Can someone simulate 3 years residency program ?

[maxaxe]

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Considering IM / FM residency schedule in mind what would a typical 3 years of resident.
1st Year
Like first year something like 80 hours / per week ? Shift hours like 7am - 9pm Monday to Saturday ?
24 hours shift every thirld day ?
On call after 9pm ?

2nd Year
Will this schedule get relaxed if yes how much and what changes can be expected.

3rd Year

Is weekend is off on residency 3rd year. Is resident is working less than 65 hours per week, and expected to be home after 8pm ?


Can you expect to have some social life in last year ?

 

[EM_Rebuilder]

Considering IM / FM residency schedule in mind what would a typical 3 years of resident.
1st Year
Like first year something like 80 hours / per week ? Shift hours like 7am - 9pm Monday to Saturday ?
24 hours shift every thirld day ?
On call after 9pm ?

2nd Year
Will this schedule get relaxed if yes how much and what changes can be expected.

3rd Year

Is weekend is off on residency 3rd year. Is resident is working less than 65 hours per week, and expected to be home after 8pm ?


Can you expect to have some social life in last year ?

Every program out there is different as far as call numbers vs 'shift'/night float systems. Every program is different in what year you do what and how 'much' you work. I dont think you are going to get the answer you are wanting here. I am also not sure if you are asking IM vs FM or combined IM/FM (does that exist?). If you want to know what IM/FM combined residency is generally like, just picture it as an IM residency but a bit more involved with an extra year. Which means... call most months (probably >8 per year), probably Q4ish. I dont know that your hours will decrease so much as you move up, but maybe your hours are a bit more free in the hospital. When I did medicine, us two interns on call were running around writing up the H&Ps and writing orders after clearing things with the senior..in between taking BS floor calls. The senior was around, but he was not having to answer the high K+ calls. Also, I think clinic tends to become more days per week as you move up the food chains as you need less guidance from attendings and thus your work is desired....

If you are wondering about difference in IM vs FM, I think most would agree that FM residency will have less call and less hours in the hospital, but you will be farmed out to other services more (general surgery, OB, ER, etc). Probably more clinic in FM than in IM also. Its also going to depend so much on which program as some entire hospitals (JPS?) are family med run so you have to see near every admitted pt vs other places where FM takes FM patients and IM takes the rest....

Good luck...

 

[maxaxe]

OK to be more specific let's say simulating IM residency program at average level. What would be my program like, my wife and 2 years old daughter will relocate with me will I ever get chance to see them, may be after 2nd year ?

 

[Winged Scapula]

max what you don't seem to understand is that every program is different.

The hours do tend to get better after the first year in many programs, but they don't in others. There is no such thing as an "average" program because they are all individually run. Some may stay within work hour restrictions and some may not. Your census may vary day to day, affecting your work hours, your colleagues may be on vacation, out ill or on maternity leave - there is just no way to tell you, with anything resembling certainty, how many hours you will work as a resident.

You WILL see your wife and family, even as an intern. What you need to tell us is HOW much you expect to see them and how much you expect to work. If you were to say you cannot imagine being at the hospital over 60 hours per week, then I'd advise you to choose another specialty - something outpatient based perhaps. Residency is a but a brief moment in time, things will change once you finish. Choose a specialty based on your interests and what fits your needs, not whether you work 80 hrs per week in one and 70 hrs in another (because for *most* hospital based specialties, you will work close to the same hours). IM has in house call; FM generally doesn't except on off service rotations. But again, this will vary with program and census.

On the whole, IM is not one of the lighter hours specialties. Some FM programs can be more rigorous than others; the more inpatient work you do, the longer hours you will have.

 

[maxaxe]

Thanks to all for answering my questions, I know each program depends upon it's own requirement. But by simulation I wanted to know how bad it could get, may be in end I might not relocate my wife and 2 years old kid with me. I am looking for simulation or idea like something like this considering long hours
1st year
5am - 9pm + on call
24-36 hours night shift every 3rd day
80-90 hours per week
one day off in a week
2nd year
6am - 9pm + on call
12-24 hours night shift every 3rd day
70-80 hours per week
one day off in a week
3rd year
7am - 8pm + on call
12 hours night shift every 3rd day
65-75 hours per week
one day off in a week

 

[DrMom]

I'd bring your family with you regardless of the hours. As Winged Scapula says, you will have time for your family...maybe not as much as you'd like, but you'll see them.

