Are surgical residency hours really that much worse?

[DermViser]

---

Members don't see this ad.

Yeah, but let's be honest. Anybody who's been in a surgical residency since the institution of the intern work hour rules knows they don't make patients any safer. Contrary to the people who seem firmly committed to the "you're against the 16 hour intern shift so you must support rolling back the 80 hour work week" logical fallacy, the two sets of rules are DRAMATICALLY different. 80 hours a week is fairly common sense. In contrast, why one gains the magical ability to safely work for 28 hours on month 13 of residency but not month 10 is illogical and basically just pure PR grandstanding. I'm actually more bothered by being up all night as a senior resident than I was as an intern.

We essentially just need some evidence to reinforce the concept that it was stupid to implement intern shifts without any data supporting that being the key driver of patient/resident problems. Doesn't need to be perfect level 1 gold plated.

If it was fairly common sense, it wouldn't have required the ACGME to FORCE surgical program directors to do it. By the way, there's no data supporting that patients haven't been harmed with 80 hour weeks either.

 

[ThoracicGuy]

I trained entirely in the 80 hrs system, both in residency and fellowship. I can understand the perspective of what vhawk was saying about being on-call and patient ownership issues. Sometimes the message gets lost without a reality check. I am at an academic center for reference (and that matters). The last two weeks for example--my partners were out of town, and I was on call so I dealt with everything. This week I am not on-call, but I'm still doing cases, and I take every call on my patients any time of day--I never defer to another on-call attending when I'm in town--so if my patient goes down for whatever reason, I take the call, even when I'm not "on-call". I think this is the essence of what vhawk was saying; even when you're not "on-call", you're still on for your patients. I would imagine that most/every attending on here would probably agree that they would want to take the calls on their in-house/recent post-op patients when problems arise (assuming they are available). If a patient I operated on 1 or 2 weeks ago shows up in some ER 100 miles away with a surgical issue and they call my hospital, I get the first call whether I am on-call on not (this is how our hospital call center is set up)--I think this is a fairly typical scenario.

I own my patients, and I loved the 80 hr work week.

I experienced both the pre and post 80 hour work week residency and then during fellowship I got to experience the intern 16 hour rule. I agree with SLUser11, there were alot of days as post-call intern that I was expected to stick around until evening rounds even if they were in a long case that got done at 10 pm so that we could round before going home. After 6 pm, all the regular calls were going to the on-call residents, so there was literally nothing to do except sit around and wait. That was worthless. In the post-80 world, it was nice to actually be able to take care of errands that you couldn't do on weekends as needed. Signouts were much more important post-80 and there was some issues with covering other teams at times because of post-call residents, but we all seemed to make it work. Now the 16 hour intern rule, that is something that I cannot support. What makes an intern suddenly able to handle a 30-hour shift when they make that PGY1 to 2 transition? It's caused night floats to become the norm and hour rules wouldn't even be able to be followed without it. Weekend shifts are hell on interns now. My service as a fellow would now require our two interns to be on call essentially every weekend (morning vs evening shift) instead of just taking a Saturday or Sunday. It's a horrible schedule, but the 16 hour rules tie our hands.

As for patient ownership, I do think that suffers some in the post-80 world, but significantly more in the 16 hour, night float world. That essentially is turning the residents into shift workers. When you become an attending, you'll be in for a rude awakening if this continues...

 

[joanofarc0907]

I'm sorry, are you seriously suggesting that on average, a MS4 who matches into an IM spot is going to spend the same number of years in training as an MS4 who matches into a surgical spot? And your argument is that those IM people who spend the maximum possible time are about equivalent to surgeons who spend the minimal time? SDN is hilarious

I said nothing about it being equivalent training. I only said it was equivalent in # of years so people should stop focusing on how old they'll be when they are done and just do what they want.

 

[thedrjojo]

Is the 16 hour max rule a better lifestyle factor? Would you be happier not working 28 hours straight? Cause if this study turns out to show no difference in outcome, you can bet good money that people will argue that if it does not harm the patients, it's more humane treatment of people, and not only should stay, but maybe expanded.

I find it somewhat amusing that we (myself included, I'm a glutton for punishment and want to do transplant and never sleep/leave the hospital) think it's a horrible tragedy that shifts can ONLY be 16hours...most lay people can't fathom how we can be functional, let alone be responsible for life altering decisions for others after 24 straight hours of work...

 

[Silent Cool]

Try saying YES once in a while. Doesn't it make you feel a nice tingly sensation? 😀

Vhawk is the only person here who thinks it's ok/cool to be on 24/7. He doesn't realize 99% of current med students disagree and would laugh at his face.

Case in point, all med students would roll their eyes if they are told they need to be available to their patients all the time.

Oh, but Knux, you're forgetting: that would make Dr. V "weak" and "uncommitted."

It's a badge of honor. Where's your commitment? The mighty DeBakey would not approve.

#BrainwashedFTW

 

[Silent Cool]

General Surgery as a medical student is NOTHING like General Surgery as an actual intern/resident. As an MS-3, you don't nearly do as much **** as the surgical intern has to do, you just THINK you do. Most surgery teams know that most students don't want to do surgery hence the expectations for students is ridiculously low. Surgery is one of those fields where you truly have to LOVE surgery in order to be able to get thru it, bc you will be living, breathing, and eating Surgery for 5 years. This is not like this even in IM, where at least some elective months are "easy". There are no "easy" surgery months in General Surgery residency. There's a reason that Surgery looks down on other specialties, esp. the ROAD specialties, bc the level of dedication required is SO much higher (I'm not talking about just time here) than most other specialties. Read the front of Surgical Recall regarding "The Perfect Surgery Student" esp. the term used HAMMERHEAD. Now apply that to 12 months of the year instead of just 8 weeks.

http://doctum-aphorism.tumblr.com/post/24552003854/the-perfect-surgery-student

 

[DermViser]

Oh, but Knux, you're forgetting: that would make Dr. V "weak" and "uncommitted."

