Disability accommodation during residency/medical school

[Jc2008]

I would appreciate feedback from people who are familiar with this issue, as opposed to people just speculating about what may happen

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[Psai]

Why not just do clinical psychology? 35 hour a week residency?

 

[Jc2008]

Why not just do clinical psychology? 35 hour a week residency?

"I'm also committed to medicine, so I am not interested in trying another field." 🙂

 

[0ncogene]

"I am trying to ascertain whether I should let this disability dissuade me from going into medicine."

I am not familiar with this process, so I don't have an answer for you. But after reading your concerns, I can tell you that medical school and residency are very stressful as it is for a person without disability. Medical school has a curriculum where you will be required to do group assignments with discussions and working up cases with your classmates. Taking less classes per semester will not allow you to do this, because you will be behind everyone else and will have no idea what everyone is discussing.

I don't know the average hour of work for a psych resident, but I can tell you that you will not be working 35hr a week during your intern year. You will be rotating through other services like internal medicine where you will be expected to work close to 60-80 hours week with night calls. And I don't know how you are going to cut the work hours when your attending is working at least 40hrs a week during outpatient clinic; you can't just ask to go home in the middle of the day to accommodate you disability.

My advise is that you should probably go into another field. Medicine very stressful, and it is definitely not for everyone. And I don't think it is worth it in your case, given that you have to go through a lot more hoops trying to get approval for less units per semester and find a residency program that will accommodate your specific needs.

 

[nlax30]

What sorts of current accommodations did you get during undergrad?

What kind of official evaluation did you get for that?

 

[bashwell]

Please note I am posting this here instead of the pre-med forum because I would prefer answers from residents and MDs.

I am in the process of applying to medical school and have a disability. I am trying to ascertain whether I should let this disability dissuade me from going into medicine. My disability is not physical, I can do everything a non-disabled individual can- except that, I suffer from extreme fatigue, a side effect of medication I have to take for my condition. This is not something I can change by trying a different treatment (I've already done that) , so I would prefer to avoid any replies suggesting I try to get better treatment. I'm also committed to medicine, so I am not interested in trying another field.

In order to get through medical school and residency, I would likely be requesting an accommodation consisting of a reduced course load (maybe one class less per term), while in medical school. I would also be requesting reduced hours during residency (likely around 35 per week). In my chosen specialty, psychiatry, the average residency work week is 45 hours...so I would not be working that much less than full time.

I am trying to find out whether there are any other people who in medical school ended up taking a slightly reduced course load and who maybe finished in 4.5 or 5 years instead of 4 and whether there are other people in residencies who are working slightly reduced hours (for medical reasons or otherwise).

My main purpose is to get an idea of how such an accommodation request would be viewed during my medical education and to find out how rare (or not rare) such accommodations are.

I am particularly worried about getting through medical school with a reduced course load but having problems finding a residency, due to having taken longer than 4 years to complete my education (while I know there are laws to protect against such discrimination, there are also stories out there of ppl who were not able to practice medicine as a result of not finding a residency, directly related to their taking longer than 4 years to graduate).

Let's assume my grades, USMLE scores and everything else would be good- the only issue would be that I would need to have the reduced course-load .

I would appreciate feedback from people who are familiar with this issue, as opposed to people just speculating about what may happen (I have done that plenty myself 😉. My sense is that the accommodation would be granted by medical schools (as per ADA) but you would have to explain to residencies why it took you slightly longer to finish school, if they asked (although you would not have to disclose your disability or the accommodation request until after you are accepted into the program). I am less clear of what would happen after you are accepted as a resident. Technically, as your employer, they would have to grant your request for less hours unless there is a very good reason not to (and decrease your salary at the same time). So it may take a little longer to finish the residency (which is OK). But given that this type of situation is not common, I am a little apprehensive and would love to hear from other people who have dealt with something similar or who know of other people who have had a similar situation.

I am far from any sort of expert here, but my understanding is that, according to the Americans with Disabilities Act, you're allowed "reasonable accommodations" during residency. However, what that precisely means depends on your specific disability and your program.

