Differences in Residencies by Specialty

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mry1010

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I know it is early but when consider the prospect of wanting to begin a family around the same time I am applying for residency, what specialties have more less strenuous residency programs (below 80hr/wk) and less overnight shifts? I know it varies depending on specific residency program, etc but I am just trying to get a general idea to see what I am in for. I understand residency is boot camp for medicine but I am concerned about the quality of life I'd be living at a time when many people are starting families.
Thanks for your input.
 
Doing what you love for 80 hours a week is better than doing what you hate for 40.

Cross this bridge when you get to it.
 
I think you'll find that pretty much every residency will put you close to that 80 hrs/wk. Most residencies will have overnight shifts and call as you'll be rotating through lots of different services. I'd worry more about what the specialty is like after residency.

Some specialties that are less demanding on time as an attending:

The classics: Radiology, dermatology, opthamology, anesthesiology
Others: emergency medicine, hospitalist/intensivist/laborist, PM&R, pathology, medical genetics
 
True, I would definitely rather work 80hrs "saving lives" than 40 pushing papers for a big business.

That's certainly a good point cougar, and I agree. I'm pretty certain a specialty like surgery wouldn't be for me, I simply value other things in life more than work (not that I have ever minded hard work and have worked full-time jobs before). Are psych or neurology relatively lifestyle friendly specialties?
Little daunting to know that 80hr weeks during residency will be inevitable though.
 
When choosing a specialty ther are many factors that one must consider and I agree that the length and malignancy of the residency are two things to consider. Of course, don't pick a specialty you don't enjoy just for better hours - you will be miserable.

I have 3 kids, a husband and a pretty complicated life in residency. EM is a great field to combine with having a family...if you like working in the ED! Residency is 3 or 4 years depending on the program and my hours on months in the department work out to be about 20 9-hour shifts per month plus conference and didatic time. Off-service rotations require call q3 or q4 and hit the 80 hour weeks but the majority of my time is in the ED. Jobs after graduation are available full-time or part-time per diem. The downside....nights and weekends. EM is 24-7 and you will work nights and weekends but personally I would rather work a crazy 9 hour shift than be on call for 24 hours and have to round on patients on a given Saturday. Medicine is certainly tough is balance with a family and honestly there are times that being a resident really sucks. However, if you love what you do and do what you love it can be a good life.
 
mry1010 said:
True, I would definitely rather work 80hrs "saving lives" than 40 pushing papers for a big business.
...
Click to expand...

You won't be "saving lives" as much as you think in residency, and will be doing a ton of charting, dictating and other paperwork. Residents are there to learn and in a LOT of cases won't be making the plight of their patient better during this learning effort. (But will be documenting things daily, ad nauseum.)

Most residencies are going to involve a lot of hours. Even the cushier paths tend to require a preliminary year in medicine or surgery before you settle into the more comfortable pace, and even those paths will have their share of overnight call (Somebody has to do it, and the resident is the low man on the totem pole even in the cushiest of paths). Once you get past the residency, the ROAD specialties, PM&R and psych all have some of the better lifestyles (but most still working an average of about 60 hrs/week). EM has shorter hours due to shift work, but a lot of those shifts are going to be overnights, and you will be "on" your entire shift, as opposed to other fields where there is signifcant downtime. You are entering a path that makes balance difficult. So you are better off picking what you are interested in. Residency is going to suck in terms of time regardless.
 
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mry1010 said:
True, I would definitely rather work 80hrs "saving lives" than 40 pushing papers for a big business.

That's certainly a good point cougar, and I agree. I'm pretty certain a specialty like surgery wouldn't be for me, I simply value other things in life more than work (not that I have ever minded hard work and have worked full-time jobs before). Are psych or neurology relatively lifestyle friendly specialties?
Little daunting to know that 80hr weeks during residency will be inevitable though.
Click to expand...

Psych is very lifestyle friendly in residency and after. Neuro residency can be demanding (about average hours-wise, similar to medicine) but has a fairly good lifestyle after residency.
 
I'm not looking for a cush residency. i want the volume that will make me an excellent doctor. I don't want to be hazed, but I want to be good.

I think in any specialty you can figure out a way to make it work for you. I also think you'll gravitate towards specialties that attract people with similar life goals and expectations.

I'm ready for adventure!!!