It's a badge of honor. Where's your commitment? The mighty DeBakey would not approve.

#BrainwashedFTW

General Surgery thrives on their residents being brainwashed, as no true human being would be able to tolerate such abuse otherwise. They then become attendings like Vhawk. Honestly, I hope Obamacare hits them the hardest. Fully deserved by a specialty that destroys their residents.

 

[Dwindlin]

General Surgery thrives on their residents being brainwashed, as no true human being would be able to tolerate such abuse otherwise. They then become attendings like Vhawk. Honestly, I hope Obamacare hits them the hardest. Fully deserved by a specialty that destroys their residents.

Not calling you out particularly, but I've seen this general comment several times now. Now I'm not advocating going back to pre-80 hour week, but frankly it's not as bad as this (and similar posts) make it out to be. It is far from abuse. For the most part my colleagues are genuinely happy. Before I get called brainwashed I am not a surgeon, I'm done after this year, but I would without question do a surgical internship again if I had to pick again.


Sent from my iPad using Tapatalk

 

[ram006]

Dermviser in particular has been dropping gems like that throughout the thread.

I'm not brainwashed. I love my job, I love the patient population, and I've gotten to do so many amazing operations the past few years I can't even keep track of them all anymore.

My attendings must have missed the memo that they're supposed to be beating the spirit out of me, because they've been outstanding personal and professional mentors.

I am quite glad for the 80-hr work week. Someone above pointed out the fallacy of conflating opposing the 2011 duty hours with opposing ALL duty hour limitations. To be clear on my position - I believe from my personal experience that the 2011 duty hours are worse for residents QOL and learning. Those are the reasons I oppose them (because I am in favor of maximizing learning and QOL)

Well put. Hopefully med students pay more attention to these types of comments than some of the others left by nut jobs on this forum.

 

[DoctwoB]

Is the 16 hour max rule a better lifestyle factor? Would you be happier not working 28 hours straight? Cause if this study turns out to show no difference in outcome, you can bet good money that people will argue that if it does not harm the patients, it's more humane treatment of people, and not only should stay, but maybe expanded.

I find it somewhat amusing that we (myself included, I'm a glutton for punishment and want to do transplant and never sleep/leave the hospital) think it's a horrible tragedy that shifts can ONLY be 16hours...most lay people can't fathom how we can be functional, let alone be responsible for life altering decisions for others after 24 straight hours of work...

The problem isn't that people want to work more, it's how the work is divided. On my rotations I've found working 6 ~14-16 hour "shifts" in a week is a lot less pleasant then a schedule in which you can take an overnight call then get a post-call day, or in which weekend call can be alternated and allow for occasional golden weekends.

 

[thedrjojo]

The problem isn't that people want to work more, it's how the work is divided. On my rotations I've found working 6 ~14-16 hour "shifts" in a week is a lot less pleasant then a schedule in which you can take an overnight call then get a post-call day, or in which weekend call can be alternated and allow for occasional golden weekends.

i agree. Those post call days are glorious. Its a little sad telling how much we work that we prefer working 28 hours so we can get a day off instead of being forced to work 6 days a week for 14-16 hours a day. Those weekends, we aren't doing that much operating, and while there is great value in caring for patients on the floor, we can't think of a better system? I don't know

 

[DermViser]

Not calling you out particularly, but I've seen this general comment several times now. Now I'm not advocating going back to pre-80 hour week, but frankly it's not as bad as this (and similar posts) make it out to be. It is far from abuse. For the most part my colleagues are genuinely happy. Before I get called brainwashed I am not a surgeon, I'm done after this year, but I would without question do a surgical internship again if I had to pick again.

Sent from my iPad using Tapatalk

Sorry, but a prelim surgical internship (where the expectations for you is quite low) is completely different from a categorical surgical intern.

 

[ram006]

Sorry, but a prelim surgical internship (where the expectations for you is quite low) is completely different from a categorical surgical intern.

True, but they don't work fewer hours. If they consistently take off early or slack off too much they end up getting canned.

Based on my experience as a categorical intern, I would say many of the prelims worked just as hard. In the case of undesignated prelims, they often disregard duty hours entirely in order to be more visible in hopes of securing a spot.

Your brainwashed comment was a bit dramatic, though. Despite what you may think, there are in fact those of us who work incredibly hard and neither view ourselves as morally and/or clinically superior to others (like VHawk and Neusu) nor are we miserable, brainwashed drones as you claim.

Surgery is rough. If you don't mind working over 80 hours a week (sometimes) you'll survive residency. If you find that internal motivation (without being a pompous jerk) to stay when you could leave you'll thrive. If not, then it's not your thing. No reason to get all emotional about it either way.

 

[Dwindlin]

Sorry, but a prelim surgical internship (where the expectations for you is quite low) is completely different from a categorical surgical intern.

Not in my program. Everything that is expected of them is expected of me. Including a minimum number of surgeon junior cases.


Sent from my iPad using Tapatalk

 

[Dr.LeoSpaceman]

Surgery is rough. If you don't mind working over 80 hours a week (sometimes) you'll survive residency. If you find that internal motivation (without being a pompous jerk) to stay when you could leave you'll thrive. If not, then it's not your thing. No reason to get all emotional about it either way.

This is probably the most succinct way of putting it. The actual number of hours is irrelevant. The issue at hand is that people who thrive in a surgical residency are those who aren't looking at the clock and itching to sign out right at 6pm. It also isn't about the guy who lives in the call room. Some days and weeks are busier than others, but if you're interested in your patients and their diseases, it often doesn't feel like work.

