Tuesday, June 22, 2010

If Medical Schools Didn't Have to Find Residencies for Their Students, it Would Resemble the Legal Profession

Upon graduation, the medical student and newly christened Dr. Don, one in a class of 300 students, ranked 47% of his class, was one of 80% of his class without a job and saddled with $250,000 in debt. He began to wonder how he would repay his loans because the search for a residency was not going well.

After initially believing that he was one of "the chosen ones" (or one of the "lucky bastards") for getting into medical school, his search for a residency was quickly sucking the life out of him. He sent his resumes to OCI, but nobody offered to even interview him. Career services had spammed his inbox every semester and assured everybody that even somebody in the 99% once got a job interview so nobody should "worry" because they will all find jobs eventually. However, at graduation, only 8 members of his class had landed residencies with "prestigious" medical facilities. Another 23 landed something at the free clinic. Another 27 were still planning to work at their old internships and hoped that the newest batch of resumes that they were mailing out would land them "something." Another 15 had taken various positions such as food sample presenter at the grocery store and perfume counter assistant at Macy's. Another 19 were going to get their business degree.

Months later, his bills becoming due, one deferment down, and the latest batch of 230 resumes being ignored, Dr. Don decided to create his own residency.

It's what people told him to do. Why, he was now a doctor who had graduated from medical school. Plus, it was his own fault that he couldn't find a residency. He should have "tried harder" while in medical school to get into the top 10% of his class. Besides that, he should have "tried harder" to get a residency. It isn't enough that he sent out 300 or even 500 or 1,000 resumes and chased down every last residency position in a mall in the bad part of town in the middle of Butt Feck Idaho. (Actually, he let that one go and didn't apply for it because it was clear across the country. Now, he wonders if he's completely missed his one opportunity to ever have a residency). He needed to call and harass these employers to see if they got his resume, otherwise they wouldn't know that he really wanted this job and he wasn't just simply spamming them. He needed to redo the margins on his resume and properly space the dates because the employers would automatically throw it in the garbage can if they figured out that he wasn't insanely dedicated to detail. He needed to qualify his "interests" section and specify where he liked to travel because its not enough just to say that he liked to travel. He needed to write the name of his medical school organizations on his resume in bold and italics, otherwise, the employer who was absentmindedly scanning his resume for the exactly two seconds they dedicate to each individual resume might miss that he was "involved" while in school and was simply a loser who went home and took a nap after class. He needed better "Thank You" notes, otherwise, they will think he is insincere about wanting the job. He needed to fold his hands in a particular way during the interview because if he gestured too much, he would look a bit threatening and maybe like he didn't even want the job. He needed to go to more medical conferences and meet other practicing doctors because nobody likes to hire people who they've never met. He needed to show up at happy hour with the local medical association because he needed to pass out business cards like candy. He needed to shine his shoes because dirty shoes suggest disorganization and inability to take his image as a successful attorney seriously.

This guy was a complete failure because he only did about half of it.

Where he went to school and the sheer lack of residency positions had nothing to do with his unemployment. He was just a creep. A loser. What in the hell is he doing here? He doesn't belong here. And if he can't dedicate every breathing second to making himself the perfect candidate in the way that Nicole Kidman should have tried harder to be a Stepford Wife (for even if she was a Stepford Wife, she obviously still wasn't Stepford-y enough). If it means slapping on a little rouge and pretending like he watches Boston Red Sox games, it didn't hurt a damn thing because he would be a complete moron if he didn't do it. This is a competition, my friends. Perfect resume margins said everything that the employer needed to know about Dr. Don's ability to diagnose cancer. If he didn't correct those margins, the employer would take notice and draw an immediate conclusion that Dr. Don was just the kind of guy that missed those subtle symptoms that House would catch.

He also wasn't applying for nursing positions. Or jobs for orderlies, medical billing, or lab technicians. He was told by the nay sayers, "Hey, you have a medical degree, which allows the possessor to pursue a wide range of employment because it is still a science degree. They would appreciate your medical skills and ability to 'think like a doctor.'"

