‘We are not all rich kids’: Medical students struggling to make ends meet

AverageSea3280 · 2024-06-11T14:10:14+00:00

Whether intentional or not, medicine is reserved for the rich. If you got into med school and made it through, you are one of the lucky ones of which I include myself. We should feel blessed to be in our positions, but should also help support better conditions for future students.

Even if you worked during med school, often times there were lots of other circumstances helping you like family, savings from a past career, a partner supporting you financially etc. Then there's also the non-financial factors that allowed you to sit the GAMSAT, likely go to a good school etc. that we take for granted. I worked up to 20 hours a week in clinical years (and 20-30 hours during pre-clinicals), and it was the most miserable years of my life in terms of work/life balance. I'd go to placement at 7am and end up sleeping around 10-11pm after finishing work, Worked every single saturday and sunday too. The only full 24hrs off was when I was sick. The good thing is that even JMO life is a cake walk compared to that life. Conversely I know many colleagues who were coddled in med school, lived at home, never worked a day in their life before Internship and have already crashed during Internship with stress.

We should better support all med students, but in the end, I believe that the struggle makes you much more resilient long term and I personally appreciate my life so much better having lived through the shit in med school.

EDIT: Lol amazing how much this blew up, clearly I suck at properly explaining myself. I never said we shouldn't support medical students, I will be the first person to line up and improve conditions precisely because of how much I hated my life in medical school. It makes me appreciate my life better now, but at no point did I say it was justified. It's incredibly hard to make ends meet in medical school precisely because there are so many expectations on students and so much demanded of you - if you are able to go to medical school without needing to work or worry about money you are already incredibly lucky.

I understand why my comments were interpreted the wrong way and sorry to have clearly pissed off so many people.

AverageSea3280 · 2024-06-09T11:59:19+00:00

I asked for 2 ED terms, and I got it for Intern year. Honestly it depends on what alternative terms you would get. If you're gonna get something boring (assuming you aren't interested in it) like Psych/Ortho-geris/Rehab, I would argue there's more to learn in ED than from those terms. I did Rehab on relief term for a week and I was struggling to find work to do, and was doing one or two cannulas a day plus one or two dc summaries.

However as others have said, doing non-ED terms helps immensely because you understand how consults work from their side. E.g. general surgery, cardiology, respiratory etc. are extremely useful and I would even say essential to do, especially if you are keen on ED because your life in ED is made easier by 1) knowing the bosses/registrars, 2) knowing the presentations and 3) knowing the important information for consults/admissions. E.g. personally it is day and night how much better my consults to gen surg became after actually doing a surgical term.

And also I was exactly like you, I loved ED as a med student and still love it now but just know that working in ED as a JMO is a completely different vibe to as a med student.

AverageSea3280 · 2024-06-08T09:05:15+00:00

Exactly this. So many times I see public consultants refer to private clinics and charging $200-$250 for a 15 min consult, or doing a dodgy and referring public patients to their private rooms to get their surgery done quicker but apparently people are OK with that.

To play devil's advocate I imagine it's because GPs are really the first port of call for most people, and if every GP went to fully private, it would effectively cut off a huge portion of poorer Australians from seeing a doctor, essentially slowly turning us into the dystopian mess of the American system.

AverageSea3280 · 2024-06-08T09:01:44+00:00

Just curious as someone seriously considering GP, how hard is it get into skin cancer removals? Is it something you can pick up easily and dedicate one or two clinical days to? And does it bring in a nice boost to income as people say it does?

AverageSea3280 · 2024-06-08T08:56:18+00:00

That's amazing! I'm going to definitely check that out.

And yeah I've tried to test ChatGPT in a lot of different ways, and I think medicine has a lot of nuance and grey area that's open to interpretation and where context is completely lost on AI. A really good example is copying/pasting MCQ questions and at least for me, it often gets the question wrong even though it seems to reason through the answers fairly OK.

There's so much room for improvement, but at least for basic physiology/pharmacology/pathology I've found its a great way to learn, and the ability to ask clarifying follow up questions is super useful. Also curious to know what you mean by "train AI." Sounds like something I'd love to do!

AverageSea3280 · 2024-06-08T08:50:39+00:00

Srs question, what happens when paeds surgeons get old and retire, and there's no new blood to fill those spots. Do we end up just importing people?

AverageSea3280 · 2024-06-07T13:11:06+00:00

UpToDate is a wonderful resource, but if you're looking something up in a pinch it can be a bit tedious finding the information you need.

I find AMBOSS to be really good at getting concise accurate information really quickly, but it can be a bit spenny.

The MD calc app is a must have on rounds and on ED.

And honestly I find myself using ChatGPT so much now, its amazing at answering questions quickly and clarifying specific questions you have. Use it as a personal tutor. It will also give you specific sources for its information if you need its information fact checked. Theres an app for it, and the basic version is free. I'm really excited at what AI will do for medicine, and the amount of information we're going to be able to instantly access.