To the OP: Answer this hypothetical. Say you just admitted a patient to your service at 5pm with free air, and he's going to the OR. Your chief gives you the option of signing out at 6pm, or coming down to help with the case. What are you going to do?

I'd say someone that's going to do well in surgery, and not be miserable, wants to go to the OR regardless of how long they've been there or how many hours they've worked that week. Why? Not because they feel obligated, but because they're genuinely interested and think it may be fun (at least, that't the way I still feel 4 years into residency). On the other hand, if the only way you're going to stay is if your chief (or someone else) pressures you into doing it, then surgery probably isn't for you.

 

[circulus vitios]

Interesting. I am not saying they don't share our beliefs. What I am saying, is most people who inquire about our hours do not share our beliefs. Personally, I never questioned how many hours a week a neurosurgeon worked. All I knew is what they did, and I wanted to do that. Would this work if had had the preconceived notion, well I only want to work 60 hours a week at most. Likely not. I went in to this field, having heard stories of working 120+ hour weeks. Went in to the field, worked 120+ hour weeks. Am not disappointed. What I am disappointed by, for that matter, is people who want to marginalize medical care because of their own personal interests.

You're disappointed that people want to have a life outside of the hospital?

 

[DermViser]

You're disappointed that people want to have a life outside of the hospital?

Well, apparently, by not breathing the hospital 24/7, you're "marginalizing medical care". Reminds me of the phrase, "the beatings will continue until morale improves."

On Surgery, I used to always laugh inside at the ridiculously high level of disdain that General Surgeons had for EVERY OTHER specialty except theirs: Rads, Optho, Anesthesiology, Dermatology, Psych, Peds, etc. There is a reason that their specialty is hated by almost every other specialty and it isn't bc of their "dedication" by any means. Their specialty also has the HIGHEST percentage of "disruptive" physicians that could keep Psychiatrists busy if they just had this group alone for patients: http://www.fsmb.org/pdf/pub-jmr-misuselabel.pdf

 

[SLUser11]

Their specialty also has the HIGHEST percentage of "disruptive" physicians that could keep Psychiatrists busy if they just had this group alone for patients: http://www.fsmb.org/pdf/pub-jmr-misuselabel.pdf

I thought you were actually providing a source for your ridiculously outlandish claim, rather than a link to the definition of “disruptive.”

What you have is some serious tunnel vision. You’ve experienced one, MAYBE two surgical residencies in your life. You mention that “general surgeons” have disdain for other specialties, but how many board-certified surgeons practicing general surgery did you truly encounter? Are you sure you didn’t just have a couple bad residents, and you are using that limited experience to make an inaccurate blanket statement about an entire specialty?

In the real world, disruptive surgeons are infrequent, and their disruptive behavior typically occurs in the OR, where other doctors would not see it. Generally, physicians from multiple specialties get along well and work together.

Like I said before, if a surgeon was truly disruptive in the real world…which you seem to know very little about…then he wouldn’t eat.

 

[ram006]

Well, apparently, by not breathing the hospital 24/7, you're "marginalizing medical care". Reminds me of the phrase, "the beatings will continue until morale improves."

On Surgery, I used to always laugh inside at the ridiculously high level of disdain that General Surgeons had for EVERY OTHER specialty except theirs: Rads, Optho, Anesthesiology, Dermatology, Psych, Peds, etc. There is a reason that their specialty is hated by almost every other specialty and it isn't bc of their "dedication" by any means. Their specialty also has the HIGHEST percentage of "disruptive" physicians that could keep Psychiatrists busy if they just had this group alone for patients: http://www.fsmb.org/pdf/pub-jmr-misuselabel.pdf

Being relatively new to SDN I didn't really understand the term "troll" before reading your posts. For someone who disdains surgeons you sure seem to care a lot. As a side note, you seem to be really angry for a Dermatologist. Do you actually have a spot?

 

[Winged Scapula]

And yet none of us are trolling on the derm forum by repeatedly dropping the most simplistic of stereotypes...

It is important to note that doing so (posting in another forum with the intent to troll, inflame or insult practitioners of that specialty) is an SDN TOS violation. Thoughtful educated discussions are welcome but simply posting insults are not.

 

[DermViser]

I thought you were actually providing a source for your ridiculously outlandish claim, rather than a link to the definition of “disruptive.”

What you have is some serious tunnel vision. You’ve experienced one, MAYBE two surgical residencies in your life. You mention that “general surgeons” have disdain for other specialties, but how many board-certified surgeons practicing general surgery did you truly encounter? Are you sure you didn’t just have a couple bad residents, and you are using that limited experience to make an inaccurate blanket statement about an entire specialty?

In the real world, disruptive surgeons are infrequent, and their disruptive behavior typically occurs in the OR, where other doctors would not see it. Generally, physicians from multiple specialties get along well and work together.

Like I said before, if a surgeon was truly disruptive in the real world…which you seem to know very little about…then he wouldn’t eat.

If anything, I felt sorry for them, that a specialty they love would treat them in such a manner - and this is at a university academic medical center. The level of Stockholm Syndrome in General Surgery is unreal, and so unlike other specialties like Urology or ENT, for example.

