How do I advise/support my sister who is a burnt-out PGY1 medical resident? (

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP here:

Also, "your sister is not cut out for medicine" is not needed or appreciated. I just can't tell if this is a passing fancy, or growing pains/adjustment. Aside from a year of research between college and med school, it is her first job.

This can't be concerned controlled on a free message board.

OP here. This may be the case, but honestly, I am now realizing that my motivation was to get support from the DCUM community as how to approach the situation individually (i.e. myself) as, for a number of personal biographical reasons, I am a significant figure in my sister's life. And, her stress is also impacting my own academic work.

The hate is unnecessary. Her expressed intention for going into IM was the diversity of procedures, before specializing further. Now, I worry that is all in question and years of graduate education may be at risk. Not to mention, years of private school tuition.

So, for those who call my sibling "spoiled" – ask yourself, how does it feel were the same applied to yourself, your own sibling, or child? Seems like unnecessary hate to put out in the world. I asked for actionable, specific advice. Trashing people is not actionable, except engaging in projective identification on your own part.

Also, I will end by saying – is this forum populated entirely by women? The snark re "spoiled" or "entitled" seems heavily gender-coded in a way that would not be applied to a man. Are the three blonde ladies from the White Lotus on this thread? This isn't a matter of not being able to take the heat – I am simply asking: what are you contributing to this conversation? Why are women in healing professions expected to be sacrificial lambs, whereas a man might – to my imagination, at least – be seen as a martyr?

I'll take input from physicians, parents of physician children, or spouses of the same, but otherwise, I am not interested in the petty resentment of DCUM posters who, for whatever, reason, seem invested in speaking derogatorily about loved ones. I can pass comment on my sister's psyche; ya'll cannot. This may be a public forum, but whatever happened to decorum? This is why this country is falling apart.

And finally, given the program she matched into, the one thing I can assure you above all is that there is was no issue with her board scores. I think the main triggering factor is the fellow resident – a young female, in her same year – getting punched in the face. Like I said, I myself am a university professor so I think what I am now realizing I am/was trying to do is – how do I maintain credibility in supporting or advising her, when she is right to call me out, I work in a completely different milieu. That said, AGI may kill the social sciences before I make tenure, so part of my frustration is that she has guaranteed job security and these days, social science academics do not.

Once again, I would like to reiterate my gratitude, particularly to those physicians who were detailed and went point-by-point. I do think the fiancé is an issue, but that ship has sailed. To those of you who project your own insecurities or misery onto others – I wish you a most thoroughly unpleasant day.

OP, you just need to ignore some of these posters. Are you relatively new to DCUM?

[Anonymous]

OP here, again. I guess I'll keep coming back.

I guess I'm at a loss as to what to say.

Personally, I'd love to be a physician! In my field I deal with on-the-ground fieldwork abroad, but there is obviously no "healing" or direct community service. I just died of boredom in organic chemistry in college so that was the end of that.

But, returning to the original point: "hang in there" or variations of "it will get better" (actually, what this thread and conversation with a physician ex-GF have made clear is that for the next three years, it in fact will not...) are not validating or helpful with her.

During her rotations, she would call me fascinated and super excited about what she was learning, the diversity of knowledge/experience, and also go on and on about how she loves (loved?) dealing directly, long-term with patients on cases. We spoke for an hour this morning (she's off today), and what's clear is that she seems to be really projecting her angst/anger at the hospital system, state of the medical field, and capitalism:

"Dude, how am I supposed to actually care for a patient when my resident calls me out for spending more than 10 minutes with them?! I want to get to know people as people. Not as a f***ing series of lab results. This is not medicine, this is a business.”

What am I supposed to say? What she is saying is in fact true.

Thinking out loud earlier on the phone, I suggested she consider kickboxing (face-palm, I know), because what I'm starting to realize is that it may be anger/ frustration with how the medical industry is configured that is alienating her from being able to actually connect with patients. She did a lot of service work at clinics in NE/SE DC in HS and in college, but that was through the aegis of an independent school and college. So it's not like she's not worked with underserved populations before, it has just been a different setting.

Also, there are in fact Gen Z dynamics,, which seem to be universal, based on what I’ve read about generational changes in the medical industry:

Sister: “No one, in any situation, should be punched in the face in their line of work. That is my boundary.”

