Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Medical Education

Episode Date: March 17, 2015

This week on Sawbones, Dr. Sydnee and Justin explain why Sydnee gets to call herself and Justin doesn't. Music: "Medicines" by The Taxpayers (http://thetaxpayers.net)

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, two, three, four. We came across a pharmacy with a toy and that's lost it out. We pushed on through the broken glass and had ourselves a look around.

The medicines, the medicines, the escalators, my cop, for the mouth. Hello everybody and welcome to Saul Bones, a rental tour of Miss Guy and Medicine. I'm your co-host Justin McAroy. And I'm Sydney McAroy. The bids are back. We heard you loud in Clear America and you do want us to do bids at the beginning of our podcast. Even if we don't necessarily feel like doing one that that week. It turns out that you guys love Uncle jokes. Yes, Uncle jokes, as the teen Titans would say, Uncle jokes. You know, like they're not very good. They're kind of like puns and weird, I don't know, back doors and phrasing.

I don't know. They're not necessarily funny, but for some reason you guys love them. So. Yeah, and everybody when we said we're gonna get rid of bits, everybody said, no, wait, please, I love the bits. In fact, hearing from all the listeners has been quite an education about how much everybody out there loves bits, the beginning bits.

That's very true, Justin. And speaking of education. That was the bit. That was the whole bit. You guys should have sent us a script for this one. I do love the scripts. You guys sent us by the way. We got some little scripts for bits. If we can use those, believe me, we will. We're lazy. We're just that lazy. So speaking of education, yes, it. You know, some of our listeners have asked that we talk about medical education. Yeah, you know, it's interesting.

It's so regimented now. I mean, it's very well documented what you need to do to be a doctor, but I'm assuming that that is a goal post that's been shifting throughout the years. Well, absolutely. I mean, it makes sense that you'd want a certain set of standards that you'd hold all people to to like be like so you'd know what you were getting So it wasn't just a role of the dice, but it was obviously not always that way So first of all, thanks Carson for suggesting this topic

Carson And so as you can imagine throughout history as long as there've been people who have been practicing medicine And I mean you got I got to imagine that it kind of started in an earnest, like the first person who was like, hey, I've got a leaf for that. That thing, that I see that cut on your leg there. I have this one leaf over at my house. I could use it on you. Yeah, that's probably how medicine started.

What's your point? I mean, what I'm just saying, like there probably wasn't like a, you know, a doctor. Well, it's a, yeah, it's very, there's just a guy who like knew some stuff about some leaves or like something and. Yeah, it's a very, it's very chicken in the egg question. Who, who, talk the first,

now who taught the first doctor to be a doctor? Nobody. Think about it. Somebody. It's mind blowing. Somebody just learned and then somebody was like, I'm gonna start telling other people how to do this. I am wrong about it. Somebody. Mine blowing. Somebody just learned. And then somebody was like, I'm going to start telling other people how to do this. I am wrong about everything.

This is the next thing they said. So strap in, it's going to be a rough millennium. Throughout most of ancient history, when we're talking about medical education, we're really just talking about apprenticeships. Which is pretty standard. I think probably anything, any trade you were learning, that was how you learned it.

Through, right. And you probably didn't need from a diploma from a school per se, it was probably more, I learned from this person who learned from this person, bigat, bigat, bigat, kind of deal. Exactly. And there wouldn't have been schools initially. So, this would have been-

What would there have been initially? No, just like guys who, and I say guys because for most of history, they were guys. Right. Guys who were doctors, and if you were lucky enough to be their son, then they would probably teach you how to be a doctor. And if you didn't have a dad who was a doctor, then you would have to go ask somebody who was a doctor, hey, can I basically spend my life learning from you? I mean, that's the thing. Like, a apprenticeship didn't have like a defined beginning and end.

You would just go find somebody who was a doctor and chill with them. Yep. Like until you hang going exactly until you felt like you knew enough to be out there on your own or until people trusted you enough, which probably involved you being older because they wouldn't trust a young kid. Your doctor got until you're teacher one. I got super drunk and said, listen, honestly, we're making it up and we have been for a thousand years.

