A Day in the Life

[RinaBe]

---

Members do not see this ad.

So we've all heard the hours are long, the lifestyle is rough. I'm curious about the layout of your day more specifically. What percentage of your day do you spend operating? Charting? Rounding on patients? What else fills in your time while you're in the hospital? The Grey's Anatomy residents sure seem to have a lot of down time 🙂 (note: I'm not using any "medical" show as the basis for a career choice, just curious if there IS downtime during the workday, and if so, how much).

How does your schedule change after you've completed residency?

 

[Winged Scapula]

The fact that a "day in the life" of a surgery resident is so variable is what attracted many of us.

For any resident, regardless of specialty, the day to day work can vary considerably. So there is little way to give you an answer about what it is like except to say that "today my day was....".

Surgical residents will spend more or less of their time in the OR, dependent on the rotation, their level of seniority and patient load. I went days without seeing the inside of the operating room (heck, even month at a time if you consider rotations like SICU) and i've SPENT days doing nothing but being in the OR. On some rotations, the amount of surgery done is less (ie, trauma) and it may be more on others. Some programs may have a very busy transplant service whereas others are slow...we simply cannot paint a picture which would adequately describe all surgical residencies.

Surgical rounds are typically shorter than IM ones, but the amount spent on them will vary depending on census, what level resident you are and whether or not the service has teaching rounds (or the attendings just round on their own or with the Chief).

There is downtime in surgery...waiting for the case to go (they never go when scheduled), waiting for labs to come back, tests to be done, etc. On some rotations you can use this downtime to study, eat, relax, etc. and on others there is enough/too much work to do to allow yourself these "luxuries" while waiting for other things.

Your 3rd year surgical rotation should have given you a fairly good idea of what residents do and why this question cannot be answered definitively.

 

[redbeans]

that's my favorite song of all time

 

[Castro Viejo]

So we've all heard the hours are long, the lifestyle is rough. I'm curious about the layout of your day more specifically. What percentage of your day do you spend operating? Charting? Rounding on patients? What else fills in your time while you're in the hospital? The Grey's Anatomy residents sure seem to have a lot of down time 🙂 (note: I'm not using any "medical" show as the basis for a career choice, just curious if there IS downtime during the workday, and if so, how much).

How does your schedule change after you've completed residency?

Downtime for me only comes if the OR is quiet, and usually is after the morning cases are done. Typically at about 2:00PM it gets quieter and I go back to my office to read and study. Downtime is also built into things such as if your institution's Anesthesiologists have a high MAFAT index (Mandatory Anesthesia Fool Around Time) or the OR staff have a high turnover time to clean the room and prepare it for the next case. My institution's MAFAT is about an hour, with the turnover around 45-90 minutes. So during these times I'll do things like check my email, read the paper, take a nap, watch Judge Greg Mathis or something stupid. I don't find this short interval during the operating day to be useful for reading and studying. I can't get anything useful done.

I think the lifestyle certainly starts out rough, but gets a little easier as you progress through the program. Surgical interns are the most harried of all the residents and their downtime is supposed to be non-existent. Heck, if I saw an intern sitting around doing nothing, I'd ask why wasn't there any work to do. If his reply, and this would be a bad idea, is "the work is all done," I just know I'll find something that wasn't all done on PM rounds and it'll drive me wild. So they know to sort of scurry if they see me come around.

There can be a lot of downtime duirng the workday. There isn't anything like they have on Grey's Anatomy. Interns aren't running over to the library in the middle of the day to check out some books and read about thier patient's disease in an effort to help their attending make a diagnosis. That episode was ******ed. Medicine residents, maybe, but definitely not surgeons.

But here's my partial breakdown from last Friday (I was in-house for call and this is typical for call days):

6:00AM -- Arrived for AM rounds with my team (a fourth-year resident, three interns, a PA, and two medical students).

7:00AM -- Morning Report with the service attending.

7:30AM -- Arrived in Preop to say hello to my patient and sign the chart. The case was a small bowel resection for primary small bowel obstruction. A preop CT showed a 5cm tumor in a loop of small bowel with mesenteric lymph adenopathy. Anesthesia took over with bringing the patient into the room and the assistant helped out from our standpoint. Our Anesthesia people have an unusually high MAFAT index, so I had some time to run upstairs to write notes on my primary patients (patients on whom I was the primary surgeon, complicated patients on the service, and patients I admitted to the service).

8:00AM -- Came back to the OR and Anesthesia was still talking to the patient and untangling IV lines. 🙄 Went to the lounge to have some tea and watch a part of the morning news. (Downtime)

8:30AM -- Started the operation.