(Of course when I'm the old guy in residency I might be too tired to be good...)
 
thanks for the input guys. yeah I have shadowed in the ER before and it is definitely really intense and exciting. It was in a big city though so 70% of it was just primary care for those without health care and even then the doctors seemed to like their work.

L2D i was referring to being an attending as opposed to a businessman with that comment, I was pretty unclear. But yeah I agree about the value of doing something you really enjoy.

Thanks for that link, pretty much exactly what I was looking for.
 
circulus vitios said:
http://www0.ama-assn.org/vapp/freida/spcindx/0,,TR,00.html

Might be useful. Lists the average hours worked for each residency, along with some other stuff like average days off per week.
Click to expand...

Just bear in mind that these hours reflect the hours reported, rather than what residents actually do off the books. Meaning from sign in to sign out, notwithstanding that sometimes residents show up earlier or stay later than either of these marks to clean up loose ends and make themselves look like stars. So these published hours are always going to be shy of what the real average is.
 
My psych residents this rotation work like 45-50 hours a week. Yowza.
 
Dermatology residents only work 45.1 hours a week and earn $45,613 per year?

That sounds too good to be true. This almost seems like a normal "job" as opposed to indentured servitude or an 80 hour/week hazing extravaganza.
 
mry1010 said:
I know it is early but when consider the prospect of wanting to begin a family around the same time I am applying for residency, what specialties have more less strenuous residency programs (below 80hr/wk) and less overnight shifts? I know it varies depending on specific residency program, etc but I am just trying to get a general idea to see what I am in for. I understand residency is boot camp for medicine but I am concerned about the quality of life I'd be living at a time when many people are starting families.
Thanks for your input.
Click to expand...
Hours in radiology residency aren't bad, especially in comparison. Usually, you're in around 7:30 and leave by 5. Most programs have a night float where you're on nights for a week, while others have traditional 24 hour call (out around 8am the next morning). First year residents don't work weekends at most programs unless you're on call. Certain rotations, mainly IR and neuro, require more time.
 
IHeartNerds said:
My psych residents this rotation work like 45-50 hours a week. Yowza.
Click to expand...

You only see a snapshot. A lot of places have psych residents also doing months of IM, neuro, working in the ED where often their hours are different. The danger of a third year rotation is that you might be seeing a lighter month, you just don't know. I've seen a psych resident breaking the 80 hour limit now and then during one of his months of IM during his psych residency.
 
This is a little off the main topic, but what is the average resident's salary? Is it something one could raise a family off of (at least for the time being of the residency?)
 
Gallix23 said:
This is a little off the main topic, but what is the average resident's salary? Is it something one could raise a family off of (at least for the time being of the residency?)
Click to expand...

Most places start first year residents in the $42k-45k range. It goes up a couple of grand per year of seniority. In high cost of living areas it might start at closer to 48k, and the lowest I've seen is about 37k. It's near the poverty level if you have a family and are the sole supporter. But it's a lot better than the $50k/year you were paying out during med school.
 
Law2Doc said:
Most places start first year residents in the $42k-45k range. It goes up a couple of grand per year of seniority. In high cost of living areas it might start at closer to 48k, and the lowest I've seen is about 37k. It's near the poverty level if you have a family and are the sole supporter. But it's a lot better than the $50k/year you were paying out during med school.
Click to expand...

wow so what tax bracket is that?
 
Law2Doc said:
Most places start first year residents in the $42k-45k range. It goes up a couple of grand per year of seniority. In high cost of living areas it might start at closer to 48k, and the lowest I've seen is about 37k. It's near the poverty level if you have a family and are the sole supporter. But it's a lot better than the $50k/year you were paying out during med school.
Click to expand...

Yeahh, making money is a lot better than dishing it out =) I was actually expecting less, so that's pretty cool. It'll help pay off some loans at least so the burden is eased a little.
 
Gallix23 said:
Yeahh, making money is a lot better than dishing it out =) I was actually expecting less, so that's pretty cool. It'll help pay off some loans at least so the burden is eased a little.
Click to expand...

it is much more than i expected isn't the average wage like 20k
 
Trying to choose your life's work based on the hours of residency is not very sound. First of all, every PGY-1 year is busy and the surgical PGY-1s tend to be more physically demanding because of the operative schedule. If you love surgery, then doing medicine just because you want to have more time at home is going to make you miserable in the long run.

