Light at the end of the tunnel?

Sisyphus, Netherlands (2008)

I totally understand if you have a strong opinion about the validity of social media like Twitter or Facebook. Sure, I used to think that Twitter was just another way for Paris Hilton to inform the world that she was like totally digging her new colonic irrigationist.  And Facebook might be a questionable way to delude yourself into believing that you actually do have 200 bestest buddies. I have now embraced both (I’m still apprehensive about Google + and LinkedIn) with alacrity totally unsuitable for a shy reserved person like myself. Anyway, if you are not on FB or Twitter you would have missed the announcement that I apparently was deemed competent enough to practice medicine. In other words, I passed medical school.

I remember shrugging my shoulders when I received my email. How do you celebrate the end of 8 years of studying? Especially when the further you dig the more you realise that the real hardcore learning is still ahead. The giddy excitement of wearing a stethoscope around my neck in the first year has long since given way to hastily shoving it in my bag as I hurry home from the hospital.

So what’s next? That’s kind of awkward: I’m no longer a medical student but I’m not yet a doctor (there goes my plan of booking the airline tickets to NZ under a new title!). I’m a Print student, a.k.a. Pre-Internship student. I’m attached to a general medicine team in one of Sydney’s hospitals and my only purpose is to prepare for future everyday life as an intern. And it’s far from glamourous, folks. Long ward rounds with consultants where your main job is that of a glorified scribe (taking down every word of medical wisdom, no, I’m not being sarcastic), becoming a detective tracking down patients’ records, their doctors, their previous operations and their family; writing discharge summaries, ordering tests, requesting consults, taking bloods, inserting cannulae, catheters and other pieces of equipment into patients’ bodies. No more lectures, no more trying to impress the examiners and not very much brain work compared to the life of a student.

As an aside, I did my elective term in the US and I saw medical students being expected to do all of these routinely in their 3rd and 4th year. In the Australian system medical students are somewhat “mollycoddled”, i.e. left to our academic devices. We are expected to focus on taking a history, examining the patient, formulating a differential diagnosis, coming up with investigations and a comprehensive management plan. We are kindly spared from the actual practical implementation of most of the above. Sure, we can do basic bloods and procedures but nobody would let us near a pediatric lumbar puncture. My jaw hit the ground when I saw a 3rd year perform one in the States. I was jealous and terrified at the same time. You choose what system you prefer. I might do a separate post on this later.

After 8 weeks of mostly paperwork I will be moving 5 hrs north of Sydney closer to the hospital where I am allocated for the next 2 years. I’m looking forward to the work, responsibility, earning money (hell yeah! after so many years!) and spending my limited spare time on the beach in one of the most beautiful spots in Australia.

If you are wondering how medical students turn into baby doctors then turn into big doctors, then specialise, then superspecialise, then earn bucket loads of money and buy a yacht (hahahahaha I wish), let me break this down for you.

Here is an overview of a graduate* pathway into medicine in an Australian system:

*undergraduate medical school requires an insanely high UAI + UMAT score (Undergraduate Medical Admissions Test) and a sheer determination to avoid any social life in your teenage years. The plus side is that it cuts down your Uni time to 6 years. 

3-4 years – Undergraduate degree: a happy slightly drunk student with not a care in the world
4 years – Medical school: a conscientious medical student with little social life and few friends who don’t do medspeak
* I’m here!
1 year – RMO1/Intern: paper work, routine hospital care, finally money! but no time to spend it, no friends
1 year – RMO2 /Resident: more paperwork, more routine hospital care, more money, a few friends with the same attributes
*At this point if you are lucky you may get into a specialty training program like Basic Physician training. However, for some of the more popular specialties you might have to hang around the hospital as a SRMO (senior medical officer) for a few more years, sorry!