10:00AM -- Finished. Took the patient to recovery. Started on the postop orders.

10:30AM -- Went back to preop to say hello to the next patient. This would be a laparoscopic cholecystectomy.

11:30AM -- Case started.

12:00PM -- Case ended. To recovery for postop orders again.

1:00PM -- The next patient is seen in preop. Assisting my Chairman on a Whipple. I hate these. Downtime for MAFAT.

2:00PM -- Case started.

7:00PM -- Case ended. To recovery.

7:30PM -- PM rounds. Postop checks on the two patients admitted from the three cases I did.

9:00PM -- Downtime. Was in my office reading, studying, and surfind the web intermittently. Went to bed around 2:00AM.

4:00AM -- Trauma code: multiple stab wounds to the chest (out of the box, thank God), belly, and back. Tachycardic, but blood pressure stable. Responded to fluids. FAST ultrasound showed a lot of fluid in the belly. Chest tubes placed. Not much blood.

4:30AM -- Patient on the OR table. Another middle of the night/early morning trauma lap. Liver lac, splenic lac, multiple injuries to the small bowel, colon.

7:00AM -- Finished. Started AM rounds and took off for home at around 11:00AM (cleaned up some things from the night before, writing notes, scheduling cases for Monday, checked on some labs, Xrays, etc.).

It really is a great career despite the relative loss of personal and family time. To be good doctor, no matter the field, you'll be making personal sacrifices all the time for your patients. Just get used to it and it won't be so bad. Hopefully you'll be with someone who can understand that, but most lay people don't unfortunately.

Most of my friends from college (premed dropouts who went into things like trading, banking, super duper high finance, etc. and make a ton more money than I'll ever see) think I'm wasting my life doing this because I'll never make their kind of salaries, but I think that depends more on your priorities. I like what I do. I often go home feeling like a superhero. Maybe that's childish and stupid, but that's a feeling all the money in the world wouldn't be able to do for me. And the money, at least for now, isn't terrible. I can't remember the last time I saw a doctor standing on the side of the road holding a placard reading, "Out of work. Will do physicals for food."

 

[RinaBe]

I absolutely agree that you should pick a speciality based on the feeling you get from doing that sort of work. It's not worth any amount of money to do something that will make you miserable. At the same time, some sacrifices, like the ones you make as a surgeon, are worth it if your job makes you feel like you're doing something meaningful and exciting. I'm wondering though, if you are in a significant relationship, is it with another physician? Another surgeon? So far, the surgeons I've come across who are in relationships either met their SO before medical school and went into it with their partner's understanding that their time in the future would be limited, or met their SO in medical school and are married to fellow physicians.

 

[SocialistMD]

I'm wondering though, if you are in a significant relationship, is it with another physician? Another surgeon? So far, the surgeons I've come across who are in relationships either met their SO before medical school and went into it with their partner's understanding that their time in the future would be limited, or met their SO in medical school and are married to fellow physicians.

I met my (non-physician) wife while in medical school. I think that, no matter the profession of your spouse nor when you met them during the timecourse of your training, they will have to be understanding of the fact that your life at work more often than not comes first.

 

[Winged Scapula]

My SO throughout residency and fellowship was another surgery resident (different program, a couple of years ahead of me) whom I met my first month as an intern.

I understand that many people are not interested in being with another physician but I found it very beneficial in that only another surgeon can understand the hours, the pain, the schedule, etc. I don't think even another physician could really understand how things work in the surgical field when their only experience has been as a 3rd year medical student, but at least a physician might be more understanding.

I think the hours and unpredictability of the schedule takes a very understanding SO and someone who has to have a life outside of you. They have to understand that plans may be broken and that sometimes, patients come first.

It helps though, if your SO is someone you could see yourself with, even if they weren't a surgeon (ie, my ex and I had a lot of things in common, surgery was just one of them).

 

[TheMightyAngus]

Great responses. How do your clinical responsibilities change as you advance during residency after intern year? I assume it's more operative and more autonomous. But is it less grueling? What about call? Does your quality of life improve?

 

[Winged Scapula]

Great responses. How do your clinical responsibilities change as you advance during residency after intern year? I assume it's more operative and more autonomous. But is it less grueling? What about call? Does your quality of life improve?

Its different.

As you note, there is typically more operating, more autonomy and less in house call.

But I did not necessarily find my quality of life improving as a senior and Chief resident. For example, for my program, the Chief's pager was never off. If there was a fellow on service, at least I did not have operative and admitting responsibilities every other night, and could reasonably have some wine, go out to dinner more than 15 minutes away from the hospital, etc.