In the article:
Table 1
Disruptive Behaviors
Aggressive behaviors:
• Yelling
• Foul and abusive language
• Threatening gestures
• Public criticism of coworkers
• Insults and shaming others
• Intimidation
• Invading one’s space
• Slamming down objects
• Physically aggressive or assaultive behavior
Passive-aggressive behaviors:
• Hostile avoidance or the “cold shoulder” treatment
• Intentional miscommunication
• Unavailability for professional matters, e.g., not answering pages or delays in doing so
• Speaking in a low or muffled voice
• Condescending language or tone
• Impatience with questions
• Malicious gossip
• Racial, gender, sexual, or religious slurs or “jokes”
• “Jokes” about a person’s personal appearance, e.g., fat, skinny, short, ugly
• Sarcasm
• Implied threats, especially retribution for making complaints

After reading this list, are you seriously saying that general surgery as a specialty doesn't have a high percentage of people who demonstrate the above behaviors? Seriously?!?! Hiding disruptive behaviors or having enablers (i.e. hospital administrators who realize that Surgery makes a lot of money for the hospital) doesn't make the behavior any less disruptive. Also disruptive behaviors aren't just to other doctors.

 

[DermViser]

Being relatively new to SDN I didn't really understand the term "troll" before reading your posts. For someone who disdains surgeons you sure seem to care a lot. As a side note, you seem to be really angry for a Dermatologist. Do you actually have a spot?

Pointing out observations, doesn't make one "angry", esp. after having many friends who went into Surgery truly loving doing Surgery, and having their own specialty treat them this way, as some type of hazing ritual. I do not disdain the specialty of Surgery, just the personalities that it foments. I am a Dermatology resident.

 

[DermViser]

I thought you were actually providing a source for your ridiculously outlandish claim, rather than a link to the definition of “disruptive.”

What you have is some serious tunnel vision. You’ve experienced one, MAYBE two surgical residencies in your life. You mention that “general surgeons” have disdain for other specialties, but how many board-certified surgeons practicing general surgery did you truly encounter? Are you sure you didn’t just have a couple bad residents, and you are using that limited experience to make an inaccurate blanket statement about an entire specialty?

In the real world, disruptive surgeons are infrequent, and their disruptive behavior typically occurs in the OR, where other doctors would not see it. Generally, physicians from multiple specialties get along well and work together.

Like I said before, if a surgeon was truly disruptive in the real world…which you seem to know very little about…then he wouldn’t eat.

Yes, please tell an academic Surgery resident/attending who asks what you plan on going into and say you want to do Radiology, Optho, Anesthesia, or Derm and see the response you get. Even better, tell them you plan on doing Psychiatry, and see what response you get.

 

[ram006]

Yes, please tell an academic Surgery resident/attending who asks what you plan on going into and say you want to do Radiology, Optho, Anesthesia, or Derm and see the response you get. Even better, tell them you plan on doing Psychiatry, and see what response you get.

I think plastics has traditionally been viewed with more contempt by general surgeons than any of those specialties and I've received nothing but support from my faculty.

But nonetheless, you should know the world isn't at a loss because you choose to keep your thoughts to yourself. You've said essentially the same thing multiple times and contributed nothing to the discussion perhaps it's time to move on?

 

[DermViser]

I find it refreshingly honest when a student actually tells me what they are interested in rather than the generic "keeping their mind open" responses. I can also try to tailor some of my teaching when I know what they are likely to do with their lives. One of the best med students I ever had was going into psychiatry.

You are definitely in the minority. Medical students (in general) aren't stupid. Obviously saying one wants to do Surgery, could also easily backfire. Saying a "lifestyle" specialty definitely backfires, as residents know those fields require getting Honors on multiple rotations in MS-3 year, not to mention, there is a slight twinge of jealousy involved (whether subliminal or not).

They know that if they are asked what specialty they're going to and they tell the truth, there is a possibility of getting dinged on their evaluations. That's why so many end up saying, "I'm not really sure yet" or "I'm still trying to decide".

 

[Winged Scapula]

I have seen some of the behavior that DermViser talks about, especially when students profess interest in non-surgical fields, but c'mon - it works both ways. Tell a pediatrician, or psychiatrist or dermatologist that you're doing General Surgery and see what sort of comments that begets. Some of the worst speciality bashing I heard came not from GS but from other fields so it shouldn't surprise anyone that we get tired of hearing about it.

 

[PB n J]

...c'mon - it works both ways. Tell a pediatrician, or psychiatrist or dermatologist that you're doing General Surgery and see what sort of comments that begets. Some of the worst speciality bashing I heard came not from GS but from other fields so it shouldn't surprise anyone that we get tired of hearing about it.

So true. I've heard my fair share of IM bashing by a good many of my GS attendings, but never have I heard so much specialty bashing as when I told everyone in my third year (I'm one of those guys who says right out, "I want to do surgery") that I would be applying for general surgery. I mean you'd think these people had personal vendettas against surgeons or something.

 

[Dr.LeoSpaceman]

You are definitely in the minority. Medical students (in general) aren't stupid. Obviously saying one wants to do Surgery, could also easily backfire. Saying a "lifestyle" specialty definitely backfires, as residents know those fields require getting Honors on multiple rotations in MS-3 year, not to mention, there is a slight twinge of jealousy involved (whether subliminal or not).

Do you find it challenging to define things with such broad generalizations? I think I would.

Consider that the attendings/residents here know more about surgery and surgical trainees/staff than you do, and so when many of them say that a medical student who doesn't want to do surgery isn't "dinged", perhaps they probably aren't in the minority. As with others, I like when a medical student is honest about where their interests lie...but it's usually dependent on them articulating why they enjoy that field. If you say you love emergency medicine because you can work 3 12's and get to the beach every weekend, my disdain is completely detached from what specialty they chose to name. And I would hope that people in that same field would share that opinion. Choosing any career (whether in medicine or another field) simply because of the lifestyle and earning potential underlies, on some level, a lack of maturity. Furthermore, they're actually admitting that their potential to succeed is going to be directly linked to how much work they will have to do. So if I'm choosing people to mentor/train, why would I want to choose that kind of person?

