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I'm wondering how much time is spent with 80 hrs/week vs easier weeks. Can you tell approximately what part of your residency training you spend 80 hrs/week in hospital? and how much time you spend in some of the "easy" rotations
I'm wondering how much time is spent with 80 hrs/week vs easier weeks. Can you tell approximately what part of your residency training you spend 80 hrs/week in hospital? and how much time you spend in some of the "easy" rotations
But if it's in 80 hr/week for 5 years, that's pretty much ignoring your spouse and kids for 5 years straight. No matter how hard one tries, schedule like that would have a negative effect on a relationship with them.
I don't understand why asking questions about life in residency such a touchy subject for surgeons. Wouldn't you want med students to know what it takes to get through? Or the field of surgery is OK with the current attrition rate?
In any case, everyone would benefit if such things like number of hours spent in training are discussed. You wouldn't have people (possibly someone not-fully informed like me) who drop out of surgical residencies. However, I do have a lot of respect for those in surgery.
In his book, Outliers, Malcolm Gladwell demonstrates how it takes about 10,000 hrs of practice to become a master at something (whether it's a musical instrument, the stock market, writing, etc). Let's assume you average as a resident 8 hours of OR at least 3x/wk 52 weeks/yr for 5 years--you'll graduate with 6240 hrs in the OR. That's not considering a year of internship so you're really talking 4992 hrs of ENT surgery. That's less than 1/2 of what it takes to get to master something. Consider that those hours are divided over a number of different cases.
From personal experience, if my family is happy, I'm happy; if I'm happy, my patients will be happy.
I am glad you acknowledged the fact we hardly operate as interns.
(only logged 130 cases this year, starting to get stir crazy)
To the OP, the further you go along in training, the more you realize the sheer amount of things you should (and should want to) learn. As you start to stare down the barrel of the gun called independent practice, you start to feel that a 5 year residency, 80 hour weeks, and a couple thousand surgeries no way in hell adequately prepares you for being on your own practicing medicine or performing surgery. It can, but its not given to you. Personally I have petitioned the cosmos multiple times to slow the earth's rotation and add another dozen hours to the day, so I could use those hours to read more and practice more. But so far they haven't cooperated.
The gist is- ENT is a surgical residency. Surgical residencies are a unique beast where you're given a finite amount of time to master both medical management and surgical technique. There's a certain mentality, almost an aggressiveness, about seeking out experience that's required to maximize a surgical residency. The number of hours spent performing clinical duties is important, but so is the time outside the hospital spent reading and practicing. Is time with family important? Absolutely. Being a good spouse and parent is one of the few noble things left in this world. And I know residents who are both excellent surgery residents and excellent family persons (yes, they are. their children recognize them when they get home and for all intents and purposes appear to be normally developing children, but I am a poor judge of character). Not to say that it is easy, it isn't. I think what concerns the attendings on this forum when asking about hours is that it conveys an attitude of looking to do "just enough." Doing "just enough" in a surgical residency isn't going to cut it as far as preparing you to be an adequate surgeon.
And yes, if you add up the hours including clinic, OR, consults, didactics, reading for cases, studying for ABOto, prepping for weekly conferences, research, administrative chief stuff, etc I think around or over 80 hours a week for most weeks for all 5 years is safe to say (but hey, we get vacation!)
Btw, its possible to have a vibrant life outside the hospital and still work long hours. One of my favorite chiefs as a student once told me "The hours never get better, but you get better at the hours." I think that's very true. We have residents who have found the time to train for marathons/ironmen, write a (non-medical book), go on multiple-state bike rides, climb mountains, close down bars (a favorite of my program), etc. Time is precious, sure, but 80 hours isn't some magical threshold where life stops when you arent at work.
Resxn , although I completely agree with your last sentence, I also believe that we have responsibility to our families. From personal experience, if my family is happy, I'm happy; if I'm happy, my patients will be happy.
I'd like to add that I understand that there are plenty of months where you guys work 80 hrs/wk and I would do it too to learn the craft; however, I wanted to know what part of training residents spend 80/wk.
let's say if it was 1/2 time of residency in 80/wk format and 1/2 in 40 hr/wk, I really wouldn't mind that since I can spend sufficient time with family on on-and-off bases. But if it's in 80 hr/week for 5 years, that's pretty much ignoring your spouse and kids for 5 years straight. No matter how hard one tries, schedule like that would have a negative effect on a relationship with them.
