Residents and fellows around the country have bought into the “medical training myth.” The myth states: “Life will get so much better when I finish residency/fellowship.” Sadly, too many house staff buy into this false belief and experience tremendous letdown when they graduate. Residents often see their attending stroll into the team room with a cup of coffee at 8 a.m., ready to round. Meanwhile, they think, “I’ve been here for hours, and he just shows up now? Man, I can’t wait until I’m the attending. He’s got it made! I’m doing all the work for him!” I’m not sure how this has become the prevailing attitude among residencies and fellowships around the country. Oddly, it’s definitely a belief widely held among trainees. During residency and fellowship, I rotated at more than a dozen different hospital sites with many different universities. At each site, this was a pretty consistent belief. Unfortunately for the believers, it’s just not reality. Now, this shouldn’t be too surprising, really. Residency is harder than medical school, which is harder than college, which is harder than high school. So, why would we assume that things get easier after we graduate? I think part of it is just wishful thinking. We hope that when we reach the conclusion of the breakneck pace of medical training, our reward is an easier career with opportunities to reap our just rewards. Why do we believe in the medical training myth? I think part of it is an observational bias. Residents may only interact with their attending for the three hours of morning hospital rounds. The attending then leaves residents to go about their work. Residents assume that’s all the attendings have to do for the day. They don’t see us in our office for hours before rounds or after rounds. They don’t see us going down to our clinics to see patients. Nor do they see us going off to write grant proposals or conduct our research experiments. As an attending physician now, I can tell you I definitely keep longer hours than I did as a resident or fellow, and most of my colleagues do the same. I have more time on call, a wider range of responsibilities, and higher expectations for seeing patients and doing procedures. In addition, I’m expected to participate in hospital committees, prepare lectures for the residents, and run the day-to-day operations of my clinic. There is a lot that happens out of view of the residents and fellows that prevents them from seeing the full scope of practice of their attendings. The medical training myth sets up unrealistic expectations In academic medicine, physicians have clinical duties. But, they typically also have high expectations to produce quality research and publish articles in peer-reviewed journals frequently. If you think the job is hard while you have a high clinical load, imagine adding on all of the academic requirements on top of that. Our residents may be thinking, “Yeah, but it’s easy if the residents are doing all the work for you.” However, you should remember that the attending has to review everything residents do, sign all their notes, and ensure that they catch all of their mistakes. As a resident, I worked hard to avoid making mistakes, but occasionally my attending would point out an error I had made or a piece of information I had overlooked. That oversight was critically important to my development as a physician but was even more important to the patients we were treating. In private practice, you’ll have much harder clinical schedules than you did as a resident. There are no hours restrictions, no caps on admissions, and no limits on how many days in a row you can take call. Moreover, there’s no one there to oversee all of your work. You are the final word in the treatment of your patient. You have the ultimate authority and responsibility for treating your patients. You’ll have long hours, frequent late-night calls, and lots of nights and weekends spent catching up on tasks for patients, filling prescriptions, or reviewing charts for the next day. You’ll have business responsibilities in addition to all of your clinical duties, and your clinical duties will be more strenuous than you ever had in residency. You may be responsible for hiring and firing staff, managing your electronic health record, recruiting new partners, buying supplies for your clinic, or marketing your business. The medical training myth gives us an excuse for poor performance None of this is by way of complaining about the level of responsibility I now have. I would personally rather be busy than be bored. People are constantly telling me, “Doc, you work too hard. You’re here too early. Don’t you ever take a day off?” The reality of the medical profession is that people are sick every day, and patients need us every day, so I have to bring my A-game every day. I still love it, though. I wouldn’t have it any other way. A lot of my colleagues experience whiplash upon first entering practice when they finally realize that it’s going to be much harder than they expected. Fortunately, as physicians, we are self-motivated to rise to the challenge. After a few months, the increased workload and bigger demands become part of the routine. It’s the new normal. We find ways to become more efficient and productive. We find ways to make it all work. To our medical students, residents, and fellows nationwide: if you’re waiting for the day when your life gets easy, you should stop waiting now. Your life is hard, and it’s going to get harder. You’ll be busier and have tougher jobs at each stage of your career. You’ll do great though, because you’ll be better equipped to handle each new stage as a result of the training you received at the previous stage. Once you come out of training, you’ll be battle-tested and ready to tackle the challenges of clinical practice. So, abandon the medical training myth and embrace your future. You will be amazing. Just own it. Source
