I was wondering if you guys want to take your vacation, is there a restriction on when you can take it? Are some months off limits for leave?
Also, if you want to take a week of vacation, do you have to make sure that you have an upper level who can cover for you during that week?
Your program will let you exactly what's what with your days off and vacation. You do not need to find an upper to cover for you. That would happen it let's say unofficially you needed to get out early that day for an appointment or something, the senior might cover some of your work. Don't do this lightly, pay things back, and assume that there is not a single moment that belongs to you when you start residency. See what the system is there and what people do, especially things that may not be addressed on the books.
Most programs have rotations where vacations cannot be scheduled. If that's the case, they will be sure vacation is not scheduled at that time. Some places solicit your preferences per their rules and may work that in, others assume they own you (they do) and will just hand you schedule and that's it.
I don't know how sick days play into your 4 per month. I *do* know that sick time like FMLA leave and whatnot, longer stretches, *cannot* replace your paid vacation time. So let's say you get 4 weeks a year paid time off and are ill and get approved to have 3 weeks off for illness, this does not take away you getting the 4 weeks true vacation in addition. However, the pay that went for your paid vacation can go to you on your sick weeks depending on individual program structure around that vacation pay versus sick leave pay, sometimes you'll get your vacation pay and when that runs out then the rest of your sick leave is unpaid, in which case later you still get the vacation but maybe unpaid, and you cannot say "no, rather work that vacation week and get paid." If between this sick leave and mandatory vacation time, you miss too many weeks that year, you will not graduate on time and will have to make up the sick time, but working vacation time to make it up that year is not an option. Also, sick leave may have to change the timing of your vacation weeks because of coverage stuff. They could pull someone from their vacation to cover your sick time, in which case later you may work what was supposed to be your vacation while they take theirs. But everyone gets their vacation despite any sick time that happens. ACGME demands you get the promised vacation time, but when is up to negotiation.
If you followed what I said at all about timing of vacation and peopled getting pulled and what not, you can see it's a scheduling f8ckshow, so you really need to be so laid up that it is literally impossible for you to will yourself to work.
Often ACGME for your specialty demands you complete a certain number of certain rotations, but then there is some wiggle room as far as elective time.
For example, a program may have you do 4 ICU months the first year when ACGME would have allowed 3. Once the program has met the minimum required ACGME rules on rotations, the program has wiggle room on electives. So, let's say you were supposed to do 4 months wards, but were sick one ward month. Now, you may have to do that ward month during what was supposed to be your elective, because the elective could be cut but not the ward month. Again, your vacation time cannot be taken, but it can be moved, and they can take away elective. In fact, because vacation can't be used, often elective months are sacrificed not only by you, but by who covered you (they still have to have their vacation and core rotations months despite covering your sick ass). So when one person is out for a while, the price is paid not only by you but by others of elective time, which is also having to sacrifice weekends. You may be condemning a number of fellow residents to 6 day work weeks and NO weekends on the only 3 months of elective time they would had weekends on. This is really significant. They will hate this. If they truly believe you are that ill, while they will be miserable, they may take pity and not shank you the next time you're asleep in the call room. (also my example where the program had programmed you to do 4 ICU month when 3 would suffice for ACGME requirements, it's up in the air and depends on bodies and what not, if you are sick this month perhaps that's all there is to it, however, often if they are designing the program for you to spend more time than required by ACGME, then it is because they want/need residents to cover that month, therefor typically someone is getting stuck with it period. This could suck really bad.) So ladies, do NOT get pregnant during residency because it can turn into a f8ckshow for everyone, be prepared to have an abortion, your fellow residents and PD will be so grateful. (that is a totally sick joke, and I make it to highlight something disturbing about training)
I'm sorry, none of this has to do with individual single sick days. Those will still blow for everyone involved but more manageable than a stretch of time. Hopefully the above gives you some insight into scheduling stuff and how people get pulled/called in. Someone else's life will generally suck more because you're not there.
Ah yes, the toxic culture of medicine, where when you are sick you "owe" someone else a shift (what other job works that way?!?) and where you're never supposed to be sick at all. We'd expect more from actual doctors - people who in theory are supposed to take care of sick people - to understand. Because disease can happen to anyone.
At my institution, there's a PGY2 surgery resident who had appendicitis. Didn't go in to get it checked out (cuz, you know, he's too macho - or terrified - for that and because his ***** colleagues and attendings would surely chew him out for taking 4 hours out of his day to have his acute abdomen assessed in the ED). As a result, his appendix ruptured and he had to take 2 weeks off for recovery and will need to get an interval appendectomy down the line.
It's poor form when a surgical program has residents with ruptured appendicitis. Just saying.
Plenty of other jobs would expect you to "pay back" a shift covered for you. That is not unusual or what I take issue of in medicine.
What is ridic and toxic is the notion of never being sick and doctors not caring for each other. I agree the surgical resident story you share is very poor form.
I think there are doctors who would like to be more understanding of colleague illness and have more support for them, but the system (as I described above) is hard-pressed to accommodate it, so good intentions go by the wayside
and then there are doctors that are into sadomasochism and like the culture being that way, hazing and punishing human weakness, only the physically fittest should care for the sick (?)
a change in culture will not be enough to make up for lacking resources, however, a change in culture may facilitate a change in resources, and would need to be addressed if the culture is what is preventing change/use of resources
EDIT:
what I said about the relationship between sick time not replacing your vacation time is true for IM, and is not set by ACGME but the individual specialty boards, you need to read both what your specialty boards sets forth as rules and your individual residency program contract