I too have the same stories about how the best medical students I've worked with were interested in other fields besides surgery. Why? Because they showed general interest in learning and worked hard. Not because they were trying to get the best grade, but because they realized that their knowledge of surgery might prove beneficial in their development as a physician (regardless of the field they end up in). It also helps me improve their experience on the rotation, because I can focus what I'm teaching them on their interests or find things that they might find interesting. If someone is really interested in endocrinology, and I have a surgery patient who has blood sugars that are all out of whack, maybe I can have that student tell me what changes I should make to the medications they're getting or take charge of the endocrine consult I'm going to get.

 

[Dissected]

I have seen some of the behavior that DermViser talks about, especially when students profess interest in non-surgical fields, but c'mon - it works both ways. Tell a pediatrician, or psychiatrist or dermatologist that you're doing General Surgery and see what sort of comments that begets. Some of the worst speciality bashing I heard came not from GS but from other fields so it shouldn't surprise anyone that we get tired of hearing about it.

Most attendings/residents were receptive and at least pretended to be intrigued by my choice to go into surgery when I was a student, but my ob/gyn rotation became essentially worthless after I told my attending I was going into general surgery. He was very vocal about how much he looked down upon my specialty choice. Definitely works both ways. Some people can't seem to let go of past experiences and it influences how they view anyone associated with a certain specialty...and I think we all know the reputation surgery can have with other fields, whether it is warranted or not

 

[megamindo]

in ASU, Egypt dt lack of order the Junior Resident is doing most of the work
we take 6 hours per week as a vacation 🙂
we may work from 6 A.M til1 11 PM

 

[PB n J]

we may work from 6 A.M til1 11 PM

I do this as a medical student.

 

[megamindo]

I do this as a medical student.

jajaja 🙂
but if u go to sleep, you wont be punished or fired 🙂

 

[ram006]

jajaja 🙂
but if u go to sleep, you wont be punished or fired 🙂

One of our residents is from Egypt and was an attending for 3 years there before starting residency here. His motivation for coming to the states was inadequate training back home. So, you're either not being entirely honest about the hours you work or the amount of hours are certainly not up to par with the US in terms of quality. In either case, it sounds like you should leave Egypt as soon as possible because that sounds miserable.

 

[Kahreek]

I like how some surgeons here think they are in a holy mission and are the chosen martyrs for the holy cause. Self thoughts of grandeur are ugly. Imo

 

[mercaptovizadeh]

On my clerkships, when I said I wanted to do med-peds I got positive responses on inpatient pediatrics and outpatient medicine, outpatient pediatrics, and family medicine. Neurology was kind of dismissive, psychiatry was positive, as were ENT, EM, and ophtho. Ob/gyn and IM there were mixed responses. On the surgery rotation there were frequent and repetitive put downs on internal medicine. Definitely multiple times a week. I liked my surgery rotation, and obviously I can't assess how other specialties view people applying to surgery, but they did seem to be the most vocal in putting down non-surgical specialties.

Oh, and during my surgical rotation I heard a LOT of random put downs regarding ob/gyn. Almost as bad as the IM-hatred. Nobody was busy bashing pediatrics or psych, they probably don't even consider them real medical careers. 🙂

 

[vhawk]

I like how some surgeons here think they are in a holy mission and are the chosen martyrs for the holy cause. Self thoughts of grandeur are ugly. Imo

You seem to be imputing a whole lot of your own baggage into what other people are saying. I certainly never said anything like the above, and I'm sure I'm the worst "offender". Don't feel bad, you aren't alone, seems like most of the responders in this thread have ignored what was actually said and just assumed based on tone that the other side was saying horrible terrible very bad things.

More succinctly...cite?

 

[Bostonredsox]

I agree, I see medicine as a job, not something I'd attach to the hip 24/7. We are doctors, normal people, and have lives too!

This is a fundamental principal I learned early on when I was an intern and it transcends to all fields of medicine and all facets of life. Your job...is your job. It is a means to an end. A way to provide a roof for your family and feed your children. You need to always remember that. Is what we do as physicians more complicated, require extensive training, etc etc compared with theman who picks up your garbage? sure. but the commonality is we both do it to earn a paycheck. You show me any physician coming out of his/her residency that says they do this for the love of the field and then tell them they will be paid $60,000 annually for their efforts going forward, and99% will scramble for a rewind button on their lives.

I see this most commonly in surgeons, the older generation, who feel they must stay late, come in early, spend every second of their time helping their patients. Thats very noble, but it is not the way life is meant to be lived. Our time is finite on this planet and when you look back on your life in your 70s and see what % of it you spent at work instead of at your kids soccer games, having dinner with your wife, etc, it will be a wave of depression. A wise attendign once told me that after a blistering 30 hour effort in the MICU, caring for a **** ton of sick patients, the moment you smile, feel good about what you did, and walk out the door, another patient is going to roll in. It never ends. You have to know when your time ends and where the next person can pick up where you left off.

There is an old saying comparing european quality of life to american...Europeans work to live, americans live to work. Remember what life is really about.

 

[LucidSplash]

To some extent, I agree with the above. Despite being a surgery resident and aspiring surgeon, I do have outside interests and a life I want to live and the remuneration angle is important. It is important to know when to let someone else take care of the next patient coming in, though as I progress through my residency I am forever chased by the idea that I have a lot left to learn and a dwindling amount of time to learn it and sometimes that can make it difficult to let go. I am less interested in "balance" during my training than I will be in the future because my perspective is that NOW is the time I have to learn the intricacies of surgery so that I will be a surgeon my patients can trust later on. In surgery, sometimes that means staying late because we can't really plan for when the perforated colon or ulcer, AAA, or GSW comes in. You have to just BE there when the opportunity to learn arises, you can't plan it, so sometimes that leads us to staying later than our prescribed hours.

