The Realities of Studying and Practicing Medicine

Discussion in 'General Discussion' started by Logic, Sep 6, 2018.

  1. Mana

    Mana Resident Medical Officer Administrar

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    Job stability is probably the only one of those in medicine you'll get and thats only if you do an in demand field of medicine (we're talking psychiatry or geriatrics here). All the 'glorious' specialties are at saturation point so you'd be looking at working and living rural if you want any decent shot at job stability and good money.

    Clinical work is easily 'overly stressful' - a recent study showed that 70% of all ED doctors exhibit signs of burnout.
     
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  2. LMG!

    LMG! UTAS MBBS II Moderator

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    ChiangKS

    I think everything that needs to be said on this topic has now been said. Thanks everyone for your contributions, but we're now officially seriously off topic for this thread. Further posts will be deleted. There may be an existing thread where this would be more appropriate if there are more questions.

    ETA: this content has been moved to a new thread. Please feel free to continue discussing if there are unanswered questions.
     
    Last edited: Sep 7, 2018
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  3. chinaski

    chinaski Regular Member

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    Yeah... no. You really need to look into the realities of being a doctor and take off those rose-coloured glasses. I'd also suggest as an aside that a career in academia is a bloody hard road, too.
     
  4. Benjamin

    Benjamin Resident (JCU MBBS) Administrar

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    In the spirit of fulfilling the thread title I think I might chime in here and offer a bit of a current perspective on the job as a junior; Mana, Pi & Chinaski can probably add their perspectives too if they feel like it.

    At the moment I am in my second postgraduate year of work after studying for 6 years at medical school immediately after graduating from highschool, I am 25. My overall job consists of rotating through different terms on a ~10 week basis (but sometimes fortnightly) & my day-to-day job varies drastically depending on what rotation I am on. So far this year I have been moved from vascular surgery to palliative care to general surgery to cardiology to emergency to rural rotations & later in the year I'll be in the ICU.

    Each of these jobs requires something different of you & often they will have very different workloads - vascular surgery was minimum 10 hour constantly busy days where I would often miss lunchbreaks & had frequent overtime spent in theatre when things went wrong at 4pm, palliative care was much more strict with rostered hours & slower paced but I spent a lot more of my day talking with a lot of people which tired me out, cardiology was a heinous mixture of medicine/surgery where patients flew in and out of the ward often without enough time for me to learn their names, emergency is typically a hard slog 10 hour shift without any reprieve due to constant influx & pressure to see people, & my current rural term is essentially me alone overnight in a hospital with a phone to call for help if I need it.

    Often I don't know what my job is going to be until I start and then when I do figure it out we change jobs & have to start all over again. Some of the jobs are standard 8pm - 4pm Monday to Friday, some of them are rotating shift work (days one week, evenings the next, nights the week after or some variation) and others are specifically late or night time shifts. You get some say in what rotations you want to do but for the most part it's rare to get everything you want without also being given something you don't want - i.e. seeking out a coveted ICU / Paeds / ObsGyn / Anaesthetics term will probably result in you also getting an entire term of nights or something similar. This is the reality for the majority of junior doctors from internship until they either begin a non-rotational job or start on a training program. I got my ICU term but have been sent to a rural hospital in payment.

    In terms of job security it depends what you mean by that - it's unlikely you would ever be OUT of a resident/junior doctor job if you wanted one & were competent but it's also unlikely you would get a job and be able to say "I'll be here for 5+ years". Applications need to be done yearly around July and staying at the same hospital in the same job isn't always guaranteed. Most of my friends who have applied for jobs haven't found out & won't find out where they are next year until November. Rotational jobs (as described above) are generally largely available / easy to retain but don't guarantee you anything specific. Non-rotational jobs or moving up in the job ladder often necessitates moving around / to the job you want and quite frequently this means moving yearly. Even when you're in specialty training the same thing happens - each year of training has specific requirements & you go where those requirements can be met.

    Non-rotational jobs as a junior (e.g. a year of paediatrics, medicine, surgery or emergency) are generally considered stepping stones towards a training pathway and as a result they often come with increased expectations - after all, you're likely trying to both become competent enough for the next level job & impress someone so that they will hire you in the future on a training pathway. They give you the opportunity to become a bit more comfortable in your job but this is often coupled with increasing responsibilities as your seniors get more comfortable with your abilities, the end result (anecdotally, I've not been there) is hopefully a constant progression in your knowledge that is borne out of constantly testing yourself. This same idea is carried over into specialty training where you are progressively faced with higher & higher expectations / responsibility for making decisions while focusing on a more specific area of medicine. Thrown into this mix of a job that constantly gets harder as you get more competent is the need to do exams +/- research +/- maintain your sanity.

