Venting about residency program. Alternative careers?

[invisibledoor24]

Hey all,

So...i pretty much hate my residency program. And because of it, not sure if I hate medicine now or not. A little backstory, i'm a PGY2 in family medicine in an unopposed program that covers 3 hospitals so we do A LOT of inpatient hospital work. My intern year I did 9 months straight before my first vacation and never had more than 1 day off a week. I did 35 weeks of inpatient service total my first year and the whole time I was like "it sucks for everyone, next year...next year will be better."

Well the first month was better, then I found myself working the week at various rotations or filled clinic schedules, and then having to cover weekends because the 3rd year class and the intern classes aren't particularly strong. I was scheduled for 13 weeks of inpatient this year which is great compared to last year but compared to the rest of my class....I still have the highest number of weeks in the hospital and i've done the most weekend shifts. Its because of all this that I didn't even bother running for chief.

My program could be great. But we have about 4 full time attendings and each hospital has a team consisting of upper level and two interns and our census is rarely ever below 20. In fact last time I was on service i came in and our census was 36 so I had to carry my own load of patients while trying to look over the interns work. The hospital had a meeting about this that summed up seemed to tell us that we need to suck it up, but at the same time work at having less medical errors.

I know residency sucks for everyone. But I absolutely hate it. My attendings understand and are overworked but the program, to me, seems to be about generating money. I guess I'm just looking for advice on how to get through this and maybe alternative careers with a family med licence? I have a huge chunk of loan to pay off but as soon as it's done...I wouldn't mind switching careers to something I don't loathe. And really i'm not sure if I loathe medicine anymore or if it's just that I hate residency

---

Members don't see this ad.

 

[Doctor4Life1769]

Look to switch. Sounds terrible.

 

[invisibledoor24]

Look to switch. Sounds terrible.

I just wasn't sure if this is how it is or if my program sucks since I have nothing to compare it to

 

[teacherman84]

I only did 13 weeks on wards an an intern...9 as a pgy-2 including night float, and as chief I volunteered for extra next year but an still only looking at 6 weeks including night float. Our service typically caps out around 18 with 3 interns, less when it's 3.
That sounds rough and I agree education sounds like it's trumped by profit. On the bright side, you're a few weeks away from pgy3

 

[JustPlainBill]

Unless you're masochist, that's enough to make anyone want to run screaming from the building....but I digress ---

Yeah, it's a lot of inpatient -- I managed to piss of the powers that be in my residency by telling them (after they asked) that their inpatient service sucked and No, it wasn't the "family medicine difference" when you listed hyperlipidemia as a hospital problem in a problem list for a COPD exac --- and I got spanked -- hard --- 3 months of inpatient in PGY1, 3 months in PGY2, 3 months plus 2 weeks in PGY3 with 2 of those months being nightfloat. Our service was usually around 14-20 with 2 interns and a PGY2 that we could never figure out what to do with and a PGY3 chief of service -- the PGY2 did admissions that came in while we were rounding, helped oversee the interns and was supposed to come up with "journal articles" regarding questions that came up on rounds -- never happened but that's the fiction we told the ACGME -- we did cover 2 hospitals for a while, then folded it down to 1 after getting kicked out of the other, and then they were talking about opening it back up again.

Our outpatient was strictly a money making operation -- strangely enough, we were not encouraged to bill 99214s as it would require the attending to see the patient so county hospital patients with the troika (DM, HTN, HLD) which was the mainstay and many of whom were non-adherent, were always billed as 99213s --- but our load was increased from 6-8 patients per 4 hours so the attendings could spend time teaching to 12-15 per 4 hours to "get you ready for the real world" -- but then the onus was on you to read up and if you didn't and had questions -- too bad, so sad, hope you don't get yelled at in the charting room....

Get out of there, soonest....

 

[hallowmann]

Hey all,

So...i pretty much hate my residency program. And because of it, not sure if I hate medicine now or not. A little backstory, i'm a PGY2 in family medicine in an unopposed program that covers 3 hospitals so we do A LOT of inpatient hospital work. My intern year I did 9 months straight before my first vacation and never had more than 1 day off a week. I did 35 weeks of inpatient service total my first year and the whole time I was like "it sucks for everyone, next year...next year will be better."

Well the first month was better, then I found myself working the week at various rotations or filled clinic schedules, and then having to cover weekends because the 3rd year class and the intern classes aren't particularly strong. I was scheduled for 13 weeks of inpatient this year which is great compared to last year but compared to the rest of my class....I still have the highest number of weeks in the hospital and i've done the most weekend shifts. Its because of all this that I didn't even bother running for chief.