The next thing to consider is that your performance in medical school is going to largely determine what residency/specialty you can go into. You may not have as many choices as you think considering the calibre people that you will be in class with. The better you do in school the more choices you have for speciality or residency location.
 
Law2Doc said:
You only see a snapshot. A lot of places have psych residents also doing months of IM, neuro, working in the ED where often their hours are different. The danger of a third year rotation is that you might be seeing a lighter month, you just don't know. I've seen a psych resident breaking the 80 hour limit now and then during one of his months of IM during his psych residency.
Click to expand...

Sorry Law2Doc, I forgot that you're the national expert on residency hours as a medical student at some medical school, whereas I am simply a medical student at some medical school. I must have passively assumed they never worked harder than that, nor did I possibly ask them how their hours were over the entire PGY2-4 residency. 🙄 The bottom line is that it's freaking cushy compared to a surgical lifestyle.
 
Law2Doc said:
Just bear in mind that these hours reflect the hours reported, rather than what residents actually do off the books. Meaning from sign in to sign out, notwithstanding that sometimes residents show up earlier or stay later than either of these marks to clean up loose ends and make themselves look like stars. So these published hours are always going to be shy of what the real average is.
Click to expand...

My neighbor is a G1 in an IM program at our county hospital. The hospital explicitly states that they comply with the 80 hour per week limit. My neighbor explicitly states that he works 100 or more hours per week almost every week.
 
TooMuchResearch said:
My neighbor is a G1 in an IM program at our county hospital. The hospital explicitly states that they comply with the 80 hour per week limit. My neighbor explicitly states that he works 100 or more hours per week almost every week.
Click to expand...

Exactly. On paper all programs comply. Residents sign in and out well within the hour limits and are explicitly told that they must go home after they have been there 30 hours in a row or are pushing the rolling average limits. But at a lot of places residents who do the minimum or leave major loose ends for the next shift aren't given very positive feedback. So despite programs telling you to sign out and go home there's strong incentive to covertly not abide by this.
 
mry1010 said:
I know it is early but when consider the prospect of wanting to begin a family around the same time I am applying for residency, what specialties have more less strenuous residency programs (below 80hr/wk) and less overnight shifts? I know it varies depending on specific residency program, etc but I am just trying to get a general idea to see what I am in for. I understand residency is boot camp for medicine but I am concerned about the quality of life I'd be living at a time when many people are starting families.
Thanks for your input.
Click to expand...


While I understand what you're trying to get at, I think the wiser decision is to do what you want and find programs within that field which are family friendly (they do exist in every field). Hours are one thing, but how the program relates to you and your growing family is another.

For example, Pediatrics in general - obviously more family friendly, but there are definitely programs where everyone has kids and programs where no one has kids. One program I interviewed at had 13 pregnancies in the last year out of about 60 residents. Further, being in Internal Med or Peds - where the mid-size programs may have anywhere from 12-20 residents per class - may mean your absence is hardly noticed because there's redundancy built into the schedule. Compar that to the most family friendly ENT program where largest programs may take 4 residents a year...it's a lot easier to be happy for someone when you don't have to do extra work to cover the call shifts they're missing. Larger programs are better equipped to handle maternity leave and the inevitable times you'll have to stay home with sick kids on short notice.

So my advice, when the time comes, is to go into what will really make you happy, and then scour websites and pay attention on interviews to see how many residents are pregnant (this was a topic that came up on nearly every single one of my interview days). Also realize that you'll likely to need to be pretty vigilant on planning when you're going to get pregnant - having a baby in fourth year of med school or the second year of residency is a lot easier than intern year.
 
Thanks a lot for all the information guys, definitely gave me a more positive outlook on residency. Obviously it will be the hardest thing most of us will ever do, at least as far as work is concerned, but I now know it is at least possible to live a somewhat normal life during this period.
 
mry1010 said:
...but I now know it is at least possible to live a somewhat normal life during this period.
Click to expand...

