Can ya help me? (surgery)

[NevadaBoy]

Howdy-doody!

I'm a newbie to this board--my first post. Just wondering if you could help me out with my residency search:

I'm a 3rd year at the University of Nevada, and I just decided to go into general surgery, possibly with the hope of pursuing critical care/trauma/whatevayawannacallit.

However, my significant other has made it clear that she is not happy with this, and we are trying to compromise. I'm looking at community based programs, and specifically for ones that won't kill me (or her!). In a nutshell, I'm looking for programs that have one or more of the following qualities:

1. Q4 or greater on the general surgery service (for 1st and 2nd years).
2. Post-call-home-early, or better yet, post-call-day-off like the gas boys get! I've heard rumors of these programs, but I've yet to see one.
3. A program where you can generally leave the hospital by 6 pm on a non-call night (this is an important one! It's the difference between eating dinner with your loved one and sitting at the table eating cold mac-and-cheese by your self).
4. A program where you don't have to be in until 6:30 am or later (this one is the least important. I'm pretty good at getting up early!)

If anyone knows of any such programs, please let me know and I'll research them. I'm willing to look at just about anywhere in the US. 'Preciate your help. I'd sure hate to have to leave my honey for surgery. <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />

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[carddr]

Then you might be a candidate for any of the NY state programs as they have laws concerning Resident hours called the Bell COmmission. After being on call you MUST leave the hospital for so many hours, you can get further info on the web. The laws are based on a court case(Zion v hospital)and you can look that up on the CourtTV web, its quite an interesting case.

Don't know about getting home every night at 6m. Maybe your s/o may be sending you a message. Some comprising is going to have to take place for everyone to be happy. Surgery as you know is not 9 to 5, at least not any program I know. And Trauma is one of the most demanding, you may have to make a real tough choice.

My opinion, to do what you want to do should be a duet decision, if not maybe there's another trail you can take. Big decision to make!!!

 

[Winged Scapula]

Boy if you can find a program with such hours which still allows you the education you need, call me! IMHO and seeing that of my friends, I think your expectations/needs are unrealistic. On *some* rotations you might work less than 12 hour days but they are frankly few and far between. Even community programs have trauma/emergency room call and you cannot, almost without regard to specialty, expect a schedule without disruption. I learned months ago not to have a certain time in mind when I would go home - invariably patients would crash, traumas would come in, etc.

I would spend a great deal of time thinking about your needs and that of your SO - one of you may have to do some more compromising. Even NY programs have longer hours than you are anticipating and day off post-call? Never heard of it. 'Course now with surgery dwindling in favor, maybe its due time!

 

[JS-UNMC]

check out St Joseph Exempla (Denver) and Iowa Methodist (des moines, IA). Both are extremely competetive community programs to get into but have excellent reputations and non-malignant staff. I know a lot of the residents at Iowa Methodist and their call is rigorous but definately a program that I am looking into as well. Good luck.

 

[dr.evil]

q4 or greater call is doable in some of the programs I've seen (albeit the community programs such as Exempla,colorado; wichita, ks; i can't think right now but really look into the community programs. these places can really turn out some technically outstanding surgeons ).

post call home early? hmm. don't think i've seen too much of that. I know that some rotations will allow you to scoot out early post call but on the whole, you're there.

out of the hospital by 6pm. Of course this is also variable cuz it's surgery but there are many programs which have shorter days and you can get out of there at a decent time. If you stay away from the university programs, this is very possible. Community programs are usually with private docs who want to get out of the hospital at a decent time too.

In the hospital no earlier than 6:30am? This isn't happening anywhere that I know of. Many places I went had conference at 6:30 or 6:45 so you had to have seen and rounded on all your patients by then. The attendings don't have that great of hours.

Trauma has horrible hours so you may want to rethink your decision. Critical care can be done by anesthesiologists as well as internal med docs which could be an option.

When I was trying to decide want I wanted for the rest of my life, I wrote a huge list of everything I wanted to do when I was done and what I wanted very little of. Surgery was definitely not a flippant decision for me. Hours and years invested were definite negatives compared to other specialties but the positives outweighed the negatives for me. PLUS, my wife is extremely supportive and told me to go for whatever I wanted. This is more important than you could ever imagine. If the significant other is happy (or tolerant) then you are happy <img border="0" alt="[Lovey]" title="" src="graemlins/lovey.gif" /> .