However, on services without a fellow (which was most of them for us), we were on back-up every night and in house call (for trauma) usually 1 in 6 (with backup for trauma about the same frequency...so it generally average about 1 in 4). That meant that all problems that the interns wanted to run by us came to me...regardless of what time or whether I was post-call. That meant that I came in for operative issues on my service and even for stable admissions (on some services). I did not go home early post-call, especially if the Administrative Chief had screwed up the schedule and had me AND the intern or junior resident in house the night before. The junior resident went home, I stayed - to do cases, sign out the service, correct the patient list, etc. There were days when I was the service intern, junior resident and Chief all rolled into one.

So while home call sounds great, if you are awakened every few minutes (either by a nervous or new intern, or a problem patient or a nurse who figures she will bypass the underlings and go straight to you), you don't get much sleep and it doesn't "count" as call, so you are still there all day and much of the evening.

My body actually found it harder to take in house call when I did so less frequently. Perhaps I just got used to it in the old days. So sure, I was home more, but I didn't find it less grueling...interns and junior residents are protected from a lot of BS by the Chiefs (or at least you should be). We lie for you when you screw up and take the blame, we do the work left over after we have sent you home because we get yelled at if you are over hours, we have to remember what stuff attending X likes and what attending Y likes, even if it doesn't make any sense. The responsibility and expectations are greater.

So different stuff, different responsibilities and different stressors. But that was my program, YMMV.

And it doesn't get any better. Before my first day as an attending, I had a dream that I was in the operating room and forgot where to make the incision. And I felt sick to my stomach while driving in (at least I didn't vomit...a friend of mine admitted to doing so before her first case as an attending). If the Front Desk/OR/nurse screws up, it reflects on me and will be reflected in my paycheck.

 

[Castro Viejo]

I absolutely agree that you should pick a speciality based on the feeling you get from doing that sort of work. It's not worth any amount of money to do something that will make you miserable. At the same time, some sacrifices, like the ones you make as a surgeon, are worth it if your job makes you feel like you're doing something meaningful and exciting. I'm wondering though, if you are in a significant relationship, is it with another physician? Another surgeon? So far, the surgeons I've come across who are in relationships either met their SO before medical school and went into it with their partner's understanding that their time in the future would be limited, or met their SO in medical school and are married to fellow physicians.

My fiance is in private equity. I don't know what that really means, but I think it's Latin for "Laugh stupid doctor, my paychecks are WAY bigger." 🙂

 

[Castro Viejo]

Great responses. How do your clinical responsibilities change as you advance during residency after intern year? I assume it's more operative and more autonomous. But is it less grueling? What about call? Does your quality of life improve?

Like Kim Cox said, it depends on your program.

Our interns are tortured, but it's mostly scut. They do about 120 cases a year despite this.

Our R2s are in the SICU for probably nearly a year, but this has improved. They log about 100 cases.

The R3s and R4s are in-house Q3 for trauma, ED/floor consults, and backing up the interns and R2. For each year they log about 300-400+ cases.

The Chiefs are in-house Q3 for trauma, but only for potentially operative stuff or complex crap (that the R3 or R4 is uncomfortable with), have independent OR privileges (attending dependent or in the event of a patient that needs an immediate operation and the attending isn't available), and serve as lightning rod for anything that goes wrong. We typically log about another 200-300+ cases.

My program's a bit malignant in this regard, I guess. 😳

As interesting as my Chief Resident year has been, I'm also on Administrative duty for the entire year, so that means I get all the complaints regarding the schedule, make up the call schedule for the entire program for the entire year, pick up extra calls for the other two slacker Chiefs, discipline all my juniors, and receive complaint after complaint from my Chairman about what a bad job we're all doing. And post call? I usually have to stay (much to the chagrin of the RRC) to do cases that I booked unless it's something stupid. I usually have to come back in the evening to prepare the educational component for the juniors and assign cases for the next day to all the juniors. I get reprimanded for poor attendance at lectures, bad M&M presentations, and general badness in patient care because of a junior by the attending staff.

I do like the majority of my faculty, though. They mean well, though they're a little lazy for the most part. This translates into this laissez-faire attitude, and it can be a bit scary on some services.

 

[doc02]

Don't forget all the complaints from outside services about how surgery residents are such meanies.

 

[Castro Viejo]

Don't forget all the complaints from outside services about how surgery residents are such meanies.

I just remembered I have a meeting tomorrorw morning with the Medicine PD about how I "verbally battered" one of the medical interns and how this may be a violation of some professionalism code at the institution.

Oops... 🙂