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July 05, 2007

Support your local intern

For some reason, it just occurred to me that it's the first week of July. I want to give a big congratulations to all the medical residents out there who are through with another year, especially to those who are finishing up and moving on to the nonstop sex and drugs of life as an attending.

And to those starting their intern years...I don't know what to say to you other than good luck. I don't know what anyone could have said to me that would have helped.

If you know someone who is starting out as an intern, don't assume you're going to lose contact with them for the year; outside-the-hospital friends are crucial to getting through it. Yes, he'll be busy, but the hardest part about being an intern isn't the hours or the workload--it's the expectation. So many people expect so many things from you, from the simple and mundane to the seemingly miraculous, that when you get home you don't want anyone to expect anything from you.

The best thing to do is to try to put together spontaneous, low-pressure social outings, because if you plan it too far in advance it becomes another expectation. Don't be surprised if he isn't very talkative; he might just want to listen to people talking who are relatively healthy and happy and don't expect him to fix them. Don't forbid talk about the hospital, because he probably feels like it's all he knows right now.

Of course, you don't have to get him out just to show some support; an e-mail, card, or phone call may be just what he needs to bring him back to reality (because it really seems like you're living in another universe sometimes).

(Note that these things don't necessarily apply only to interns (aka first-year residents); the rest of residency can be just as tough if not tougher in a lot of ways. So keep it up.)


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I was never very clear on the whole proces of becoming a doctor. There is the internship, resedency, and then what? When they are in their internship I am assuming they get paid? Could someone please explain this whole process?

After med school, you do a residency to learn your specialty--internal medicine (mine), family pratice, pediatrics, general surgery, neurology, psychiatry, etc. This typically lasts for 3-5 years.

Some people will go on to do a fellowship for a subspecialty; for instance, cardiology is a subspecialty of internal medicine. Others will go on into regular practice, where they're known as attending physicians.

The first year of residency is called the internship. It used to be distinct from the residency, and some people still do them separately, but most of the time it's all the same program. It's generally the most work- and time-intensive year of the whole process (though, in fairness to our forebears, it isn't what it used to be).

Residents (and interns) get paid decent money, but it's far from "doctor money"--usually $40-45K, regardless of location and specialty. (Believe me, it seems like a fortune when you've been living on a student stipend for so long.)

I wonder if it's appropriate to use 'he' when talking about doctors. Since a large percentage of women are becoming doctors.

No, not really, but "he or she" is awkward, alternating "he" and "she" is confusing, "they" is incorrect (though less so every day), and "s/he" is just ridiculous.

I meant it in a gender-neutral sense.

By the way, if any grammar nerds want to educate me on this point, please do. My English construction skills (and, oddly, my spelling) go downhill with each passing year.

In academic literature "she" is considered more acceptable than "he" as a gender neutral pronoun.

"They" or "one" are preferred, however.

Awkwardness is also a hallmark of grammatical correctness. Cf. prepositions.

My grandfather, who did his internship and residency in the 1920's, had some good stories about the bad old days. Among other things, he and my grandmother couldn't live together while he was an intern, and I think they even had to hide the fact that they were married. He used to like to joke about how soft things were for later generations, but I think he was not sorry to see conditions for interns made a bit more humane.

I use "they" as a gender-neutral singular pronoun. It's becoming more accepted, especially in spoken English.

When I was busy not dying at Walter Reed, I had an intern.

He was, so it seemed to me (36 years old, and fresh out of a combat zone) about 12.

He was also the best thing to happen to me. Walter Reed is, among other things, a teaching hospital. I saw 14 doctors, from five disciplines, as well as the residents on rounds. That was the first two days of my stay.

But there he was, rain or shine, visiting me at least once a day, and usually twice, to see how I was doing; find out what had happened, etc.. He provided a continuity of care which was a great relief. Heather, my primary nurse was there, most days (and when the IV blew, and the nurse who tried to move it kept hitting the radial nerve, until we decided it could wait, she came in and found a good vein, stuck me; and helped me nurse it until I was discharged).

He made what could have been a worse time, much better.

Sadly, I can't recall his name (I want to say Britten, but I know I'm confusing him with the West Point 2LT I got to take care of in Iraq. They looked alike, and both seemed to be fresh out of short-pants).

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