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10-01-2005, 09:29 AM
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a lowly intern's opinion
Medicine in its purest form is one of if not the greatest professions in the world. Think about it, people who dont know you will entrust the most intimate of possessions, there body and health to you. the problem is that day to day you arent dealing with it in its purest form. You are dealing with bureacracy, drug seekers, and other garbage. Medicine is like any other field in that you cant lose all of yourself in it, you have to keep something for yourself. Your reward comes from those few precious moments where you really did make a difference in someones life. that is what keeps you coming back. As far as residency goes, yes it is hard. and the hours suck, but thats life. THere are some rotations where getting up at 5am is sleeping in for me. But I chose this life and I love every minute of it.
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God must be a Florida Gator fan because everyday at sunset the sky turns orange and blue!!! Its great to be a Florida Gator and IM Board Certified!!     
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10-01-2005, 10:59 AM
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Finally beat Super Mario Bros within 7 mins.
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10-08-2005, 02:27 PM
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 this is an interesting article i read about this topic from new yorker i think Feature Doctor Feelbad Time was when doctors were at the pinnacle of our society -- with the Mercedeses and country places such status merited. Now, buried under paperwork, their income chiseled by HMOs, their power and independence eroded, they feel like any other employee. It's enough to make you sick. By Steve Fishman (Photo credit: Corbis)"Vacations? Are you kidding?" Mark Fox is a physician. he's got a handlebar mustache, a sharp widow's peak, a bright tie, and his own private practice in Scarsdale. He's 53, in the prime of his career, and just now, seated behind the desk with a life-size plastic nose on it -- he's an ear-and-nose specialist -- he is recalling how he used to take vacations. "Every winter and every summer," he says. Photos of high-mountain camping near Mount Rainier hang on his office walls. First the summer vacations disappeared. "Haven't had one in five years." This year he skipped the winter vacation. Fox's own doctor has urged him to take some time off. He doesn't disagree. "I have increased stress, high blood pressure," he says. He's so wound up by the time he gets home from the office that his wife won't talk to him for an hour afterward. He's watched a couple of physician friends undergo open-heart surgery. Still, he's reluctant. His income dropped 25 percent in one recent year. And if he's not working, he's not only losing income. "I'm still paying for the overhead," he says, and it's doubled in recent years. So what does he do? "I tighten my belt and get a headache," he says. Dr. Bernard Schayes, a 43-year-old internist on the Upper East Side, is the kind of doctor who puts his cell-phone number on his office answering machine. He likes to be available to patients. Of course, when he was starting out, availability was easier -- he lived around the corner in a two-bedroom apartment. But he had two kids and private-school bills of $30,000 a year. (He also owned a Mercedes and a Jaguar.) Then his income dropped. "There's no way to live in the city anymore," he says. He moved to Roslyn, Long Island, where his children attend public school. Now he wakes at 5 a.m. and gets in his Acura, occasionally fielding phone calls from patients on the way. First, he heads to his part-time job at a nursing home, where he works before his own office hours begin. Not long ago, doctors had it all. They did challenging work -- they saved lives! -- and didn't have to worry about money: They earned tons. They regularly visited the Mercedes dealership. They island-hopped on vacation. They owned the best real estate. Their kids went to private schools. Everybody wanted to marry a doctor. Or be one. Half a dozen years ago, most doctors -- three fourths in one survey -- were happy. No longer. Doctors still say it's a privilege to be a physician, to intervene in people's lives in times of need. "But there's a gloom now," says one family doctor. "A lot of sitting around the dinner table and asking each other, 'Where did we go wrong?' " <IMG height=1 width=1 border=0>"The general population decided we weren't worth all that much," says Dr. Bernard Schayes. Or, as he sometimes puts it, "people decided they wanted us to drive Acuras." <IMG height=1 width=1 border=0> Doctors have lost ground. Insurance companies have ganged up on them. "I have anxiety about staying in business," says an internist who's put his own money toward payroll. The trouble isn't just financial. Perks, privileges, esteem (self-esteem too) have all been hit. Many physicians work longer hours. And now, it seems, all kinds of people -- including