Me: “Look Sister, you have to remember that patients are not only terrified and alienated when they enter the ER/hospital – particularly if they are coming from an underprivileged community – there is also a natural element of regression because they come to you for care…”

Sister: “I do not endorse violence in any circumstances. My friend got punched in the face. Was given 10 minutes to compose herself in a storage closet, and then had to go back to doing rounds and keep charting. How is that OK?????”

Me: “Wow. I can’t imagine – that sounds terrifying. It’s not OK. And you know if that ever happened to you, I’d want to beat that person up. But remember, they are your patient. Even as a resident, you are the physician. And, remember that they are in PAIN.”

Sister: “Mmmmm.”

To wrap-up this blast, my big concern, which I haven’t really unpacked before, because I personally don’t know how to address, is the fiancé, with whom there is a class dynamic at play. Backstory: neither fiancé’s mother or father went to university, and though her future FIL worked a physically demanding job, it was punch-in, punch-out. MIL-to-be was a stay at home mom. She baked her kids super elaborate birthday cakes, put notes in their lunchboxes, et cetera. This is not a statement invalidating emotional labor or “blue-collar” labor – union workers and mothers are the engines driving this country; it’s ultimately a concern that the fiancé may project low-key trad-wife, take-it-easy expectations on her. His mother’s kitchen literally has a plaque that reads “Don’t worry, be happy!” (or similar)...

So, while her fiancé is very, very supportive (e.g. takes on 70-80% of the household load... I myself would not do this. My sister can do her own laundry) and also relocated with her to an apartment walking distance to the hospital she works at (bad decision IMO; there should be some geographic separation between work and life), my concern is that he is unconsciously projecting trad-wife expectations onto her. Our mother, on the other hand, had a research career spanning several countries. So the dynamic I worry about from my future BIL is: “why put yourself through this, if you’re so miserable?” Dude is great otherwise. Values education. Government worker with terminal degree. But definitely not the grind.

Again, this is not to pass judgment on his mother’s class position; in fact, it speaks a great deal towards her love for her son and the great amount of [unpaid] emotional labor she did engage in while raising fiancé, but I’m worried this will make my sister eventually come to the conclusion: why am I bothering with this?

This morning, me: “Sister, look. Its three years. If you wanna specialize, you could do ID and transition to research; if you want, you can go group practice and treat people at some plush practice in Chevy Chase or Bethesda”.

Sister: “I would never do that. Rich people have enough doctors taking care of them already.”

Me: “Well………..”

I think at this point, I’m just venting. I’m also frustrated/annoyed because I recently took a tenure-track position in another city six months before she graduated medical school/matched and before, I literally would have been in the same city as her and been able to provide more in-person support. We come from a culture where siblings are very close, and were raised by our parents to mutually support each other. I just can’t tell if the conversation I had with her on Saturday (which really alarmed me and led to my rather rambling original post) is venting, or true, long-term concerns. And I’m also weary of over-stepping my role as older brother, because at a certain point, she must make her own decisions.

I did tell her to go into IB or consulting when she graduated college, but she insisted that capitalism is evil, and she wanted to serve and work hands-on with patients. She also has an instinctive, knee-jerk aversion to anything deemed “élite” or “high-prestige”, which is somewhat a product of our faith which places a huge premium on community service and social action. So, I think she ultimately feels that she is not practicing medicine; she is working for a university hospital that is at the whims of a corporate/board structure, so there is that element of broken idealism. That is what really worries me. Because broken idealism can spiral into nihilism very, very quickly.

So I’m trying to maintain credibility, but it feels hard because like I said, I was incredibly lucky – needless to say, privileged too – but literally, in my field, it was just luck; a prof emeritus died, so now I have a job.

TLDR: How do I address the fiancé issue? His mother has made comments at lunch like “Oh, don’t worry, I’ll do the dishes. I wouldn’t want X to damage her hands!”

(I was livid).