 

[NotAProgDirector]

Thanks to all for answering my questions, I know each program depends upon it's own requirement. But by simulation I wanted to know how bad it could get, may be in end I might not relocate my wife and 2 years old kid with me. I am looking for simulation or idea like something like this considering long hours
1st year
5am - 9pm + on call
24-36 hours night shift every 3rd day
80-90 hours per week
one day off in a week
2nd year
6am - 9pm + on call
12-24 hours night shift every 3rd day
70-80 hours per week
one day off in a week
3rd year
7am - 8pm + on call
12 hours night shift every 3rd day
65-75 hours per week
one day off in a week

This is WAY CRAZY!

Here's the scoop:

Most IM programs will have inpatient and outpatient/elective blocks.

On an inpatient block, you're likely to work from 6 or 7AM to usually somewhere between 4-6PM, depending on the service and how busy it is. You will likely be on call every fourth night. Q3 call is fading away. You will get one day off per week, approximately.

On the outpatient/elective blocks, you are likely to work 7:30A - 5PM, no call, no nights, all weekends off. There may be some orphan call on the weekends, sometimes not.

Some blocks, like ED, are shifts. You might work several day shifts or night shifts per week. ED weeks are limited to 60 hours per week, usually have 2 days off per week.

As a PGY-1, expect 9-10 inpatient months and 2-3 outpatient months.
As a PGY-2, expect 8-9 inpatient months, and 3-4 outpatient months.
As a PGY-3, expect 6-7 inpatient months, and 5-6 outpatient months.

Something like that.

 

[elwademd]

This is WAY CRAZY!

Here's the scoop:

Most IM programs will have inpatient and outpatient/elective blocks.

On an inpatient block, you're likely to work from 6 or 7AM to usually somewhere between 4-6PM, depending on the service and how busy it is. You will likely be on call every fourth night. Q3 call is fading away. You will get one day off per week, approximately.

On the outpatient/elective blocks, you are likely to work 7:30A - 5PM, no call, no nights, all weekends off. There may be some orphan call on the weekends, sometimes not.

Some blocks, like ED, are shifts. You might work several day shifts or night shifts per week. ED weeks are limited to 60 hours per week, usually have 2 days off per week.

As a PGY-1, expect 9-10 inpatient months and 2-3 outpatient months.
As a PGY-2, expect 8-9 inpatient months, and 3-4 outpatient months.
As a PGY-3, expect 6-7 inpatient months, and 5-6 outpatient months.

Something like that.

then there's other stuff to thrown in, such as increasing responsibility as you move up, preparing for conferences/research/case presentation(s), teaching students, etc.

as maya angelou once said "ain't nothin' to it, but to do it." i'm sure that each poster could list what their schedule was/is like, and you'd have a ton of different answers. some will be similiar, and some will be completely different. and in the end, what's on paper may not be reality!

having finished residency, i know plenty of people who had families who got through just fine. they (the resident and the family) managed to make it work. but there's no way to tell you what a potential schedule is and if that will work for you. there's no way to prepare for it, because there's literally nothing like residency.

if you've spent all day with a patient and their family in the icu, your "shift" is up at 9, you have plans to be somewhere at 930, and the patient dies at 850... do you stay or do you go? what would your family think? what would your friends think? do what your friends and family think matter in that situation?

if your night float coverage begins at 9, and you look at the clock and its now 930, what's your responsibility?

there are so many variables to a call schedule and in residency, that its hard to predict how it would be, even after laying it out.

again, ain't nothin' to it, but to do it.

expect to work a lot, and hope that you get out on time or even early! 😀

 

[Winged Scapula]

I think it would be a BIG mistake not to bring your family with you.

Having a support system when you're under stress, in a new place, doing residency, is vitally important. I don't know how I would have made it without my SO (who is now my ex, but that's another story).

You will not see her as much as you would like, but certainly more than you would if they didn't come with you.

Please reconsider any plan you have to leave your family behind during residency. Everyone will suffer under that plan.

 

[maxaxe]

Thanks I am much relieved now, I love my wife and daughter. I will relocate them with me. Sure information is informative, I know have some idea about it, my wife understand's she can't expect to see me everyday, but If I am home after 6pm it's like a bonus 🙂 may be even it happens 2 - 3 days in week, that's all I need.

 

[8744]

Thanks I am much relieved now, I love my wife and daughter. I will relocate them with me. Sure information is informative, I know have some idea about it, my wife understand's she can't expect to see me everyday, but If I am home after 6pm it's like a bonus 🙂 may be even it happens 2 - 3 days in week, that's all I need.