My program could be great. But we have about 4 full time attendings and each hospital has a team consisting of upper level and two interns and our census is rarely ever below 20. In fact last time I was on service i came in and our census was 36 so I had to carry my own load of patients while trying to look over the interns work. The hospital had a meeting about this that summed up seemed to tell us that we need to suck it up, but at the same time work at having less medical errors.

I know residency sucks for everyone. But I absolutely hate it. My attendings understand and are overworked but the program, to me, seems to be about generating money. I guess I'm just looking for advice on how to get through this and maybe alternative careers with a family med licence? I have a huge chunk of loan to pay off but as soon as it's done...I wouldn't mind switching careers to something I don't loathe. And really i'm not sure if I loathe medicine anymore or if it's just that I hate residency

Your schedule seems much rougher than most I've talked to. Add to it that most people hate residency, and I wouldn't jump the medicine ship just yet. Get through, get BC, and then see how the first job works out. The good news is that you'll be well trained for inpatient if you ever wanted to do something like hospitalist medicine, but it sounds like that's not really what you want. That said, 7 on and 7 off is pretty different from 6 on and 1 off.

 

[invisibledoor24]

Your schedule seems much rougher than most I've talked to. Add to it that most people hate residency, and I wouldn't jump the medicine ship just yet. Get through, get BC, and then see how the first job works out. The good news is that you'll be well trained for inpatient if you ever wanted to do something like hospitalist medicine, but it sounds like that's not really what you want. That said, 7 on and 7 off is pretty different from 6 on and 1 off.

Honestly there was a time I wanted to do inpatient medicine but this program has left a bad taste in my mouth about it. Also, even though my numbers are high, I don't feel like i've learned because we're so busy that didactics are forgotten in favor of getting the list down so we can do the new set of admissions.

Further example of things sucking, i'm on nights currently with an intern. The list is at 20 but we are not allowed to close at nights at all. So we wind up admitting 6 people. 2 gi bleeds admitted to the ICU, one of whom goes into torsades. Gets mag and shocked into a normal rhythm but is now intubated. Tuck them away and then hours later the ICU nurse is complaining about something or other on the patient and how the residents messed up. I JUST SAVED HER LIFE!! Oh and the attending in the morning to check out about all the patients and overnight events such as the intubation....sat around 30 min with no reply phone calls....they're probably still asleep...

 

[JustPlainBill]

Honestly there was a time I wanted to do inpatient medicine but this program has left a bad taste in my mouth about it. Also, even though my numbers are high, I don't feel like i've learned because we're so busy that didactics are forgotten in favor of getting the list down so we can do the new set of admissions.

Further example of things sucking, i'm on nights currently with an intern. The list is at 20 but we are not allowed to close at nights at all. So we wind up admitting 6 people. 2 gi bleeds admitted to the ICU, one of whom goes into torsades. Gets mag and shocked into a normal rhythm but is now intubated. Tuck them away and then hours later the ICU nurse is complaining about something or other on the patient and how the residents messed up. I JUST SAVED HER LIFE!! Oh and the attending in the morning to check out about all the patients and overnight events such as the intubation....sat around 30 min with no reply phone calls....they're probably still asleep...

So this is one of my pet peeves, I've had a rough morning seeing drug seekers and I'm resisting really twisting off --- As hard as it is, don't let the nurses (and it seems that the more extra training they've been to, the more their head swells "I know just as much as a doctor!") get to you. Recall that there's a big difference between following a protocol and writing the protocol and understanding the nuances of when you break away from the protocol..... I've had an ICU Ph.D in nursing studies almost kill my father in law due a level of stupidity that reached almost galactic proportions (ok, well maybe not that bad but the egotistic nature of that call was something to behold).

And without hijacking the OPs thread, I always hear pushback from RNs and people going through an RN curriculum to remember how many times an RN bailed me out --- So I'll ask --- how many times has an RN truly saved your tail? I don't mean doing the job -- report critical values, deviations from vitals, patient changes, etc., I mean truly saved you from doing something stupid or things like that -- I'd be real interest in that number.....not just from the OP but from the community on this forum.