[Anonymous]

Dude - you are way too enmeshed. It’s her life, let her live it. She calls you up to vent not for actual advice. Let her vent to you. Listen for the most part, be supportive and agreeable. Maybe encourage her to find a mentor at the hospital where she’s at. No clue why you are so bothered about the fiancé’s mom. Sounds like you have something against stay at home parents. I doubt that your sister is so easily influenced by the fiancé’s family. Let your sister figure it things out. Life can be very rough at times. Millions of doctors have gotten through residency. I bet your sister will too. The medical system is broken. Yet there are some amazing doctors doing incredible things for patients and making the best of it. Remind her that both things can be true

[Anonymous]

She is right that rich people have lots of people to take care of them, but you don't have to take the most miserable version of a job to be doing good.* My spouse goes to a concierge practice, and while we're solidly upper middle class, we have a house that any realtor would consider a tear-down, our kids went to public school, and we have no pricy hobbies. Doctors who can take more time with patients are providing data that there are ways to improve quality of care.

Anyway, just keep listening, and don't brightside her.

*One of my siblings is an ophthalmologist, which I believe is considered a slacker specialty. But they work at a VA hospital. Still slack? Another family member is a public school teacher. Heroic? What if the public school is in a nice neighborhood? What if the nice neighborhood is in one of the worst red states?

[Anonymous]

Anonymous wrote:OP here, again. I guess I'll keep coming back.

I guess I'm at a loss as to what to say.

Personally, I'd love to be a physician! In my field I deal with on-the-ground fieldwork abroad, but there is obviously no "healing" or direct community service. I just died of boredom in organic chemistry in college so that was the end of that.

But, returning to the original point: "hang in there" or variations of "it will get better" (actually, what this thread and conversation with a physician ex-GF have made clear is that for the next three years, it in fact will not...) are not validating or helpful with her.

During her rotations, she would call me fascinated and super excited about what she was learning, the diversity of knowledge/experience, and also go on and on about how she loves (loved?) dealing directly, long-term with patients on cases. We spoke for an hour this morning (she's off today), and what's clear is that she seems to be really projecting her angst/anger at the hospital system, state of the medical field, and capitalism:

"Dude, how am I supposed to actually care for a patient when my resident calls me out for spending more than 10 minutes with them?! I want to get to know people as people. Not as a f***ing series of lab results. This is not medicine, this is a business.”

What am I supposed to say? What she is saying is in fact true.

Thinking out loud earlier on the phone, I suggested she consider kickboxing (face-palm, I know), because what I'm starting to realize is that it may be anger/ frustration with how the medical industry is configured that is alienating her from being able to actually connect with patients. She did a lot of service work at clinics in NE/SE DC in HS and in college, but that was through the aegis of an independent school and college. So it's not like she's not worked with underserved populations before, it has just been a different setting.

Also, there are in fact Gen Z dynamics,, which seem to be universal, based on what I’ve read about generational changes in the medical industry:

Sister: “No one, in any situation, should be punched in the face in their line of work. That is my boundary.”

Me: “Look Sister, you have to remember that patients are not only terrified and alienated when they enter the ER/hospital – particularly if they are coming from an underprivileged community – there is also a natural element of regression because they come to you for care…”

Sister: “I do not endorse violence in any circumstances. My friend got punched in the face. Was given 10 minutes to compose herself in a storage closet, and then had to go back to doing rounds and keep charting. How is that OK?????”

Me: “Wow. I can’t imagine – that sounds terrifying. It’s not OK. And you know if that ever happened to you, I’d want to beat that person up. But remember, they are your patient. Even as a resident, you are the physician. And, remember that they are in PAIN.”

Sister: “Mmmmm.”

To wrap-up this blast, my big concern, which I haven’t really unpacked before, because I personally don’t know how to address, is the fiancé, with whom there is a class dynamic at play. Backstory: neither fiancé’s mother or father went to university, and though her future FIL worked a physically demanding job, it was punch-in, punch-out. MIL-to-be was a stay at home mom. She baked her kids super elaborate birthday cakes, put notes in their lunchboxes, et cetera. This is not a statement invalidating emotional labor or “blue-collar” labor – union workers and mothers are the engines driving this country; it’s ultimately a concern that the fiancé may project low-key trad-wife, take-it-easy expectations on her. His mother’s kitchen literally has a plaque that reads “Don’t worry, be happy!” (or similar)...