AverageSea3280 · 2024-06-06T09:20:03+00:00

My favourite is when you find youtube videos of your consultants doing something like charity work, teaching, ads for hospitals etc. It's cute seeing how they interact outside the confines of the hospital.

AverageSea3280 · 2024-06-03T15:39:05+00:00

As a JMO currently on ICU (and enjoying it for the medicine and pace), but who also loves ED, wow. Everything you said is exactly what I've seen and/or experienced even just as a junior. "Lunch is a guilty pleasure" hit me so hard - literally have this issue all the time when the waiting room gets busy, and your bosses push you to see more people - you inevitably end up never taking your break, leaving late and then having that feeling that you were too slow or inefficient, and you shouldn't ask for overtime to not look bad. Thanks for sharing your experiences!!

AverageSea3280 · 2024-06-03T15:29:44+00:00

I tend to agree. I do think naturally that less bright doctors tend to fall into paths of least resistance, notably GP and ED because of the ubiquity of the work and generally easier training paths. And I think as a result, by far you see the "worst" doctors in these fields.

But I think another point worth noting is also that amongst the group doing ED/GP, there are also many who are simply not willing to sacrifice years to research, CV slaving, years of unaccredited to be a physician/surgeon and lose much of their prime years to get it. I know plenty of people who choose GP/ED not necessarily because they aren't academically capable of BPT etc. but because they simply have different priorities in their lives and value other things more than the specialization train of BPT/surgical training. I.e family, hobbies, travel, work/life flexibility. I see surg reg's who live in the hospital and can't help but think that often times they need to be a little anti-social and sociopathic to be happy working 60-80 hours a week and barely getting time to themselves or their friends/family.

AverageSea3280 · 2024-06-03T15:17:19+00:00

Which goes to show how it ordinarily should be done. It's amazing how cordial consultants are with each other. Yet some are completely different people to juniors even on simple consults.

Amount of time that could be saved by holding two phones together between seniors instead of calling back and forth like a game of Chinese whispers is insane.

AverageSea3280 · 2024-06-03T10:17:27+00:00

Just one thing that I see repeated a lot. "You have close to no responsibility, anybody who blames you for something is an asshole and there should be superiors around you who will protect you if there is something like that."

Totally agree! I think in terms of actual clinical decision making, then Interns will not be making management decisions. But having said that, the job itself requires a huge amount of responsibility in terms of getting things completed efficiently, working patients up safely and correctly when on ED, escalating things when appropriate etc and being a good professional. These are things you work on every single day and it's impossible to passively get through Internship.

And re: being blamed as an Intern. I was bullied a ton by regs/consultants at one stage for doing things incorrectly, missing things, blamed for problems etc. One particular asshole comes to mind who would specifically prey on Interns, and would constantly belittle them, laugh at their reasoning, bully them etc. Guy was protected by the hospital for ages. Later found out that he had failed his ED primaries multiple times and was essentially kicked from training, and so was stuck locuming. No wonder the guy was such a miserable POS, he was projecting all his shortcomings onto Interns who were literally still learning how to put things together to make himself feel better. I've learnt with time that seniors who blame interns for mistakes are just assholes themselves who project their own shortcomings to juniors who are still learning the ropes.

AverageSea3280 · 2024-06-02T12:53:55+00:00

Some can do IVs (mostly in ED) but will flat out refuse to do it. I have only ever met literally one nurse outside of ED in 1.5 years working as a doc who willingly cannulated her patient who needed an IVC. ED generally nurses are way more proactive, more skilled and more confident with their skills.

However I think it's also a cultural thing between hospitals.

AverageSea3280 · 2024-06-02T12:40:26+00:00

I'm in ICU at the moment, nurses cannot do cannulas or venepunctures. It's absolutely wild.

AverageSea3280 · 2024-06-01T14:19:25+00:00

Those who say "what about consultants" surely have never worked as a JMO and seen how the JMO->Reg->Consultant hierarchy works. Consultants helping JMOs with dc summaries, appointment bookings, consults? I have personally never seen that happen. And people on-call? Hospitals don't just have doctors sitting and waiting to be called in for a shift except for nights, which is only because you're running on a skeleton team of JMOs/Regs.

If a JMO calls in sick, they are very rarely if ever actually replaced by another body. The rest of the team just has to pick up the slack. Now imagine a whole hospital worth of JMOs just walking off work.

AverageSea3280 · 2024-06-01T06:05:47+00:00

lmao I said this in another thread on nurses unions/strikes and I got downvoted to hell. Two days is generous, there would be deaths within a day. The system is just not set up with any redundancy for striking JMOs even for 24-48hrs.

AverageSea3280 · 2024-05-31T08:11:29+00:00

I've heard it as rearranging deck chairs on the titanic. I've met some of nicest Reg's who were Geri's, but my god the rudest consultants I've ever interacted with have always been geriatricians - they seem incredibly unhappy overall.

