indentured servanthood

the last few days before indentured servanthood

sometimes the more you think about medical “economics” the more you think The Flood was a good idea. i mean does it really make sense for someone to graduate with a 6 figure debt and virtually no practical skill whatsoever? we’re not talking about a school that leads to a job where no practical skills are necessary. we’re talking about being a doctor. i mean what could be more practical than being a doctor? doctors affect people’s lives, their health, and if we screw up, patients can die. and yet we graduate with our practical skills limited to… not crying when we get yelled at, performing rectal exams, and reading a bunch of numbers from a patient’s chart. i don’t see how anyone thinks it’s a good idea to go from making no decisions affecting someone’s health, to suddenly making a lot of them.

i suppose the only rationale i can see for making smart people deeply indebted and lacking in any real practical skill is to force them into residency. i mean, if we learned something valuable, that we could actually use in the real world, how many of us would go into residency? it’s not like residency is a very appealing path for us. 80 hr workweeks (if we’re lucky), 40k salaries, 100k+ debt… yeah, sign me up.

i don’t appreciate the fact that a PA or NP can earn more than a second year resident, or even a fellow. i think PA or NP should earn more than interns. let’s face it, interns are stupid and dangerous. but by the end of the year, i think they catch up real fast. so why do midlevels earn 60k or even 80k, while the second year resident is stuck at 40-45k? why is the surgery fellow, who has finished at least 5 years of general surgery, earning less than someone with a 2 year masters degree? and to make things even more screwed up, why is a fully trained cardiothoracic surgeon, fresh out of residency, offered jobs that pay LESS than some physician assistants?

i realize doctors do earn more after training (unless they are heart surgeons, you know, the ones that suture tiny vessels into a beating heart and save lives), but does that mean that residents should be paid less per hour than some high school student working a summer job at the gap? other jobs have 40 hour work weeks, which, if my math is correct, is half of what residents work. and yet these other jobs pay twice as much. now i’m really using a lot of brainpower here, but that means we roughly get paid 1/4 of what other people earn.

that is insanity. i’d hate to sound like someone who has an inflated sense of entitlement, but come on. i don’t think i should earn much as an intern. but after that year of hell, most of us will become pretty competent, and will have practical skills exceeding that of people earning much much more than us. that to me, is unfair. when you have fully trained heart surgeons earning less than someone who writes discharge paperwork, it’s not very encouraging.

by the way i start on trauma. and i’m on call the first day. and on the 4th day, i get the joy of covering multiple surgical services for 12 terrifying hours. some say there are no atheists in foxholes. if i finish those 12 hours without praying for god to take my life, i will consider it a small victory.