I'll ask around and see if I can let you know about more lifestyle friendly programs.

 

[NevadaBoy]

Allright, cut me some slack!

I didn't say the program(s) had to have ALL of those qualities! Just ONE OR MORE!

And those qualities don't have to be met every single day, on every single rotation--just a reasonable amount of the time.

Seriously, though, thanks for your replies. I do appreciate it. I'll check out some of those programs.

In the meantime, I based some of my "desires" on info found in the the freida database. (Did you know that was developed here at UNR?) Anyway, here are some of the results of my digging, let me know what you think:

Maricopa Medical Center (Phoenix, Arizona):
Max hours on duty/wk , 1st year: 55 (yeah, right!)
Max consecutive hours on duty: 26 (that sounds like post call home early!)
Call: q5d 1st year, q4d next 4.

University of Kansas, Wichita:
Max hours on duty/wk , 1st year: 70
Max consecutive hours on duty: 36
Call: q5d all 5 years.

Geisinger Medical Center (Danville, PA)
Max hours on duty/wk , 1st year: 68
Max consecutive hours on duty: 24 (hmmm....)
Call: not posted.

Swedish Medical Center (First Hill): Seattle, WA
Max hours on duty/wk , 1st year: 60
Max consecutive hours on duty: 24
Call: 1/wk 1st year, 2/wk yrs 2-4, 1/wk yr 5.

Soooo....whaddya think? Are they just straight up lying? Could their PD not figure out how to fill out the freida survey form correctly? Or are they telling the truth?

 

[dr.evil]

well, FREIDA is good for some info and not so good for other types. For instance, the program's address and website is usually correct. The rest can be a bit of a stretch at times.

Remember that hours per week are reported without beeper call (what a crock that is). Another thing programs will sneak on you is that they report call as q5. This may mean in house call of q5 but you're still required to take all calls on your patients 24 hours a day/7 days a week. So you are at home but still "on call" (which doesn't sound too bad really). If you'll notice, every gen surg program reports residents get 1 day off per week. They say this because it is part of the RRC's requirements for accreditation but sadly is not followed by all programs. Also, the maximum consecutive hours is also without beeper call (aren't they sly the way they do that). So what there saying is, if you're not on call the most hours you will work is 24 hours straight.

The true secret is to ask around. Go see the programs for yourself. Ask the residents at the programs. There are livable programs out there that will train you well. You just have to look hard.

 

[NevadaBoy]

Thanks for the honesty, LionTrees. Surgery is definitely not for everyone, and definitely not a flippant decision. And I know what you mean about the database's accuracy.

I'm going to ask around as much as I can. Anyone else out there knows some liveable programs, please post.

 

[GTMD2Bee]

Can't disagree with most of the above posts. Most of the programs that I visited had q3 call, usually got in before 6:00am, left when work was done (anywhere from 5:00-midnight??). You will have a hard time finding a program with a lot of those qualities (especially getting in after 6:30am and leaving early post call), but if you're really only looking for ONE or more, than I can throw some out there for ya:

St. Joseph's-Oakland in Detroit, MI: Community based program who really sold the fact that they were easy on the lifestyle. Not sure about matching into a fellowship, but a less competitive fellowship shouldn't be a problem. Think they have matched somebody in trauma. Don't know if they have q4 call since they only have two categoricals/yr.

MSU-Grand Rapids in Grand Rapids, MI (one of my personal faves): Community based-university affiliated program that has its own critical care fellowship and good track record of placing residents in good fellowships. Told me call was q4 with 2 weekends off a month. Residents seemed very happy.

Baptist Health in Birmingham, AL: community based program that doesn't have any trauma call except when you go away to do the trauma rotation. Didn't check out the program, but I hear they take two categoricals/yr, and are very busy.

Univ of Tenn. in Knoxville and Chattanooga, TN-2 university programs (kinda community based) that seem fairly friendly to resident lifestyle. Can be tough as an intern. Call is q4 with 1 weekend off a month at both from what I remember. No trouble matching into fellowships except the most competitive.