Let me warn you however that residency is going to be harder on your wife than it will be on you. You think that she understands that you won't be home a lot and it sounds good on paper but you need to be careful not to get so involved with work and so wrapped up in your residency that when you come home you have nothing to give to your family.

That's the biggest complaint of residents in my program, most of whom are married and have kids, namely that the work is so exhausting that all they want to do when they get home is sleep. And I'm by no means in a particularly malignant or hour-intensive program.

All of you hard-chargers and driven individuals my laugh and belittle this advice but if you value your family and expect to be married when you finish take care not to drift apart. I say this with sorrow because, although I have a strong marriage, I think the last three years could have been a lot better and my wife would have been a lot happier if this mother****er known as residency training was a little less intense and if I had learned to not let it grip me even when I was at home.

Which is one reason why I quit my blog, by the way.

 

[coastal]

Thanks I am much relieved now, I love my wife and daughter. I will relocate them with me. Sure information is informative, I know have some idea about it, my wife understand's she can't expect to see me everyday, but If I am home after 6pm it's like a bonus 🙂 may be even it happens 2 - 3 days in week, that's all I need.

You make it work, I figure. My wife and I have our first on the way in a few months and plan to have one or two more during residency. I'm only one month into my ortho residency, but I'm not overly concerned about having enough time for family. Just gotta be efficient is all.

The other key is to be boring and have few outside interests besides work and family. I'm a pretty darn boring guy so I'm set.

 

[Winged Scapula]

Panda is absolutely correct.

Having seen marriages disintegrate (especially when the SO is not in medicine, because its probably slightly harder for them to understand), do not overestimate your wife's ability to cope.

You will presumably be moving her to a town where she knows no one, leaving her at home with a small child and then you come home, full of grumpiness, tired and really not interested in her and your family. She will tell you she understands but she does not. She thinks it will be hard, but she doesn't know how hard it will be.

Therefore, you must do your best to make sure that when you are on call, that you call her as often as you can, that she tries to come by for dinner if possible and when you are home you deprive yourself of some sleep to spend time with her.

People can call themselves hardcore all they want, but I've never known anyone who regretted treating those who love them a little better and giving them more attention than they have the energy for. I have nothing but disdain for programs and people who tell others that they should neglect their families for the sake of their profession (it wasnt long ago when an unmarried resident was preferred).

 

[Danbo1957]

maxaxe,

Bring your family with you.

 

[Doowai]

My family was willing...wanting....willing...wanting .... somewhere between those 2....willing to move. It is my oldest son's senior year in high school, and he has gone all years in the same district with the same friends - so I did not want to move him his senior year. He is quite popular, a great athlete trying to break a state sports record this year, and is scheduled to take his second year of college calculus - and all his courses are college level. he will be graduating with roughly 2 years of college under his belt. All of my other children enjoy a highly performing school district. The public schools where my residency are suck, IMO. I insisted everyone stay here while I moved 1400 miles.

I obtained a prematch in a family medicine residency in a deep south program that taught lots of procedures. I really did like most of the program. My first rotation was in the women's and children's hospital : pediatrics (not PICU - just regular sick kids floor), newborns and pregnant women with problems. I had no senior resident with me, but an attending maybe 2 or 3 hours a day. I had a census of 10-15 patients per day, but normally the service is much slower ; like 2-6. It was unusually busy, I was told by several seniors they never heard of it being so busy. I had intrauterine fetal demise, lots of gestational diabetes, rota virus, UTI, pyelo, sickle cell, meningitis, skull fractures, small bowel obstruction, pancreatitis.

I had a different attending each week. One week my attending was by far the best instructor I have ever had. My last week the attending was very smart but the rudest loudest yellingest "boss" I have ever had , or even heard of. THe PD seems like such a great guy , its hard to imagine him tolerating someone like this. When I worked burger King in high school I cannot imagine someone behaving as they did. I owned business' for 16 years and cannot imagine acting that way with the worst employees (and I had an employee by street drugs in the office once - fired them but never yelled at them). I politely resigned, but in retrospect should have let the person know what a lousy superviser/boss/teacher they were. I taught high school for 2 years, and if someone in administration talked to me like that the crap would have hit the fan. I have never seen someone yell and behave like that in any work environment before. They must have brain damage. The sad thing is, from private messages I have recieved its not so uncommon - unbelievable, I did a prison rotation in school and convicts are not treated that way.

