Call schedule and days off during residency

[splendanator]

I am an MD / PhD student who has always wanted to do ortho, but I am having a bit of a crisis. Many of us got interested in ortho because we love to be active. For me, being active in the daylight (running, swimming, etc.) is a staple that "keeps me going" in life. I don't mind working like a maniac (I work ~80 hours currently), but I need to be able to take care of myself as well.

So my question is about how one could potentially coordinate getting outside while the sun is still up a couple of times per week in residency. Could this be done using "post-call days" and "days off?" Typically, are post-call days considered as the 1 in 7 day off, or is the day off usually a different day? In other words, if I worked all night on call until 8am on Tuesday and then did not return until Wednesday at 6am, would I still get a separate day off? Night call seems like a way to potentially solve this problem, but I am not sure how it works at most places.

Thanks in advance for your advice.

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[massmocha]

Unlikely you will be able to exercise during the day unless you are on night float. To get a workout in you usually need to do it when you get home after work. As an intern our schedule is typically one day off per week, and most rotations you need to be there by 5am and get out anywhere between 7pm and 10pm depending how much there is to do at the end of the day and how much your program is accepting of signing t0-do items out to the night person... so exercising before work is not reasonable if you care about sleeping ever. Add onto that reading articles for conference/journal club or reading about new patients and usually free/sleep time is at a premium.

Since interns at most programs don't work 24-hour shifts (unless in the pilot program), you don't get post-call days as an intern. As you become a more senior resident your schedule usually varies by rotation, some are more amenable to exercising, and depending on the size of your program you will likely take 1+ 24-hr calls per week that will have a mandatory post-call day to exercise.

 

[blaqmamba]

you need to be there by 5am and get out anywhere between 7pm and 10pm

Sounds like you're violating duty hours, and contributing to the problem.

 

[orthojuniorfaculty]

Residency is a lot of work but it sounds like you already clock a lot of hours. The biggest issue, as you mention, has to do with a lack of control about how you schedule a day or a week. And you will lose that control, moreso in a surgical field, but in most residencies. This loss of control over your schedule is something that does grind on you, or at least did on me, increasingly over time. Sure some of it remains after residency, but it is different. I don't miss that part!

Each year and each program will vary. That said, even at a busy program, I had co-residents who seem a bit like you and managed to go running, cycling, or to the gym on a regular basis (up to five times a week). Me, I tried to be within a mile or two of at least one hospital so I could bike or walk there. And what for you is exercise, for others might be spending time with friends, family, or another hobby. Yes you have to stay sane, but personally I'd rather stay sane by doing the career I am completely passionate about, than pick something perceived as 'easier' but isn't what I know deep down is what I want to be doing and have more hobby time.

Strange advice: you should think about location, and consider somewhere more southern. Depending on how far north you are, exercising during daylight hours is more than you can expect, at least for part of the year. If you are someone who likes to see the sun on a regular basis - most people do, but some people more than others - then just check out the average sunrise and sunset times at places you are considering. I don't think that is crazy at all, because there are times you might not see the sun for 5-6 days during the winter in some places... 5am to 7pm five days a week (70) and 10 hours on either Saturday or Sunday is not so atypical for interns, comes to an even 80 hours, and precludes winter sunlight.

So yes, you can exercise in orthopaedics, of course. If doing that during daylight is critical, I think expecting more than 1-2 such exercises a week (at least during the winter) is setting yourself up for disappointment. I think there will be some rotations where you can easily run in the sun 4-5 times a week, especially during the summer and once you are an R3, and some where you can't.

 

[numberwunn]

Residency is a lot of work but it sounds like you already clock a lot of hours. The biggest issue, as you mention, has to do with a lack of control about how you schedule a day or a week. And you will lose that control, moreso in a surgical field, but in most residencies. This loss of control over your schedule is something that does grind on you, or at least did on me, increasingly over time. Sure some of it remains after residency, but it is different. I don't miss that part!

Each year and each program will vary. That said, even at a busy program, I had co-residents who seem a bit like you and managed to go running, cycling, or to the gym on a regular basis (up to five times a week). Me, I tried to be within a mile or two of at least one hospital so I could bike or walk there. And what for you is exercise, for others might be spending time with friends, family, or another hobby. Yes you have to stay sane, but personally I'd rather stay sane by doing the career I am completely passionate about, than pick something perceived as 'easier' but isn't what I know deep down is what I want to be doing and have more hobby time.