I have no idea. Best of luck out there. I hope you invent Tylenol. That's what everyone said until a guy invent Tylenol. Yeah. Finally, we didn't even know what this was that we've been talking about. The Egyptians really did, they had like a system of medicine that they followed

and it was a little more regimented in that like, there were certain people who practiced what was like accepted as medicine, you know, at the time. And they probably taught it to each other, like there's some evidence just simply from, when we look at the titles that we have, like that we see were given to certain ancient Egyptian people, like there were chiefs of medicine,

people who were referenced as, you know, translated to the chief of medicine. So certainly they were like in charge of some group of doctors, so maybe they taught people. There was also somebody called the Lady Overseer of Lady Physicians, which indicates a couple of interesting things, one that she was probably teaching other lady physicians, which indicates a couple of interesting things, one that she was probably teaching other lady physicians and two that she was a lady, by the way.

So there were female physicians. Oh, that's interesting. There were also like the physicians who oversaw butchers, which I think is interesting. There was also the one with like the monitor of liquids, something like that. I don't know what that was a doctor. I got that. That's a pharmacist, right? Maybe. Maybe. Maybe. Or maybe the maybe it was like a urologist. Maybe. Oh, well, yeah, that's possible. They even had like a name for proctology. They don't just decide, just decide not to found this for Proctologists. And it translated to like shepherd of the anus. It's...

It's... I don't even have a joke there. I think that's enough. It writes itself, yeah. The ancient Greeks primarily practiced apprenticeship as well, although they did start to institute some medical schools. But I think it's important to remember that,

you know, from the Greek view of education, everybody, like if you were going to be well educated, you studied everything. You studied science, you studied medicine, you studied philosophy and art and everything. Look, there are educations for everybody. Exactly. So there were probably a lot of people who were doctors as well as a lot of other things. But the, the main thing was that you had an apprenticeship if you were actually gonna be a physician because the books and the lectures in school were kinda like, well, if you can do that, that's great,

but mainly just hang out with a doctor. And of course, from the Greeks, we get the Hippocratic oath. So they actually get, you know, Hippocrates laying down some rules for what a doctor should take. That's the, uh, that's the do-no harm cat, right? You know what's interesting is that nowhere in the Hippocratic Oat, that we actually say first do-no harm. Really?

No, it's kind of like it's insinuated or I'm, yeah. Applied? Yeah. Yeah, same thing. Yeah, yeah, same thing. Uh, but it's not, but thing. Yeah. Yeah. Yeah. But it's not actually said. And I found the original Hippocratic oath because I thought, oh, I should include the Hippocratic

oath because I said that. Right. Remember when I was my wife, because I remember you took it. Yeah. I took the Hippocratic oath, except for what I realized is I took something that was based on the Hippocratic oath, but isn't the actual Hippocratic oath. Is it just falling out of fashion or? Well, let me give you some examples.

Okay. So it starts off, the actual Hippocraticoth starts off, I swear by Apollo the Physician and Esclapius the Surgeon, likewise Hygia and Panacea, and all the gods and goddesses to witness. So I didn't say any of that. It would be a weird start. That would be a weird start. That would be a weird.

Yeah, that would get a little like stone cutters, I think. For me, I would be looking for helpless lambs to be led on the stage. I don't think I swore by Apollo. I'm fairly certain I didn't. I would have remembered you swearing to Apollo. I'm certain you didn't. Now, in the, the next part really highlights the the fact that they they did value educating people in medicine, like actually learning how to be a doctor before just saying like, hey, I think I'm a doctor now because I love bleeding people. So the next part, I will

reverence my master who taught me the art. Yeah, I bet you should point that out to your students. Let's know. Yeah, especially it goes on equally with my parents, will I allow him things necessary for his support? In other words, I'll give him money if he needs it. And we'll consider his son's as brothers. Wow.

So this is like a serious relationship. Yeah. It ties you very tightly to your, to your, we, they say my master, but it's to the person who's teaching you medicine. As he goes on, there's some good stuff like with regard to healing the sick, I will devise in order for them the best diet. Good, that's important. And I will take care that they suffer no harder damage.

I think that's where we probably first do no harm. That's where that probably comes from. There's some interesting things that I found in the original one that I don't remember saying in our oath, I will give no sort of medicine to any pregnant woman with a view to destroy the child. Whoa.

So basically no, I mean, you take an oath to not, I mean, in the original oath, of course, that I guess it means to not perform abortions? I think that you could interpret that from the original oath, of course, that I guess it means to not perform abortions. I think that you could interpret that from the original oath. Wow. There's also, it says, no, no shall any man's in treaty prevail upon me to administer poison to anyone, neither will I counsel any man to do so. And so that's come into context.