For me, the difference between being a surgeon (of any ilk) and another specialty is that what we do is typically much more invasive. To be entrusted with cutting into someone's flesh and removing/rearranging their internal organs is, to us, different than the medical management of DKA, a stroke, an MI, etc. It is NOT that what we do is any more important than an internist, an EM physician, pediatrician, etc. It is just different sometimes. If something goes wrong, whether it is technical error or not, I feel responsible and I consider it my responsibility to be there to correct whatever went wrong if at all possible. Yes sometimes that means that one of your coworkers or partners takes care of your patient at 2am when disaster strikes and one of the reasons it is so important to trust those people you work with. But that doesn't mean I'd be ok walking out the door at 6pm, KNOWING that one of my patients is on their way to the operating room for a takeback, because I had dinner reservations/wanted to make a yoga class/go to running club, and it is supposed to be my night off. That person trusted me to take care of them and taking someone back to the operating room is a bit different than modifying medical management. This is not me having a "hero complex" or being a martyr to my profession, it is simply trying to uphold the responsibility/commitment I made to the patient when I agreed to operate on them in the first place. Again, I see this as qualitatively different than those who never leave the hospital for fear of missing ANY case that comes in through the ED; after a 14-16 hour workday, I'm generally willing to let the call guy look out for the gall bladder/appendix/perforated whatever transferred in from OSH that we know is coming (but not when) if there's no sign of them at 6pm. But that is very different, to me, than leaving when I know someone I operated on is sick/unstable/having a complication, etc. Technically I COULD hand that off to the night guy - and the ACGME wants me to do just that - but that doesn't mean it is the RIGHT thing to do.

 

[KnuxNole]

This is a fundamental principal I learned early on when I was an intern and it transcends to all fields of medicine and all facets of life. Your job...is your job. It is a means to an end. A way to provide a roof for your family and feed your children. You need to always remember that. Is what we do as physicians more complicated, require extensive training, etc etc compared with theman who picks up your garbage? sure. but the commonality is we both do it to earn a paycheck. You show me any physician coming out of his/her residency that says they do this for the love of the field and then tell them they will be paid $60,000 annually for their efforts going forward, and99% will scramble for a rewind button on their lives.

I see this most commonly in surgeons, the older generation, who feel they must stay late, come in early, spend every second of their time helping their patients. Thats very noble, but it is not the way life is meant to be lived. Our time is finite on this planet and when you look back on your life in your 70s and see what % of it you spent at work instead of at your kids soccer games, having dinner with your wife, etc, it will be a wave of depression. A wise attendign once told me that after a blistering 30 hour effort in the MICU, caring for a **** ton of sick patients, the moment you smile, feel good about what you did, and walk out the door, another patient is going to roll in. It never ends. You have to know when your time ends and where the next person can pick up where you left off.

There is an old saying comparing european quality of life to american...Europeans work to live, americans live to work. Remember what life is really about.

True dat.

I would be extremely depressed being a workaholic. I want to work hard, but not to a crazy extent where I have 0 free time. Medicine isn't the most important thing in my life. It's a job, a job I love, but at the end of the day, it's a profession. We are doctors after all, nothing too special. I remember the times spent with my relatives, with my friends, people that matter. Having a balance is key. Doing too much of work with completely missing 80-90% life would make me not want to think about doing this job. Thankfully, I'm in a field where you can have work-life balance and something I like to be a part of daily 🙂

 

[Bostonredsox]

To some extent, I agree with the above. Despite being a surgery resident and aspiring surgeon, I do have outside interests and a life I want to live and the remuneration angle is important. It is important to know when to let someone else take care of the next patient coming in, though as I progress through my residency I am forever chased by the idea that I have a lot left to learn and a dwindling amount of time to learn it and sometimes that can make it difficult to let go. I am less interested in "balance" during my training than I will be in the future because my perspective is that NOW is the time I have to learn the intricacies of surgery so that I will be a surgeon my patients can trust later on. In surgery, sometimes that means staying late because we can't really plan for when the perforated colon or ulcer, AAA, or GSW comes in. You have to just BE there when the opportunity to learn arises, you can't plan it, so sometimes that leads us to staying later than our prescribed hours.

For me, the difference between being a surgeon (of any ilk) and another specialty is that what we do is typically much more invasive. To be entrusted with cutting into someone's flesh and removing/rearranging their internal organs is, to us, different than the medical management of DKA, a stroke, an MI, etc. It is NOT that what we do is any more important than an internist, an EM physician, pediatrician, etc. It is just different sometimes. If something goes wrong, whether it is technical error or not, I feel responsible and I consider it my responsibility to be there to correct whatever went wrong if at all possible. Yes sometimes that means that one of your coworkers or partners takes care of your patient at 2am when disaster strikes and one of the reasons it is so important to trust those people you work with. But that doesn't mean I'd be ok walking out the door at 6pm, KNOWING that one of my patients is on their way to the operating room for a takeback, because I had dinner reservations/wanted to make a yoga class/go to running club, and it is supposed to be my night off. That person trusted me to take care of them and taking someone back to the operating room is a bit different than modifying medical management. This is not me having a "hero complex" or being a martyr to my profession, it is simply trying to uphold the responsibility/commitment I made to the patient when I agreed to operate on them in the first place. Again, I see this as qualitatively different than those who never leave the hospital for fear of missing ANY case that comes in through the ED; after a 14-16 hour workday, I'm generally willing to let the call guy look out for the gall bladder/appendix/perforated whatever transferred in from OSH that we know is coming (but not when) if there's no sign of them at 6pm. But that is very different, to me, than leaving when I know someone I operated on is sick/unstable/having a complication, etc. Technically I COULD hand that off to the night guy - and the ACGME wants me to do just that - but that doesn't mean it is the RIGHT thing to do.