Carolinas Medical Center (another fave): excellent community program that has matched people in excellent fellowships (including 2 in peds in the last 10 years). They have some funky call schedule that is somewhere around q3 but you always get at least one weekend off and sometimes two. Residents seem to get out at a decent time, don't really know when they get in. Charlotte is a great town too. Lots to do for the wife.

That's enough for now... e-mail me if you would like any more info on programs in the southeast and in Michigan (those are the ones I am familiar with anyway).

 

[hosskp1]

•••quote:•••Originally posted by NevadaBoy:
•Howdy-doody!

I'm a newbie to this board--my first post. Just wondering if you could help me out with my residency search:

I'm a 3rd year at the University of Nevada, and I just decided to go into general surgery, possibly with the hope of pursuing critical care/trauma/whatevayawannacallit.

However, my significant other has made it clear that she is not happy with this, and we are trying to compromise. I'm looking at community based programs, and specifically for ones that won't kill me (or her!). In a nutshell, I'm looking for programs that have one or more of the following qualities:

1. Q4 or greater on the general surgery service (for 1st and 2nd years).
2. Post-call-home-early, or better yet, post-call-day-off like the gas boys get! I've heard rumors of these programs, but I've yet to see one.
3. A program where you can generally leave the hospital by 6 pm on a non-call night (this is an important one! It's the difference between eating dinner with your loved one and sitting at the table eating cold mac-and-cheese by your self).
4. A program where you don't have to be in until 6:30 am or later (this one is the least important. I'm pretty good at getting up early!)

If anyone knows of any such programs, please let me know and I'll research them. I'm willing to look at just about anywhere in the US. 'Preciate your help. I'd sure hate to have to leave my honey for surgery. <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> •••••I hate to say this--- but you might have to dump your girlfriend in order to fulfill your career dreams. If she is not a plus, she is a minus. If you let your woman determine what you are going to do now-- it is only going to get worse later on. If you do this early-- there may be more time for you to find someone else. You might not be able to work things out. I know most people will not say this-- but do not be naive about things.

 

[wbd161]

I was wondering....since a lot of surgery programs are pyramidal in nature, what happens to the guys and gals who don't make it to the next year level? Do they get booted out or something?

 

[Winged Scapula]

A lot of surgical programs ARE NOT pyramidal. To be so is to be in violation of RRC rules. Most programs have Preliminary residents who may or may not continue on into the Categorical track. However, this is not considered Pyramidal as most of these residents have already matched into PGY2 spots elsewhere and those who don't understand that there are no guarantees that they will be rehired the next year or that a Categorical spot will open up for them. Thus, the guys and girls who don't make it to the next year (ie, Prelims without a PGY2 spot matched earlier and not offered a spot) are usually given that information early enough so that they can go through the match and try to obtain a place elsewhere.

Hope this helps.

 

[squeek]

For Swedish Hospital, you might check this out--It's Swedish's general surgery residency info.

<a href="http://www.swedishmedical.org/surg_train.html" target="_blank">http://www.swedishmedical.org/surg_train.html</a>

It looks like you do some rotations at Harborview Hospital, the trauma branch of University of Washington Medical Center. For what it's worth, I worked at UW on a med/surg floor for a year (Sunday mornings and weekday evenings), and I remember the surgery residents ALWAYS being there.

Seattle is a wonderful city--I spent five years there during and after college, and I hope to go back for my residency, too. It's a great mix of residential and city life. So you really can't go wrong there.

Regarding your significant other, remember that small community-based programs often do not have a lot of surgeons on staff. i.e., if you choose to be a surgeon in a small community, you'll have to take an awful lot of call AFTER residency, for the duration of your career. It's something to ponder.

 

[Sheerstress]

Most of the Michigan State University programs (Lansing, Grand Rapids, Kalamazoo, Saginaw) are pretty nonmalignant (call Q4, nice facilities, sympathetic administrations). The Grand Rapids program was mentioned above, and is a very solid community program, as are the others (I personally did my med school clinical rotations in GR and a surgical prelim year in Kzoo). As far as your specific desires, this was my experience in Kzoo:

1. Q4: Is pretty standard in the first couple of years, although seniors have more backup responsibilities as time goes on.