clerks! -- are telling them what to do. Now, announces the New England Journal of Medicine, "many American doctors are unhappy with the quality of their professional lives." The literature on this reads like the intake form at a depression clinic: "increasing marginalization," "discontent," "confused," "angry," "insulted." (Is it any wonder med-school applications are down again this year?) Yes, the doctor is in, but in case you haven't noticed, there's a good chance he's seething. "It's no fun being a doctor anymore," is the way one puts it. Medicine hasn't always been a path to privilege. For most of this century, doctors might have been stars in high school and college, but they were solid upper-middle-class earners, a notch above your general contractor, maybe. Then, starting in the sixties, Congress enacted Medicaid for the poor and Medicare for the elderly. The number of paying customers per doctor eventually quadrupled. "That was the goose that laid the golden egg," says Dr. Jerome Breslaw, a Manhattan gastroenterologist who began practicing in 1973. Doctors bought themselves Mercedeses, Cadillacs, Beemers. They went from upper class socially to upper class financially. Even in the eighties, when family doctor Mark Horowitz attended medical school, he thought, "Doctors are rich people." Mostly, he was right. Society's bargain with physicians seemed to be this: Spend ten years training, then you'll be taken care of. Shortly after Dr. Schayes, the Upper East Side internist who owned a Jaguar and a Mercedes, left his residency, he worked hard -- including nights and weekends -- but in the early nineties he earned upwards of $300,000 a year. By the mid-nineties, circumstances had changed. "The general population decided we weren't worth all that much," says Schayes. Or, as he sometimes thinks of it, "people decided they wanted us to drive Acuras." Actually, it was business that first made that calculation, since in large part business footed the bill for double-digit medical-cost inflation. Managed care was one result. This insurance scheme was sometimes hailed as a way to encourage preventive medicine and ensure quality, but its initial intent was to trim costs. Doctors could once charge as much as they wanted -- a rare thing in business. In medicine, the law of supply and demand didn't seem to hold. No matter how many doctors crowded into one area -- like Manhattan -- fees seemed to do nothing but rise. One way managed-care companies attacked costs was simply to reduce doctors' fees. "Where a fee was $1,000, now a doctor is getting $300," says Andrew Kleinman, a plastic surgeon in Westchester County. Once, patients were responsible for the shortfall. In managed care, physicians swallow the loss. "The insurance industry has created a slave workforce out of the doctor," says Moshe Rubin, a gastroenterologist at Columbia. That may be an overstatement, but no doubt that's how it feels. And as if reduced fees weren't enough, insurance companies have sometimes, willy-nilly, not reimbursed anything. "We're fed up but we're taking it," says Kleinman. Not always. (Recently, a group led by Kleinman went to the New York State attorney general's office, which threatened to sue before Aetna settled.) Reduced revenue is only part of doctors' new burden. Managed-care companies also created all kinds of paperwork, tons of it, which they, using the jargon of the day, outsourced. In this case, they outsourced it to doctors. Suddenly, physicians had to beef up their staffs. Steven Fochios, an internist, has one employee who handles almost nothing but the referrals required by managed-care companies. Ten years ago, Fox had one assistant; now he has four staffers to deal with the 64 different insurance plans he takes, most of which have different rules. His overhead accounts for almost 60 percent of revenue. Reduced fees and increased expenses put pressure on income, especially of primary-care doctors and pediatricians -- the doctors most of us see most of the time. "I never expected that as my career progressed, my income would contract," says Mark Horowitz, a family doctor. "In the mid-nineties, it was easy to save and invest. Now there's less money in the kitty at the end of the month." These days, after eight years of training, a 30-year-old pediatrician can expect to earn $95,000. Starting internists probably earn $100,000 to $110,000. Not bad, perhaps. But the first year at one of the city's better law firms -- that's after just three years of law school -- will bring you close to $150,000. "And I can be on vacation and I'm always available to my lawyer friends," points out Adam Stracher, an internist at Cornell Medical Center. "And they have secretaries. They have expense accounts. You think we get tickets to Knicks games from our firm?" Lately, lots of doctors have to pick up work on the side. Horowitz works as a medical consultant at Juilliard. One doctor got involved with a dot-com for a few years -- which was the last time he flew business-class. Some physicians augment their incomes by selling herbs, food supplements, cosmetics, even