My wife finished medical school a bit over 4 years ago. While she thought medical school was brutal, it was comparatively easy compared to the challenges she faced in residency (she did her prelim at UCLA-Harbor and is now at Boston Children's hospital doing pediatric neurology). 80+ hour work weeks are the norm, and sometimes she works 14 days straight and has a pager that beeps throughout the night that she must respond to before going in again in the morning.<p>After one does complete residency, it does seem to get a lot easier based on observing some of her friends that didn't do fellowships, especially if the person takes a more clinical job. But after all of that effort, a lot of people become attending physicians where they are putting in just as many hours, if not more, because it is more prestigious. Those are the people that run the teaching hospitals, so it feels like there is a lot of "I survived and it made me a better physician, you can too" mentality.
medical school is humbling and difficult. Being a physician is difficult. I finished medical school in 1996 - didn't find it ridiculously hard, but then again, studying a lot was what I did in my youth. Now, I'm 47 years old, and work about 90 hours a week as a surgeon - I laugh when people say that we make too much. All I know is that 25 years ago, you had to be in the top 10% of your class to become a surgeon. When I applied, it was top 20%. Now, it's basically if you graduate from medical school and want to be a surgeon, you can become one. General surgeons put in long hours for not that much glory - today I waited 2 hrs to drain an abscess that took me 10 minutes, so I got home at 6:30 pm.<p>The upside is that when I do a great job, it really is rewarding. The downside is telling families and patients I do not have much to offer, and their disease is too far gone. Anyway, don't go into medical school / surgery if you don't want to work hard. No one has a gun to your head. Physicians that pick the right profession for their personality / skill set are very happy.<p>PS my undergraduate degree was computer science
I wish more people knew and understood this. I didn't write about the suicide angle specifically, but I did write, "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school:" <a href="https://jakeseliger.com/2012/10/20/why-you-should-become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-school/" rel="nofollow">https://jakeseliger.com/2012/10/20/why-you-should-become-a-n...</a>, which covers similar topics.
One thing that strikes me is that the medical profession is one of the only professions that hasn't industrialised. Basically one highly paid, highly trained doctor in front of every patient. It's a craft industry... It doesn't scale well, and it is very hard to maintain a consistent quality.<p>Perhaps will AI change that...
The presence, or increase, of suicides does not mean that medical school is too "brutal." It could very well mean that young people are becoming worse at coping with stress. Or perhaps students feel more pressure because of their perceived consequences of their failures: basically no alternative career path that would provide the same standing as medicine, whereas in previous generations, med school dropouts could go on to dental / law / cushy corporate gig more easily. This could be one of the consequences of rising inequality.<p>I'm not disputing anything here, just want to discuss this logically. I've been in graduate school, and it wasn't that hard, and yet some of my peers would freak out constantly. And some wouldn't.<p>I will say that there's definitely a hazing culture across all professions in America that's completely unnecessary and inappropriate.
I see parallels with medical school in tech hiring.<p>They put the students through hell because that's what they had to go through, and they're rent seeking.<p>In most other countries, doctors don't have an accreditation board. Most things are simple, and it doesn't require years of school to set a bone or put in some stitches, or even diagnose the flu or pneumonia.<p>Similarly, you don't need a rockstar or ninja to write your CRUD app. Anybody who knows what he's doing will be able to do that, he doesn't need to be the best of the best, he just needs to be competent.
Many people want the status associated with being a doctor (of course some are pushed that direction by parents and some also just want to help people). When you have an abundance of people trying to get into an industry the profession have the ability to only choose the absolute pinnacle of talent. It's the same with being a pilot. Many of them work long hours in shit conditions for years hoping to get a decent route. I have often had notions of throwing my career in to be a Doctor but the price you pay to climb to the top of the heap is not worth it, long hours, student loans, bad pay for the first decade, no social life, worry about malpractice, make it simply not worth the tradeoff for some status and job security.
> average acceptance rate for fall 2015 was 6.9 percent<p>But most students apply to multiple schools. Actual acceptance rate is 40% across all demographics.
<a href="https://www.aamc.org/download/321480/data/factstablea12.pdf" rel="nofollow">https://www.aamc.org/download/321480/data/factstablea12.pdf</a><p>Edit: also, 25% of the applicants are repeat applicants. So, first application acceptance rate is probably closer to 50%.
I just finished residency and, based on my experiences, I have three points.<p>1) This situation seems analogous to the higher rate of suicide in very competitive colleges. Both feature putting people who did very well in the prior stage and then demanding a high level of content mastery in a short period of time. Interestingly, some places a pushing for a 3 year med school experience for primary care to reduce loan burden and get more productive years out of the training. I wonder how this will affect this pressure.<p>2) I wonder if discussing the harsh reality of medicine - charting, team management, things being beyond your control - rather than emphasizing the 'higher calling' and 'privilege to care' would dissuade those seeking prestige form entering medical school. I think it is a much greater service to have them figure out before school starts and not be saddled with 40-50k of debt that first year.<p>3) A big transition I always heard in med school was the difference of the trainees in that they value work/life balance much more than the titans of medicine in the past. How to rectify this priority with traditional medical school is a VERY interesting question.