Like, is it then what about for physician assisted suicide? Is that a problem? Yeah, but at the same time, this is the same document that summing down Apollo and everybody at the beginning of it. So maybe exactly. And let's call a living document. Well, and I mean, it says, I will comport myself and use my knowledge in a godly manner next.

So that's a little, well, I mean, and how many doctors do you know who are like, yeah, I of course, I act in a godly manner. Not that doctor, I ask. As for sure, I got a real stick in the mud. And I mean, I should point out, this is not a legally binding document. Like you can't lose your license for violating the Hippocratic oath.

Right, right, right. There's kind of a nice sentiment. More of a ceremonial type deal. I like this, I will not cut for the stone, but we'll commit that affair entirely to the surgeons. What's that mean? So, cut for the stone would have meant at the time to actually cut someone open to remove a kidney or a bladder stone. Oh, wow.

That was something that was done. But this was a... And this kind of... You see this throughout medical history. There was a differentiation between surgeons and physicians. So, surgeons would cut people open. And in general, throughout different parts of history, you didn't have to have as much rigorous training to be a surgeon as you did to be a medical physician. Now that's obviously not true now. But then there's some nice stuff. Whatever house I may enter, my visit shall be for the convenience and advantage of the patient. I'll refrain from doing any injury from acts of an amorous nature. You know what that means?

Get that, do you hear that? Hawkeye Pierce? Mm-hmm. Get that libido in line. Watch yourself. Whatever I may see or hear in the course of my practice, I will not repeat it. Okay.

There's HIPAA. That's HIPAA right there. Yeah, that's HIPAA all the way back then. And if I faithfully... HIPAA short for HIPAA. No. No. Okay. No. It's the health, it's an act. Something. It's a... Yeah, HIPAA. Protection, privilege, I don't know, information, health information. Anyway, look it up. I don't know. Don't run your mouth about people. That's it for doctors. Yeah, don't talk about people. That's it. That's a whole bit. If I faithfully observe this oath, may I thrive and prosper in my fortune and profession

and live in the estimation of posterity or on breach thereof, may the reverse be my fate. The deck done. Explanation point. Whoa. Yes. That's punchy. I like that. Yeah. So I took something to that effect. Something like that. Not that exactly. Many students would learn the first dissection from their father, because a lot of these doctors were learning from their dads who were doctors. And they would learn it when they were little kids. So a lot of people started doing disactions pretty young. This tradition continued into Roman times.

And that's when we first really start to see people writing things down and illustrating what they see, especially like from dissections. We see Galen drawing pictures of the inside of the human body, so you can start kind of creating an anatomical text. And you see more medical schools based on these teachings that people are now, finally kind of...

Something encouraging, more... Like a regimented shared knowledge, more just due to, to, to do. Exactly. But that, this didn't always result in like practical application. There was a lot of thinking about medicine and writing about it. But again, these, these people were still in this kind of Greek view of education that like at the same time they're thinking and writing about like philosophy. So even people who are really well versed in medicine

might not necessarily make a career out of it. When we go to like medieval times, as you can imagine, there weren't a ton of medical schools or people who were seeking higher education because we kind of like, things got a little weird for a while. We forgot everything we knew. We forgot everything and tried to kill everybody. Yeah. All the time.

There was a great medical school that was established in Solerno and in Southern Italy. And you read about this. Any time you want to read about the history of medical education, you're going to read about this med school. And it was supposedly started by representatives from the, there were four different medical traditions that were kind of respected and practiced at the time. We've kind of talked about the Greek and the Latin traditions, but there was also the Arabic tradition of medicine and the Jewish tradition of medicine. And they had masters from the four different traditions come together and form the school. And students would come from all over the old world to study there. And they dissected animals.

I don't think they did a lot of actual cadavera dissection, but they dissected animals, like biology class. I don't know that that would help you. No. But they actually did study texts. And then after men completed their studies. And there is, I should say men, there

is evidence that maybe some women attended. Snuck in. Possibly. Did that Shakespearean love tape down and just went for it? The Shakespearean love tape down. As I call it. That's what it's called.

But mainly men, and then they went and established schools elsewhere after they had completed their training and went back home. Now, just on a side note, the system of medicine that is being taught in all these schools at this time is the humor, the four humors that we talked about in a previous episode. So, yes, we're teaching things in a regimented fashion. I don't know if that's a good thing or a bad thing. We're teaching something. We are teaching, which is maybe better than nothing, but even that in itself is arguable.