I have heard of women who have gone part-time in residency (pediatrics, family) due to being pregnant and/or having a baby, but I don't know if psych has anything like that. See here and here for some information.

 

[nlax30]

I'm not an expert in that ADA or the ins and outs of this sort of stuff but I would encourage you to read some of the similar threads linked below as a PD there has posted some from the standpoint of what a residency may request.

Your situation may be hard. Honestly with a physical disability it's probably easier to come up with a concrete, practical and reasonable solution to address that disability whether it be with extra equipment or physical access to something.

In your case I would think that it's much more nebulous what exactly they could do to accommodate you besides just giving you extra time. Based on the ADA your residency would need to be able to come up with "reasonable" accommodations which is vague and I'm not sure if they would include less than full time schedule or even extending the length of training as reasonable..... It may be worth contacting the ACGME and speaking with someone regarding this issue as there may be some programs out there to address this sort of thing that I'm not aware of.

Whatever you do decide I hope you are able to get some wise council from whoever is managing this condition. I'll echo what was said above and you may want to seriously think if this is a path you want to pursue. Medicine is already tough enough on your physical and mental health, let alone potentially looking at adding on a couple years from the start because of a pre-existing issue. If you're ok accepting that and going forward then good luck.

 

[Jc2008]

I have also uploaded my Q to "confidential consult"

 

[Jc2008]

I am far from any sort of expert here, but my understanding is that, according to the Americans with Disabilities Act, you're allowed "reasonable accommodations" during residency. However, what that precisely means depends on your specific disability and your program.

I have heard of women who have gone part-time in residency (pediatrics) due to being pregnant and/or having a baby, but I don't know how common that is. Or if psych even has a part-time option. See here for some information.

Thanks for helpful reply, I was not aware of the existence of part time residencies, so your response is VERY helpful 🙂 yes, they technically have to accommodate you by law since a residency is a job, but some discrimination does exist, depending on the field and the organization, which is why I am doing some digging first. It looks like 10-15% of advertised residencies (at least in PEDS) are part time, so that's a good sign.

 

[Jc2008]

I'm not an expert in that ADA or the ins and outs of this sort of stuff but I would encourage you to read some of the similar threads linked below as a PD there has posted some from the standpoint of what a residency may request.

Your situation may be hard. Honestly with a physical disability it's probably easier to come up with a concrete, practical and reasonable solution to address that disability whether it be with extra equipment or physical access to something.

In your case I would think that it's much more nebulous what exactly they could do to accommodate you besides just giving you extra time. Based on the ADA your residency would need to be able to come up with "reasonable" accommodations which is vague and I'm not sure if they would include less than full time schedule or even extending the length of training as reasonable..... It may be worth contacting the ACGME and speaking with someone regarding this issue as there may be some programs out there to address this sort of thing that I'm not aware of.

Whatever you do decide I hope you are able to get some wise council from whoever is managing this condition. I'll echo what was said above and you may want to seriously think if this is a path you want to pursue. Medicine is already tough enough on your physical and mental health, let alone potentially looking at adding on a couple years from the start because of a pre-existing issue. If you're ok accepting that and going forward then good luck.

 

[nlax30]

I only briefly skimmed through it but I came across this article which seemed interesting:

The Implications of the ADA Amendments Act of 2008 for Residency Training Program Administration
http://jaapl.org/content/40/4/553.full

From the article:

Having been informed that an employee has a disability and may need accommodation in the workplace, the employer has a duty to provide such reasonable accommodations. The employer is entitled to request supporting documentation that conceptualizes the best ways to overcome the worker's limitations but, barring undue hardship, must engage in good faith in an interactive process with the employee to identify reasonable accommodations.22,23 The EEOC suggests possible accommodations, such as time off, modified work schedules, room modifications, increased supervision and guidance, provision of a job coach, and job restructuring.24 The employer, however, is not obligated to restructure essential job functions or transfer major job responsibilities to a different worker.

