Rich Without Money

In contrast to my Goldman post I found this article very refreshing.

"...At the age of 36, Bob gave up his career as a quality control technician, went to medical school and set out to improve the quality of the planet. He opened his office in a neighborhood where most doctors wouldn't open their car door [poorest part of Albany, NY], and welcomed in all the people mainstream medicine would rather ignore..."

My first reaction is that we need more of these people in medicine. I worry, however, that the selection process weeds them out. It's hard to ace your classes, complain to your Professors when you don't, research, engage in other leadership and extracurricular activities, etc. when you're busy going around doing unrenumerated acts of kindness. Unfortunately there is no correlation between empathy and "objective" test scores (when they say objective, do they mean this person will "objectively" be a better doctor?), at least for the standardized scores currently weighted heavily in admissions. While I think the new MCAT Communications Skills project is a start, I propose a radically new admissions criteria. Somehow someway students need to be faced with a situation in which they must decide between helping someone in need and succeeding career wise. Maybe they could delay a premed student such that he/she was running late for an important premed exam, and then strategically place a seriously injured person in the path of that student as he/she was rushing to the exam. Pick those students who stop to help. Easy.
My second reaction was to stick my chest out ever so slightly with pride for being Canadian. Maybe I'll buy myself a Canadian flag doo rag and next time I hear the Canadian anthem put my hand on my chest. It would take over 100,000 Dr. Paeglows to serve those people in the US without medical insurance. If Dr. Paeglow lived in Canada, he could do what he was doing, get paid for it (he could just give the money to the patients if he is so inclined), and get the same kind of resources for his patients that everyone (theoretically) enjoys. I make such an observation not to criticize the US system but to glorify ours. In fact, I'm not a US basher at all. I try to avoid criticizing the US because I'm sensitive to the new found Canadian sensitment of moral superiority over our friends of the south. We'll save that topic for another post. The bar chart is from the Yes! Magazine article: Has Canada Got the Cure?

For high strung med people - time to relax

Rising income disparity

“…After making record profits, Wall Street giant Goldman Sachs Group Inc. reported that it will pay its workers an average of $622,000 this year.

That's more than three times the average salary of a Massachusetts surgeon; four times that of a Massachusetts chief executive; and nearly 12 times that of a Massachusetts high school teacher, according to the state's Department of Workforce Development…”

Read Article

Wow?! As a former Wall Street employee I just can’t comprehend why Goldman employees should make 12x a high school teacher. It’s too bad wages weren’t based on positive impact to society. How many of the deals these firms orchestrate are actually accretive in the med/long term (for shareholders, not the CEO and bankers that is)? And despite the increasingly commoditized nature of M&A deals and proliferation of M&A shops the lucrative 7% commission remains…

I was surprised with the B-School Prof’s justification of the excessive income. He said this despite knowing he’s probably smarter than a majority of the people at Goldman yet makes 1/5th what they do.

“…While the salaries on Wall Street can be outsized, they reflect risk that few other professions face, said S.P. Kothari, a professor at MIT's Sloan School of Management. Traders and investment bankers constantly have to meet the bottom line: One year they can make $600,000, the next year, lose their jobs…”

What kind of risk is there to cashing in on $600K in one year (a cool $30K/year return in safe investments)? How about being laid off from the most prestigious financial firm in the world? Not exactly a CLM (career limiting move).

To the brink and beyond

Stuff happens, there's no doubt about it. However, this is taking it to the extreme:

"...Naum Ciomu, 58, was operating on the man to correct a testicular malformation when he lost his temper. Grabbing a scalpel, he sliced off the penis in front of amazed nursing staff, then cut it into three pieces before storming out of the operating theatre at the Panduri Urology Hospital in Bucharest..."
Read Article

Stress and personal problems have been forwarded as the cause. No one enters medicine thinking they would do something like this, and presumably, few people will. My worry is the negative personal changes that will occur over my med school training - the affects of busyness, stress, and dealing with the emotionally charged routinely. How could someone that was able to pass through all the hoola hoops to becoming a surgeon do such a thing? It's hard for a young, idealist, self flattering medical student to understand. Yet, I've already seen changes in myself. 4 months ago I would have told you that urology (assuming I actually knew what urology was) is disgusting. After meticulously dissecting a cadeaver, speaking to a few gleeful kidney transplant recipients, learning about emerging prostate cancer research, and general desensitization to anything anatomically private...it's suddenly become a specialty of interest. That's only 4 months.

I've witnessed a doctor uncover a sensitive area of an older woman without asking her. I've heard a pediatrician refer to a child as a FLK (funny looking kid). These things bother me...at least for now. In doctors' defence, I suspect one cannot deal with emotionally charged things all day. Could a doctor look at private parts all day comfortably if she saw them as private? Could a pediatrician sustain himself without depersonalizes the innocent suffering around him (treating children who could easily be his own)?

So what are some strategies to ward off the jadedness and remain emotionally balanced?

-hang out with people outside of medicine

-blog about stuff other than medicine; I hope someone comment slaps me if I become overly fixated on med stuff

-document my current idealistic euphoria regarding my future career in medicine

-complain about stuff that doesn't seem right

We'll see how it goes.