Yeah, I mean, we spread these bad ideas all over the place. And the main treatments that we were telling people, if you remember from the Four Humors, there were some like herbal treatments, but there was also like diet and exercise, which I mean that's fine. But then there was also because of the time period we're talking about, there was a lot of spiritual teaching as well. So like prayer and sacrifice is to certain saints and stuff that was also being taught. When we get to the Renaissance, that's when we really start to see

a lot of different medical school spreading all over Europe, especially in Italy, I think we've already kind of established this tradition, but then all over. When you go to places like Oxford and Cambridge are around by now, they're teaching something called physics, which is sort of like the about the human body and medicine, but there's no, there's not a lot of like practical application going on there. So you're reading and talking about stuff, but people aren't actually like Seeing patients are following doctors around in a lot of these places They're just kind of learning yeah just kind of hearing about it

A lot of students would travel to Italy to get more practical training There's a lot of talk about theory of disease But it it isn't really until we get to the 17th century that people are going to start going to hospitals to train and actually see sick people And this but this is an important time period because this is when we stopped For a long time we had all these great pictures and and writings by Hippocrates and Galen and all these really smart Greek and Roman dudes and everybody from the past and We kind of just said well, you know what whatever they figured out hundreds of years ago is probably still right. So, let's just...

This guy's already nailed it. Let's just read about it and memorize it, but let's not actually try to figure anything out. And in the Renaissance, we actually see the beginnings of like critical thinking and the scientific method and people going, you know, maybe we should question some of these ideas. Maybe we should try things out on our own and see if we can get better results. Because nothing we do seems to like really have an impact on anything. Like everybody's still dying. All the time.

So maybe if we have like a pill, I just admit it's a word pill. Just like that. That's my contribution what you guys got. This led to a lot more dissections and new drawings and diagrams and a better understanding of human body. And it's weird if you look at drawings of the, like anatomical drawings from the time

they're all in like weird poses. Like in my anatomy textbook, it was just like a body laying there and like here's their dissected a hand or whatever. But like if you look at some of these Dissections and the drawings of them from the Renaissance, they're like all Like dramatically pose like their arms up in the air, you know, like sprawled over a chair or something Like that body's exhibit we went to yeah, yeah, I don't know why I'm not entirely sure why that was the fashion

Thanks better picture. I guess just looks cool. Yeah I'm not entirely sure why that was the fashion, but it's better picture. I guess just looks cool. Yeah After the 1600s, there were there were more well-respect of medical schools all over Europe So that was great So all of a sudden, you know people are learning this is a time where we're like Testing things and we're learning new things and we're taking the ideas of the Greeks and the Romans and we're really Investigating them and seeing what works and what doesn't but of the Greeks and the Romans, and we're really investigating them and seeing what works and what doesn't. But again, we're still dealing with general medical knowledge, and we're not. A lot of the hospitals aren't letting people have, like, the students have a lot of contact

with patients. In London, for instance, you actually could learn a lot more if you went to some private doctors' houses. I mean, I would say like medical schools, but they really weren't medical schools. They were just physicians who had learned a lot and understood a lot and knew that the education that students were getting in hospitals wasn't the best.

So they were like, just come to my house and, I don't know if you paid money or not. I think you did. I think you had to pay money and you could attend these lectures and learn a heck of a lot more from those people. So you could just go to a dude's house and listen to these lectures. And if you wanted to be a surgeon, going to these lectures and then sitting for an exam afterwards was usually enough to be like you would you would pass the exam and you'd be a

surgeon and that would be it. It was a lot harder to be a physician. And again, I'm not saying that, like I'm not needling surgeons at the time there was a distinction. And I believe, and I think I've said this before, I believe in the UK, they still refer to surgeons as sir as opposed to doctor, like mister, you know, or misses, or miss. I don't believe anybody out. But like I said, it was harder to be a physician. There was more certification. You had to go to university, you had to actually get a degree

if you wanted to be a physician. It was also really hard though to get cadavers at this time. So we're still not doing a lot of dissection at this period. Remember, we've kind of talked about this before. It was like, for a while, you could just do whatever you wanted and then they were like, no, let's stop cutting up cadavers. This is evil. It's weird. It's weirding everybody out.