Strange advice: you should think about location, and consider somewhere more southern. Depending on how far north you are, exercising during daylight hours is more than you can expect, at least for part of the year. If you are someone who likes to see the sun on a regular basis - most people do, but some people more than others - then just check out the average sunrise and sunset times at places you are considering. I don't think that is crazy at all, because there are times you might not see the sun for 5-6 days during the winter in some places... 5am to 7pm five days a week (70) and 10 hours on either Saturday or Sunday is not so atypical for interns, comes to an even 80 hours, and precludes winter sunlight.

So yes, you can exercise in orthopaedics, of course. If doing that during daylight is critical, I think expecting more than 1-2 such exercises a week (at least during the winter) is setting yourself up for disappointment. I think there will be some rotations where you can easily run in the sun 4-5 times a week, especially during the summer and once you are an R3, and some where you can't.

Much wisdom here. One of the things that I miss most is seeing the daylight -- with the recent weather, and having young children, I rarely get to spend the time outside that I'd like, and I'm realizing more and more how hard that is. That being said, I've heard it said that you can pick one "hobby" outside of residency, and mine is my family.

Would stress the differences between programs. While my observation is limited to n=3 of programs I rotated at, some of them (I guess like massmocha's), worked crazy hours, not necessarily providing better education. Some are more reasonable. The call rotation setup and the flow of the day/week make a huge difference. For instance - is there a daily fracture conference, and if so at what time? When does OR/clinic start? How many inpatients do you have to manage? Is there a commute between different sites?

 

[massmocha]

Sounds like you're violating duty hours, and contributing to the problem.

Unfortunately it is not within my control. When you're at a busy trauma center and the night guy has too much to do, you don't want to be the resident that dumps even more on them. My co-residents are my friends, and we treat each other the way we would want to be treated, which means tying up all the loose ends from the day with the expectation that the same will be done for us when we are on nights.

Maybe this is a program-specific type of behavior, but we like to stay until the job is done here. Personally, I don't mind it. I like to take ownership for my patients and want to do the right thing for them, rather than abide by some arbitrary hours restriction standard.

 

[ChiDO]

Unfortunately it is not within my control. When you're at a busy trauma center and the night guy has too much to do, you don't want to be the resident that dumps even more on them. My co-residents are my friends, and we treat each other the way we would want to be treated, which means tying up all the loose ends from the day with the expectation that the same will be done for us when we are on nights.

Maybe this is a program-specific type of behavior, but we like to stay until the job is done here. Personally, I don't mind it. I like to take ownership for my patients and want to do the right thing for them, rather than abide by some arbitrary hours restriction standard.

This. When you are a resident, you help your co-residents out. Lot easier to tackle multiple pending consults together then dumping on the night guy, because you'll need help during residency eventually. You're attitude of "contributing to the problem" needs to be dropped really fast otherwise people are going to hate you as you sound like you have an "entitlement" issue. I put junior residents in their place with this attitude and students (ie. you wont get an interview..no one wants a co-resident with this attitude.)

Most programs, your intern year has "easy" and "hard" rotations meaning easy hours and longer hours. There are plenty of residents who make time to do their hobbies. Does this mean, when you are on a busy service you'll get to run everyday, probably not, but you can make up for that on easier rotations when you are done at 4 PM.

Once you hit PGY2, most programs have heavier call for junior residents and then gets easier as time goes on. You may have a night float or home call or be on q3 call or q2 weekends...just really depends on where you end up.

 

[blaqmamba]

Unfortunately it is not within my control. When you're at a busy trauma center and the night guy has too much to do, you don't want to be the resident that dumps even more on them. My co-residents are my friends, and we treat each other the way we would want to be treated, which means tying up all the loose ends from the day with the expectation that the same will be done for us when we are on nights.

I never said you should dump work onto others, It's obviously great to cover all bases so the night guy isn't getting paged like crazy. But this is a real issue and your personal health should never be jeopardized because of a system issue. Whether it's exercising, or having time for an appropriate/healthy meal, or getting enough sleep, you should never have to sacrifice that. The ACGME has set out clear guidelines to help residents with these issues, so really, you should be discussing these issues with your PD. Patient care is what matters, and we can't do that if we're not at our own optimal health.

This. When you are a resident, you help your co-residents out. Lot easier to tackle multiple pending consults together then dumping on the night guy, because you'll need help during residency eventually. You're attitude of "contributing to the problem" needs to be dropped really fast otherwise people are going to hate you as you sound like you have an "entitlement" issue. I put junior residents in their place with this attitude and students (ie. you wont get an interview..no one wants a co-resident with this attitude.)