2. Post-call-home-early: Check out was generally around 5 or 6, and most senior residents were pretty cool about not dumping on you.

3. A program where you can generally leave the hospital by 6 pm on a non-call night: Again this was USUALLY the case, but there are plenty of times where if a case goes over or something comes in, you have to stay to get the job done.

4. A program where you don't have to be in until 6:30 am or later: Can't help you there. When on the service, you had to be in at 6 at the very latest to see your patients by chief rounding time (usually around 7), and there were plenty of very busy months where I was there at 5 or even 4 to get all the patients in the SICU.

The only resident I knew who was unhappy with his training had wanted a more urban program to begin with, so if you want a community program, I'd say I could recommend any of the above four, although I am most familiar with the ones I was part of.

I would add, however, that all surgical residencies, have the same features (e.g. rounds, OR, clinic, conference, etc.) plus the procedure and case quotas that they all have to meet. And a chief year in even the nicest program is going to be BUSY if not all-consuming, no way around that. Finally, as an attending, although you'll have some control of your schedule, long hours day after day, month after month, and year after year is the norm for most surgeons. So I would agree with those above who say that you'll probably want to look long and hard, particularly during your Surgery clerkship, to see if it's the field for you. Good luck.

 

[wbd161]

i got a different problem: my grades ain't too good. i was a slacker in school but i wanna go into surgery. what do i do now? i'm a lame duck and i'm dead in the water. what can i do to increase my chances of getting into any (i repeat ANY) surgical program?

 

[snowballz]

My advice is dump her. If you take the community residency and later break up, you're really going to be regretting the fact you DIDN'T take the high powered residency. Career first.

People who hamper your career do not love you...and they aren't your soul mate.

Alicia

 

[Mindy]

Poor snowballz...its lonely at the top <img border="0" title="" alt="[Frown]" src="frown.gif" />

 

[dr.evil]

ouch snowballz! Now I realize why the divorce rate in the U.S. is so damn high. Career first huh? Well, to each his own. When they bury me, I sure don't want my epitaph to only say "Here lies a dedicated surgeon." Believe it or not, there is a much larger world outside of the hospital.

Of course, NevadaBoy is just talking about his girlfriend. He hasn't taken that extra step and put a ring on her finger so I guess he can still go with snowballz suggestion. Once you're married, COMPROMISE. If the S.O. isn't happy, neither are you.

I reiterate this: High powered residency does not necessarily produce a better surgeon (maybe a more egotistical one , but I'm ok with that too). Just do interviews for surgery everywhere and see where you fit in the best. A few of my friends went to the big name institutions and hated their life. They transferred to a different institution and are much happier and feel no loss in the quality of training. So, whatever works for you.

 

[I love Johnny Walker]

Hello guys, I am also interested in a lifestyle friendly residency program. I like to work hard but I really need a place where there is a good life (restaurants, clubs, etc.), plus I'm a single male. Where are the places to go for single males? I definitely need a diverse place. But more importantly, I have no problem going to a community program with a good reputation as long as they train excellent surgeons and have a good track record in placing people in several fellowships. I like big cities, like Chicago, the Detroit area, possibly east coast, but I have no interest in these southern places or anything west of Chicago. Can anybody suggest anything? Thanks

 

[tulanestudent]

I'm with snowballz. Your significant other must be understanding of your lifestyle. If you are ANY type of physicain, you really can't guarantee being home by 6pm. All residents have call at least a few times a month, and what if that call falls on birthdays or special events? If a significant other is not willing or able to adapt to your demanding carreer, you should consider finding a partner who is more suited to your lifestyle. It's good that your s/o is being honest at this point and you can talk things through and decide what you want. But it sounds like if you are set on this carreer choice, you two probably aren't going to be totally happy together and you should be honest with yourselves about that and adjust accordingly. Giving up a carreer you really want may not be healthy either, as you may end up resenting this person who made you give it up. It's a tough choice and I wish you the best in sorting out what is best for you in all areas.

 

[droliver]

My advice: There is no surgery program that will meet your needs as described and I suggest you examine your goals more closely. Out of hand it would seem to me that you would not be happy doing this. Consider some of the subspecialty surgeries GU or ENT