And so since it is hard to become a doctor, you're seeing more and more like charlatans in this time period, like barber surgeons who don't really know what they're doing, who were like, yeah, I'm a doctor. See, I wrote it on the sign out front. That's a whole poll and everything. And we're seeing a lot of like,

we're entering into the patent medicine era where like everybody's a doctor, or at least they say they've got a doctor working for them. In the same way that they're also a Native American. Yeah, or whatever. They're, yeah, or from somewhere that's exotic that you don't know anything about, but definitely has a cure for whatever your problem is.

Sid, I want to hear about what's going on in the US now, more modern times, but I don I want to hear about what's going on in the US now in more modern times. I don't want to take a quick break if you don't mind. And I talk about the Max Fun Drive. That is happening this week and next. We're part of the Max Fun Network here on Sobans. What that means is we're part of a local network of podcasts. This is not local network, they're kind of all over earth,

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If you're gonna bankrupt those guys. Let's bankrupt those guys. Go to MaximumFund.org for a slash donate, write this second. Sydney, let's bring it over to the Americas and a little bit more modern time. So let's talk about the US. So of course initially, people who were doctors in the New World were basically traveling back to Europe studying at the schools there and then coming back over here and practicing

medicine. Eventually, some guys got the idea and I believe they started in Philadelphia. Hey, why don't we actually start teaching medicine here? Because that's like a long trip. It's like on a boat. Yeah, we can't we can't fly it. I don't make it back because C-Serbants were still very active in the time period. So, so why don't we start teaching medicine in the US and of course they did, but as soon as university-based schools popped up, a lot of other schools popped up that had nothing to do with universities and maybe nothing to do with medicine. But they were really good at making money. And for a while, that was how a med school was judged,

how good they were at making money. They were also a lot of- That's how I dodge everybody and every entity. There were also a lot of doctors who just declared themselves doctors after various lengths of apprenticeship with who knows who, for how long doing what, but just called themselves doctors. So, eventually we had formal licensing and board certification in the late 1800s and the early 1900s. This became a thing.

So that when somebody told you they were a doctor, they were held to certain standards and they actually had to go to medical school. And then we started holding our medical schools to certain standards so that, you know, you couldn't, you couldn't charge somebody to teach them how to be a doctor if you didn't actually know how to be a doctor yourself. The hard part after this was just getting hospitals to, to kind of jump on board. There were the schools, they were associated with the universities, the the didactic education, the lectures and what not was good, but we needed to send students into hospital so they could actually see patients. And a lot of the hospitals were like, you know, we're really, no, we don't want that.

That's so interesting. So there was like a disconnect between, I wonder if that was a generational thing, like they grew up without fancy medical schools. What do they need a student run around biting their heels for? Well, and I don't know if it was also just, we are charging our patients a lot of money and we don't, like we want them to have a good experience so they'll keep coming back and we don't want a student in the room.

I don't know if that was part of the problem. But anyway, so they were offered a lot of money to partner with schools. A lot of them said no, even after being offered money, there were even actually separate entrances for med students in some hospitals. Yeah, so you wouldn't know they had them. But eventually, the hospitals that did accept students saw the benefit of, once you're an academic institution, you know, it's clear that you're on the cutting edge, you know,

with the biggest, newest thing is you do better, your hospital is better. And so then the new people coming up the ranks. Well, and you're associated with university, so you're doing research, and you're constantly on the, you know, on the brink of what's coming next. So, and there's a lot of money there too. So anyway, this idea started to change.

In 1927, the first residency was established, and that made all of our lives miserable forever. I shouldn't say that. It's a tough time. And since then we have a lot of changes. So we have medical school, we have residency, and obviously we all have to take certification exams and be licensed and whatnot.

Well, sit there, bring us into something else I'd like to talk about. Can you tell them, I want to talk a little bit about just sort of your, I think, using your career as sort of like a case study for how this goes because it's an interesting process that when you and I were going through it, I had no idea how a regular Joe college becomes a physician. So maybe we could walk through

just like a brief chronology of how you got to be a doctor. Sure. And I think this will be interesting too for anybody who doesn't live in the US because I think we have a different system in a lot of different places. Right, we should mention this is just for hearing the Americas. So you had, what did you major in college?

So I majored in biology and college. You don't actually have to major in a science to go to medical school. There are just certain core science classes that you have to take in order to go to medical, to sit for- Just to have a basis of- Yeah, just to go to to tip for. Just to have like a basis of. Yeah, just to go to medical school.