My in-patient schedule was roughly 5 or 5:30 Am to 6 to 9 PM. We had 3 days of call a month. Call was roughly 24 hours. My other classmates said it was about the same, but adult in-patient medicine started at 4 or 4:30 AM for some of my classmates. So some weeks were maybe 65 or 70 hours and others were 90 to 95 hours.

Electives varied but were often 7 AM to 5 PM. During electives you still had roughly 3 days/nights of call per month. The program had 2 months of nightfloat for interns (5 PM to 7 AM Sunday night to Friday morning).

I resigned.

When I was there I was quite happy when working, except when having the one attending chew me out for everything including the way I walked. But I cried every night missing my wife and 4 children. I mean hot tears of sadness. I almost quit the first day and I think it was Winged Scapula who told me in PM that it was just homesickness and would get better. In 5 weeks it did not get better.

I quit and on the drive home had 2 jobs lined up - one 30 hour per week teaching job and another 5 or 6 hour per week job. And the combined salary equals what I could have made in residency - and that is only working only 35 or so hours per week. Half or a third of the hours what residency would have required - although I really loved working as a MD. I have other opportunities I need to talk to people about such as returning to work as a Chiropractor as I worked in a former life. And I gaurantee you nobody is going to yell at me in front of coworkers as occured in residency.

When I was in residency and my family was geographically distant I loved/liked work and cried every night missing my family. Now that I am home I love being at home with my family - and while I wish I was still in residency, I sure as hell have not cried over not being in residency any more. It was my favorite job ever, but when all was said and done, it was just a job after all. No matter how good the job, for me.... its just a job. If you hate your family, or are thinking of divorcing your wife and/or have no kids maybe it can work.

I would not go somewhere your family would not follow, or be happy. Residency can be great at times, and it can be terrible at times. If your time off is bad, then your life will see to suck at times. If you have no other career choice then you are stuck. If like me the door is open to go and do other things, it seems to easy to walk. Maybe its better to be a niaeve 25 year old kid whose only other choices are Burger King, it kind of forces you to finish.

 

[Winged Scapula]

When I was there I was quite happy when working, except when having the one attending chew me out for everything including the way I walked. But I cried every night missing my wife and 4 children. I mean hot tears of sadness. I almost quit the first day and I think it was Winged Scapula who told me in PM that it was just homesickness and would get better. In 5 weeks it did not get better.
.

In my defense, I also told you that leaving your family behind was a mistake.

 

[Doowai]

In my defense, I also told you that leaving your family behind was a mistake.

Sorry that was not meant to be an accusation or attack. I could not even remember actually if it was you. I think you did tell me it was a mistake. I was not blaming you or anything. Its just my homesickness did not seem to lessen. But I like my family. If someone is looking for an out, or opportunity to cheat on their wife it could be a good thing

 

[dragonfly99]

maxaxe,
aprogdirectors list/info is a good estimate. Every program is different.

Here was mine:
intern/1st year:
-9.5 months wards/medicine with Q4 overnight call (30 hours) for 8 months an Q6 overnight call for 2 months of that. When not on call, hours are something like 6am or 6:30am - 4 or 5 p.m.
-1 Medical ICU month with Q3 30 hour call, but you would get out early (like shortly after noon) if you were not on call, and would have a day off every 6th day, no average.
-1outpatient month, where you would work 7am-5 or 5:30pm and be off on weekends, and have no call.
-2 weeks vacation

2nd year:
-5-6 or so months of inpatient wards (Q4 or Q6, as above), but had some choice of which ones to work (i.e. avoid cardiology if you hated it as an intern, or avoid oncology ward if you hated it as an intern, etc.).
-1-2 months ICU (Q3 hours 30 hour call, but again with every 6th day or so off)
-2 months of outpatient, including some psych and neurology (no overnight call)
-1 month of ER (12 hour shifts, but no more than 60 hours/week, and you will have quite a few days off)
-3 weeks vacation
-1 elective month

3rd year:
-4 months of inpatient wards (Q4-Q6) but some choice of which ones you get stuck with
-1-2 months ICU
-1 month ER
-3 months of electives (medicine consult rotations, working 7 or 8am-5pm with no overnight call, get most weekends off; and/or can do up to 2 months research if you want).
-2 months outpatient medicine (no overnight call, and no weekends)
-4 weeks vacation

I would say bring your wife and little kid with you, unless your wife really, really doesn't want to come, in which case she could come later on in the year, or after your intern year. It's not like you will NEVER be home. You will have some clinic/outpatient months, and consult months, during which you really won't take overnight call. Also, some programs have gone to a system where most of the call is not overnight. In those systems, you will have months of "night float" though, where you will work overnight shifts (I think they are 12-16 hours?). Also, most medicine programs do obey the part of the work hours rule that says you have to average 1 day off in 7. It's hard to get around that one. That means even in inpatient months they have to give you some days off (sometimes they cheat and give you many 3/month instead of 4, but it's not like you'll never get days off...).

