[bronbron]

> Is this just one of those cases where, if you made it through medical school for an obscene number of years, you "don't care about the money"

I think it's more like "holy shit I have $300k in medical school loans, I better put up with whatever I have to in order to become an attending."

> makes market forces impossible to act on it

I believe (though I could certainly be wrong) that market forces are actually mostly responsible. Because a medical intern's negotiating position is pretty weak (they're saddled with medical school debt, they still require a great deal of on-the-job training), hospitals are well aware that they can torture interns because the alternative is pretty grim - even if you went off and became a software developer at Google, $300K in student loan debts will eat up pretty much all of your salary.

[zanny]

But logically if interns were being exploited by hospitals and burdened with tremendous debt then potential MDs would stop going through the program seeing that on the other side you are just abused.

Is that happening? Last I heard enrollment in medical programs was still at capacity. Which just goes back to my "don't care about the money" stance, because that seems to have to be the motive if students see whats on the other side yet willfully put themselves through it.

[bronbron]

> then potential MDs would stop going through the program seeing that on the other side you are just abused.

Not necessarily, for the same reason that people join fraternities/sororities even knowing that 'hazing' happens: they think the rewards are worth the temporary punishment.

> Which just goes back to my "don't care about the money" stance

I don't think that's a conclusion you can draw from the circumstances, because there's a big payoff for sticking it out through 4-5 years of abuse. Especially in fields like dermatology, the payoff for 4-5 years of abuse could easily be a 7 figure salary.

I would wager a large sum that medical students and interns are well-versed in delayed gratification (I mean, that's sort of how they get to become interns to begin with), so putting up with a few years of hell for a big payoff is something they're quite used to already.

In many ways it's similar to other high-pressure fields with insane initiation periods like investment banking, though deciding to quit in your 2nd year of investment banking involves a lot less risk than deciding to quit in your 2nd year of residency (because of both debt and alternatives).

[zanny]

Then how is the situation bad? It would seem like market equilibrium - students have full knowledge to know the hell they have to go through post graduation before they get a respectable position with a salary worthy of their effort, and apparently the medical system even under such physiologically unhealthy conditions still has all the MD's it needs. If it was ever actually "bad" then potential doctors would stop going to medical school and we would have a doctor shortfall, and the industry would have to stop being so antagonistic of its recruits or better compensate them to regain enrollment.

I was just worried the problem was that students were not aware of what awaited them after 6+ years of bank breaking schooling, and were stuck between a rock and hard place after graduating.

[bronbron]

Sorry, just going through I just saw your comment, but I thought you deserved a reply.

> apparently the medical system even under such physiologically unhealthy conditions still has all the MD's it needs

Interns will agree to work 100 hour weeks because they have no alternatives, but I don't think that it's necessarily efficient from an economic standpoint. They have all the MDs they need, sure, but it's highly arguable about whether it's efficient from an economic standpoint. We'd have to compare the cost of medical errors (which is non-negligible) from interns due to fatigue vs. the cost of hiring another intern.

> I was just worried the problem was that students were not aware of what awaited them after 6+ years of bank breaking schooling...

We're talking about basically a decade between when you make the decision to become a doctor and when you receive a MD. Even if you start out on the path to be a MD with perfect intentions, people change heavily over the course of a decade (and especially so at that age).

The grim reality is that even after undergrad (halfway in), if you chose a typical "med school" major you're still in a bit of a bad spot unless you decide to go into research in the life sciences. After graduating med school, your MD qualifies you for 1 thing and comes with the heavy cost of crippling debt. Deciding you don't really like medicine in your 3rd year of med school is incredibly costly and practically unfeasible for most people going through school.