household cleaners in their offices. Schayes sells vitamins. "I buy wholesale and sell retail," he says. "It was kind of embarrassing at first. But at the end of the year it makes a big difference." Last year, Schayes, an M.D. approaching the height of his earning power, earned about $120,000 -- which doesn't come close to buying what people once thought of as the M.D. lifestyle. Soon, Schayes figures, his wife will have to go back to work. She hasn't worked in five years while the kids grow up. "She doesn't want to, but I'm making her," says Schayes. "Besides, she's a lawyer. Her earning potential is greater than mine." Income isn't the only factor squeezing the fun out of doctoring -- and maybe not the key one. After all, doctors earn about $160,000 on average, which makes them affluent, by any measure. "I actually believe the biggest issues are not economic," says Dahlia Remler, an economist at Columbia. Once, as Ed Salsberg, head of the Center for Health Workforce Studies, explains, "everything in health care revolved around physicians. They were king of the hill." Accordingly, they were treated in a kingly fashion. Every 50-year-old nurse remembers fetching coffee for a doctor, giving up her chair so he could sit down. The hidden curriculum of medical school is that the doctor is the decision-maker, the brain, the star. But these days, most doctors are just another member of the team. Teamwork is emphasized. Health care is thought to be a system, not something one person does to another. And so doctors have got a new title: health-care provider, a category that includes nurses and lab techs. That alone drives doctors crazy. It's like a demotion. "I'm no health-care provider," says one NYU doc testily, sounding like McCoy from Star Trek. "I'm a doctor." Along with power, doctors had autonomy. But now the insurance companies behave like supervisory adults, like scolds suggesting -- implicitly, of course -- that doctors can't be entirely trusted. "You used to have a conversation with a patient and come to agreement," recalls Breslaw. Once, for instance, doctors could prescribe as many MRIs as they felt necessary. Managed-care companies, however, now insist they have to approve such expensive tests in advance. These days, physicians have to get on the phone and plead their case. And with whom? "Now if I need to order a scan, I need to call not a nurse, not a doctor, but an uneducated technician," says Rubin, the Columbia gastroenterologist. Of course, no one in the industry doubts that too many unnecessary expensive tests were prescribed in the past -- especially when doctors happened to own the CT or MRI scanners. What's more, as Christine Cassel, chair of geriatrics at Mount Sinai, says, "if you look at the literature on quality of care, there were huge divergences." Different diseases are treated differently in different places with different results. Doctors haven't always taken responsibility for making sure quality is up to snuff. Still, doctors' pride hinged on a belief that the decisions they made mattered. Now, at every turn, insurance companies generate standards of care, templates that ride herd on them, as if they were unruly kids. "It is an insult, it's infuriating," says Rubin. "Though after a few years you stop taking it personally." It's not just insurance companies that now oversee -- and subtly undermine -- doctors. At one time, most physicians were their own bosses, entrepreneurs who set up their own small businesses. That was part of the fun. "Now," says Fox, who is just such an entrepreneur, "I'm a dinosaur." There has been a vast, largely unnoticed change in the organization of the medical labor force. The solo practitioner, the one most of us grew up trusting, is nearly out of business. From now on, doctors will be employees like everyone else. Just 4 percent of new doctors in New York say they plan to open their own practices. As an employee, the doctor has a fixed retirement age and a set lunch hour -- not that physicians ever take expense-account lunches. (This isn't the business world!) As employees, a lot of physicians won't have secretaries anymore, not their own anyhow. At Mount Sinai, specialists who once had assistants now have answering machines. Yes, there's a receptionist, a billing department. But they work for the administration, just like the doctor. "I can't hire or fire secretaries," explained one specialist at Montefiore. "I have no control over staff." Sure, you can always write up a secretary for misbehavior, but then a receptionist can write you up, too. "If we say one wrong thing, they go to the compliance office," said one doctor who was reported for raising her voice. "Apparently, I have to be on perfect behavior." The world has changed on the middle-aged doctor. And, to add insult to injury, the younger generation doesn't seem quite as upset. "We're less insane with it," says Stracher, 37 years old. "Our expectations are different. We didn't know a different way." Making sure patients actually get better is still the responsibility of physicians, as malpractice insurers remind