4-8 yrs – Specialty training/Registrar: the time in your life when you know the most about the most of general medicine/surgery. Glamourous but hardworking creatures.
1-2 years – Fellowship/Fellow: All the ones I have met look lovely but aloof, only joining the conversation when their particular area of interest is discussed.
*Hopefully by this time there will be a hospital position available. If not, you might go and do a PhD. Or a Masters. Or take up knitting. 

The End – Consultant/Specialist: You are now officially allowed to wear a suit and ask medical students deep and irrelevant questions about medicine, theatre and religion. I’ll get there one day, hopefully before my hair goes grey.

Get your calculators ready: this makes on average 12-16  years from the start of your first uni degree till you are fully qualified as a specialist. If you are a woman who wants to have children you have to factor in some maternity leave. Somewhere. Anywhere.

The General Practice route (family medicine) and Paediatrics are a little different as you can enter into the training program as an RMO2 and generally finish in 3-4 years after that.

For the record, I AM very excited about finishing medical school. However, don’t rush to book an appointment with this new doc yet As you can see I have a long road ahead.

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18 thoughts on “Light at the end of the tunnel?

  1. Great news! I am happy for you that you already has a daughter and can plan your future without paying attention on the biological clock.

  2. I find it so ironic that people think docs are overpaid and that they can be easily replaced (as we do so often in the US system) with physician’s assistants, midwifes, techs ‘primary caregivers’ and pharmacists…and when you finish this mass of education, what will your debt be, and when do you calculate having it paid off? yes, there are shortcomings to our medical education system, but frankly, i think it would be frightening to have docs be any less prepared…the majority of people don’t understand the shear amount of work and experience involved, and that you don’t ‘learn’ medicine by reading a couple of articles online and then slamming those who complete the sacrifice necessary to obtain the honorable privilege of servicing human beings in this capacity. congratulations to you in this next exciting step to becoming a physician! such sacrifice is underappreciated, at best, but I’m sure will be fulfilling to you in the end! will you be on the Gold Coast for your internship?

    • Thanks for the comment, Bridget. Yes, in Australia we hear similar sentiments sometimes. I can understand the logic behind them, the general dissatisfaction with the medical profession and the medical system isn’t helping. There is a huge gap between reading an article about a condition and seeing patients with it (hundreds if you are a registrar, thousands if you are a consultant). We are lucky in Australia that we graduate with only a fraction of a crippling personal debt of our American colleagues. I will be based in a small town of Port Macquarie on NSW Mid North Coast.

  3. Congrats!! I’m really glad I showed up at internship with ready knowledge of how to do catheters, lumbar punctures, ABGs, X-rays, other blood draws, intubations, surgery closings and 2 years of 160 hour work weeks already under my belt… of course, a different system has its own advantages.

    So happy you are a Print!

    • Hi Emily, in Australia public hospitals comprises the backbone of the medical system. Patients routinely object to having a student/intern performing procedures (blood draws and IUD excluded obviously). An intern would never be doing an unsupervised LP or an intubation. And the only peopall who do surgery closings are surgical registrars. But since most residents hang around hospitals for 4-8+ years after graduation there is never a shortage of senior residents or trainees. In fact we are in the middle of an oversupply of junior stuff which will make it very tricky getting into a training program.

  4. Congratulations! The subject of the accompanying photograph does put things into perspective.

  5. Congratulations and good luck in the next stages! If only more medical students and doctors worldwide were also critical thinkers like you.

  6. Congrat Anastasia.. as someone about to be a “a conscientious medical student with little social life and few friends who don’t do medspeak” I’m in awe and slightly scared. 😉
    Enjoy your well-deserved break.
    Any idea of which specialty is calling you?

    • Thanks Tess. Med school will fly by before you notice. Nothing to be scared of, just enjoy doing what you love, learn things that interest you and just pass everything else. Re specialty: still early days. But I think I can make some positive change in a primary care situation. So currently thinking of my own general practice with good allied health support.

      • Thanks Anastasia, I hope so! 🙂
        That’s a great idea, if it’s still your dream in a few years I have no doubt you’ll make it happen. And then I can come and work for you, yay! 😉

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