I personally have no issue with medical students asking if ENT is an easier surgical specialty. I have no problem with them asking how many hard months are there, what are the easier rotations and what programs are "hard" so they can avoid them. Honestly, I think it allows me to know which students to avoid placing on our rank list, and allows me to adjust any LOR.
I've also commented to the students who ask these types of questions that when the time comes to seek out an OB for their partner or themselves - ensure that they seek out the one who met the minimal requirements for graduation, yet had plenty of time at home during their residency. I am sure that the experience of the OB has no relationship to obstetrical bad outcomes...
Should their child need ear surgery - it is important that the ENT have had plenty of time at home during their training - 80 hours per week is clearly far beyond what is needed to train a surgeon. Although current graduates have performed far less mastoidectomies than previous trainees, I am sure they can read about the surgery and be competent if hours were reduced even further. I mean - if the surgeons home life is good, the surgeon is happy and the patient is happy. Who cares about facial paralysis from mastoid/parotid surgery, vocal cord paralysis from thyroid surgery, etc. While it is well known that the best surgical outcomes come from the more experienced surgeons - I am sure patients will accept less than ideal outcomes if their surgeon has a happy home life.
If you have asked about how "hard" is ENT, if you have to work close to 80 hours during your training and disagree with any of the comments above, then, honestly, I think it would be best to pick another non-surgical career - unless, of course, you have a narcissistic, perhaps slightly psychopathic personality that desires personal satisfaction and gain at the expense and potential harm of others. If you want to become a safe, competent, compassionate surgeon who understands the time requirements to obtain this in 5 years - and is willing to work the hours required, then please apply to ENT. Until the AAO-HNS increases the length of residency to 6-7 years, I do not see how we can train competent surgeons with continually reduced hours. Quite honestly, there is talk to mandated any complex surgery to the realm of the sub specialists - which may be the direction the field may need to go.... Perhaps like the German model, where people are trained in basic ENT operations (basic FESS, PE tubes, tonsils, septum's etc) - and anything even mildly complex - tympanoplasties (much less mastoids), laryngology, and H&N, facial plastics, etc is referred on....
Do you guys have on-call days in the US? I mean staying in the hospital overnight after completing your daytime duties.
Or you just take night floats alternating between residents??
How are the hours?
I'd like to know, just for curiosity...
One of the tenants to which I hold dear is the following stated by one of my favorite leaders, "No other success can compensate for failure in the home."
Family is first. However, if your family cannot tolerate you maximizing your opportunity to learn a lifetime of care in 5 years, a surgical specialty may not be right for you and your family. I have posted on numerous occasions on this forum how hard it was on my wife and I during residency. However, we both recognized that I couldn't adequately do what I do now and do it as well as I do, without sacrificing family time for those 5 years. The time invested then now allows me to do something I love and do it well enough that I have time to spend with my family. 5 years of suffering for an hopefully lifelong career of family time. I make an income that allows me to take 2 half days off a week to be with family. Let me know how many PCP's do that. Also, while you're checking, see how many ENT's went through residency with a plan on getting a lifestyle simply doing the B&B cases and can make a reputation grand enough to gain the respect they need to garner the referrals they need to support the practice they desire to have the time off they want. I'm guessing that will be the exception, not the rule.
In my day, we spent most rotations at or above 80hrs. Our Children's rotation was busier than H&N and we often came close to 100 on the former, 90 or so on the latter. The VA rotation was lightweight and we hit 60 far more than 80.
I can't even imagine a rotation where you'd work 40 hrs/wk and have it be worth anything. I can't. I suppose there may be a few primary care rotations where it is possible, but I think my face would melt off if I ever heard of a surgical resident of any specialty having a 40hr work week at a respectable (read accredited) program.
While you may be correct that long hours has a negative effect on a relationship with family, so too does having a lifetime of working more than you had planned with less off time than you desire to make up for what you failed to invest in during residency. If there's serious risk to your family in the 5 years of a surgical residency, don't do it. However, I think despite all the trials and missed time with my family during those 5 years, I've been lucky enough to get back in spades what I wouldn't be able to do without having worked my tail off in residency. Moreover, we've gone through the refiner's fire. There is very little that faces us now that we can't get through because we've run the gauntlet. We've conquered it. We're stronger for it and I can't foresee a trial that we are not better prepared for now because of our strength having come through residency together.