 

[invisibledoor24]

So this is one of my pet peeves, I've had a rough morning seeing drug seekers and I'm resisting really twisting off --- As hard as it is, don't let the nurses (and it seems that the more extra training they've been to, the more their head swells "I know just as much as a doctor!") get to you. Recall that there's a big difference between following a protocol and writing the protocol and understanding the nuances of when you break away from the protocol..... I've had an ICU Ph.D in nursing studies almost kill my father in law due a level of stupidity that reached almost galactic proportions (ok, well maybe not that bad but the egotistic nature of that call was something to behold).

And without hijacking the OPs thread, I always hear pushback from RNs and people going through an RN curriculum to remember how many times an RN bailed me out --- So I'll ask --- how many times has an RN truly saved your tail? I don't mean doing the job -- report critical values, deviations from vitals, patient changes, etc., I mean truly saved you from doing something stupid or things like that -- I'd be real interest in that number.....not just from the OP but from the community on this forum.

You know i sat down and thought about it and asked a few of the other residents, and we could not come up with a single time where they truly saved us from making a drastic mistake. They may have suggested things like "are we going to consult cards on this patient?" But never something that I did out of neglect or stupidity. I will say that for the most part the ICU nurses are pretty good at managing codes. They're better than I am without question, but they also deal with it on a daily basis so I listen to their suggestions when it comes to that.

But for every 1 nurse that has really truly helped me out, there are at least 10 others that have done something to hurt my patient including completely ignoring crtical values or labs, giving too much ativan to patients that were no longer withdrawing just so they didn't have to deal with them, canceling lab orders in the middle of the night that were very very crucial all so the patient can sleep while they had a sodium of 166. For the most part I have a good relationship with all the nurses but there is one ICU nurse that completely hates me and voices it to all the other ICU nurses and even to my fellow residents. She has told other residents that ICU nurses know more than they do. She's been an ICU nurse for two years, I've been a resident for 2 years....and she swears that I had a dka patient that I put on an insulin infusion protocol rather than a dka protocol and she tried to correct me but wouldn't listen...which sounds nothing like me. Regardless....as long as they're getting insulin and fluids then they should be correcting. I mean hell i've had to correct dka on the floor before due to lack of ICU beds. But I digress...

 

[Doctor4Life1769]

So this is one of my pet peeves, I've had a rough morning seeing drug seekers and I'm resisting really twisting off --- As hard as it is, don't let the nurses (and it seems that the more extra training they've been to, the more their head swells "I know just as much as a doctor!") get to you. Recall that there's a big difference between following a protocol and writing the protocol and understanding the nuances of when you break away from the protocol..... I've had an ICU Ph.D in nursing studies almost kill my father in law due a level of stupidity that reached almost galactic proportions (ok, well maybe not that bad but the egotistic nature of that call was something to behold).

And without hijacking the OPs thread, I always hear pushback from RNs and people going through an RN curriculum to remember how many times an RN bailed me out --- So I'll ask --- how many times has an RN truly saved your tail? I don't mean doing the job -- report critical values, deviations from vitals, patient changes, etc., I mean truly saved you from doing something stupid or things like that -- I'd be real interest in that number.....not just from the OP but from the community on this forum.

Zilch.

 

[hallowmann]

You know i sat down and thought about it and asked a few of the other residents, and we could not come up with a single time where they truly saved us from making a drastic mistake. They may have suggested things like "are we going to consult cards on this patient?" But never something that I did out of neglect or stupidity. I will say that for the most part the ICU nurses are pretty good at managing codes. They're better than I am without question, but they also deal with it on a daily basis so I listen to their suggestions when it comes to that.

But for every 1 nurse that has really truly helped me out, there are at least 10 others that have done something to hurt my patient including completely ignoring crtical values or labs, giving too much ativan to patients that were no longer withdrawing just so they didn't have to deal with them, canceling lab orders in the middle of the night that were very very crucial all so the patient can sleep while they had a sodium of 166. For the most part I have a good relationship with all the nurses but there is one ICU nurse that completely hates me and voices it to all the other ICU nurses and even to my fellow residents. She has told other residents that ICU nurses know more than they do. She's been an ICU nurse for two years, I've been a resident for 2 years....and she swears that I had a dka patient that I put on an insulin infusion protocol rather than a dka protocol and she tried to correct me but wouldn't listen...which sounds nothing like me. Regardless....as long as they're getting insulin and fluids then they should be correcting. I mean hell i've had to correct dka on the floor before due to lack of ICU beds. But I digress...