They look for certain chemistry and biology classes and physics classes that you took and then you have to take the MCAT exam, which is the big. What's that? The MCAT. What is that? I mean, not what it stands for. That doesn't matter. It's like, what is it?

It's like, it's sort of like the ACT or SAT, but for med school. Okay. Same idea. The but for med school. Okay. Same idea. The M's probably medicine. Yeah. That's that much for me, sure. I don't know what anything. The T is probably test.

The A is probably aptitude. Sir, no. Aptitude, yeah. Okay, somewhere in there there's a C. Just trust us on this one. The thing is, it's a really hard test that you take to get in a medical school. What is dance for is not one of the questions. I did really well on it. I just don't know what it stands for. So I chose major in biology because I like that and minored in chemistry by default because I had to take so many chemistry classes to go to med school. And once

you so you go to college, you take the right courses, you apply to medical school, you have to take the MCAT and there's no like certain score you have to get to get into med school. It just increases your chances if you do better on the MCAT and you have good grades and then good, you know, all the other stuff, just like getting into college, except I would say probably harder. Then you go to medical school, which is four years. Go ahead.

Yeah, what's the, the, in the first year of the law, I remember your first year really clearly because there was a lot of you locking yourself in a room and just like hard core memorizing a lot of stuff. That's really the first two years. The first two years of most medical schools are very much lectures and didactic sessions. We do our anatomy training then, so that's when we actually do cadaver lab and do all of our dissecting and kind of learn the human body firsthand. And there's tons of memorization.

It's like learning a new language at first, because you have to, I mean, you know, it's interesting. I always used to think about that when I would take an anatomy test, like all the answers are right here inside me. Literally. I just popped myself up before P-Grew. I don't know what they're called. But the first two years are really intense,

and if you know any medical students, you'll know that you just spend hours and hours studying the first couple of years. And there's a lot of like 3am studies sessions, I remember. Oh yeah. And at the end of your first two years, you take step one of your board examinations, which alludes to the fact that there are multiple steps. And that's probably the hardest test.

I say the MCAT's really hard. That's probably the hardest test I've ever taken. And it's everything you learned in your first two years of med school in one big test. And you have to pass it to move on. And it dictates where you're going to go for residency later, like how well you did, what you're eligible for. So then you actually get to start doing fun stuff. So your third year is usually largely clerkships, meaning that you rotate through...

That sounds fun. Clerkships? Clerkships. It is fun. You rotate through the different medical specialties and you work first hand with patients and doctors and residents and you actually get to go do stuff. And that's great. And that's when you know-

And you get to all the different departments, right? Yes. So for me, it was really helpful because I went into medical school thinking I was going to be an infectious disease specialist. And after I did all my clerkships, I realized that I kind of wanted to broaden what I was interested in and go into family medicine because I liked everything I did. And that's what they always tell you. If you do all of your clerkships and you love everything, you should probably do family medicine because that's a good swath of everything you can do

in medicine. A lot of variety. Yeah. And you can tailor it to what you like to do as well. So then your fourth year of medical school, you can spend time for one, there's a lot of time to go interview places because you're about to do your residency. But then you can take some extra like clerkship type classes in what you are interested in and you can do what we call sub internships in those areas where you go and you really work like a resident, even though you're not a resident, and you're in your supervise, of course, but you can kind of get a taste for what you're going to be going into.

And then there's a lot of time to do fun, extra stuff. I got to do a really cool health department rotation. And that sounds cool. Yeah, sounds cool. Going about vaccines. I got to go and inspect restaurants. It was awesome. Hey, talk about the match for a second, because that's a really really bizarre concept. I think to a lot of people who don't know.

So during your fourth year, you're interviewing at programs, residency programs in the specialty that you're choosing. So for me, that was family medicine. Once you've interviewed at all the places that you wanted to interview at and that would see you, you know, you apply for an interview and they say yes or no. So once you're done with that, you're going to make a list of all the programs that you like in the order that you like them. The top one being the one you want to end up at. At the same time, every program in the country is making a list of all the people they interviewed. With the students they want the most at the top of the list and the least at the bottom of the list. Both of these lists are closely guarded secrets.