So, while her fiancé is very, very supportive (e.g. takes on 70-80% of the household load... I myself would not do this. My sister can do her own laundry) and also relocated with her to an apartment walking distance to the hospital she works at (bad decision IMO; there should be some geographic separation between work and life), my concern is that he is unconsciously projecting trad-wife expectations onto her. Our mother, on the other hand, had a research career spanning several countries. So the dynamic I worry about from my future BIL is: “why put yourself through this, if you’re so miserable?” Dude is great otherwise. Values education. Government worker with terminal degree. But definitely not the grind.

Again, this is not to pass judgment on his mother’s class position; in fact, it speaks a great deal towards her love for her son and the great amount of [unpaid] emotional labor she did engage in while raising fiancé, but I’m worried this will make my sister eventually come to the conclusion: why am I bothering with this?

This morning, me: “Sister, look. Its three years. If you wanna specialize, you could do ID and transition to research; if you want, you can go group practice and treat people at some plush practice in Chevy Chase or Bethesda”.

Sister: “I would never do that. Rich people have enough doctors taking care of them already.”

Me: “Well………..”

I think at this point, I’m just venting. I’m also frustrated/annoyed because I recently took a tenure-track position in another city six months before she graduated medical school/matched and before, I literally would have been in the same city as her and been able to provide more in-person support. We come from a culture where siblings are very close, and were raised by our parents to mutually support each other. I just can’t tell if the conversation I had with her on Saturday (which really alarmed me and led to my rather rambling original post) is venting, or true, long-term concerns. And I’m also weary of over-stepping my role as older brother, because at a certain point, she must make her own decisions.

I did tell her to go into IB or consulting when she graduated college, but she insisted that capitalism is evil, and she wanted to serve and work hands-on with patients. She also has an instinctive, knee-jerk aversion to anything deemed “élite” or “high-prestige”, which is somewhat a product of our faith which places a huge premium on community service and social action. So, I think she ultimately feels that she is not practicing medicine; she is working for a university hospital that is at the whims of a corporate/board structure, so there is that element of broken idealism. That is what really worries me. Because broken idealism can spiral into nihilism very, very quickly.

So I’m trying to maintain credibility, but it feels hard because like I said, I was incredibly lucky – needless to say, privileged too – but literally, in my field, it was just luck; a prof emeritus died, so now I have a job.

TLDR: How do I address the fiancé issue? His mother has made comments at lunch like “Oh, don’t worry, I’ll do the dishes. I wouldn’t want X to damage her hands!”

(I was livid).

First, the fiance issue is not yours to address. Do not get in the middle of someone else’s relationship. You are endangering your own relationship with her if you tread into those waters.

Second, I think the big picture here is that her idealism is meeting reality. This is part of growing up and maturing. The world is a flawed place. She has limited ability to change that. She can only do what she can do. In some ways, this is a grieving process. She has to get through it and face the reality of modern medicine in our current society and figure out a way to navigate the system that makes sense to her. Maybe it’s slogging through this current path, maybe it’s finding a different specialty, maybe it’s finding a different place to work when she finishes residency.

I assume she has typical student loans for med school? Medicine is unique in that burden. I’d encourage her to be realistic about the financial implications of getting out of medicine now. And I’ll just say, she’ll have the same disillusioning experience if she goes into teaching, and end up paid a tenth of what she’ll make as a doctor.

Honestly, I just think she needs to grow up. I’m not saying that to be mean. She’s facing reality and that can be a painful experience. And her fiance probably hates seeing her in pain which is why he’s suggesting something else for her. You’re both doing the typical guy thing of trying to fix her problem. Try just listening instead. Let her vent. Stop trying to change it or take her pain away. Let her process it by talking about it.

[Anonymous]

I'm sorry I don't have an answer OP, but I think it's really nice that you care about your sibling like this.

Best of luck to you and her.

[Anonymous]

I’m also a physician and went into med school with one kid and graduated felllowship with 3. She needs a supportive husband. He will be the de facto parent. Intern year is the worst. You are drowning in learning not just medicine but the EMR, the grunt work, really dealing with other staff, logistics of the call annd the hospital system, figuring out residency expectations, and working insane hours and shifts. And despite her attempts to get away from capitalism, healthcare is being destroyed by it. Since Covid the respect for physicians and the resources available have diminished significantly.

But, she’ll grow closer with her coresidents (shared trauma can do a lot to bring people together), she’ll gain knowledge and then ultimately confidence, and in a year or two the new interns will be looking up to her while she figures out her next steps.