    The end result is that in one way or another medicine often ends up pushing people fairly hard either through high workload, constantly changing jobs & expectations, not being confident on where they are working for the next week or next year, & generally through the actual job itself. I got into medicine not having any idea whether I wanted to do it (I liked chemistry & engineering) and figuring it opened up a lot of potential doors & I'd find something I liked - I'm glad I have because if there wasn't something that I loved about the job then it would be pretty crappy & my engineering friends make way more money than I do.
     
    Last edited: Sep 7, 2018
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  5. hpfanfiction

    hpfanfiction Paediatric Healer at St. Mungo's Hospital Magical Moderator

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    This is a very accurate picture of what my prevocational and even early specialty years were like . I’m 29, in my 6th postgraduate year of medicine and in my 4th year of overall training /1st year of advanced training in my chosen specialty. To give you some idea of how much shift work is involved - I’m currently doing my first predominantly day job in over 2 years (having done 13 hour day/night type rosters throughout last year with 10 hour shift based jobs earlier this year and for the last 6 months of 2016). I still have after hours shifts and on-call shifts (evenings , nights , weekends) but at least my base hours are 8-5 which means I get most weeknights and over half of my weekends completely off . This is the most work-life balance friendly job I have had in a long time , but it’s not in an area that interests me or many of my colleagues so for that reason it’s not considered a particularly desirable job (it does , however fulfill a training requirement, and I’m getting more out of this than I anticipated ).

    Everyone handles shiftwork differently . Personally, I especially struggle with nights but am lucky in another way as I seem to be able to handle long 15-16 hour days (I have 1-2 of these a fortnight currently ) better than many of my colleagues . My partner is also medical and due to our rosters - we have sometimes gone upto a whole week without spending any time (let alone quality time) together despite living under the same roof. Access to leave especially at the times when I have wanted it has been very difficult at my hospital due to service requirements and general understaffing so it has been 3 years since I had more than 2 weeks off at a time . I’m hoping that changes next year .

    The comments Ben made about getting a mix of desired/undesired terms and the different expectations within each job are very true . At this stage of my career , I now switch jobs less frequently than before (every 6 months instead of every 10-12 weeks ) , but I still have to apply for jobs (yes, plural) every year . I’m not ashamed to admit that there have been various stages during my career when I have felt burntout , unsure of myself , overstressed and overworked . Things have improved in the last 12 months since finishing exams (the 18 months in the lead up to my written and clinical fellowship exams were unbelievably stressful) even if some of the time I used to spend studying for exams is now being spent on courses/research /teaching/ studying for my job as I’m still new to my role /term and generally working on my CV (which was largely neglected whilst I was focusing on exams ).
     
    Last edited: Sep 7, 2018
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  6. DLVP

    DLVP Lurker

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    Hi KRO, not sure if it's the right place to ask: if I come from interstate, can I come back to my city after graduate from JCU or do I have to work in rural/remote area?
     
  7. Crow

    Crow Moderator Moderator

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    Mana/pi/Benjamin/chinaski/hpfanfiction are probably the best people to answer this in detail, but short answer is: no you don't need to work in a rural/remote area after you graduate (but JCU's program will best set you up for this, and I would read about it in detail before committing to the course if you really have no interest in this), but as a graduate from a QLD medical school you are most likely to do your internship (and probably residency) in QLD because of each state's internship priority lists. What is your home state?
     
  8. DLVP

    DLVP Lurker

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    Am I right that basically the internship will be done in the state where medical school locates?
     
  9. A1

    A1 Admissions Speculator Moderator

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    Where you work immediately after graduating depends on where you get an internship. Being a CSP student you are guaranteed one in the state you graduate med from, but you may also apply for one in your home state. This usually works out okay if your home state is NSW, since the NSW gov offers more internships then there are NSW CSP grads and being a returning grad you are slotted in below NSW CSP but above other CSP & int'l grads (although you likely end up in a pretty undesirable location).

    Vic is different though, there Vic int'l grads are priority ranked higher than returning CSP grads. There's no guarantee the Vic gov will offer enough internships in future to cover Vic int'l grads let alone lower-ranked returning CSPs.
     
