Too long! (that's what she said)

[H_Caulfield]

Anybody else in awe of how freaking long these programs are? I'm really interested in neurosurgery, and am inches from finally deciding and looking into sub-i's, but there's that lingering doubt in the back of my mind, whispering "idiot, two years from now you'll wish you were leaving at 5:30 with the anaesthesiologists, rather than q3 for 7 years." Also, I'm convinced I can handle any sort of schedule, so long as there's a light at the end of the tunnel. In a 3 year program I can see the light, as well as with a four, but more starts to seem ridiculous to me. Seven?!

To prospective subspecialty surgeons, cardiologists, radiologists with fellowship training, have you found some way to justify spending the better part of a decade in residency? I feel as if it's an elephant in the living room that nobody is mentioning...nobody seems to think this is ridiculous but me. I desperately want neurosurg but come on...seven years? Seven years ago I was in highschool and can hardly remember !@#$ about it.

Anyone want to offer any strategic thinking? I've already been told to "see it as a job, not school," BUT it's hard to see it that way when you have morning report, rounds, seminars and noon conferences to attend every day, complete with presentations you need to prepare and regular evaluations. If I chicken out and go into something shorter (dx rads?) I may regret it and hate myself forever. Can't win I guess.

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[Winged Scapula]

I'd recommend you get the "pie in the sky" out of your eyes about life beyond residency. Its not like you finish and then there aren't conferences to go to, reports and papers to prepare, etc. as an attending.

I "justified" spending more time in training because:

1) its what's required, so I didn't have a choice
2) it got me where I want to go. There were shorter residencies but frankly 7 years doing what I love seems shorter to me than a 3 year program where I want to poke my eyes out at the end of the day.

 

[elwademd]

I'd recommend you get the "pie in the sky" out of your eyes about life beyond residency. Its not like you finish and then there aren't conferences to go to, reports and papers to prepare, etc. as an attending.

I "justified" spending more time in training because:

1) its what's required, so I didn't have a choice
2) it got me where I want to go. There were shorter residencies but frankly 7 years doing what I love seems shorter to me than a 3 year program where I want to poke my eyes out at the end of the day.

do what you love, love what you do.




if you enjoy anesthesia and neurosurgery, then i can see your concern. but if you don't enjoy anesthesia, i'd think that the entire residency would be boring as hell.

residency has its ups and downs. so does life as an attending. as winged pointed out, you still have meetings/conferences, reports, papers, presentations, etc. but if you enjoy the "meat" of what you do, it makes it much more rewarding.

 

[Apollyon]

There's a direct relationship between the longer one spends in residency and fellowship, the more money one makes. However, there's a LOT more than money that goes into it. As the old saying goes, "If you love your job, you won't work a day in your life!"

Do what you dig, and the hours won't bug you.

 

[soulofmpatel]

Do what you dig, and the hours won't bug you.

Dude. This is BS. There are three guys I know at my school who wanted to do neurosurgery who changed their minds after doing an away rotation. They all enjoyed the field but felt that the hours were utterly ridiculous. They made estimates of a workload consistently around 110-120 hours per week. With this sort of schedule, you have virtually no free time. What chance do you have to find a spouse, pusure hobbies, or stay in shape. What if you want to have kids? What if you value personal fitness and health? What if you have interests outside of medicine?

I am a very disciplined, hard working person, but I am not willing to saccrifice personal health for my career. Sure...I may not be completing a full triathalon anytime soon, but if I graduated residency 50 lbs heavier, I would consider it to be a complete disaster...regardless of how great the training was.

My advice: Consider your options, take everything into account, and make an informed decision. Do not make the mistake of overvaluing or undervaluing certain factors. Many people are perfectly happy doing something other than their dream job. Whereas neurosurgeons....four out of the four I met were unquestionably unhappy. Unless you are truly a bad-***** mo fo who loves neuroscience and surgery, and has the energy of tigger, you're probably making a big mistake.

 

[Samoa]

Dude. This is BS. There are three guys I know at my school who wanted to do neurosurgery who changed their minds after doing an away rotation. They all enjoyed the field but felt that the hours were utterly ridiculous. They made estimates of a workload consistently around 110-120 hours per week. With this sort of schedule, you have virtually no free time. What chance do you have to find a spouse, pusure hobbies, or stay in shape. What if you want to have kids? What if you value personal fitness and health? What if you have interests outside of medicine?

