Thread by @arghavan_salles

It’s been almost 2 years since I left my academic surgery job. In this time, I’ve become acutely aware of how much we have to PAY ($$) to build an academic career. I stopped submitting abstracts to meetings because I had no money to pay for going to them. When students…

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…asked to submit abstracts based on our work, it was heartbreaking to tell them that I couldn’t pay for them to go but that maybe we could try to find another way. (I made so little myself I couldn’t pay for them out of pocket).

When I got asked to give talks...

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...I could only do it if they were paying me. Of course, most societies don’t pay their own members to give talks, even when they’re invited opportunities. This is what I mean about paying, and many of you know this. You have to pay an annual membership fee...

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...for each society, hundreds of $ each. You have to register for the meeting, again hundreds of dollars. Of course, pre-COVID (and probably again in the coming year) you had to fly and stay in a hotel as well.

At the time I left, I was a member of 7 surgical societies.

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All those fees quickly add up. I was a committee member in almost all of them and chaired committees in two. The first year, I was able to get some reimbursement for membership fees and meeting travel through my generous supervisor.

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But after that, I was unemployed (more on that in another thread--I know many of you didn’t know that). And societies were asking me to support their fundraising efforts in addition to these astronomical fees. Mind you, none of these societies was there for me when…

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I had to leave a toxic situation and needed help. Not a single one. I stopped paying membership fees. And I’ve basically faded into the background in most of these societies (like this Homer gif).

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I’m sharing all this because being in this position has highlighted for me how perverse this system is. If you have money, you can sort of buy your way to promotion. Pay for membership, become committee chair, get invited to give talks, and voilà, you have a national reputation.

Of course, you also have to do work along the way. It’s not just the money that counts. But without the money, it doesn’t matter how brilliant you are or how much work you do. If you can’t pay for these things, you’re done.

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And honestly it’s been amazing how few people have asked why I stopped going to these meetings and why I stopped doing work I was previously quite engaged with. But that's ok--when people show you who they are, you believe them. But I digress.

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Medicine is all about money. To get in, you have to have money. To stay in, you have to have money. As someone with very little financial resources to begin with, I was only able to apply to medical school because my then-boyfriend’s father got me plane tickets with his miles.

If not for that, I would have been screened out. And maybe that would have been fine, because I’ve basically been screened out now anyway and I could have saved myself a lot of heartache in the interim. Anyway the point is if we want to make medicine a career that’s...

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...possible for EVERYONE, yes, we have to change med school admissions. AND we have to change the whole f*cking system—residency interviews, fellowship interviews, and what it takes to “succeed” once you’ve completed training.

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Maybe one day the profession will be ready for that change. Until then, many of us who see things differently and have new ideas will keep getting pushed out when we can’t pay to play. And the machine marches on without us.

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PS I haven't given up completely, as you've seen with my new job which, to be perfectly clear, is not a clinical position. So I'm not totally out of the game yet, but I've been pretty darn close.

cc @drjessigold @DrPoorman @PoojaLakshmin @DrHowardLiu @TsengJennifer @FutureDocs @jack_turban @ChaseTMAnderson @EileenBarrettNM @ShikhaJainMD @LindaNguyenMD @DrAyanaJordan @RoxanaDaneshjou

This person repeatedly harasses me rather than unfollowing or muting. My salary was <$100k. If anyone can afford to rent a place in Silicon Valley & send yourself & your students to meetings on that, I’m open to learning how!