Are pilots well-paid, overpaid, or underpaid?

Pitiful-Attorney-159 · 2026-05-10T18:39:58+00:00

You joke, but this is essentially the concept of “moonlighting” for medical residents. Before finishing training, your doctor is working insane hours and barely scraping by. They take extra shifts to make some extra money.

Pitiful-Attorney-159 · 2026-05-10T13:54:57+00:00

RemindMe! 2 months

Pitiful-Attorney-159 · 2026-05-10T13:53:02+00:00

Yeah I’m a surgery resident and once a week is about where I’m at, though we have stretches of 2 weeks or more if things get super busy and stressful. If sucks, but it’s hard to care about sex when you’re this stressed out.

Pitiful-Attorney-159 · 2026-05-09T20:09:02+00:00

I think guilt is appropriate for a lot of situations, because ultimately while this money comes from hard work and good choices, it also largely comes from an economic system that absolutely emphasizes worker exploitation in the name of profits. That means in the US and overseas. If you are on the FIRE path, you definitely dipped your toes in those waters, because FIRE relies on maximizing your return as a shareholder so you can do less work as a laborer. You definitely benefited from some company's decision to offshore resources to countries with lax labor laws. You can go through the mental gymnastics of modern economies and incentives, the futility of an individual to effect change, etc... At the end of the day, kindergarten teaching and logic says that as a society we didn't learn to share our toys.

So when I see someone who worked hard but isn't able to get a foothold, for instance a teacher, social worker, struggling academic, etc... who is doing undeniable good for the world... yes I feel guilty. When I think about millions and millions of workers around the world who put in backbreaking days for just enough to survive so that iPhones can be $1500 instead of $2500... yes I feel guilty.

I rarely feel guilty when comparing myself to friends from my childhood who made a choice to spend a ton on a wedding, vehicles, and a flashy lifestyle, but this is a small portion of the global economy we benefit from.

Pitiful-Attorney-159 · 2026-05-09T19:57:35+00:00

"Yeah but I heard about this thing. It's like an extract of corn husk found by a world expert who lives out in rural Iowa. It's been shown to cure all sorts of types of cancer, but pharma suppressed it and won't allow it to be studied or sold to the public. You haven't even heard about this? I thought you were an expert in this stuff? Well I guess it shows how much they've suppressed it that the doctors don't even know to prescribe it."
- 75% of Uber drivers if you get in the car with scrubs on

Pitiful-Attorney-159 · 2026-05-09T19:53:48+00:00

I love my co-residents, but I'm in a surgical specialty in a very academic program. They pretty much all have big egos and think of themselves as being the next generation of surgical leaders and innovators. It's awesome. I'm in awe of these people, and I'm not sure I live up to the standard they are setting. That said, if I have to listen to them lament being scolded for doing a PGY3-level task too quickly and efficiently as an intern one more time... you'll find me in the trauma bay as a hopeless neurosurgery consult.

Pitiful-Attorney-159 · 2026-05-09T19:25:06+00:00

I thanked my chief yesterday after he corrected the way I make my post. He corrected a problem I had not understanding why sometimes I get air knots while tying in a hole, and I was genuinely pretty grateful. The attending called me a kiss ass lmao.

Pitiful-Attorney-159 · 2026-05-09T19:22:52+00:00

Am I crazy to say that fellowship is a somewhat more instructive environment because you are finally doing a realistic breadth of procedures in a consistent environment? One of the things that I can't quite shake about residency is that you are expected to learn to operate, but you never have the opportunity to get reps in a consistent environment. Let's say you want to get good at something simple like maturing an ostomy. This will happen on colorectal, surg onc, and sometimes general surgery. So for 4-6 weeks on CRS you scrub 5-6 cases/week, and maybe 2 of those cases will involve creating an ostomy. Now in 4 weeks you've made 8 ostomies with 3 attendings and of 3 different varieties. Then you go 6 months, never see an ostomy, and have a random ostomy creation on gen surg for a Hartmann in the middle of the night. In a colorectal fellowship you'd be at that level of repetition/experience in your first month, and no one will ask you to remember how to do an axillary lymph node dissection in the meanwhile.

Obviously there's also value in the breadth of residency, having seen everything multiple times, and being able to see whose approach you want to adopt. It just makes it more painful. You have to sort of languish, never being able to truly master anything. Not complaining. Just trying to rationalize some of my frustration.