I feel that I can offer if not the best, then equalling the best, ENT care any of my patients can receive any where in my neck of the woods. I can only state that because of the quality and quantity of my residency (in that order). I also feel now that with that success, I can offer my family more time than I ever would have if I didn't build a successful practice. Lots of luck, lots of blessings for sure, but none would have come without hard work and sacrifice up front.
It all goes back to hours. I could potentially be the world's greatest violinist, but if I don't put in the practice time, I may only be good enough to entertain friends and familiy at reunions and parties. If I practice, I can become a master.
So it boils down to this: do you (and your wife) want to sacrifice time now for time later so that you can be a master of your craft and then work on family with all the resources that come with success? Or would you like to choose something that doesn't require those kinds of hours so that you can be the master of fatherhood and marriage now without the same career prestige/success/financial resources later? Or do you want to try to ride the fence and be mediocre at both?
Whatever your goal, family or career, you can't expect to live in the 95th percentile and invest at the 50th percentile to get there.
Dear LeforteI personally have no issue with medical students asking if ENT is an easier surgical specialty. I have no problem with them asking how many hard months are there, what are the easier rotations and what programs are "hard" so they can avoid them. Honestly, I think it allows me to know which students to avoid placing on our rank list, and allows me to adjust any LOR.
I've also commented to the students who ask these types of questions that when the time comes to seek out an OB for their partner or themselves - ensure that they seek out the one who met the minimal requirements for graduation, yet had plenty of time at home during their residency. I am sure that the experience of the OB has no relationship to obstetrical bad outcomes...
Should their child need ear surgery - it is important that the ENT have had plenty of time at home during their training - 80 hours per week is clearly far beyond what is needed to train a surgeon. Although current graduates have performed far less mastoidectomies than previous trainees, I am sure they can read about the surgery and be competent if hours were reduced even further. I mean - if the surgeons home life is good, the surgeon is happy and the patient is happy. Who cares about facial paralysis from mastoid/parotid surgery, vocal cord paralysis from thyroid surgery, etc. While it is well known that the best surgical outcomes come from the more experienced surgeons - I am sure patients will accept less than ideal outcomes if their surgeon has a happy home life.
If you have asked about how "hard" is ENT, if you have to work close to 80 hours during your training and disagree with any of the comments above, then, honestly, I think it would be best to pick another non-surgical career - unless, of course, you have a narcissistic, perhaps slightly psychopathic personality that desires personal satisfaction and gain at the expense and potential harm of others. If you want to become a safe, competent, compassionate surgeon who understands the time requirements to obtain this in 5 years - and is willing to work the hours required, then please apply to ENT. Until the AAO-HNS increases the length of residency to 6-7 years, I do not see how we can train competent surgeons with continually reduced hours. Quite honestly, there is talk to mandated any complex surgery to the realm of the sub specialists - which may be the direction the field may need to go.... Perhaps like the German model, where people are trained in basic ENT operations (basic FESS, PE tubes, tonsils, septum's etc) - and anything even mildly complex - tympanoplasties (much less mastoids), laryngology, and H&N, facial plastics, etc is referred on....
Dear Leforte
Dont you agree that its more about quality of time rather than quantity of time ?
I mean what is the point of doing 200 hours per week if you end up performing same number of surgeries as in 80 or less hours per week ?
JUST WONDERING
Dear Leforte
Dont you agree that its more about quality of time rather than quantity of time ?
I mean what is the point of doing 200 hours per week if you end up performing same number of surgeries as in 80 or less hours per week ?
JUST WONDERING
There are only 168 hours in 1 week.
Being an otolaryngologist is not solely about how many people you operate on. You have to learn how to see patients in clinic. You have to learn how to evaluate and manage patients both nonoperatively and operatively. You have to learn how and when to take a person to the operating room. You have learn how to operate on that person and as many variations of that person as possible. You have learn how to avoid mistakes and how to recover from mistakes. You have to learn how to talk to family members and the patient about a mistake you make and how to assure them that you are doing everything you can to get to the bottom of the error and to put into place a system that will help you avoid it in the future. You have to learn how to manage a patient once he gets out of the operating room and is recovered or is in his hospital bed. You have learn how to manage problems that arise in the immediate post-operative period that occur 24 hours per day. You have to learn how to think straight when you are awoken from your sleep at 3am in the morning to deal with a sometimes very serious issue. You have learn how to discuss with a family a bad outcome or a hospital-acquired problem. You have to learn how to talk to a family when your patient dies or is about to die. You have to learn to determine the conditions of discharge. You have to learn the appropriate course of follow-up. You have to learn how to manage patients long after their surgeries and when you can safely discharge them from your clinic.