> . Fortunately, others are speaking up as well. In online magazines and on NPR, medical students who have lived through suicide attempts, depression and other mental-health issues are standing up against this stigma. Medical schools are now training faculty to recognize risk factors for suicide and assuring students that seeking help isn’t a sign of weakness.<p>I wonder whether and hope that mental illness will end up like homosexuality in the sense that people will no longer have to hide who they are. On the other hand, I suspect that would be a more difficult battle, especially when it comes to employment discrimination.
This is the important part, I think:<p>"But one part of medical school culture has been especially hard to overcome: the stigma of mental illness. When they need help most, medical students in anguish rarely reach out. Students attribute this reluctance to seek care to fear of stigmatization by peers and to concerns over professional ramifications, particularly during applications for residency and licensing."
Compared to previous generations (and the change is quite steep -- I am talking about students today vs. students 5-10 years ago), a growing proportion of medical students have entitlement issues.<p>Those issues are roughly two-fold : (1) feeling entitled to a "balanced" lifestyle; (2) feeling entitled to help people. The first one is obvious: student want to leave early, they don't understand that patients always come first, that, sometimes, you have no choice but to be sleep-deprived for days, and so on.<p>The second one is a kind of "Mother Teresa Complex" when students experience uncontrolled anxiety and distress upon seeing a fully competent adult actively undermining his own care. I see it all the time when they try to talk a lung-cancer smoker into stopping for 30-40 minutes, come back almost crying that he's not interested, and can't believe that their "trying to help" means they are now late, and I'm not happy at all.
> "I checked the medical licensing requirements in California to make sure I wouldn’t lose the ability to care for patients... Fears were unfounded."<p>You should get help. But you can't be sure you will be allowed to practice medicine. The medical board will decide on an individual basis. For reference, texas medical board form for mental illness and self referral program: <a href="http://www.tmb.state.tx.us/dl/C5EAB589-0916-C88D-FF94-DE8D9623C5A4" rel="nofollow">http://www.tmb.state.tx.us/dl/C5EAB589-0916-C88D-FF94-DE8D96...</a><p>Of course, if you don't self report, and practice anyway, and a patient complains, you might be facing criminal charges.<p>First do no harm. Help yourself before you help others (seek mental help if you need it).
My sister is currently finishing medical school at Penn. We talked about suicides in hospital and university settings.<p>She had an interesting perspective on the problem. She said that it isn't the intensity of the work, the academic rigor, or even the emotional damage from constant exposure to death and disease.<p>It's the sleep deprivation.<p>There is a very large amount of evidence that one night of reduced sleep massively increases medical errors. Despite this knowledge, sleep deprivation remains this massochistic macho hazing ritual, which increases in severity through residency.<p>It's dangerous and unnecessary.<p>This article does a good job of capturing the chain of internal events that lead from exhaustion to burnout to severe depression and finally to suicidal ideation.
My partner studies how and why mainstream hospitals are turning increasingly to complementary and alternative medicine (CAM). Interestingly, one reason is that many current doctors burnt out (because of the conditions described in the article and developed chronic and/or psychological conditions either in med school or practicing. These doctors (or soon-to-be-doctors) find that CAM offers better remedies for many chronic conditions, which the current biomedical stack really isn't optimized to handle. Then when they finish med school, they're in a privileged position to confer institutional legitimacy on CAM treatments. So in some sense, this brutality is changing medicine more generally.
I love the medical school analogy "drinking from a firehose" since a lot of the knowledge has to be frontloaded. This makes sense since making errors is less forgiving.<p>software engineering might be closer to "drinking from a running facet.. forever". I know doctors have to keep learning but I always wondered if it was more or less than engineers after school.
A company I used to work with makes a program [1] for monitoring medical student well-being over time to try to detect early warning signs as well as provide anonymized data for research<p>[1] <a href="http://www.mededwebs.com/well-being-index" rel="nofollow">http://www.mededwebs.com/well-being-index</a>
I wonder if the high salary is worth the mountain of debt on top of all this.<p>Could part of reason why the education is so expensive due to the monopoly in all the tests med students have to take? <a href="http://endstep2cs.com/petition/" rel="nofollow">http://endstep2cs.com/petition/</a>
A med school student's contemporaneous journal describing his time in med school:
<a href="https://news.ycombinator.com/item?id=12680306" rel="nofollow">https://news.ycombinator.com/item?id=12680306</a>
If you get into med school especially if you are Asian means you are pretty competitive. You basically need a 3.8 GPA and about 31 to get into an average med school. If you get into a specialty you are making close to 250-300k+ starting. Obviously its going to be competitive. Its basic economics.