Any doctors-in-training/doctors have anything to say about this?
I think it’s interesting from a shadowing point of view, namely, shadowing is incredibly important to know what you’re getting into; it’s not all one on one patient contact, which may or may not be the what you’re looking for, and could lead to future burnout if you don’t mentally prepare yourself for what you’re getting into.
Also, I like that the authors point out that we’re not sure, just based on these facts alone, whether this is a good or bad thing in terms of patient outcomes. We can hedge our bets, knowing what we know here about the importance of the psychosocial factors, as to what we think, but still, empirically, that needs to be tested.
Im no MD or med student but i can understand why its like that. I can understand a student spending their first year learning topics like biology, anatomy among others in depth before coming in contact with patients so they can get an idea of the nuances of how to treat a patient which i assume is whilst doing rounds with their attending/residents.
I’m not a doctor but I work with junior doctors in a tertiary hospital. I’m not sure of exact figures or percentages, but this seems fairly accurate and not surprising. It obviously depends a lot on the specialty, ward, hospital etc you are working in as well - there is a decent amount of variation depending on the acuity and even between medical, surgical (where you may get to help out in theatres), emergency (a lot more opportunity to examine patients), rehab (more interaction with families), psych, etc. A typical set up in a medical ward seems like it involves a ward round - usually the senior doctors are doing most of the patient interaction while the junior doctors document. If it’s a new patient, junior doctors are given opportunities to examine and ‘admit’ the patient and verbally handover/discuss with their seniors. But after the ward round a majority of the time the junior doctors are sitting in the office and sorting through their jobs for the day (which have been generated from the ward round) - submitting their notes, preparing discharge summaries and prescriptions, referring to other specialties, ordering tests, writing up charts, etc. While they are trying to do all of that an array of nurses and allied health will be bugging them with questions and give them more jobs. Then there are meetings, teaching, and they might try to fit in a break amongst all of that… A lot of junior doctors I have encountered describe their job as admin work - but they know that that’s the gig for the first year, and not that much different the following year.
On the job is how you get good at your job. Ultimately different doctors do different stuff. I know a couple doctors who probably spend a majority of time at work in client consults. That said I don’t think that is the norm, I think it varies by the job (I don’t know a ton of doctors). Its similar in my profession (attorney). I meet with clients a lot, but other attorneys rarely meet with their clients.
Regardless of what your job is, you get good at it by practicing it, so if the doctor will eventually have to spend lots of time with patients, spending only 13% of time with patients as a 1st year resident is probably not a really efficient training system. By contrast if that is what their job will look like after residency it could be really good training.
In my opinion, the first year of doctors is the hardest one. It is not because the lessons are very hard, but because in the first year you are not used to this rhythm of life. It is very hard to get used to the thing that during the semester you study almost all the time. I remember how hard it was for me to accommodate such a lifestyle. Also, you need to make the decision of what type of doctor you want to become in the future. Luckily there are different sites that can help with it by making charts with different types of doctors in different categories, like difficulty and the salary.
Really depends on the specialty, intern year for internal medicine is very different than intern year for surgery. Though you’re still on the wards and the ED a lot (with sprinkles of OR time if your seniors are nice to you), hours can vary. An ICU rotation is different from a trauma rotation. And then it depends on the call schedule, night float (12 hours on 12 hours off) or traditional 24 hour call every 2-3 days), each hospital and residency program is different. But, my experience as an intern was pretty similar to what the article says.
Sure, every now and then you get to do some real medicine, remove a bullet in the ED, or acutely treat a patient in respiratory distress (though even that is mostly done by the rapid response team nurses before the big dogs show up). You are the lowest rung of the ladder, it’s your job to get all the bureaucratic stuff done that seniors and attendings don’t have time to (or don’t want to) do, answer pages, put orders in, make sure any emergencies are elevated as needed. Basically you are the conduit between the patient/nursing and the seniors/attending.
An example that still sticks out in my mind of the amount of multitasking interns have to do was on trauma where, after a scheduling issue, I ended up being the only intern on a team with 20+ patients, other than morning and afternoon rounds, where we directly assess the patients, I was not able to get up from my chair because of the nonstop pages (we usually have to answer within 30 minutes) and mini emergencies that could be taken care of by a mouse click and an order placed in the EMR.
The way I think about it, without interns, the seniors would not have time to get the actual work done, be it making the big decisions or finishing the OR cases. Or that may just be a bit of Stockholm syndrome talking… This is a good article about the importance of docs to take some time for themselves and stay both physically and mentally healthy outside the hospital: Call in Well | AANS Neurosurgeon