Monday, November 7, 2011

What is most important to residents looking for a practice setting?

Question: What is the most important thing concerning residents finishing training and looking for a practice in 2011?

a. Feeling of insufficient medical knowledge
b. Health system reform
c. Educational debt
d. Availability of free time
e. Dealing with patients

If you said “d. Availability of free time,” you are either very perceptive and in tune with today’s young doctors or you read an article about this in American Medical News. According to survey performed by Merritt & Hawkins, a physician recruiting company, 48% of newly graduating residents are most concerned about finding a practice which will allow them adequate free time. This is up from 33% in 2008. Only 7% chose availability of free time as “least concerning.”

Insufficient medical knowledge and dealing with patients were concerns of 7% and 2% of the residents respectively. To put some perspective on that, I worry about my fund of knowledge and dealing with patients every day.

Other interesting survey findings are that almost no one wants to practice in a small town and certain “must haves” include geographic location [sic], adequate call coverage/personal time, lifestyle and good financial package. Sixth on the list of “must haves” was good medical facilities/equipment.

AMedNews cites an Association of American Medical Colleges report showing that 28% of medical school graduates owe more than $200,000 in student loans. Despite all the concern about educational debt, only 12% considered loan forgiveness important, a finding with implications for those dreamers who think that loan forgiveness will entice doctors to practice in unglamorous locations.

Does all this bother anyone else? I wonder what people expected? Did they not know that being a doctor involves commitment and self-sacrifice? Apparently not for at least one, as a revealing blogger wrote a few months ago. See my comments about that here.

The future of medicine is not looking too good to me right now.

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Anonymous said...

i think the problem is its either medical students or the residents have lost the meaning of being a doctor. People are either getting into medicine without knowledge of what it entells or for totally wrong reasons ! Medicine is about patient care. .better still human care, so time shouldnt be a factor if you are helping in restoring someone's health. .

Anonymous said...

Being a doctor is not a job like being a banker or contractor. It is a life. The decision to become a doctor should carry as much weight as the decision to enter the priesthood. There are few other examples in modern life of the level of commitment that we should be demanding of our doctors. There is no place for dilettantes here. I say to those surveyed: get out. We don't want you here.

Anonymous said...

Most of the complaining I hear is not from residents or students, but *about* residents and students. ;)

Skeptical Scalpel said...

Thanks for the comments. I got some pushback on Twitter. I just tweeted that if free time is your #1 priority, maybe you should choose medicine as a career.

Anonymous said...

With multiple fellowships, subspecialty training, etc, etc. Some that finally enter the actual adult working world, fail to grasp that they must work hard to make a name, and a reputation for themselves and the practice, the business, they now are a part of.

Ex: I cannot "carry" some of these new guys. I understand that you don't like that patient, but he/she is YOUR new patient and I tire of hearing that all patients are crazy (we all know that :o) So get some coping skills and figure out how you are going to be a valuable asset to the practice. Do not make me worry that the practice won't survive.

-SCRN (stepping off soapbox)

Skeptical Scalpel said...

Good comment as usual from SCRN.

Anonymous said...

Let's see here... So after 12-15 years of hard work and training making little to no money only to hear from "old timers" that we don't care and we aren't working hard enough. Sorry, but that's total bullshit. I love what I do and am honored to be able to care for patients. But yes, I am tired of caring for patients who don't give a damn about their own health, who expect perfection in their medical care (which they aren't paying for) and are very quick to sue.

There is a profound shift in this generation that older docs will never understand. Just because you chose to sacrifice your family, marriage, seeing your kids soccer games etc doesn't mean we are. I expect more... I want to live a healthy balanced life so I can do my absolute best to care for my patients. That sure doesn't make me lazy and it sure doesn't make me incompetent. It just means I am being honest.

Anonymous said...

How is a rushed, tired doc who doesn't have time to answer phone calls and emails from patients better than someone who is relaxed, happy and able to have extra time to respond to patient's questions without making them come in for an appointment? I am in my third year of med school and see the change that my generation is bringing. All the older docs I have worked with either bash medicine or tell me how much they would love to go back and do medicine all over again with my generation's attitude. I believe the future of medicine looks great right now. The happier generation of med students will become happy residents who will become happy attendings... And this will make for patients who think their doctors care and who are more central to our medical system. The way I see the older generation is more self involved and narcissistic than we who are coming up.

Skeptical Scalpel said...

To the two Anonymouses,

Thanks for commenting.

First anonymous,I think you will be very unhappy in just a few years. You aren't supposed to become cynical about the patients for a few more years.

Anonymous #2- You are calling us narcissistic. Wow! I think you are deluded.

Anonymous said...

I'm a med-student, and I agree with you although I did not see those statistics but I've seen my colleagues here!! they all think about which specialty would offer them more money and more free time, no matter they love it or not or if they will be good at it or not.. it's like spending years in studying and learning just to relax for the next years..?!!

Doctors and medical students need a motivation, a goal that push them to work harder and keep them going.. and helping others, saving lives and giving back no matter where, when or for what, is that goal that every doctor and med-student should attain,not looking for a better socioeconomic state..!!

Skeptical Scalpel said...


Thanks for the supportive comment.

Anonymous said...

Look. You cannot escape any of it anons. Don't believe all the bull they tell you in school. Get ready for a huge rude awakening.

