Drunken rants about pediatric sports medicine

With my heart beating slowly but loudly, and my prickly underarm hair gathering sweat like dewdrops, I face my first day of residency. I didn’t know where I was going in the morning and of course ran in 5 minutes later than I meant to because I cannot plan my mornings well. My attending came in 10 minutes after our first patient’s appointment, already behind schedule for a day of 35 patients. Great.

I don’t want to write about this. I want to write about how much I don’t like the experience of moving to a new city just for training for my career, in a city I didn’t really get to choose, and be sent to do work that nobody needs me to do, and to just sit here in my free time alone in the fucking 110 degree heat waiting for something exciting to happen.

I just spent a week as an intern in a non-surgical sports medicine rotation and it was so boring that it made me wonder WHY I ever quit my old job that was just as boring but paid me 35k more per year. I am not helping people. I am not adding value. I am not doing anything but making sure the fingertips aren’t blue, but of course they aren’t because if they were the patient would already have marched themselves back to the emergency department. Whatever. I hated almost every second of my week on sports medicine.

I think this whole specialty could be moved outside of the scope of a physician. Give it to NPs. Shit, give it to chiropractors and naturopaths. You know what they would LOVE? Bracing and casting and describing the healing process as the piezoelectric effect (which is real but is not what’s responsible for bone healing). X ray, cast, cut off cast, send to PT. It. Does. Not. Take. That. Many. Years. Of. Training. To. Do. This.

Let me paint a picture of the life of an attending physician in sports medicine. Pediatric sports medicine is a non-surgical orthopedics clinic which deals mostly with fractures, sprains, joint pain. The attending gets to show up 10 minutes after the patient arrives and give zero shits about his or her schedule because it’s double-booked and there will be no-shows, and who really cares? Most patients already saw a real doctor at the ER the day they broke their arm, where they got x-rays and a splint. The patient comes to see you three days later. But guess fucking what! You can’t put a cast on a fracture until 10-14 days after the injury because the swelling has to go all the way down otherwise the cast won’t work right. Also, some fractures won’t even show up until about 10 days after the injury so in the ER they sometimes don’t even know if it’s broken but splint it anyway.

So the patient shows up in a splint 3 days after they broke something, with or without xray evidence, and the sports med attending gets to make sure their fingers aren’t blue and then tell them, “okay come back in a week for a cast.” Can you imagine how much parents hate that? You mean to say they took PTO to take their kid to the doctor and then be told they didn’t really have to come in for another week? All the attending does at that point is make sure the kid’s fingers and toes aren’t blue and numb. It does not take anything more than common sense to know that would be bad.

Aight, a kid comes back 10 days after a fracture. what do we do now? Well, you can repeat x-ray if for some reason you aren’t sure if it’s broken you idiot. Then after that you make sure their fingers aren’t blue and numb. Easy peasy, moron. Then you tell the cast techs to put a cast on it, and you go sit down at your computer and tell your scribe to write a note and your MA to order a follow up visit to take it off.

So in a day, the sports medicine attending sees patients who already have a definitive diagnosis, do not do anything at all for the first visit (except bill), tell someone else to put a cast on their arm at the second visit (and bill), and then (I skipped this part) look at the limb after the cast is off and determine that the fingers and toes are not blue and then send them to physical therapy. They hire a scribe to write their notes. And when they have a dumb resident (me), they don’t have to even spend more than 1 minute in the room with each patient. At worst, the hours are 8-4:30 and sometimes the schedule is pretty empty so there’s breaks during the day.

Now, you may be asking what a pediatric sports medicine doctor gets paid. I know you were. I am too. I just googled it for a while and I cannot easily find that information but it looks like around $280k? Pretty fucking nice for that kind of job.

The attending has to get a bachelors (4 yrs losing money), MD or DO doctoral degree (4 yrs losing money), pediatrics residency (3 yrs making just over the national average salary in the US), and sports medicine fellowship (3 yrs making approx 100k per year). Mind you, the monthly payment for student loans throughout residency and fellowship is about $3000. So subtract 36,000 from those salaries: it ain’t glamorous getting there.

This blog marks the first of my new series: Dr. Ford gets drunk and rants about what she hates about her job. Welcome. Up next: child abuse medicine. Can’t wait.

-computer based training

-sleeping 8-9 hours a night and still feeling tired

-not making friends because i’m isolated

-fear that this is going to be just as unfulfilling as my last

-what if the only thing I like is being in school, because I am always so ready to graduate and be done with school, but then I get to have a job and