Surgery: 4 AM Wake Up Calls, The List and other Assorted Drudgery Pt. I

Im sorry. I really want to keep up with this blog, I have so many things I want to say but sometimes it just falls off my list of things to do.

The past few months I have been dealing with some significant family health concerns coupled with my surgery rotation I've had little to no time for anything extra.

But the show must go on! Just as with everything else on this blog these are my personal thoughts and opinions--not meant to offend but merely to inform and present one naive young person's perspective.

***

Surgery.  Those of you who are not in medical school probably don't know but the moment this rotation comes up in conversation it strikes fear into the heard of 98% of us.  There is that bizarre little group of people who are giddy with excitement and actually electively choose to spend the rest of their lives doing this.

To be honest before I started this rotation I thought it was what I wanted.  I love working with my hands.  I've always been a tinkerer and I thought surgery would be the perfect way to merge my personal passion and strengths with my career.

I was wrong.  Lets first discuss how awful the hours are.  For the last 8 weeks I've been waking up at 4 am everyday, barring the one day a week we get off.  I arrived at the hospital between 4:45 and 5 and am expected to see my patients and have my notes completed before 6 when the team will round with the senior resident.

That wouldn't be all that horrible except for another menial task that is assigned to students: The List. What is the list you may be asking yourselves?  Let me tell you.  It is a print out of the list of patients the team is responsible for that day it includes the name and age of the patient in a grid like format.  You would think with the electronic medical records (EMR) that we use (the hospital I was at had the cadillac of EMRs, EPIC) there would be the option to say right click all the things you wanted for the patients and have them come out in list format. WRONG.  Every morning myself and the other two students on our team would by hand have to fill in for every patient in the 1 cm row like space the following information: reason for admission, overnight events, vitals [temperature, heart rate, respiratory rate, blood pressure], total intake, total output, urine output by shift, medications, diet status ([NPO (if they can't eat anything], clear liquid diet, full liquid diet, pureed diet, heart healthy, general, etc).  That is completely absurd.  It would take between 30 and 40 minutes every morning to make this list and to be honestly most of the time nobody even used it.

After pre-rounds with the residents were completed we were expected to split up the surgeries on the board for that day and scrub into those and keep an eye out for when attending rounds would happen.  Thats another disaster.  As students nobody really ever remembers us and attending rounds occurred on a pretty haphazard basis so we had to rely on our interns to let us know when and where they were happening.  This led to one too many occasions where we would run into one of our team members somewhere only to have them let us know that rounds had just finished.

Frustratingly enough there was a second list we were asked to make during the day too.  Sometime between pre rounds finishing at 7 am and attending rounds occurring whenever the attending decided to show up we were expected to record the labs values for every patient.  This entailed printing out another blank list and filling it with hemoglobin, hematocrit, platelets, WBC, sodium, potassium, Cl, bicarb, BUN, creatinine, glucose, calcium, phosphorous, magnesium and any other assorted values that were recorded such as PTT, PT, INR, CEA, etc.  The worst is when we would scramble to finish the labs only to find out we missed rounds.

Although there was a lot of busy work involved with it being in the OR was quite a unique experience. The excitement of holding the camera during laproscopic procedures did start to wear off but I can definitely appreciate the fact that surgical interventions are kind of mind boggling.  More on the woes of scrubbing in and accidentally touching your face and other comedic moments during my surgical clerkship.

Medical Jargon Demystified II: Pecking Order

Something that I have always found incredibly confusing until I became a part of this structure myself was the hierarchy of medical education. I thought it may be useful to just clarify who is who and how far along in their educational journey in a post.

• Attending (This person is definitely a doctor, they are what we usually think of when we say doctor. Undergrad + Med School + Residency (depending on the field, fellowship))
• Resident (All of these people are technically doctors, they have an MD or DO after their name)
• PGY (INSERT #) (post graduate year) depending on how long their residency training program is this could be PGY 1 - 10)
• PGY 1 (these guys are the interns, they are the lowest of the low in the MD totem pole.  They are first years that were medical students between 2 and 10 months ago and act fairly clueless for the better portion of the year)
• Medical Student (These people are not doctors yet, they DO NOT have MD or DO after their name)
• M4 (4th year student, operates at a similar level to a PGY1)
• M3 (3rd year medical student, fairly clueless but depending on how far along in their 3rd year are closer in performance to an M4)
• M2 (2nd year medical student.  Still in the didactic learning years with minimal clinical exposure, have net to no idea what they're doing)
• M1 (1st year medical student.  In their first year of didactic learning, little to no clinical exposure, has absolutely no idea what is happening ever)

I hope that little snippet helps give a better understanding of what all these weird letters and titles really mean. 