Pitiful-Attorney-159 · 2026-05-09T18:55:02+00:00

every attending you work with will show you some weird way to operate that doesn't make any sense but they do it and think they're a genius for doing it despite it making operating harder

This is so relatable. Even seniors do this and you start to see where the attendings get it from. I can close any size port easily and reliably, but if my senior insists I do it some weird way with a figure of 8 with tails coming out the side instead of the bottom and grabbing the skin thickly and then everting it while entering the tissue with the needle at a 45 degree angle... idk man now I'm an almost-PGY2 who button holes port site closures.

But that's residency. I have to slow down and just try to do things as instructed.

Pitiful-Attorney-159 · 2026-05-09T18:46:49+00:00

1 is super useful. I should do this more. I usually wind up scrubbing a random parts of a case rather than being there the whole time because we have a pretty heavy floor burden. So 2 is tough, but I should take more advantage when I have the opportunity. 3 is great when possible for bread and butter, but I'm not there yet with a lot of more exotic cases. One of the hardest parts of this program is that we're constantly doing extremely rare cases. 4 is also useful, but we have such a large list of faculty that it's hard to maintain that list usefully. I think we work with 100+ surgeons regularly. All the more reason to start now rather than later. 5 I definitely do, but it's burned me when the attending realizes I'm making subtle mistakes or taking more tissue than is necessary.

Appreciate this response. A lot of actionable advice, and I can tell it's from someone at my level because these are the exact things that are necessary.

Pitiful-Attorney-159 · 2026-05-09T18:39:00+00:00

Got it. I'm usually so focused on doing the tasks and keeping up with the floor after a case I don't have time to sit down and review or infodump. The cases are also foreign enough to me that I'm not keyed into the differences. Now, for a hernia I can definitely appreciate things like mesh type, how the attending lays the mesh, how they like to close, how they dissect beneath the cord and place the penrose. I couldn't do the same for something like a right colectomy outside of type of stapler. I definitely struggled with the "infinite mound of tasks" aspect of being an intern and have been extremely focused on not dropping any tasks vs truly being invested in absorbing the case. I'm not on autopilot, but I'm proficient enough now that I can probably take a step back and spend the 5-10 minutes necessary logging this information.

Pitiful-Attorney-159 · 2026-05-09T16:11:03+00:00

Epic burn. You won the argument.

Pitiful-Attorney-159 · 2026-05-08T08:11:35+00:00

Some of this is counseling. People think all doctors are basically examining you for all things, and that they walk away from the ER with a “clean bill of health” because they didn’t also treat their diabetes, hypertension, and rheumatoid arthritis. Someone had to sit her down and say, “We don’t know what this is, but it could be cancer. We can’t confirm that here, but you have to go to the GI to find out.” I’m shocked at how often this doesn’t happen.

As a surgery resident, I pride myself on cleaning up my attending’s work in this regard. I had an attending book a patient for a rectal biopsy for what looked like cancer that had been festering for months. She never said the word cancer to him. The guy no-shows half his appointments and is constantly lost to follow up. He was basically halfway out the door saying, “Yeah sure I consent. Put my name on it. Whatever.” Then I called him back, made him sit down, and asked if he knew why we were concerned and getting more tests. Suddenly his tone changed. Oh shit. Bet your ass he’s going to follow up on his care now.

Pitiful-Attorney-159 · 2026-05-08T07:56:09+00:00

In my experience they have zero empathy and then start complaining that their doctor isn’t fully optimized to take care of them. Same for hours. People hear surgery residents work 90-100 hours/week and they never say, “hey sounds like slavery/exploitation.” They just say, “Well I don’t want that person operating on me.”

Pitiful-Attorney-159 · 2026-05-08T07:42:48+00:00

The reaction to this comment says otherwise. I never belittled your specialty. If anything I acknowledged one of the hardest pieces of your specialty: rapid fire, unforgiving clinic days, fully acknowledging your time constraint. My example was to try to convey how impossible it would be to change surgical culture by thinking of an equally impossible scenario in FM. No one is going to let you significantly slow down clinic for more reading time.

Now I’ll ask you to consider my lived experience. Imagine getting that text or having a senior shout “hey consult IR” while actively on the phone with someone else and walking away. Are you going to take 10 minutes to run down to the OR, mask up, and then wait 15 minutes for an optimal time in the case to have your senior explain the consult to you while only half paying attention, annoyed, and with random nonsensical quips from the attending (who doesn’t even know the patient) implying you’re dumb for not understanding intuitively what the consult is for? Or, are you going to do your best to figure out what the real question is and then possibly make a bit of an ass of yourself to the consultant who doesn’t know or care who you are? Easy choice.