The question remains whether there is any reasonable accommodation for a person whose impairment substantially limits a skill set that is at the very essence of his profession. As Gold and Shuman explain, “[a] requested accommodation that requires extensive job restructuring on the part of the employer might … be considered an undue hardship” (Ref. 3, p 227).

The key maybe assuring a potential residency that you will have no problem fulfilling the ACGME's core competencies (which shouldn't be an issue for you given your existing academic background) and that whatever accommodations you need will be reasonable and won't place an undue burden on the program. Now this may place certain specialities/residencies out of reach as it would be much more difficult for a 5 year Gen Surgery program to accommodate someone needing a say 35 hour work week vs a psychiatry or FM program that may already have better hours to begin with.

 

[girlofgrace7]

I think accommodations could be made fairly easily during the first two years of medical school, but you will have a much more difficult time during clinical years and residency. It's not uncommon on a surgical rotation to be there for 14-18 hours a day (even without call). Even if you have an accommodation made through the school saying that you only have to stay so long, I can pretty much guarantee you will get negative evals as a third year for leaving "early" (possibly veiled under phrases like "uninterested," "not a team player," etc.). Most schools post all comments verbatim in the dean's letter, which will be viewed negatively by residency programs. During residency, it gets even more difficult because medicine does not lend itself to shift work (even in fields that have "shifts"). You are responsible for your patients, and sometimes they throw wrenches into best-laid plans. We technically can check out at 7 pm at my program if we're on call... but that doesn't mean that I haven't stayed until after 11 pm some nights because my patient was too sick to leave right away, etc. (might not be a problem once you're in psychiatry rotations... but it will be when you have to do internal med, etc. rotations... and off-service rotations are not going to be very open to having you dictate what hours you'll work).

"Reasonable accommodations" have to be made, but that term is incredibly subjective. We have a peds resident in a wheelchair in our program right now, and we are having a lot of difficulty accommodating in a way that doesn't jeopardize patient care, doesn't put undue stress on all the other residents, and allows her to get the education/procedures she needs (for instance, unstable NICU babies on an oscillator are at high risk of decompensating when she has to lower their beds way down to examine them, sterility and limitations of how low beds can be lowered makes doing things like lines difficult and dangerous for the patient, she can't respond to codes or stat deliveries in a timely manner and thus can't be an upper level on nights, etc.).

We also have a resident who made arrangements to work "part-time" for mental health and family reasons. She basically works two weeks on, two weeks off on ICU and clinic rotations but still has to complete ward months in their given month since it would throw everyone's schedules completely off to do those part time. Even though these accommodations were made, I can tell you that it has definitely affected her relationships with other residents and attendings because it means everyone else has to do more work to cover the areas she isn't working (like they're one resident short 2 weeks out of a month). Also, many programs are only allowed to have so many residents because they're accredited for X number of residents based on the amount of patients they see and education they can provide. If you stay in the program for an extra year, they will have to have one less person in the class below you (which will likely mean they'll have one less resident at some point in time); how much that affects the program depends on its size.

As people have said above, think long and hard before you take this on. It's one thing to go in with the mindset of "I'm going to try to tough it out and ask for accommodations if absolutely necessary" and a completely different one to go in ready to fight the system and planning for all of these accommodations that may or may not be reasonable to make (and if they are made, will likely make you quite unpopular with your coworkers). Medicine is exhausting, physically, mentally, and emotionally. It's completely draining on someone who is completely healthy, and I can only imagine how much more difficult it would be with a disability.

Just some things to think about.