These are all valid concerns. Deciding on a specialty is a complicated bit of calculus. Here was a little bit of mine:
How much do you value the things you'd have to sacrifice? a lot, but at the moment they are not things I have, anyway. So the sacrifice is merely theoretical.
Are you sure you really would have to sacrifice those things? maybe not, but it depends on factors outside my control, and would do so no matter what I choose.
How much do you like your other alternatives? not much
How much does your motivation depend on the extent to which you love your job? Almost entirely.

And so on. It's not easy for anyone to stare down the barrel of a seven year residency, and not feel some fear that life will pass you by in the meantime.

Many people are perfectly happy doing something other than their dream job.

If you are one of them, it makes sense to do something else.

Whereas neurosurgeons....four out of the four I met were unquestionably unhappy.

This is the complete opposite of my experience. I've met very few neurosurgeons who did not love their job. Which is not to say that they would all choose it again, but they are all reasonably happy, having made the choice.

 

[michaelrack]

Dude. This is BS. There are three guys I know at my school who wanted to do neurosurgery who changed their minds after doing an away rotation. They all enjoyed the field but felt that the hours were utterly ridiculous. They made estimates of a workload consistently around 110-120 hours per week. With this sort of schedule, you have virtually no free time. What chance do you have to find a spouse, pusure hobbies, or stay in shape. What if you want to have kids? .

Most male neurosurgeons have no problem finding a wife or having kids.

 

[Blade28]

7 years residency + 3 years fellowship for me.

 

[DebDynamite]

You have to do a thorough self-assessment. When I was in med school, I had a friend who really couldn't decide between psych and OBGYN. He liked them both equally. At the end of third year he said to me, " You know, when I'm not at work, I really don't do anything else. I don't work out tons, I have few hobbies, and I think I actually enjoy being needed by my job."

No one on these boards can tell you the right answer, as my friend and I both made good choices. Only you can decide. You are right though, it's a HUGE decision. It's the hardest one you'll make in med school.

 

[Winged Scapula]

Most male neurosurgeons have no problem finding a wife or having kids.

Agreed. I have known a couple that have had time for a wife, kids and a girlfriend.

 

[Winged Scapula]

Dude. This is BS. There are three guys I know at my school who wanted to do neurosurgery who changed their minds after doing an away rotation. They all enjoyed the field but felt that the hours were utterly ridiculous. They made estimates of a workload consistently around 110-120 hours per week.

Its not BS. They didn't love neurosurgery enough.

With this sort of schedule, you have virtually no free time. What chance do you have to find a spouse, pusure hobbies, or stay in shape. What if you want to have kids? What if you value personal fitness and health? What if you have interests outside of medicine?

If you have interests outside of medicine which conflict with the hours of residency, then you either have to find a residency with fewer hours or give up pursuing those interests as much. Its really very simple.

However, I have known plenty of residents, in the pre-80 hour workweeks, working the hours you've listed above, who were able to keep in shape, find and maintain a family, travel, study, etc. If you have an interest which requires 40 hours per week to maintain then its unrealistic to expect to keep that up during residency but its not unreasonable to spend an hour a day working out, to spend time with your family, etc.

I am a very disciplined, hard working person, but I am not willing to saccrifice personal health for my career. Sure...I may not be completing a full triathalon anytime soon, but if I graduated residency 50 lbs heavier, I would consider it to be a complete disaster...regardless of how great the training was.

Really? While no one wants to gain weight (and its not a given you will), its hardly a disaster which cannot be rectified. This is clearly a personal choice for you; many of us would and do sacrifice sleep, hobbies, bodies, etc. in pursuit of training. You don't have to if you don't want to. Some of us are far less dramatic in calling those things disasters when it means that we are reaching our personal goals.

My advice: Consider your options, take everything into account, and make an informed decision. Do not make the mistake of overvaluing or undervaluing certain factors. Many people are perfectly happy doing something other than their dream job. Whereas neurosurgeons....four out of the four I met were unquestionably unhappy. Unless you are truly a bad-***** mo fo who loves neuroscience and surgery, and has the energy of tigger, you're probably making a big mistake.

As others have noted before, it may be the program you're at. The neurosurgeons I knew were happy; almost all were married, with children, seemed to enjoy their work.

But your advice to make an informed decision is a wise one. For someone like you for whom gaining weight or not having a significant number of hours during residency to pursue other interests would be a disaster, a more hours friendly field is probably better for you. But there are others for whom work is the most important thing, or more important than what they weigh or hobbies.

 

[gutonc]

Do what you dig, and the hours won't bug you.

95% True (and the remaining 5% you just suck up and deal with). I'm a first year fellow (Onc), working as many or more hours on average than I did as an intern (IM) and I couldn't be happier. Sure, I'd love to see my daughter awake every morning and evening but the hours I do get to spend with her are better for both of us b/c I'm not miserable doing a Cards or Gen Med month and I come home happy about my day (mostly).