But it wasn't reality.

An employer looking to fill a $10 an hour job will be weirded out by having a medical doctor on the staff. He knew it. But he applied to those nursing assistant positions anyway. It didn't hurt because there were many days that there were no doctor positions posted on the job boards. It was better to apply to A job rather than NO job.

Tired of hearing criticism and feeling like he wasn't doing "enough," Don created his own residency position out of the bedroom in his apartment.

He would be the head of his residency. For the next four years, he would train himself to diagnose and treat patients. Who cares if most of his experience has come from cutting on cadavers while in medical school? This shouldn't be too bad. He put in a few hours as a volunteer at the clinic where he was treating V.D. and ear infections. He would simply open up his very own V.D. and minor respiratory infection practice. He would then work his way into more complex diseases at some point.

Dr. Don visited the Office Max where he purchased stacks of generic billing receipts and card stock to print his business cards (he discovered to his delight that they now make special printing paper that doesn't leave perforated edges).

He went home and purchased medical supplies off of Ebay for $15.73. They were slightly used and came from an estate sale from the untimely death of Dr. Geezer McGee. Dr. McGee did things the "old" way, so the supplies were slightly dated, but they would do the job. Dr. Don would have purchased better supplies, but he is severely in debt and had to go for what would do the job.

Dr. Don went home and set up his home office. He couldn't yet afford an office because he was in a Catch-22 where he needed income in order to afford an office. He thought about running a virtual office with an answering service and where he would either meet patients at their homes, in the hallways of the hospitals, or in the special office that he could rent by the hour like he was in Hollywood and Vine. He contacted a guy who graduated two years ahead of him for advice who then put him in touch with Dr. Louise. Dr. Louise has practiced medicine for 15 years and frequently allows new doctors to use her office to meet patients in exchange for free help from the new doctor in diagnosing the occasional cold when she was backed up.

Dr. Don picked up his first case.

He went down to the hospital and waited in the lobby. He saw many of his old classmates hanging around in their JC Penney suits. Their entire conversations revolved around which emergency rooms were filled with the most uninsured people. They were all giving each other tips on what forms to fill out and what time they needed to show up in order to hit the rush just right.

Dr. Don saw a guy who was bleeding out of his ear, high as a kite, and who had no health insurance. He tripped over his other classmates who clamored for the work and found a social worker who offered to get the state to pay $200 to diagnose and treat the crackhead.

Dr. Don took the crackhead back to his "office." It turned out that the crackhead had gotten into a knife fight and had a cut in his earlobe that required stitches. He got right to work sewing on the ear.

Due to his inexperience and the adrenaline rush, Dr. Don not only forgot to clean the wound, but mistakenly prescribed an antibiotic that only works on pneumonia. The crackhead got a major infection where he lost part of his ear.

Dr. Don was then sued for medical malpractice by the crackhead who would have otherwise been tossed out of the hospital that day for not having health insurance. He lost and his premiums skyrocketed thanks, in part, to the fact that he also failed to miss tell-tale signs of an obvious heart attack in another patient, and spinal meningitis in another.


  1. I see where you're going with this post, but the comparison of law school to med school that you set out above is incorrect.

    The reason the med school model is far better than what we experienced is that med schools zealously guard the gates to practice. The application process is far more competitive and entry requirements are much more strict.

    Instead of any old liberal arts degree, aspiring doctors have to have taken many hard science courses like organic chemistry in order to be considered for admission, and if they want to go the the best med schools, they have to have excelled in those courses, naturally.

    The big difference between med school and law school is that the AMA is not the accrediting body--there is an independent organization with no vested interest in creating school after school (Association of American Medical Colleges). Med schools really only accept as many students as there will be positions to fill on what is known as "match day". Based on their school performance, the students, for lack of a better word, "bid" on the types of practice areas and locations where they want to do their residencies, and depending on what jobs are available, each student is computer matched to the appropriate position.