 

[Winged Scapula]

Sorry that was not meant to be an accusation or attack. I could not even remember actually if it was you. I think you did tell me it was a mistake. I was not blaming you or anything. Its just my homesickness did not seem to lessen. But I like my family. If someone is looking for an out, or opportunity to cheat on their wife it could be a good thing

I probably did tell you the homesickness would lessen as you got busy.

I spent my lifetime moving from school to school as a military brat and then traveling around the world and US. Its fairly easy for me to start anew somewhere now (although not as a child), but then I don't like my family as much!😛

And yes, loneliness and distance has often wrecked a marriage via infidelity in an attempt to ease the pain.

 

[Doowai]

I probably did tell you the homesickness would lessen as you got busy.

I spent my lifetime moving from school to school as a military brat and then traveling around the world and US. Its fairly easy for me to start anew somewhere now (although not as a child), but then I don't like my family as much!😛

And yes, loneliness and distance has often wrecked a marriage via infidelity in an attempt to ease the pain.

When I drove home I stopped at some friends house in El Paso. She was a secretary of mine around 1996 (best I have ever had) and is now a mother of 5. He is now a very successful chiropractor, one of if not the first chiropractor with military hospital privileges in a study being done by Palmer college of chiropractic.. We were talking about the struggles of marriage - their first year of marraige was when she worked for me - then and now we talked and laughed and moaned about how hard marriage could be.

I had to confess to them my biggest fear was, in the process of being seperated from my wife and kids during residency,the moment I would NOT miss them any longer. My next door neighbor at residency was a 22 year old kid living out of the house for the first time. He invited me over several times and one time I went by - apartment full of 20 somethings drinking heavy, more than half 20 something females. I excused myself and simply told him I came by to tell him I wanted to play guitar hero with him sometime. He tried to be quiet but I could hear him and his girlfriends going at it.

I do love my wife and practically worship my kids - but one of the only ways it has worked almost 20 years is avoiding things. I am not trying to flatter myself but I once had a 19 year old secretary who started a morning conversation with "Last night my friends and I were talking about what it would be like to have sex with someone our dad's age"-even before saying HI. In fights and relationships, winning the war sometimes involves knowing when to run away.

 

[KingDani]

Panda is absolutely correct.

Having seen marriages disintegrate (especially when the SO is not in medicine, because its probably slightly harder for them to understand), do not overestimate your wife's ability to cope.

You will presumably be moving her to a town where she knows no one, leaving her at home with a small child and then you come home, full of grumpiness, tired and really not interested in her and your family. She will tell you she understands but she does not. She thinks it will be hard, but she doesn't know how hard it will be.

Therefore, you must do your best to make sure that when you are on call, that you call her as often as you can, that she tries to come by for dinner if possible and when you are home you deprive yourself of some sleep to spend time with her.

People can call themselves hardcore all they want, but I've never known anyone who regretted treating those who love them a little better and giving them more attention than they have the energy for. I have nothing but disdain for programs and people who tell others that they should neglect their families for the sake of their profession (it wasnt long ago when an unmarried resident was preferred).

not to be off-topic , but aren't they nowadays?

 

[Winged Scapula]

not to be off-topic , but aren't they nowadays?

Not necessarily. Programs now realize that a happy resident is most important and of course, also realize that they cannot openly discriminate against people based on marital status. So while yes there are probably still faculty who prefer single residents, feeling like they will devote more time to training, there are others who find married residents more stable (as long as its a happy marriage).

 

[KingDani]

Not necessarily. Programs now realize that a happy resident is most important and of course, also realize that they cannot openly discriminate against people based on marital status. So while yes there are probably still faculty who prefer single residents, feeling like they will devote more time to training, there are others who find married residents more stable (as long as its a happy marriage).

very well put ma'am.thnx a lot for encouraging words.although i am an IMG , recently finished studies and married at once , i know to the college sweetheart you might guess , and yes you are right.
so i think they still put some effort into not getting someone with more things to handle on his mind.
thnx again