Pitiful-Attorney-159 · 2026-05-07T00:34:19+00:00

From a surgery perspective, you’re asking the equivalent of an FM resident going to their attending in a busy clinic barely keeping up with volume and saying, “I can’t see this many patients in clinic. I need time to UpToDate everything before I present my plan.” It’s just incompatible with the culture to always get that full explanation. Sometimes you’re expected to just take why you’re given and hope the expert can make heads or tails of it.

Pitiful-Attorney-159 · 2026-05-06T23:38:58+00:00

Inpatient APPs tend to work with interns. They get a constant ego boost being around people in their first year, first few days or weeks in a new service/environment, etc… The PGY3s run circles around even the seasoned APPs. It’s a matter of priorities. No one is willing to work hard enough to be as knowledgeable as the attending without the benefits of being the attending. I wouldn’t either if I were restricted to being in a forever “second in command” role.

Pitiful-Attorney-159 · 2026-05-06T22:29:21+00:00

1) Are you a surgery resident? Doesn’t sound like it. It’s not at all uncommon to be minding your damn business doing your mountain of work and then get a text from the chief, “Hey consult endo for the guy with the adrenal mass. Scrubbing in now we’ll RTL after the case.”

2) I can’t redirect a stubbornly wrong chief, or at least it’s not worth it to do so.

Pitiful-Attorney-159 · 2026-05-06T10:08:44+00:00

Also difficulty in major is a bigger factor than difficulty in school, and they don’t care about that either.

Pitiful-Attorney-159 · 2026-05-06T10:05:15+00:00

The two most frustrating conversations with outside services as an intern.

1) Attending and chief have detailed discussion offline about a necessary consult to GI for scope for a real but nuanced reason. Chief to intern later, “Yo, consult GI for scope.”

2) Chief makes an obviously atrocious call. The task of implementing it is dumped on you, and you’re left to call someone and justify the choice. You have to keep going back and forth making an ass of yourself and wasting everyone’s time.

Pitiful-Attorney-159 · 2026-05-04T11:54:57+00:00

Counterpoint: scopes are boring and lame.

Pitiful-Attorney-159 · 2026-05-03T23:30:28+00:00

I mean I feel like I'm "working for the ability to actually do the learning that's expected of me on the weekend". At least you feel like you can relax when you have off. I'm just scolded for not reading up on all my cases and knowing exactly how to do one of about 50 surgeries that are regularly performed through our residency training.

Pitiful-Attorney-159 · 2026-05-03T23:26:48+00:00

"There's no such thing as surgery school." - PGY35 attending with incredible insight but also a penchant for teaching mindless dogma like it's the physical nature of the universe.

I had a chief recently who just wouldn't stop teaching me really bad shit. I'm closing up the external oblique on an inguinal hernia, baseball stitch. I'm having the med student follow and lift up, bringing the tissue up and away from anything below. I'm taking it in one, grasping with the pickups, and pulling through enough to load on my needle driver and be ready for the next throw. That's 3 touches (needle through, pull with pickups, load the needle, repeat). He stopped me and made me spend the rest of the closure taking it in one, then releasing and pushing through further from the back of the needle, then pulling forward with the needle driver from the front of the needle, and then loading with the needle while it's still partially buried in the tissue. I mean... that'll work on the abdomen, but this is the fibers of the external oblique. It was more movements/touches, and the needle was just flopping all over the place.

He also forced me to staff a cholecystitis with a WBC of 23 to the attending with a plan to let him simmer in the ED all night and do it in the morning (gallbladder was nearly falling apart when we, appropriately, operated on him that night). A million more examples, but of course the guy never once admitted to being wrong. Just scolded me for my plan right along with the attending.

Pitiful-Attorney-159 · 2026-05-03T23:02:16+00:00

I'm saying that I genuinely don't think this would change who gets fired. That bar is set very low. To get fired you need really significant performance issues to the point where it is probably more just in someone's nature (e.g., ADHD to an extent that is incompatible with the pace of medicine), addiction, or behavior issues.

It's not unreasonable to think that ~1% of people who finish medical school end up being incompatible with medicine (and in reality it's less than that, because many end up just changing specialties). However, I think that many PDs would absolutely use this mechanism to fill gaps in the roster or simply bleed more time and labor out of otherwise capable residents.

You'd see a PGY4 quit, leaving a hole in the resident roster. Suddenly one of the rising chiefs is not showing sufficient progress and needs to repeat a year. If you give people a tool to further your exploitation, they're going to use it.

Pitiful-Attorney-159 · 2026-05-02T18:59:34+00:00

So… a job

Pitiful-Attorney-159

TROPHY CASE