeal, especially for people with a low tolerance for bullshit and wasted time. On the other hand, it’s not for everybody. I mention this because my program has lost several residents recently who decided that Emergency Medicine wasn’t really what they wanted. All fine guys, don’t get me wrong, but after a little exposure it was either the pace, the shifts, or the obvious lack of depth (compared to, let’s say, cardiology) which lured them away.
I happen to like the pace and the lack of depth as I am (true to the cliche about Emergency Medicine) easily bored and have a short attention span. And I don’t mind working shifts because (as I have mentioned a time or two) all I really want is the chance to sleep every day. I also like to be at home when other people are at work.
But like I said, it’s not for everybody. Unlike the traditional lifestyle specialties, Emergency Medicine is only a lifestyle specialty if you like that kind of lifestyle. You trade relatively benign hours and high pay for continuous work while you are at work and a schedule that only a vampire could love. It also has a very reasonable lifestyle in residency once you clear all of the hurdles of intern year which is important but should not be the most important factor in your selection of a specialty. (Unless of course you are one of those lazy bastards in PM&R in which case you probably laugh and point at the rest of us idiots.)
I think we may see a backlash because Emergency Medicine’s popularity is insane and doesn’t make any rational sense. It’s a good specialty but 20 percent of my graduating class went into it. It’s not that good.