And that's just the beginning . . ..
You can't learn this **** in <80hr per week and expect to flourish in any type of practice.
There are only 168 hours in 1 week.
Being an otolaryngologist is not solely about how many people you operate on. You have to learn how to see patients in clinic. You have to learn how to evaluate and manage patients both nonoperatively and operatively. You have to learn how and when to take a person to the operating room. You have learn how to operate on that person and as many variations of that person as possible. You have learn how to avoid mistakes and how to recover from mistakes. You have to learn how to talk to family members and the patient about a mistake you make and how to assure them that you are doing everything you can to get to the bottom of the error and to put into place a system that will help you avoid it in the future. You have to learn how to manage a patient once he gets out of the operating room and is recovered or is in his hospital bed. You have learn how to manage problems that arise in the immediate post-operative period that occur 24 hours per day. You have to learn how to think straight when you are awoken from your sleep at 3am in the morning to deal with a sometimes very serious issue. You have learn how to discuss with a family a bad outcome or a hospital-acquired problem. You have to learn how to talk to a family when your patient dies or is about to die. You have to learn to determine the conditions of discharge. You have to learn the appropriate course of follow-up. You have to learn how to manage patients long after their surgeries and when you can safely discharge them from your clinic.
And that's just the beginning . . ..
You can't learn this **** in <80hr per week and expect to flourish in any type of practice.
I just dont see how I could possibly learn how to do all this in 5 years. Do you think I should aim for a fellowship even though I want to do a variety of things in my practice?
Aaahh neutropeniaboy i wish you were my attending
David O. Mckay
Chidoman, sometimes subtlety is not obtained with a sledgehammer. There may be a very good reason why I didn't say who it was (such as a quiet shoutout to those who would already understand), but thanks, Sherlock, for the stunning sleuthing. Actually, the original author of that quote, though, is James Edward McCulloch. Pres McKay borrowed the phrase in two separate GC talks in April of 1935 and 1964. He, indeed, is the leader to whom I referred.
i'm honestly perplexed by the responses from the attendings on this thread. You have been almost consistently level headed and quite sympathetic, and then all of the sudden a nerve was hit.
i'm honestly perplexed by the responses from the attendings on this thread. You have been almost consistently level headed and quite sympathetic, and then all of the sudden a nerve was hit. No one reading this thread is an idiot (assumption of course) why is it wrong for me to worry about my ability to balance my family life and residency. Would you rather I blindly run in and then have a nervous breakdown PGY-2?!?
If asking you what the hours are going to be like is going to make you think less of me - you're obviously very proud of what you have accomplished and have become disconnected from the feelings that I am very certain you once felt when thinking about making this decision.
I am scared to death about the hours, and not entirely certain how I am going to get through it with a wife and son, but that has no relationship to my work ethic or my ability to become good at what I do. I hope that my attendings and program directors are more prone to encourage and help me see the possibilities rather than trying to scare me out of proceeding.
Some of us have been around for 7-10 years. A lot of the attendings were students when this forum was started, and one thing that all the attendings (who post regularly on this forum) share is a solid work ethic.
There's not a single one of us who hasn't stressed that hard work is necessary in order to complete a surgical residency. There isn't a single one of us who has NOT advocated making the most you possibly can out of the 5 years of training. There's not a single one of us who hasn't said it before: if you don't think you can dedicate the time, don't start what you can't finish.
I'm sure no one in this forum believes it is bad to balance work and home life. In fact, I'm sure we'd all agree that you must achieve a work-home balance in order to be successful.
However, there's a right way and a wrong way to figure out how difficult this can be. Try to discern the differences between these two posts:
1. I have some questions for the attendings and experienced residents out there with families. I'm really pushing for an ENT residency. I have a wife and two children. What ways have you managed to balance your home life and work life while at the same time achieving all you can possibly achieve in residency?
2. I have some questions for the attendings and exprienced residents out there with families. How often do you actually work 80 hours? Are there easy ENT rotations? When you are off call, are you really off call? What's harder: ENT or Urology? Lifestyle and family are very important to me.
If you're asking us, you'd be wise to frame your question along the lines of NPboy's #1 above, not his #2. If residents or attendings think you are lazy and want to avoid working hard (doesn't matter if it's true or not), it's the kiss of death for your chances of matching at that program.