them. (And despite complaints, there's scant evidence that quality of care has decreased in recent years.) Still, these days, other values besides quality guide doctors through their day. Efficiency, productivity: That's what physicians hear. And just like factory workers at the beginning of the century, doctoring has been rationalized to increase productivity. In many practices, the system, even the building, has been redesigned to push the pace. Doctoring has been broken down into its component parts. Assistants take blood pressure. Nurse practitioners take histories. Physicians show up for the flourish, to review the treatment plan, as one puts it. "This does not signify inferior care or second-class citizenship!" doctors Bruce Yaffe and Ronald Ruden felt obliged to alert their patients in a handout. The current system conserves the doctor's time. And time -- this is the point -- is limited. Increasingly, salaried doctors get paid based on how many patients they see. Even at academic institutions, the elite centers where research and teaching have thrived, docs now have monthly quotas of patients. If they don't make their numbers, they're called in to explain why. "We are the new factory workers," says one gynecologist. She may be right. "I have the feeling of being squeezed to see more patients to gain the same income," echoes a colleague. Extraneous activities -- that is, non-income-producing -- are less possible these days. Those, for instance, who'd like to devote more time to research increasingly look to drug companies. "You can't do that on the academic side anymore," says Dr. Rajiv Patni, who recently took a job at Pfizer. Teaching, too, is valued less. "The Department of Medicine must reduce its budget," explained a blunt letter to one Montefiore doctor, whose teaching salary was cut by a significant amount. Maybe doctors once felt like kings of the hill. These days, a lot feel "like interchangeable parts," as one physician-employee put it. "A businessman looks at you and sees a medical license that he is going to plug into a slot in his organization," complained one physician. Of course, one reason employers can treat doctors this way is simple: There are too many of them. Doctors traditionally gained power by controlling supply and demand. No longer. In the past ten years, the number of docs has increased by 30 percent. (That doesn't even include physician assistants or nurse practitioners, who sometimes run independent medical offices. "In the future your doctor may be a nurse" is the warning issued by the American Nurses Association.) And as far as demand goes, doctors have never been overly worried about bringing in new groups of patients (like the 40 million uninsured Americans). The oddest part of all this may be that though doctors feel harried, though they feel pressured to see more patients, studies actually show that patients spend more time with their physicians than they did ten years ago. Dr. Edward W. Campion, deputy editor of the New England Journal of Medicine, suggests office visits only seem short. The reason, he believes, is "because there is more to do, more to think about, and more that is expected." Has medicine simply gotten to be a tougher profession? Consider that one third of primary-care physicians believe the scope of their practice has increased in the past two years. And, alarmingly, one quarter say it's greater than it should be. Your internist, the doctor you saw when something -- you weren't sure what -- ailed you, was once the person who organized, who managed, your care. Now look: "The notion that the internist commands the field is absolutely gone," says David Rothman, a professor of social medicine at Columbia Medical School. From the doctor's point of view, it can get worse when a patient is admitted to the hospital. Now hospitals have their own doctors working the case -- a new category called hospitalists. "It's easy to get forced out of the loop. You're not always part of the team," says Gerald Leventhal, a Manhattan internist. You have to be pushy. The sicker your patient, the more you're excluded. If a patient ends up in the ICU, for instance, specialists and subspecialists take charge. "And nobody even calls you to tell you your patient had a coronary last night," says Leventhal. "Then when you arrive the next day and the family asks what happened, you look like a donkey." People tell pollsters they still trust their doctors more than just about anybody else. (Patients in general don't seem to share doctors' discontent.) At the same time, patients increasingly act as if one physician is pretty much the same as another. Lots of patients fork over nothing but a co-pay, the mandatory cash outlay that can be as low as $10, or even $2. "What do you value a physician at if you pay $2?" asks Stracher, who says that sometimes, for that amount, patients blithely skip even bringing along money. For two bucks, patients sometimes don't show up. Or they get the idea that -- guess what? -- doctors are only worth a few dollars. Fox recalls a patient with a $10 co-pay. She had a small tumor