If you hire a good RN and become partners in crime, and allow yourself to be trained in "our art" of making things work somehow, you will be blessed. Use an RN to your clinical triage, education. The two of you go everywhere including the bathroom :) together for a while till you can almost finish each other's sentences. Build total respect and trust. Don't dump on each other, respect each other's clinical abilities and position. Watch out for each other and you will find things easier... Multi-degree/career, direct client contact background RNs best for the job.

Use an MA for rooming and vitals/labs etc.


dancestoblue said...

First — I am not a doctor, I am not in your field at all; I'm a citizen, here on the sidelines.

I'm writing to thank you for doing what you've done and what you do, for the commitments that you've made and are making to help all of us.

I've been dead — heart attacks, 2004, dead a long time, too; my cardiologist brought me back. (I *love* this guy, he's like my very own Dr. Kildare, younger than I and good looking and all of it; we have a time.) You all have helped me learn to live a better way so that I can continue to live, you've sewed me when I've cut myself, you've treated with professionalism and compassion the long-term ongoing illness that I've suffered, and suffer. You helped my brother in his struggle with lung cancer, you told him to bag it when the struggle was finished, copped to the fact that you couldn't give him anything more — I can scarce imagine what that conversation must be like from your side of the desk.

So. Thank you, Doctor Skeptical Scalpel, and thank you to each doctor who reads these words, each oncology nurse, that jammin' NYC surgeon who last month cut out and re-routed some guts (crohns) of a kid I mentor — all of you. I didn't have the smarts to contribute in the ways that you can, but I *do* have the smarts to have a sense of how hard it has to have been to walk the roads you've walked to get where you are.

Thank you.

Anonymous said...

I get where you're coming from Skeptical, and I agree that medicine is a life and not a career. I shake my head when my med school colleagues talk about "lifestyle" specialties and how they want a residency program that follows the 80 hour rule to a T. It seems like no one wants to take care of sick people anymore. However, I'm tired of getting all this baloney from the older docs about how we "don't care about our patients" because we want, um, "normal" lives post-residency. I'm sorry that I want my (future) kids to see as much of me as possible. I'm sorry that I want to be there for my family and, just maybe, take a little time to take care of myself. If you guys don't like it, tough. I'll rest easy knowing that family comes first.

And by the way, I do bust my butt in school, and I plan on busting my butt (hopefully more than 80 hours a week!) in a neurosurgery residency, taking care of (taking damn good care of) some of the sickest patients out there, and learning as much as I possibly can in the process. And I know I'll love every minute of it. But if you wanna knock me for not wanting 100-hour weeks post-residency, by all means take your shots. All I know is that I'll be in a better place--I'll still be doing something I love, I'll still be there for my family, and I'll still be taking damn good care of my patients. And I won't settle for anything less.

Skeptical Scalpel said...


Thanks for the kind comments.


I'm not knocking you and I'm not saying you have to work 100 hours/week. I am sticking to my position that if free time is your #1 priority, medicine is not for you. It sounds like free time is not your #1 priority.

Beezy said...

My humble MS2 opinion: People who value free time above anything else don’t do premed, study for the MCAT, Shun family and friends during medical school and residency. If you’ve dedicated yourself to all of that for the sake of medicine, you’re more than likely not a slacker. If you're a traditional student you’re pretty much sacrificing the best years of your life for your future patients.

I do understand your point skeptical, But I wouldn’t worry. In the event that one chooses a specialty with no appeal to them except free time will burn out quickly and leave the field. Medicine is tough and even if you only work 20 hrs a week doing something you hate, that 20 hrs will be hell.

I do think (in my young and impressionable MS2 mind) that picking a specialty for free time is far more virtuous than picking one for the money.

Skeptical Scalpel said...

@Beezy very thoughtful comments. Thanks.

Dwayne said...

Availability of free time I would agree to because I've work at a hospital and I see the med students struggling for it

Skeptical Scalpel said...

Dwayne, thanks for your comment.

HButler MD FACS said...

1. We are working on a solution to the debt students face.

In Virginia one of our schools reports students graduate with a median medical-school debt a few dollars short of $200,000, in addition to whatever debt may have been accrued in college.

Perhaps we can use a 501 (c)(3) to attract private tax-deductible donations to pay student loans costing up to 7.89%--these federally-guaranteed student loans are available at a time when mortgages cost ~3%, so I would ask why we cannot offer our future doctors a better rate; attorneys with whom I have shared these concerns say such a plan is workable.

2. A related issue is career-satisfaction. We learned from a surgical colleague in Alabama that ~50% of new surgeons want to re-locate within 3 years of starting their first position after residency.

I called the ACS about this matter and was told that ACS will not offer advice on contracts. is a web site under development to address these two concerns.
757 397 5260
H.E. Butler III M.D., FACS

Skeptical Scalpel said...

Dr. Butler, thanks for the interesting comments.

Do you really think that people will donate to doctors for debt reduction? I doubt they will. I read somewhere that the interest rate on student loans was set by law and can only be reduced by Congress. I don't know if that is true.

Regarding the statistics on relocation, 50% sounds about right. I am not sure it is much different than it was 10 or 20 years ago. I think it is quite common for doctors to relocate, especially early in their careers.

H said...

I learned from an internist, Dr. William Gough, that Virginia has a state-tax credit for doctors donating time to charity-care, under "Code of Virginia 58.1, Donations of Professional Services."

A similar federal tax-exemption would perhaps make PPACA workable. H

Skeptical Scalpel said...

H, thanks. I wasn't aware of that. I think it depends on how much of a credit is allowed.

H said...

Skeptical Scalpel said...

H, thanks for the link. A tax credit of $125/hour is way better than no tax credit at all.

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