I agree with finishing what you started. Though my practice which is mainly MICU is far more invasive then most internists, it is far less invasive than your practice, So I somewhat to a lesser degree know what you are getting at. I too feel responsible for myintervnetions. If I drop a lung putting in a cordis near shift change, I am not leaving the chest tube for my replacement, I am seeing it done and the pt tucked in before I leave. I never leave an airway that I feel will not make it through the next shift, I secure it before I leave my shift. Etc. Etc. So tying off the lose ends for your own procedures I completely agree with.

I also agree with getting the most you can out of training. Ive "omitted" hours on multiple occasions to stay and get the transvenous pacer or IABP or whatever becase they dont come along often enough and if you want to develope proficiency, you need to take them when they are available. When I was trying to get my chest tube numbers up for credentialling I had every general surgeon we have texting me when they had one regardless of what rotation I was on or what time of day so I could come and do it to get my numbers. mostly I am speaking to the hours and work philosphy as attendings. residency is residency and whether its 60 or 90 hours a week, its a finite number of years an din the grand scheme of our careers, it is a small window.

But this philosophy goes far beyond that. Its a general notion of doing the best job you can during your shift/day but then trusting the oncoming person to be able to handle whatever unforeseen trouble may arise with your patients while you are gone. Feeling and acting like it is all on you can only and will definitely, lead to early burn out. gotta know when to call it quits for the day and go home to the rest of your life, which in reality is the most imporant part.

 

[SLUser11]

Your job...is your job. It is a means to an end. A way to provide a roof for your family and feed your children. You need to always remember that. Is what we do as physicians more complicated, require extensive training, etc etc compared with theman who picks up your garbage? sure. but the commonality is we both do it to earn a paycheck.

Disagree.

One should certainly find balance and avoid burning out...not just for yourself but also for your patients.....

But, surgery is much more to me than a job. It's a life choice. I don't do it for the paycheck...if so I wouldn't be in academics, that's for sure.....I do it for the love of the game, and for the greater good. I want to provide patients with the best care possible, and train residents so that they can provide future patients with the best care possible.

Our philosophies differ, and I don't believe one is better than the other, but mine involves a higher acceptable level of self-sacrifice. The problem with surgeons is when they advertise their self-sacrifice from the rooftops, and run around acting like martyrs....

 

[@JackShephard]

Disagree.

One should certainly find balance and avoid burning out...not just for yourself but also for your patients.....

But, surgery is much more to me than a job. It's a life choice. I don't do it for the paycheck...if so I wouldn't be in academics, that's for sure.....I do it for the love of the game, and for the greater good. I want to provide patients with the best care possible, and train residents so that they can provide future patients with the best care possible.

Our philosophies differ, and I don't believe one is better than the other, but mine involves a higher acceptable level of self-sacrifice. The problem with surgeons is when they advertise their self-sacrifice from the rooftops, and run around acting like martyrs....

You may disagree with the "it's just a job" idea, but it's hard to disagree with this idea:

Our time is finite on this planet and when you look back on your life in your 70s and see what % of it you spent at work instead of at your kids soccer games, having dinner with your wife, etc, it will be a wave of depression.

Our time is finite and the relationships you have will be what is important when you realize you have a few months to live.

I've yet to meet the person who was told they were going to die in 6 months and tried to spend 100 hrs a week trying to get more work done before death. Almost without fail, they find people to spend time with instead.

 

[SLUser11]

You may disagree with the "it's just a job" idea, but it's hard to disagree with this idea:



Our time is finite and the relationships you have will be what is important when you realize you have a few months to live.

I've yet to meet the person who was told they were going to die in 6 months and tried to spend 100 hrs a week trying to get more work done before death. Almost without fail, they find people to spend time with instead.

True, but you can't treat every moment like you only have a few months to live, or you will never contribute to society. When someone is dying, they rightfully feel like they've done enough service for others, and they want to finish things out taking care of themselves and their close loved ones....but I don't want to live in a society where everyone is completely focused on numero uno all the time.

Nobody is claiming that personal life and family are not important. I am claiming that it cannot be your sole focus all the time, and I personally do not treat surgery like a simple job. I take pride in my work, and I work hard to ensure that I'm the best, and the patients have the best outcomes. That often requires extended hours and personal sacrifice. I enjoy money because it makes myself and my family more secure, but I certainly do not focus on it, and even within the specialty of CRS, I could make a lot more and buy my family a lot more toys if I simply changed practice environments.

I doubt this sentiment is limited only to surgery. There are physicians in all specialties that hold it sacred when patients entrust them with their lives and wellbeing.

 

[@JackShephard]

True, but you can't treat every moment like you only have a few months to live, or you will never contribute to society. When someone is dying, they rightfully feel like they've done enough service for others, and they want to finish things out taking care of themselves and their close loved ones....but I don't want to live in a society where everyone is completely focused on numero uno all the time.

Nobody is claiming that personal life and family are not important. I am claiming that it cannot be your sole focus all the time, and I personally do not treat surgery like a simple job. I take pride in my work, and I work hard to ensure that I'm the best, and the patients have the best outcomes. That often requires extended hours and personal sacrifice. I enjoy money because it makes myself and my family more secure, but I certainly do not focus on it, and even within the specialty of CRS, I could make a lot more and buy my family a lot more toys if I simply changed practice environments.

I doubt this sentiment is limited only to surgery. There are physicians in all specialties that hold it sacred when patients entrust them with their lives and wellbeing.

Agree completely. Good luck and we appreciate your contributions.