  10. DLVP

    DLVP Lurker

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    Thanks guys.
     
  11. chinaski

    chinaski Regular Member

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    As always, it is worth attaching the caveat that the priority lists issued by each state and territory are good only for the year in which they are issued. As such, someone applying for med school now should not assume that, when it comes time for them to graduate, they will be afforded the same list advantages as medical school graduates were in 2018.
     
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  12. treesarenice

    treesarenice New Member

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    I would to ask if you could describe your day to day life whatever year you are in and also details like from what time you normally have to wake up to your daily schedule and how much time you have left after your day of school has finished. Do you get any time afterwards for a breather or play any sports or go out and have some free time?

    Also if there is anyone close to graduating med school or a junior doctor etc, it would also be nice to hear your experiences as well.
    As much as it seems exciting to be able to help people and make some kind of difference as a living, do doctors ever get time for themselves and their friends and family? What if you have just become a parent or got in a relationship, does being a doctor compromise those things? I saw a few articles of how doctors have 12 hour shifts that can go for 10 days in a row and they get a 1 day break. That seems a little excessive but I guess it depends on what specialisation or health sector you are in. It would be cool if people can shed their light on this in some detail as I wish I know what I am getting into before I make a decision I regret later in life. I guess if I feel like it is too much, then this is not the right path for me and I should do what makes me more happy in the long run.

    Cheers!!!
     
  13. Benjamin

    Benjamin Resident (JCU MBBS) Administrar

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    I can give my perspective on being a junior doctor, hopefully others can add in as well. I think I've written a few of these but I'm always happy to write more.

    My day-to-day life varies greatly depending on what term I am on. As a junior doctor (PGY1 - PGY3) it is typical that you will rotate through a number of different terms within the medical and surgical specialties before eventually settling down into a training pathway. As an intern across Australia this means a combination of ED / medical / surgical / elective 5 weeks / elective 10 weeks terms. I will describe my most recent term & my current term that I have just started.

    For the past ~10 weeks I was on a rural rotation from my main hospital. My primary job was to run the 24/7 emergency department in this rural hospital which consisted (after hours) of myself & one registered nurse. My roster rotated from day shifts to evening shifts with on-call (being within 10 minutes of the hospital) overnight when I was doing evenings. Typically, this meant that I drove upto my rural hospital (1hr) at the start of my run of evenings (3-4 days in a row) to work 1400 - 2200 and stayed there overnight so that I could attend any calls that happened after hours. When I finished my run of evenings I would have 2-3 day shifts (0800-1600). After this I would have 2-3 days off and repeat it all again. This roster sucked. I spent ~2 hours driving to and from work on my day shifts and usually did 4-5 hours of overtime every evening shift with on-call work. By the time I finished my week I would essentially get home and achieve nothing with my evening other than food and a shower. I would usually end up sleeping a lot of the first day I had off & so only have my second day off to actually achieve anything / see anyone / do anything. This continued for ten weeks & was by far my worst rotation in terms of work-life balance.

    In complete contrast, I am now working in ICU which has a different but (IMHO) a much more reasonable roster. I work long days (12.5hrs) but I only work 7 days in a fortnight - i.e. week on week off or alternating 4 & 3 day weeks. On days where I work I am pretty useless - I wake up at ~0600, eat some food & do my usual morning stuff, drive into work at 0720 & leave the hospital at 2030hrs. I usually stay up late enough to eat some food then go straight to sleep. On days where I don't work though I am free to do whatever I want - I'm not on call, I'm not expected to be anywhere, I can literally go to New Zealand to go mountain biking and no-one will care. As someone with relatively few commitments this roster is pretty appealing.... except that 50% of my shifts are nights. I have next week off & am planning on going to Tasmania to see my sister & her new kids. Only having to work effectively 26 weeks of the year is pretty ideal and for the most part this doesn't change drastically while I go through registrar training.

    There is, in general, a lot of difference between different parts of medicine & their clinical jobs. It is hard to know what the work is like until you actually start doing it & it is equally hard to know whether it is something you will enjoy until you get involved. Given there are so many options I feel it's pretty reasonable to think that there is a likely to be something that will appeal to you if you make it through medical school without hating it - i.e. you are interested in the content.
     
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  14. govpop

    govpop Regular Member

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    Med school provides you with plenty of free time assuming you accept that being an A+ student is no longer necessary.