I personally couldn't fathom doing the 120h a week that Neurosurg and other surgical subs still seem to require inspite of the work-hour regs but I also couldn't do 40h a week in Psych, Path or EM (not saying those are the actual hours in those specialties, just that even if it was 9-5, M-F like normal people do, I'd still hate it). I'm doing 70-ish a week on ward months (50-60 on non-ward months) and I love it.

 

[masterofmonkeys]

there's a neurosurg resident here who trains MMA. *shrug*

I too think some of these residencies are ridiculous

I'm looking at 5-6 years myself. Seems suckish, but this is what I want to do and what I've always wanted to do. I'll put up with it.

FWIW during 3rd year clerkship in peds, I did over 80 hours a week, put in 15 hours a week in the gym, and still managed to neglect neither my girlfriend, my dog, my parents nor NFL playoffs...

 

[dragonfly99]

I dunno guys...
if a long residency scares you, then I recommend against neurosurgery, any other surgical field. If long hours bother you, I recommend against any surgical field, and probably IM or pediatrics as well. You have to think about your lifestyle AFTER residency as well.

 

[Finding Chi]

Like has been said, there are a lot of factors to consider. By the time I'm done with residency and fellowship, I'll have put in 6yrs - that's 6yrs of accruing interest on my loans, 6yrs of watching my friends make higher salaries, but its also 6yrs of doing work that I find captivating and rewarding... I wouldn't change any of my choices.

That said, burn-out is a really real thing. Months and months of q3 will beat you down, no matter how much you love what you do. Call does seem to get harder and harder as the years go on (maybe I'm just getting old).

So, it's a balance - you just have to ask yourself how much do you love neurosurgery? Is it enough to go through one of the tougher residencies out there? Is it enough to have lots of sleepless nights, and days where you may be standing for hours on end without a pee break? If it's not, that's ok. You just need to see what else fits. If it is, then kudos... the workload is scary as you embark, but you'll probably rise to the challenge.

 

[H_Caulfield]

Thanks for the responses guys. Honestly, the other thing I'm considering is cardiology. This is because I enjoy the idea of being a subspecialist in an area of vital importance to people, and...the TOYS are fantastic. The neurosurgery instruments need no explanation regarding how cool they are, but cardio has EKGs to read, ECHOs (was in echo lab once = fun), and the interventional stuff (like a high-stakes video game).

The cardiology choice would be highly dependent on the decision that IM --> cards fellowship would allow for me to have a considerably better life for 6 years than neurosurgery (e.g. spending no time with my parents until they're old, seeing none of my cousins marry and start families, having little time to golf, play piano, date). If somebody were to pipe in and tell me, reliably, that the cardiology path is just as strenuous...I'd choose neuro in a second. The thing is, I'm pretty sure neuro is a good deal less conducive to a decent life.

I'd never choose anything requiring general surgery, because with the same (or similar) time investment I could do neurosurgery (just personal preference).

 

[BlondeDocteur]

I'm going to be pursuing surgery-- applying in plastics, albeit it next year-- which is at minimum a 6 year training. I'd like to subspecialize after that in peds or craniofacial, which would mean 7-8 years postgrad.

I see it like this: #1, it's not like it's "seven years until I get to do what I want to do." You ARE doing what you want throughout all of those years. The last half of med school and residency are odd birds because they're hybrids: you're a student/trainee but you're also working in your field. So it doesn't necessarily mean years more of delayed gratification.

Secondly, that training time is an investment. It's an investment into an incredibly stable line of work (don't know how many of you have friends in the business world, but I can tell you there isn't an i-banker in New York who wouldn't kill for that stability right now) that's challenging, rewarding, and admired by the public. Most people in this world go to work each day counting down the minutes until they go home, and they leave without feeling like they've accomplished very much. In medicine we're very lucky to have intrinsically interesting work.

The investment of which I speak is obviously your time, your energy, your availability, your intellect, even your body. But it is for a short time, relatively speaking, and it's not like NOTHING is left over for the other things that matter: family, relationships, hobbies, faith, fitness, and so on.

That's the matrix according to which I made my decision, and sold the people in my life on it too.

 

[gutonc]

Thanks for the responses guys. Honestly, the other thing I'm considering is cardiology. This is because I enjoy the idea of being a subspecialist in an area of vital importance to people, and...the TOYS are fantastic. The neurosurgery instruments need no explanation regarding how cool they are, but cardio has EKGs to read, ECHOs (was in echo lab once = fun), and the interventional stuff (like a high-stakes video game).