 

[QuesoAndFromage]

On my clerkships, when I said I wanted to do med-peds I got positive responses on inpatient pediatrics and outpatient medicine, outpatient pediatrics, and family medicine. Neurology was kind of dismissive, psychiatry was positive, as were ENT, EM, and ophtho. Ob/gyn and IM there were mixed responses. On the surgery rotation there were frequent and repetitive put downs on internal medicine. Definitely multiple times a week. I liked my surgery rotation, and obviously I can't assess how other specialties view people applying to surgery, but they did seem to be the most vocal in putting down non-surgical specialties.

Oh, and during my surgical rotation I heard a LOT of random put downs regarding ob/gyn. Almost as bad as the IM-hatred. Nobody was busy bashing pediatrics or psych, they probably don't even consider them real medical careers. 🙂

In all fairness though, Ive been direct throughout the year about my interest in a surgical specialty and all my surgery rotations, psych, and family were the main ones with supportive responses while Peds and OBGYN were the worst. I still have IM/neuro so I have nothing to say about those.

As you seemed to imply it really does seem to be dependent on where you do the rotation and who the residents are of course.

 

[DermViser]

To some extent, I agree with the above. Despite being a surgery resident and aspiring surgeon, I do have outside interests and a life I want to live and the remuneration angle is important. It is important to know when to let someone else take care of the next patient coming in, though as I progress through my residency I am forever chased by the idea that I have a lot left to learn and a dwindling amount of time to learn it and sometimes that can make it difficult to let go. I am less interested in "balance" during my training than I will be in the future because my perspective is that NOW is the time I have to learn the intricacies of surgery so that I will be a surgeon my patients can trust later on. In surgery, sometimes that means staying late because we can't really plan for when the perforated colon or ulcer, AAA, or GSW comes in. You have to just BE there when the opportunity to learn arises, you can't plan it, so sometimes that leads us to staying later than our prescribed hours.

For me, the difference between being a surgeon (of any ilk) and another specialty is that what we do is typically much more invasive. To be entrusted with cutting into someone's flesh and removing/rearranging their internal organs is, to us, different than the medical management of DKA, a stroke, an MI, etc. It is NOT that what we do is any more important than an internist, an EM physician, pediatrician, etc. It is just different sometimes. If something goes wrong, whether it is technical error or not, I feel responsible and I consider it my responsibility to be there to correct whatever went wrong if at all possible. Yes sometimes that means that one of your coworkers or partners takes care of your patient at 2am when disaster strikes and one of the reasons it is so important to trust those people you work with. But that doesn't mean I'd be ok walking out the door at 6pm, KNOWING that one of my patients is on their way to the operating room for a takeback, because I had dinner reservations/wanted to make a yoga class/go to running club, and it is supposed to be my night off. That person trusted me to take care of them and taking someone back to the operating room is a bit different than modifying medical management. This is not me having a "hero complex" or being a martyr to my profession, it is simply trying to uphold the responsibility/commitment I made to the patient when I agreed to operate on them in the first place. Again, I see this as qualitatively different than those who never leave the hospital for fear of missing ANY case that comes in through the ED; after a 14-16 hour workday, I'm generally willing to let the call guy look out for the gall bladder/appendix/perforated whatever transferred in from OSH that we know is coming (but not when) if there's no sign of them at 6pm. But that is very different, to me, than leaving when I know someone I operated on is sick/unstable/having a complication, etc. Technically I COULD hand that off to the night guy - and the ACGME wants me to do just that - but that doesn't mean it is the RIGHT thing to do.

I don't think anyone is arguing or making the point about clocking out when someone has a complication from a surgery that YOU did, and now needs to be taken back for a redo of the surgery.

 

[DermViser]

Disagree.

One should certainly find balance and avoid burning out...not just for yourself but also for your patients.....

But, surgery is much more to me than a job. It's a life choice. I don't do it for the paycheck...if so I wouldn't be in academics, that's for sure.....I do it for the love of the game, and for the greater good. I want to provide patients with the best care possible, and train residents so that they can provide future patients with the best care possible.

Our philosophies differ, and I don't believe one is better than the other, but mine involves a higher acceptable level of self-sacrifice. The problem with surgeons is when they advertise their self-sacrifice from the rooftops, and run around acting like martyrs....

No actually, you DO do it for the paycheck. The DIFFERENTIAL may be different compared to private practice, but don't tell me you do the exact same job, with it's accompanying malpractice, for just $60,000 a year. By the way great jab at the end of "higher acceptable level of self-sacrifice" that right there shows that you believe your philosophy is better.

 

[Dwindlin]

No actually, you DO do it for the paycheck. The DIFFERENTIAL may be different compared to private practice, but don't tell me you do the exact same job, with it's accompanying malpractice, for just $60,000 a year. By the way great jab at the end of "higher acceptable level of self-sacrifice" that right there shows that you believe your philosophy is better.

Of course he thinks his philosophy is better. Who doesn't? If you believe that your philosophy is inferior to another why in the hell would you continue to embrace it? They way you've been arguing against this mentality it is clear you find your philosophy better, even though there is absolutely no objective evidence to support the hour restrictions (in the sense that they were good for anything other than resident comfort/lifestyle).

 

[DermViser]

Of course he thinks his philosophy is better. Who doesn't? If you believe that your philosophy is inferior to another why in the hell would you continue to embrace it? They way you've been arguing against this mentality it is clear you find your philosophy better, even though there is absolutely no objective evidence to support the hour restrictions (in the sense that they were good for anything other than resident comfort/lifestyle).

Um, maybe it's bc he said, "Our philosophies differ, and I don't believe one is better than the other". Reading comprehension is your friend.

 

[Dwindlin]

Um, maybe it's bc he said, "Our philosophies differ, and I don't believe one is better than the other". Reading comprehension is your friend.

I saw it. No one really believes this, and it's dumb to bring it up as "gotcha" moment in an argument, because you don't and it adds nothing. But go ahead and carry on please.