I'm not sure anyone really said this. A few said that you can normalize things post-residency. Residency is not normal hours, period. You will be working overnight pretty regularly. You will be under stress constantly. The term resident was coined because these young physicians used to live in dorms attached to the hospital and never go home -- the thinking back then was that if you went home every other night you missed half the good cases. It's considerably better now but most specialties are going to require an every 4th or 5th night overnight call in the hospital (and in surgical fields is often every 3rd night). I think 3rd year of med school will give you a lot more insight into what's involved, but by then you will be too well invested. Just expect these to be the hardest X years of your life with your priority having to be to learn your trade. You will miss a ton of family events and obligations even in the cushiest of residencies. So no, I don't think "somewhat normal life" is how many would describe it.
 
Premeds... remember when you were in Jr. High and all the high school kids were telling you that HS is so hard and demands so much time. Then, when you get to high school, you find out that it's actually really chill. The same thing happens again in college, where you find that it's a lot easier than everyone had led you to believe when you were in high school. I wonder if the same will be true for medical school and then, residency. 🙄
 
usermike8500 said:
Premeds... remember when you were in Jr. High and all the high school kids were telling you that HS is so hard and demands so much time. Then, when you get to high school, you find out that it's actually really chill. The same thing happens again in college, where you find that it's a lot easier than everyone had led you to believe when you were in high school. I wonder if the same will be true for medical school and then, residency. 🙄
Click to expand...

ROFL. Yeah, you go ahead and believe that, mike. Please post back when you get there to say whether you were right. :laugh::laugh::laugh:
 
Old school residencies must've been horrendous judging by how much it reportedly sucks now. My dad started his residency in 1964. He was paid about 200 dollars a month (in NYC) and did live within walking distance of the hospital. From his accounts, it just sounded like an all around *****whip.
 
MossPoh said:
Old school residencies must've been horrendous judging by how much it reportedly sucks now. My dad started his residency in 1964. He was paid about 200 dollars a month (in NYC) and did live within walking distance of the hospital. From his accounts, it just sounded like an all around *****whip.
Click to expand...

I was talking to an older surgeon who actually lived in a dorm attached to the hospital. He used to go weeks without ever leaving the same building.
 
I head general surgery residencies are especially bad in terms of hours. Anyone know much about GS?
 
Law2Doc said:
You only see a snapshot. A lot of places have psych residents also doing months of IM, neuro, working in the ED where often their hours are different. The danger of a third year rotation is that you might be seeing a lighter month, you just don't know. I've seen a psych resident breaking the 80 hour limit now and then during one of his months of IM during his psych residency.
Click to expand...

Most psych programs require 3-6 months of IM or peds in the first year only (except MGH, which requires 9 months of peds if you are on the child and adolescent psych fast track). There are usually 2 months of neurology in the first year, or split between the first 2 years. ED work is generally shift work (8-12 hour shifts) and doesn't come close to the 80 hour mark. The frequency that you take call depends upon your program but is generally less frequent than other programs.

Of course there are months of psych that can be demanding. But it is a very benign residency compared to the others. And since the medicine/peds/neuro months are generally part of intern year, it's really no worse on hours than the lifestyle specialties that require a transitional or prelim year.
 
Law2Doc said:
ROFL. Yeah, you go ahead and believe that, mike. Please post back when you get there to say whether you were right. :laugh::laugh::laugh:
Click to expand...

No offense L2D, but your posts are always wrought with gloom and doom, not just about residency but about med school as well. I have a few things to say. I've been posting on this forum for two years and I was lurking here for about a year and a half before that. You're a med student so you've gone through the medical curriculum and yet you managed to rack up 19,000 posts and you've only been a member since December of 2004. So if you had time to post 19,000 posts on SDN in four years, med school can't possibly be as time-consuming as you make it out to be.

When it comes to residency, I've been researching this by talking to attendings and residents at the hospital I volunteer at and by scoping out SDN's allo and osteo board and the residency board. There are some residencies that are always going to demand a lot of hours -- neurosurgery, IM, peds, surgery. But in most of those, your lifestyle afterwards doesn't have to be all bad. It is what you make it based on posts on SDN. If you're IM in a solo practice, you may have to work something like 60 hours a week (including paperwork) to keep the lights on, but you could also share responsibilities with others and only work 50 hours or 45 hours, knowing that you'll be taking a pay cut. If you want nice hours without sacrificing pay, you might try Psych or PMR. The ROAD specialities are out there too, but most people can't get into those because a lot of programs require high board scores, excellent third-year evals, good grades, and research.

Anyway, that's my take.
 
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