Exactly. And there's a lot of rules about what you can ask and what you can't ask on these interviews. And you never can ask a student like where where are you ranking our program? And you know that kind of thing. It's all very hush. But then they they take all these lists and they put them into a big algorithm. And then on match day, which actually is coming up at the end of this week, you get a letter that tells you where you're going to spend the next three to five years of your life. It's wild. Yeah. And hopefully it's the place you chose, but not necessarily.

And depending on what you want to go into, it's more competitive. You may not even get into the specialty you want to do a residency in. And some people don't match anywhere. What do they do? Yeah. So if you, let's say that you, especially if you wanted to go into something really competitive, like maybe dermatology, that's a really competitive residency.

If you don't match one of the spots, meaning they're all full and you didn't get one, then there's a process, a week long process called, again, with the abbreviations, everything in Madison is called soap. It used to be called scramble, we don't call it that anymore. But it's when you have to, you have to,

yes, it does. It does. Soap stands for, it's like a secondary open, something, application, something, secondary open application period, I don't know, something. Anyway, so where you go apply to every program that didn't fill and every student that didn't get to a program

gets to kind of, you try to meet and greet and match and secondary match basically. Yeah, well gone to match.com and their likes and dislikes, favorite films, albums, food. And then like I said, everybody finds out where they're going and that's where you spend depending on what you go into the next, like I said, three to five years of your life. For me, it was three years because I did family medicine. And so my, you know, and when we talk about interns, everybody wants to know what this is, what is an intern? Intern is just- It's just confusing because they use it differently.

Yeah, intern is the word we use for a first-year resident. So it's the same thing. And intern is a resident. It's just their first year they're an intern and then after that, they're just called a resident. And a resident is an actual doctor, but they're sort of maybe a probationary doctor. Is that accurate? Well, sort of. You're a doctor once you finish medical school. After you finish medical school, you get an MD or a DO and you're a doctor. That's it.

They can't take that away from you. But at that point, if you want to be board certified and a specialty, you have to complete a residency. And nowadays, it's much more important. You used to be able to just finish medical school, do a year of internship and anything and be a general practitioner. And while you can do that, more and more, that's not what hospitals and different places that are going to hire you are looking for.

They want you to be board certified and something. So after your first year, your intern year is over. And I should mention in your four year med school, you take step two of the exams, the board exams, and in your first year of internship, you take step three. Right. You finish your residency. Like I said, it could be up to five years like for surgery. Residency is when they have also, specifically in the intern year, when they have their really crazy hours, right,

you would work like the 40 hour hours, right? You would work like 40 hours shifts, right? I would never say that like for public knowledge. I thought that was like, I was never allowed. I mean, I was only allowed to work 30 hours. Well, okay. So I've never violated work hours. Maybe I should remember it. Maybe I should remember it.

I'd probably just remembered it wrong. The work hours, you're not allowed to work more than 80 hours a week. And well, and actually this is different now. Work hours are more strict than they were when I came through, but 30 hours. Actually, never let the students forget that, dude. Uh-huh. I tell them that all the time.

They used to be harder, you know. Now you only have work 16 hours, you know, you used to be 30. But yeah, so when somebody's in residency, they're just like, that's their whole life. That's all you do. Yeah, right. You live and breathe and eat and sleep and it would rarely sleep at the hospital. Sydney, one time got off of a shift and went straight to a play that her little sister Riley was doing.

And one of the scenes, the little skits they did, where they had signs that they had written on about what kind of person they were or something, and sitting literally started crying. And I was like, look, they're like, what are you doing? It's just beautiful, it's so beautiful. Okay, it's time to go. I was on my surgery rotation,

and I was pulling every other night call shifts. It was a hard time. It's time to go. I was on my surgery rotation and I was pulling every other night call shifts. It was a hard time. It's rough. Yeah. So anyway, you survive your residency. You work 80-hour weeks. You're exhausted. And at the end, you sit for, well, you're done with your residency.

So now you're, well, you've already been a doctor. But as long as you pass your board exam in that specialty, so for me, it was family medicine boards, then you are a board certified whatever doctor, me, a family doctor. And you have to go get a job. And then you gotta get a job. Ta-da. And then you gotta pay back your student loans.

Ta-da. Sorry about that. Thanks folks for listening to our special Max Fun Drive episode. One or mind you again, that address is maximumfun.org. Ford slash donate. Let me know you listen to solbones and yeah, speaking of student loans, I've still got a lot to pay back. Help us out here. Help me out.

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