The cardiology choice would be highly dependent on the decision that IM --> cards fellowship would allow for me to have a considerably better life for 6 years than neurosurgery (e.g. spending no time with my parents until they're old, seeing none of my cousins marry and start families, having little time to golf, play piano, date). If somebody were to pipe in and tell me, reliably, that the cardiology path is just as strenuous...I'd choose neuro in a second. The thing is, I'm pretty sure neuro is a good deal less conducive to a decent life.

Overall, the # of years of training to do Neurosurgery and Cards is basically the same, esp if you want to do interventional Cards b/c you'll need an extra year of fellowship. So don't pick it over Neurosurgery b/c of the # of years of training. And at it's worst, IM residents and Cards fellows will work as hard as Neurosurgery residents. You will however have far fewer horrible months if you do IM/Cards than if you do Neurosurgery. Those 7 years are basically a full-on slog without much in the way of down months (ICU and Neurology being the notable ones). During IM on the other hand, you'll probably have about 50/50 hard/easy months and you'll work your butt off as a 1st (and maybe 2nd) year Cards fellow but the 3rd year is much easier. In general, IM/Cards will be more conducive to having a life than Neurosurgery will be. Having said that, if you don't love it, it doesn't matter how easy it is, you'll feel like you're working too hard. Choose the one you love and the rest of it will fall into place.

 

[NotAProgDirector]

...esp if you want to do interventional Cards b/c you'll need an extra year of fellowship.

Many interventional fellowships are now 2 years long. Could be LONGER to IC than NS. I have no basis to compare the intensity of training.

 

[H_Caulfield]

Appreciate the responses.

Yea...I'm leaning toward neurosurgery again. When you can switch twice in a day based on some thoughtful words from fellow students and residents...kinda makes you realize how unprepared you are to make the biggest decision of your life.

I've only recent thought about the following: Neuro is 2 years of research, which is, from what I hear, what you make of it. If you want to live a normal life, I've heard it's possible during these years. I'm sort of counting on that. Additionally, 6 months of first year is general surgery, 3 is neurology, 3 during second year go to neuroradiology, etc. etc.

What I'm getting at, or, rather, trying to convince myself of, is that the REAL neurosurgery months, entailing those ridiculous hours we're always hearing about, only amount to 3 and a half to 4 years. I wonder whether this is somewhat accurate or if I'm missing something. It seems more reasonable if I can think of it as "4 years neurosurgery schedule, 3 years reasonable schedule."

Now if I were to find out that the research years are also ass-kickers, I'd be back to square one and considering cards again. I must be sounding like such a tool right now, treating one of the most respected fields in medicine as some sort of easier backup plan.

 

[Samoa]

The research is 1-2 years, depending on where you go. And there are still a few programs where you can avoid research entirely, if that's what you want.

The requirement, starting in 2009, is for at least 72 months total. This includes intern year. Specifically, 42 months of clinical neurosurgery with a maximum of 6 months occurring during intern year and 12 months as chief resident, 3 months neurology, minimum 3 months of general surgery, and the remainder dedicated to research and electives.

Many, if not most, programs still require you to perform some clinical duties during your research years. The nature and extent of these clinical duties varies from program to program. Some programs also have productivity requirements with respect to research and publications, sometimes even during your clinical years, while certain other programs have no requirements at all, and will basically give you a year off with pay if that's what you want to do. At either extreme, the programs are among the most competitive within the field.

Also, be aware that some programs still require you to take call on the neurosurgery service, even on your off-service electives. So don't count on those being entirely cush.

However, with respect to the research years, most programs have only nominal expectations for research productivity, and require you to provide occasional coverage for the clinical service. So it does serve as a significant break, in which you can have a life and recharge your batteries.

 

[Miami_med]

Appreciate the responses.

Yea...I'm leaning toward neurosurgery again. When you can switch twice in a day based on some thoughtful words from fellow students and residents...kinda makes you realize how unprepared you are to make the biggest decision of your life.

I've only recent thought about the following: Neuro is 2 years of research, which is, from what I hear, what you make of it. If you want to live a normal life, I've heard it's possible during these years. I'm sort of counting on that. Additionally, 6 months of first year is general surgery, 3 is neurology, 3 during second year go to neuroradiology, etc. etc.

What I'm getting at, or, rather, trying to convince myself of, is that the REAL neurosurgery months, entailing those ridiculous hours we're always hearing about, only amount to 3 and a half to 4 years. I wonder whether this is somewhat accurate or if I'm missing something. It seems more reasonable if I can think of it as "4 years neurosurgery schedule, 3 years reasonable schedule."