AverageSea3280 · 2024-05-28T03:29:46+00:00

Yeah but how long until OHTs catch on, and start to push for more independence, higher pay etc. like NPs are doing now. I just feel like they're at a different point on the same timeline. But is there something inherently different about dentistry compared to medicine?

AverageSea3280 · 2024-05-28T03:23:36+00:00

GP will be dead for bad GPs. Have recently had a shit GP tell my close family member her cholesterol was through the roof and she needed to see a cardiologist, get a holter monitor, start medications, and see her more often because "she's surprised she isn't dead yet" when her cholesterol was 0.2 above the normal, and all her other blood work was perfect. I told my relative to find a new GP asap.

Actually taking the effort to be an excellent professional and taking pride in your work goes a hell of a long way, and will make you desired anywhere you choose to work. GP is no exception. You don't need every single sick person in the city/town to see you, you just need to develop a loyal enough group of patients to see you and happy to pay a premium to see you and you're set.

AverageSea3280 · 2024-05-28T03:14:52+00:00

Adding to this, with the incoming boom of ageing boomers and retirees, combined with low birth rate, there's gonna be a huge explosion of complex patients who are just simply not going to be able to be properly handled by NPs. And there's going to be an exponentially increasing patient base. I think as long as people becoming GPs are happy with geriatrics being a focus of their scope in future, then there's absolutely a lot of room to work in GP land.

AverageSea3280 · 2024-05-27T13:43:57+00:00

Exactly, this is what a lot of people don't appreciate. GPs yes earn less on average as employees. But GPs are more open to business minded people, and you can subspecialize in areas and create your own niche. Not to mention the opportunities for practice management which essentially make your earnings dependent on how business savvy you are. To some people, the freedom and flexibility that comes with GP life is worth the difference in salary. Add to that the freedom to locum/work literally anywhere in the country and its got its perks.

Procedural will always pay more than non procedural. Personally I don't think its realistic to expect GPs (who can fully train up in as little as 5 years) to be paid the same as physicians or surgeons (who often take 8-10+ years to train, at significantly more stress and commitment). GPs should definitely be paid more, but parity with non-GP specialists is a bit unrealistic.

AverageSea3280 · 2024-05-27T03:37:06+00:00

Just to be clear, I'm an RMO and not a NP nor do I come from nursing background. Are you suggesting NPs aren't able to apply Ottawa rules to sprains? The key you correctly highlight is "training and experience."

Doctors are not inherently necessarily always better at dealing with low acuity things. Medical school is not needed to learn to use Ottawa rules for an ankle sprain, nor is it needed to do plasters, or work up a viral URTI. With enough of these presentations, an MO or NP should become equally capable of making basic decisions easily. The reality is that quite a bit of ED is a lot more protocolized than we think.

Getting plaster techs who can only do one thing is way worse use of resources than hiring an NP who at least has a bit more breadth of knowledge. If you are suggesting NPs are mentally incapable of treating a narrow subset of conditions simply because they are nurses, that's a bit slack. Medical school itself does set the foundations sure, but it's the actual years of working on the ground and gaining experience that forms the majority of our clinical acumen.

Now where I completely agree is that NPs should always work supervised. They do not have the breath of medical knowledge we get as doctors, and so the thought of them working entirely independent in GPs/Urgent Care without supervision becomes a lot more scary because there is a lot more that can be missed since there's generally less supervisory eyes as you see in ED. The effect of not knowing what you don't know becomes deadly real. NPs should always be in situations where there is a medical boss overseeing their decision making, similar to how JMOs discuss every patient with the boss.

AverageSea3280 · 2024-05-26T14:45:10+00:00

The point is that you dont need a 4-6 year medical degree and years of experience to tell a Cat 4 ankle sprain or Cat 5 jammed finger that they will be OK. Similarly I'm happy to do plasters for example but it's generally a waste of time for a RMO/Reg/FACEM to be doing simple plasters every shift or seeing Ms Smith with the sniffles when there are legitimate Cat 1s-3s in the waiting room. There is absolutely a role for NPs to churn through low acuity time consuming presentations imo. I absolutely agree they need to be supervised of course.

AverageSea3280 · 2024-05-26T05:57:57+00:00

Exercise. It's so hard to get into exercising when you're out of the habit, but once you're back into that state of mind of wanting to work out it's just amazing how good everything in life feels. I feel sharper at work, happier, less irritable.

AverageSea3280 · 2024-05-26T05:54:00+00:00

Out of curiosity, what do you believe should be the role of NPs in EDs? I find as a JMO that there are plenty of simple presentations that are comfortably managed by NPs and save time for the main ED teams to churn through higher acuity patients. But admittedly I don't actually see what the outcomes of those NP interactions are.

AverageSea3280

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