in a lymph node and wanted a second opinion on surgery. She was upset and nervous, and Fox spent more than 30 minutes calming and examining her. In the end, he assured her, she didn't need surgery. "That's the best $10 I ever spent," she gushed, leaving Fox nonplussed. To the patient, he thought, "that's what I'm worth." The stable doctor-patient relationship, the building block of every successful practice, is pretty much a thing of the past. Once, doctors attended patients' bar mitzvahs and weddings. And doctors will tell you that following a patient over a long period actually makes for better care. These days, though, patients are attached to insurance companies that shuffle them around based on price considerations. You save the lives of two members of their family, then their insurance company changes because they change jobs, and they switch doctors. "It's like I used to go to Macy's to get pots and pans; now I go to Bloomingdale's," says Breslaw. <IMG height=1 width=1 border=0>"Doctors are lumped in with hospital colleagues as "health-care providers," which rankles. "I'm no health-care provider," says one, sounding like McCoy on Star Trek. "I'm a doctor." <IMG height=1 width=1 border=0> Some patients don't mind. One of the rights they've recently asserted is the right to convenience -- their convenience. Now they find your name on the Internet and head your way because your office is close to theirs. Some doctors have already adapted. Horowitz knows that patients near his Wall Street office will call their internists back home in Westchester only to learn the next available appointment is in a week. What if they're sick today? At Horowitz's office, anyone can be seen the same day. Patients are demanding in other ways, too. These days, they want to be partners in their care. They trundle into the doctor's office with a sheaf of printouts. Never before has so much information been available. They've got answers, or challenges. Many doctors like an informed patient. Still, it may be true, as Rothman argues, that the doctor's monopoly of medical knowledge is disappearing, particularly, he points out, with regard to young, well-educated, upper-middle-income women. Some time-pressured physicians clearly don't appreciate another demanding voice in their ears. "Suddenly they ask for records," explains a New York allergist. "But patients can't understand records, and now they need an explanation. That's not part of what I have to do. I don't have to be in a position to interpret records to patients." Badgered on all sides, physicians seem to have come down with an old-fashioned case of alienation, the kind hourly workers used to suffer. "There's a sense they are doing this to us. They are the insurance companies. They is the government," says Cassel. As Fox explains, "I don't have any clout." Insurance companies have clout, institutions have clout, even patients have some. And so, just like any disgruntled worker, doctors -- doctors! -- are turning to unions. "We get more calls than we can handle these days: otolaryngology groups, orthopedists, groups that used to be fat and happy," says Bruce Elwell, an organizer for the Doctors Council, which is affiliated with the Service Employees International Union and the AFL-CIO, the same organization that, it's worth noting, represents hospital maintenance workers. Lately, Fox, the Scarsdale otolaryngologist and lifelong Republican, has become an organizer himself. But Fox has signed on with the AMA's newly formed union -- he's on the board. "The anger is still with me," he says by way of explanation. Some doctors encourage their children not to be physicians. Some doctors say they wouldn't do it again. And some are actually leaving. Robert Aldrich has been a cardiologist for 22 years in Morris County, New Jersey, an hour from Manhattan. Or at least he was. On July 1, in the midst of his prime earning years, he bought an inn in Vermont. It's not retirement, exactly. "We have to earn a living," he says. But that will be a pleasure compared with what he's leaving. "I feel in charge again," says Aldrich, who dreamed of a career in medicine from the age of 9. "I feel free again, released from prison." Last edited by newyorkjetsbrian; 10-08-2005 at 02:30 PM.
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10-09-2005, 10:39 AM
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think hard before you commit
I too wanted medicine for a long time. Now that I am resident, I am not too sure that I will enjoy practicing as much as I may another profession. Don't get me wrong , It's still fulfulling to be in the field but if If I had to do it all aver again....I wouldn't. I am upt o my neck in student loans and credit card debts. Reevaulate you reasons for wanting medicine. Don't do it for the money or the prestige. It is a secured profession but it's time consuming ( what isn't though ) GOOD LUCK.
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10-09-2005, 12:05 PM
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Bar "business?"
Listen, man, let me tell you about the bar "business."