Money, Money, Money, Money . . . MONEEYYY!

note: the title of this post was to belted out a la the apprentice theme song (if you need a little refresher click here)


There is no sense in denying the fact that one factor that often pulls people towards a career in medicine is the financial compensation.  For some reason it feels like a taboo topic, to admit out loud that the of course you have  passion for helping people and a strong desire to serve and it doesn't hurt that you're going to be making a fairly comfortable living.  Nobody gets upset at lawyers for being money grubbers (but then again, aren't we all just looking for an excuse to hate them) or accountants (although being such a personality less number-cruncher should have some kind of upside) for pursuing opportunities that pay the highest.  Its a very strange phenomenon that I think we somehow hold ourselves to a higher standard as well, when I consider my future I feel bad weighing the options because of how much pull salaries can have.

All that being said the more important point I wanted to bring up was that if you intention is to become very rich, very fast I implore you to explore other career options.  Although the compensation is likely in the 6 figure range even for those pursuing primary care positions the fact remains that compared to other career paths this one pays out far too slowly to be a viable option for those looking for quick monetary gains.  Let me explain a little bit of why I find this to be the case with a look at some numbers as well as some anecdotal experience.  Once again I have to emphasize this is how I have come to see the world, at the end of the day its my opinion and please take it as just that.

So lets look at a timeline of education and earning.  According to the AAMC the average age of matriculation to medical school for women is 24 and for men is 25 so lets put that at 24.5 years old (source).  Medical school across the board is always going to be four years and theses years have to be billed as negative income especially because as of this year all loan money is UNsubsidized which means every cent that you borrow will collect interest from the day you start to borrow it, this is a serious bummer for graduate students (source).  In any case if you bill each year at about 40,000 a year (this figure is debatable but just for argument's sake I picked a round number that comes close for many people) x four years according to the AMA the average medical student graduates with $157,944 because lets not forget the interest that will be accruing at about 7% which will be compounded at the end and you will be charged interest on the interest once you graduate (source).  So you finish medical school at 28.5 and finally start making money and residency is anywhere between 3 - 5 years during which according to the AAMC you will make an average of $48,4600 (increasing incrementally each year) (source)  So at this point you're between 31 - 33 and are about to plunge back in for some more training i.e. fellowship or you're out into the real work making some real monies.

If for example you decided to become an accountant at about 23 and start making $50,000 a year and lets say a very modest 3% raise per year, in the ten years your buddy was in medical school you've made about $570,000 assuming no bonuses or proper pay increases.

My point here was not to frighten you away from you dream of being a physician but rather to deter those who pursue this career path for reasons based in financial success.  Yes you are rewarded handsomely  eventually, but the road there is a long, long one.  If you don't do this because you absolutely love it you will without question be miserable.  Once you become a doctor paying back these loans is a matter of budgeting and financial savvy, nbd.  But the path there can be absolutely miserable.  I try to bring this back whenever I can but the best way to make it through medical school is to understand as a student (which you arguably will be for at least 7 years and longer when fellowship is considered, and don't even get me started on those MD/PhDs but most of them don't pay very much so thats a different story) your life doesn't end.

Medical education and training is a journey meant to run parallel to your life story, not completely take it over.  With that attitude you will be able to enjoy all of what your life experiences bring you instead of constantly looking to the end and making promises of what your life will be when you are finally a doctor.  I think what i'm trying to say is carpe diem (I refuse to say YOLO although it seems pretty appropriate here).

Oh yeah, with the average internist being offered $205,000 without bonuses and incentives x however may years you work for the rest of your life, I think at some point you will be able to recoup any and all  losses you have incurred.  Maybe you can even take your accountant friend out for lunch.