Again, I'm not implying I would get up and leave the hospital once I hit my 80th hour and dump all remaining work on the next guy. But, if it's a continuous issue, it needs to be discussed or it will never be resolved. I don't feel entitled, but we also have lives outside of the hospital (hey, we're human - some have families, etc...) that deserve attention as well. You probably also have an entitlement issue if you need to "put juniors in their place," and if you think working 5am-10pm daily is ever ok, then I'm glad you're not my senior because I'd never see my wife or kids.

 

[ChiDO]

Again, I'm not implying I would get up and leave the hospital once I hit my 80th hour and dump all remaining work on the next guy. But, if it's a continuous issue, it needs to be discussed or it will never be resolved. I don't feel entitled, but we also have lives outside of the hospital (hey, we're human - some have families, etc...) that deserve attention as well. You probably also have an entitlement issue if you need to "put juniors in their place," and if you think working 5am-10pm daily is ever ok, then I'm glad you're not my senior because I'd never see my wife or kids.

Are you serious? Good luck with that attitude. You go ahead and "address your concerns" with the PD. More then likely your concern will be heard on deft ears. Furthermore, some services are just busy and that's life. Unfortunately, if you come into residency thinking you'll be seeing your wife and kids every night for dinner at 5 PM, be able to go to the gym everyday, ect, you are going to have a big wake up call.

As for my "entitlement" issue, I'm not sure what you are referring to. Junior residents need to be yelled at once in a while when they **** up or start becoming a problem for the team and not helping with the issues on hand. I never said working 05-22 is ok daily, but it's not out of the realm of possibility of staying late and helping the team out. I can remember multiple times when I was "ending my shift" at 1800, yet stayed a few more hours either scrubbing in or helping with traumas because this is YOUR education and residency goes by quickly.

 

[blaqmamba]

Are you serious? Good luck with that attitude. You go ahead and "address your concerns" with the PD. More then likely your concern will be heard on deft ears. Furthermore, some services are just busy and that's life. Unfortunately, if you come into residency thinking you'll be seeing your wife and kids every night for dinner at 5 PM, be able to go to the gym everyday, ect, you are going to have a big wake up call.

As for my "entitlement" issue, I'm not sure what you are referring to. Junior residents need to be yelled at once in a while when they **** up or start becoming a problem for the team and not helping with the issues on hand. I never said working 05-22 is ok daily, but it's not out of the realm of possibility of staying late and helping the team out. I can remember multiple times when I was "ending my shift" at 1800, yet stayed a few more hours either scrubbing in or helping with traumas because this is YOUR education and residency goes by quickly.

LOL relax. You're obviously misconstruing what I'm saying. No one here is oblivious to what we're getting ourselves into and the hours we work.Trust me there are many rules I'd love to break but don't, and I expect the same in return from my program. That's all I'm saying. We all want to become masters of our field and each person has their own way of achieving that, and quite frankly, it doesn't seem like you get that.

OP- Don't pick a specialty based on time constraints. As others have said, you'll work hard regardless of who/what/when/where you are, but I truly believe you can make time to work out if you want (you'll probably be sleeping on your post-call days lol). And if you have a crappy senior yelling at you, well...let's just say he would learn not to yell at me after the first time...

 

[Optimus-Prime]

LOL relax. You're obviously misconstruing what I'm saying. No one here is oblivious to what we're getting ourselves into and the hours we work.Trust me there are many rules I'd love to break but don't, and I expect the same in return from my program. That's all I'm saying. We all want to become masters of our field and each person has their own way of achieving that, and quite frankly, it doesn't seem like you get that.

OP- Don't pick a specialty based on time constraints. As others have said, you'll work hard regardless of who/what/when/where you are, but I truly believe you can make time to work out if you want (you'll probably be sleeping on your post-call days lol). And if you have a crappy senior yelling at you, well...let's just say he would learn not to yell at me after the first time...

...barf

 

[Dires]

LOL relax. You're obviously misconstruing what I'm saying. No one here is oblivious to what we're getting ourselves into and the hours we work.Trust me there are many rules I'd love to break but don't, and I expect the same in return from my program. That's all I'm saying. We all want to become masters of our field and each person has their own way of achieving that, and quite frankly, it doesn't seem like you get that.

OP- Don't pick a specialty based on time constraints. As others have said, you'll work hard regardless of who/what/when/where you are, but I truly believe you can make time to work out if you want (you'll probably be sleeping on your post-call days lol). And if you have a crappy senior yelling at you, well...let's just say he would learn not to yell at me after the first time...