    Everyone gets a job on match day, even the person graduating last in their class...the difference being that instead of scouring the town for a "shitmed" job, they are automatically assigned to a crappy hospital or clinic.

    That's why so many scambloggers argue for law school becoming more like a med school, where you actually learn by doing during your studies and where only those who actually have what it takes to be a lawyer are the ones granted admission. Considering how useless the current law school model is, I would even suggest that we mimic the European model, where law is an undergraduate degree and you then learn on the job (that's what we do already anyway).

    I do agree that for most law school leaves you with no alternative other than going solo, for which law school does not even begin to prepare you, which is a recipe for malpractice no matter how well you do in school.

  2. Actually, this is basically how things work in Canada.

    After graduation from law school, it is necessary to "article" for 8-10 months (depending on jurisdiction) and also complete some practical/skills courses through the relevant Law Society before someone can even write the bar exams.

    In a way, this is worse than in the US because law graduates do not have the option of starting their own practice (as unappealing and unrealistic as that option may be) and/or working with their classmates in a small firm.

    There is only very limited data available on how many people fail to secure articling positions after graduation (and so never get licensed); Canadian law schools have no desire to collect these statistics. I would guesstimate that it is 10-15% nationally; probably higher in some regions.

    I am one of those unlucky few. After graduation, I applied to every firm (large, small, solo) in the city I was then living and then I started on the surrounding small towns. I probably sent in excess of 100 resumes. After about a year, I was competing with those graduates from the class behind me and I realised that I would never become a lawyer.

    I ultimately returned to school to complete a graduate degree and I secured a fulfilling (and well paying) government job based on that degree, and the experience from the job I held as a pre-law undergraduate. My employer knows that I have a law degree, but she doesn't much care as it is irrelevant to my present situation.

  3. Locke, I corrected the title of my piece to reflect what I was aiming at. Thanks! You are absolutely right. Law schools want the practice of law to be lumped in the same breath as the medical profession, but we absolutely do not deserve that distinction. We're like any other graduate school except that we actually are supposed to learn a trade where we aren't dependent upon schools to give us professorships or research opportunities afterward.

  4. Excellent post! I think you nailed it...sounds a hell of a lot like the lives of most of the doct...I mean, attorneys, in my class!

  5. Also, medical and dental school students devote the last 2 years of their education in clinic. The ABA does not require clinical programs. Even among the law schools that have clinic, there are not many slots.

    Great post! If medical schools were run this way, who would want to see such doctors? Would you fly in a plane if you knew the pilot had no actual flight training?

  6. In my humble opinion, it is my impression that the medical profession just will not stand for the misallocation of resources the legal profession does. They will not stand for practicing physicians to conduct morning rounds and spend time on students in a context where only a FRACTION of them will go on to practice and thereby use that hands-on guidance and very valuable time spent. No Way.

    Perhaps a not-so-nice-way, an alternative way, to say it, is that law professors offer no real value. There is so much of what they have to offer, or, what they have to offer is worth so little, that its waste on scads of future non-practitioners is economically tolerable.

  7. Actually the sad thing is that medical schools seem to be heading in the direction of becoming MORE like law schools instead of vice versa.
    Here is a thread on a med school forum that explains how there will soon not be enough residency spots for all the med students graduating:

  8. Also, I believe that (at least) dental schools don't allow themselves to be ranked. US News has tried several times to rank dental schools, but the ADA (or whatever governing body it is) has refused, knowing what happened to law schools.

  9. Interesting and. It important information is really beneficial for us. Thanks

  10. This was written by a non-medical professional. Everyone in medical school goes into a match process for residency. You just can't treat a patient at a hospital without a residency since the hospitals would not grant credentialing to those who did not have a residency. This is probably the most ridiculous prose I have ever read.