I've been in and out of bars working as a bartender and "security" (bouncer) for YEARS - probably as many as you've been alive. I promise you NO ONE except the owners is making ANY six-figure salaries. Perhaps in HUGE LA, NY or Miami clubs a few might make this after years of being there, but nowhere else. And, you get to deal with: 1) Dramshop laws that will have you in court being sued big time if anyone has too much to drink, injures/kills someone in a car crash, and you just happened to be one of the many bars they were in that night. 2) city inspectors who will be up your a** with a microscope constantly, especially if you serve food. 3) bartenders who WILL be pocketing some portion of the money they handle, and since it's almost all cash, there's no way to know what you're really taking in, unless you use those machine-driven shot pouring things, but then customers complain about weak drinks 4) DRUNKS! Nothing gets old faster than dealing with people who drink too much! They fight, harasse chicks, puke everywhere, fight with the staff, and on, and on, and on... 5) security that is often young brutes willing to crack heads at the drop of a hat. This, too, is a great way to get sued, even if you're just "escorting" someone out in an arm-lock, and even if they were drunk and deserved it. 6) customers who want to be treated like royality and have attitudes. The "party busses" full of drunken bachelor or bachelorete parties are the absolute worst. Then you got problems with stocking, liquor charges/supplies, food storage, finding decent cooks, the anti-smoking laws that have become so popular, and the IRS who is always suspecting (rightly in most cases) that there are two sets of books, not to mention city ordinances of all kinds, and having to "grease" the city workers to try and just do business, and this of course assumes that there is no "organized element" that wants a piece of your action (or to tell you who to buy your supplies from) so that you can simply stay in business. And, you've got stiff competition from all the other clubs making it a challenge to get the best acts if you have live music, or good DJ's if you are a dance club. I've looked at getting involved in owning a club several times, and every time the grief I saw simply wasn't worth it. Skate jobs like your friends claim they have where six-figure salaries are involved are very rare, and based upon my experience, even rarer in the bar business. Do what you're really interested in doing - something that's stimulating, makes some sort of valid contribution, and you look forward to most of the time. For me, dealing with drunks isn't it!
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10-10-2005, 02:52 AM
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10-13-2005, 03:25 AM
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of course you will be making less than them if you don't get a residency. i am here making a small hourly wage (minimal) with an M.D. not to mention an MBA. (You can't find a job as an FMG that easy if you cant get residency--you'll see). Right now I'm still trying to get residency--hoping to get a match this time. I had my cable put in and the cable guy was bragging how he was making a six figure income on his many businesses, and this guy did not even finish high school, nor ever went to college. Purely self taught, very knowledgeable too for someone that didn't go to school much-I guess each takes his/her own path. I think it's mainly about experience in getting a job. Actually if you create your own business you get money. Medicine needs to be for the love of it and the love of healing people as well as for the field itself, not for the money, because you really will make more money and have more freedom in business. In medicine, you will also have to take care of a busy practice. I guess when you get out into the real world, by that time you don't have as much time anymore, unless you create your own private practice and set your own hours, but of course many patients will want to see you. Maybe if you went into surgery and specialized, you'd be demanded less and make more, but those are very competitive and FMG's have a more difficult time getting in. Also if your friends are American Grads, they probably got their position easier as they are more favored usually. be careful when considering going the FMG way. Good luck.
Last edited by Soon2BDoc; 10-13-2005 at 03:27 AM.
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10-13-2005, 03:45 AM
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a bar business? isn't that a bit anti-health? I dont think that would be good to even put on your resume if you did that and applied to med school. Bars promote liquor which promotes bad health (you will find that out in pathology class exactly what it does to your liver and overall health status). if you were a real doctor you wouldn't even be promoting it as doctors are also about prevention. Then again there are docs out there that wanna splurge their money like that. I know a few like that and its no picnic owning things like that. You have to put a lot of time into it so that you start making profits. You also have to manage. It's not as easy as you think. The doc running this bar business has to go to work at a busy practice every single day and then at the same time has to check on his employees, train them, make sure they're not stealing anything (which several times the cashier turned out to be a theif caught on camera), has to know how to manage the business (e.g. train workers). Basically that is like working 2 jobs--where is your vacation time? When do you get to enjoy that money that you dream of? or do you just want to have it. I guess you could buy a nice house but will you be happy and will your family or future family be happy? You'll be the worker and you'll make them all happy, but then there's you--stuck to your workaholic life--your family is not going to like the fact you devote to that business only and don't have time for them. (that is, if you plan to have one or have one).
i could see you opening up a gym--maybe that would be nice. Promotes health, makes money, family friendly, and makes you feel good and your patients. The docs that open up bars aren't doing justice to their field. I wonder if they lose patients that way too. I mean it is like giving them disease causing agents just so they come see the doc later on--an evil way to make money.
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10-13-2005, 04:30 PM
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A gym in the bar????
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