Healthcare and medical education is so poorly run in this country. I’m hoping she will remember this long term. I keep myself sane by working part time for a big hospital/academic system where I see really complex patients to keep my knowledge going, a small rural nonprofit to help those in need, and then also just a day in private practice. It reminds me that there are options and that one day I will hopefully escape the hellhole hospital system and practice the way I want to and care for people the way I know best.

What she’s going through tells me that the current system in which she works isn’t a good long term solution for her, but she’s smart enough and compassionate enough to navigate into a system that’s a better fit for her.

Also, she should totally consider a “lifestyle” specialty. They are so desperately needed and the NPs and PAs are trying to take over and doing such a poor job that the rest of us are constantly having to fix their mistakes. Waitlists are months out, hours are more reasonable and honestly the underserved need them the most! She could make a huge difference.

Also, jerk patients also are out in the real world where they could punch randos. Just remind her to keep her wits about her, stay on guard, and don’t let her safety be sacrificed for the expense of the patient.

Thanks for being a caring big brother.

[Anonymous]

I’m 10 years out of residency (dental, not physician, so I can’t make a complete comparison) but I made 30k my residency year and made 450k last year. The money part completely sucks, but waiting it out has made life so much easier. Hang in there! It’s just one day at a time.

[Anonymous]

Sounds like she lacks her support system. Does she spend social time with other interns? My kid is doing her first year residency and tries to lean on to other interns for support. Doing it alone will be very hard and you can’t fill that role.

[Anonymous]

That's interesting that doctors (so weird when they call themselves "physicians") still think dermatologists are "lesser." My friend's sister steered away from dermatology because the doctor parents looked down on it. Crazy.

[Anonymous]

Anonymous wrote:

Sounds like her fiance is an issue and has no business being engaged to a professional woman. He wants a stay at home wife or wife with a low paying low stress job to mother him, not the other way around. Possibly dump him, if she actually wants to work.

There were a few women in my med school class married to guys like this. Once the novelty of saying "I married a doctor" wore off for these guys they were super resentful of everything: the hours, the emasculation, the absence from home. They wanted a "normal" wife (words from one of those guys). Honestly these were starter marriages and the lucky women dumped these guys early. The ones who stuck it out ended up divorced in residency, but that was still better than the few who made it through residency only to have the guys leave and file for alimony once she started making money. Real winners, these guys.

Yeah. I hope your sister does not marry that man.

Anyone who is telling you to SAHM after you worked your butt off to get into medical school, endure the academic load, possibly cut into cadavers, study/work except for when sleeping, and then graduate into years of low-paid work for long hours is a real problem.

[Anonymous]

She really needs to dump the fiance and concentrate on residency, he's not helping her and seems to working against her. She will easily meet someone else after residency is over.

[Anonymous]

Anonymous wrote:That's interesting that doctors (so weird when they call themselves "physicians") still think dermatologists are "lesser." My friend's sister steered away from dermatology because the doctor parents looked down on it. Crazy.

Doctors don’t. Dermatology is one of the most difficult specialties to get into.

[Anonymous]

Anonymous wrote:Dude - you are way too enmeshed. It’s her life, let her live it. She calls you up to vent not for actual advice. Let her vent to you. Listen for the most part, be supportive and agreeable. Maybe encourage her to find a mentor at the hospital where she’s at. No clue why you are so bothered about the fiancé’s mom. Sounds like you have something against stay at home parents. I doubt that your sister is so easily influenced by the fiancé’s family. Let your sister figure it things out. Life can be very rough at times. Millions of doctors have gotten through residency. I bet your sister will too. The medical system is broken. Yet there are some amazing doctors doing incredible things for patients and making the best of it. Remind her that both things can be true

That part. little sister ( or OP) needs to grow up. lifes' not fair or idealistic and most f the time it isn't fun.

[Anonymous]

Anonymous wrote:

Anonymous wrote:That's interesting that doctors (so weird when they call themselves "physicians") still think dermatologists are "lesser." My friend's sister steered away from dermatology because the doctor parents looked down on it. Crazy.

Doctors don’t. Dermatology is one of the most difficult specialties to get into.

And the rotation is called "dermaholiday."