Now if I were to find out that the research years are also ass-kickers, I'd be back to square one and considering cards again. I must be sounding like such a tool right now, treating one of the most respected fields in medicine as some sort of easier backup plan.

Perhaps it's just that I've lived significant parts of my life out of order, but I can honestly say that while being a really big decision, the choice of what to do in residency very well may not be the biggest decision of your life.

You can take that for what it's worth, relax a touch, and just go for what you really want to do to the best of your knowledge. I'm not sure that comparing "cush" months between two very long and strenuous training paths will get you anywhere. If you want to be practical, go for neurosurg. You could always get back into IM, but the opposite is unlikely.

 

[dragonfly99]

Internal medicine + cards without interventional fellowship is definitely easier than neurosurg.
Cards + interventional is still easier lifestyle wise during training than neurosurg, but both neurosurg and interventional will have a difficult lifestyle as an attending as well.

You need to not choose just by the "hardness" of the residency. You need to choose something you can keep up with doing for the next 20-35 years. I haven't met any academic neurosurgeons who had a decent lifestyle...can't say about private practice. Private practice interventional cards, and some academic interventional cards, are in the hospital all the time at night too, and work long, long hours.

You need to think more about what you want to do.

The last comment is correct about being able to drop out of neurosurg and get in to IM,though it might be a little difficult to then get cards fellowship (though likely not impossible). I'm assuming you are a great standardized test taker and have good grades, which will help for both fields.

 

[roja]

There's a direct relationship between the longer one spends in residency and fellowship, the more money one makes. However, there's a LOT more than money that goes into it. As the old saying goes, "If you love your job, you won't work a day in your life!"

Do what you dig, and the hours won't bug you.

What?

I did two years of fellowship and am making less than my colleagues who did 3 years of residency.

Of course, I would slit my wrist doing what they do so....


Balance is important but I can tell you, those who choose not to do nuerosurg because of the hours didn't LOVE it. I have friends who are transplant surgeons, trauma surgeons, neurosurg. They LOVE what they do. They knew exactly what they were getting into and to them, IT WAS WORTH it.

That is the point. If you truly love what you are doing, the hours of training become part of the process that is getting you somewhere you want to be. I loved trauma and vascular surgery. but not enough. Hence, why I am not one.

We all have things we love and nothing worth while is without sacrifice. Each person has to figure out what is to much and what is worth it.

 

[peppy]

What I'm getting at, or, rather, trying to convince myself of, is that the REAL neurosurgery months, entailing those ridiculous hours we're always hearing about, only amount to 3 and a half to 4 years.

You might want to consider that maybe this isn't really where your heart is if you find yourself wishing you could minimize the amount of neurosurgery in your neurosurgery residency.

I assume you've done enough NS rotations to know how much you actually do love the field? How did you feel about your life during those months?

 

[H_Caulfield]

You might want to consider that maybe this isn't really where your heart is if you find yourself wishing you could minimize the amount of neurosurgery in your neurosurgery residency.

I assume you've done enough NS rotations to know how much you actually do love the field? How did you feel about your life during those months?

Hmm...good point. I think an accurate answer is that I like neurosurgery most, but wish there were a way to do it for 11 hours per day instead of, say, 14. While I'm doing it, I'm really enjoying it, and time flies. But at the end of the day I'll look at my watch and feel sort of depressed that the whole day is gone.

 

[PeepshowJohnny]

One case where I think post graduate education might be getting too long (IMHO) is Internal Medicine (and peds to an extent) and its fellowships. I think 3 and 3 (plus extra stuff on the end, like for cards). I'm thinking it could be compressed to 5 years without sacrificing much, but I'm sure others would disagree.

 

[NotAProgDirector]

One case where I think post graduate education might be getting too long (IMHO) is Internal Medicine (and peds to an extent) and its fellowships. I think 3 and 3 (plus extra stuff on the end, like for cards). I'm thinking it could be compressed to 5 years without sacrificing much, but I'm sure others would disagree.

The ABIM is currently looking at this. Needless to say, there's lots of politics getting in the way.

Cardiology is considering this. One proposal has residents who match into their home fellowship program doing a "blended" third year -- basically all of your elective time in the PGY-3 becomes cards, and you save a year.

Another is blending the third CV year with an EP/IV year, again if done at the same program. Most EP/IV programs are becoming two years, so it's getting to be really long -- 3+3+2 -- might as well be a neurosurgeon...

So far, "resisitance is futile" and this is not going very far.