    After graduation yes being a doctor compromises those things you asked about. 10 days in a row with 3-4 14 hour shifts is not unusual plus however much overtime you work on the other days, which can be significant and, at least in NZ, is not recognised or remunerated.

    Shift work gives you intense days when you're on and complete freedom when you're off- days off are therefore more frequent but some people just cannot tolerate the erratic schedule and working 50% nights- which you won't find out till you do it.

    Keep in mind that studying for and sitting specialty exams is a significant time investment completely outside of work hours. Some specialty programmes can take years of your life doing 'extracurriculars' to try get into them without any guarantee of success at the end.

    That sounds a bit doom and gloom but it's realistic.
     
  15. chinaski

    chinaski Regular Member

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    The rub is that whilst you may well find something that appeals to you, the road to that aim can be very rocky indeed, and the career beyond not particularly "balanced" per se. The "lifestyle-friendly" specialties do not hold universal appeal as career options in their own right ("lifestyle-friendly" aspect aside).
     
  16. Jay39

    Jay39 New Member

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    Can anyone who did medicine as a mature student comment on how it was after graduation? I would be 30 by the time I graduate med (at least) and at my current age I feel like I could handle night shifts ect well.. but how is someone in their 30s for example handling life after med school, eg with kids and partners? It would be interesting to find out; thank! :)
     
  17. LMG!

    LMG! UTAS MBBS II Moderator

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    I'm a current Med student in my 30s so can't comment personally on the after University part, but I work in Allied Health and a doctor I work very closely with did Medicine in his 30s (after an early career in politics!) and absolutely encouraged me to apply despite my age, saying he had no problems whatsoever, despite his age and the fact that he was married with children. This was a number of years ago, and the fact that he is, well, a he, possibly played a role in the ease with which child-rearing continued to occur, so that's useful to note.

    Regardless, this is going to be the sort of thing that varies from person to person, but I suspect that is also the case for everyone, not just those over 30. Hopefully someone else can weigh in, but I'm not actually sure we have many currently active members who are practicing doctors AND who graduated in their 30s, so you might be out of luck on this forum (at least, for first hand experiences).
     
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  18. Kiwiology

    Kiwiology MSO Lawyer

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    I thought I'd give you some words of advice. For those of you who don't know me, I wanted nothing more than to be a doctor since I was about 10 years old. I was terrible at science at school so never pursued it until 30 after quite a varied 10 years of studying and working. I ended up missing out on the overall B+ GPA by 0.95% so, obviously, didn't get into the MBChB. For quite a few months afterward I was very seriously suicidally depressed, I was too embarrassed to tell my GP because after all, they were the one thing I was just told I couldn't be. I spent until about the middle of this year crawling out the very deep black hole. It wasn't fun, and I don't wish it on anybody.

    However, I can now say I'm glad I didn't get in, and that if you don't get in, or choose not to do Med, then it's not all bad because -
    • Doctors often work appalling hours, especially as a House Surgeon and Registrar, and even as a Consultant for some specialities (Emergency Medicine, Anaesthesia, Intensive Care, and Surgery come to mind particularly). This includes evenings, overnights, and weekends, as well as public holidays. This can either be at work or on-call. While your friends are off doing things in the evening and on their days off, you will, at least some of the time, be working or unable to do anything constructive because you are on-call and might have to go into work.

    • It's a very, very long road to becoming a Consultant (7-10 or more years after finishing your degree) and at the end of it you can only be one thing, a doctor. If you decide part-way through you don't like being a doctor for whatever reason, mm ... good luck with that. This will also involve studying for more exams. There is a joke the ACEM Primary Exam costs $1000 and a year of your life, so yeah, no thanks ...

    • Many other professions pay about the same or better, so it's not all about the money (although the money is nice, lets not kid ourselves)

    • Everybody you see will be sick and expect you to fix them. There is some degree of unrealistic expectation from the lay public due to media and this "Net flicks" thing, whatever that is, although to what degree is entirely dependent on the individual and their clinical problem.
    There is a little bit of me which does regret not getting in and I think always will but I think in the final analysis, the means just don't justify the end. I could easily get in with my GPA as a rural applicant for a graduate seat but I'm not going to apply.

    Being a Doctor is in some ways super interesting and really great ... but so is being a Formula 1 race-car driver or astronaut. While being a doctor has some positives, it has a lot of serious negatives which don't go away (much or at all) like hours and responsibility.
     

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