So obviously I have very little experience in this area, but I recently talked with a lot of old school nurses on my last few rotations. We're talking people who were working in the 60s and 70s, and I found their knowledge base, even their pathphys knowledge base, to be kind of amazing. They also never really complained about any physicians or residents, never really acted like they knew more than physicians and in general they rarely if ever complained. The one thing they did complain about was new nurses.

I don't know if it's the whole "back in my day" kind of thing, but they all actually mentioned that they saw a shift in how nurses were trained and in turn how adept they were at dealing with patients, their families, and just in general how lazy they were when it came to their job. They also said that in general nurses took more pride in their jobs, they used to physically round together on all the patients with the head floor nurse, and then the head floor nurse would round with the residents and attendings. It was around this point where the attending chimed in and said, yeah and the head nurse used to be able to rattle off every detail about every patient including the most recent labs, and they used to know and understand the plan on every patient because they were there when the decisions were made.

I honestly don't know at what point that kind of system changed, and like I said, I don't know if that's just the old remembering things in the past as better, but it was weird hearing nurses complain about the same things new nurses do that I hear from residents and attendings. It was also weird hearing it from nurses in multiple hospitals. It was also weird that those were also some of the most knowledgeable nurses I've ever met when it came to pathophys and management. I didn't even know any nurses knew some of this stuff, because most I've met had difficulty describing even basic pathophys of extremely common conditions, and in general they knew little more than protocol/algorithms. I guess I'm kind of wondering if any of you have had similar experiences with some of the much older floor nurses.

 

[Ericslv]

Hey all,

So...i pretty much hate my residency program. And because of it, not sure if I hate medicine now or not. A little backstory, i'm a PGY2 in family medicine in an unopposed program that covers 3 hospitals so we do A LOT of inpatient hospital work. My intern year I did 9 months straight before my first vacation and never had more than 1 day off a week. I did 35 weeks of inpatient service total my first year and the whole time I was like "it sucks for everyone, next year...next year will be better."

Well the first month was better, then I found myself working the week at various rotations or filled clinic schedules, and then having to cover weekends because the 3rd year class and the intern classes aren't particularly strong. I was scheduled for 13 weeks of inpatient this year which is great compared to last year but compared to the rest of my class....I still have the highest number of weeks in the hospital and i've done the most weekend shifts. Its because of all this that I didn't even bother running for chief.

My program could be great. But we have about 4 full time attendings and each hospital has a team consisting of upper level and two interns and our census is rarely ever below 20. In fact last time I was on service i came in and our census was 36 so I had to carry my own load of patients while trying to look over the interns work. The hospital had a meeting about this that summed up seemed to tell us that we need to suck it up, but at the same time work at having less medical errors.

I know residency sucks for everyone. But I absolutely hate it. My attendings understand and are overworked but the program, to me, seems to be about generating money. I guess I'm just looking for advice on how to get through this and maybe alternative careers with a family med licence? I have a huge chunk of loan to pay off but as soon as it's done...I wouldn't mind switching careers to something I don't loathe. And really i'm not sure if I loathe medicine anymore or if it's just that I hate residency

Part of your dislike at this time is obviously because of the residency program and the hospitals you are currently being trained. However, there are many attending that work in poor environment such as yours. I'm not sure how you ended up at this place but you can choose where you work after you are done.

You can look for empty pgy2 positions. In order to qualify for Board certification and your residency counting you have to finish the last 2 years at one place. So if you're going to bail this is the time to do it.

You can find other specialties and transfer.

There are non-clinical position and will require you to do some more training ( I don't mean getting MBA) but it will take some looking and perhaps getting a career coach to get you there. The best candidates are those who finish residency and for some jobs they require board certification.

I'm sorry your stuck in a program like that. Your best bet may be to look for another spot or specialty.

You mentioned your loans. I know that is a source of stress so lets simplify it.

Once you graduate you will be making at least 200K. Lets say you have 250K of debt.

Options:

1. Live like a resident for 4 to 5 years. Max out 401 K and roth. Then take your post tax income which should be around 100 to 120K and divide by two. Half goes to loans and half goes living expenses. In 5 years you are out of debt and free. If you happen to moonlight along the way you will have more saved or loans payed off sooner. Done.

2. Work somewhere that will pay your loans off. These places come with strings attached. So you have to be careful. But it can be done.

3. A combination of the above.

Once your loans are paid off you can go non-clinical or a combination of that.

Good luck.

 

[jm192]

I thought mine was bad