 

[Jc2008]

I think accommodations could be made fairly easily during the first two years of medical school, but you will have a much more difficult time during clinical years and residency. It's not uncommon on a surgical rotation to be there for 14-18 hours a day (even without call). Even if you have an accommodation made through the school saying that you only have to stay so long, I can pretty much guarantee you will get negative evals as a third year for leaving "early" (possibly veiled under phrases like "uninterested," "not a team player," etc.). Most schools post all comments verbatim in the dean's letter, which will be viewed negatively by residency programs. During residency, it gets even more difficult because medicine does not lend itself to shift work (even in fields that have "shifts"). You are responsible for your patients, and sometimes they throw wrenches into best-laid plans. We technically can check out at 7 pm at my program if we're on call... but that doesn't mean that I haven't stayed until after 11 pm some nights because my patient was too sick to leave right away, etc. (might not be a problem once you're in psychiatry rotations... but it will be when you have to do internal med, etc. rotations... and off-service rotations are not going to be very open to having you dictate what hours you'll work).

"Reasonable accommodations" have to be made, but that term is incredibly subjective. We have a peds resident in a wheelchair in our program right now, and we are having a lot of difficulty accommodating in a way that doesn't jeopardize patient care, doesn't put undue stress on all the other residents, and allows her to get the education/procedures she needs (for instance, unstable NICU babies on an oscillator are at high risk of decompensating when she has to lower their beds way down to examine them, sterility and limitations of how low beds can be lowered makes doing things like lines difficult and dangerous for the patient, she can't respond to codes or stat deliveries in a timely manner and thus can't be an upper level on nights, etc.).

We also have a resident who made arrangements to work "part-time" for mental health and family reasons. She basically works two weeks on, two weeks off on ICU and clinic rotations but still has to complete ward months in their given month since it would throw everyone's schedules completely off to do those part time. Even though these accommodations were made, I can tell you that it has definitely affected her relationships with other residents and attendings because it means everyone else has to do more work to cover the areas she isn't working (like they're one resident short 2 weeks out of a month). Also, many programs are only allowed to have so many residents because they're accredited for X number of residents based on the amount of patients they see and education they can provide. If you stay in the program for an extra year, they will have to have one less person in the class below you (which will likely mean they'll have one less resident at some point in time); how much that affects the program depends on its size.

As people have said above, think long and hard before you take this on. It's one thing to go in with the mindset of "I'm going to try to tough it out and ask for accommodations if absolutely necessary" and a completely different one to go in ready to fight the system and planning for all of these accommodations that may or may not be reasonable to make (and if they are made, will likely make you quite unpopular with your coworkers). Medicine is exhausting, physically, mentally, and emotionally. It's completely draining on someone who is completely healthy, and I can only imagine how much more difficult it would be with a disability.

Just some things to think about.

Thanks for the well thought out reply.

 

[Jc2008]

I think accommodations could be made fairly easily during the first two years of medical school, but you will have a much more difficult time during clinical years and residency. It's not uncommon on a surgical rotation to be there for 14-18 hours a day (even without call). Even if you have an accommodation made through the school saying that you only have to stay so long, I can pretty much guarantee you will get negative evals as a third year for leaving "early" (possibly veiled under phrases like "uninterested," "not a team player," etc.). Most schools post all comments verbatim in the dean's letter, which will be viewed negatively by residency programs. During residency, it gets even more difficult because medicine does not lend itself to shift work (even in fields that have "shifts"). You are responsible for your patients, and sometimes they throw wrenches into best-laid plans. We technically can check out at 7 pm at my program if we're on call... but that doesn't mean that I haven't stayed until after 11 pm some nights because my patient was too sick to leave right away, etc. (might not be a problem once you're in psychiatry rotations... but it will be when you have to do internal med, etc. rotations... and off-service rotations are not going to be very open to having you dictate what hours you'll work).

"Reasonable accommodations" have to be made, but that term is incredibly subjective. We have a peds resident in a wheelchair in our program right now, and we are having a lot of difficulty accommodating in a way that doesn't jeopardize patient care, doesn't put undue stress on all the other residents, and allows her to get the education/procedures she needs (for instance, unstable NICU babies on an oscillator are at high risk of decompensating when she has to lower their beds way down to examine them, sterility and limitations of how low beds can be lowered makes doing things like lines difficult and dangerous for the patient, she can't respond to codes or stat deliveries in a timely manner and thus can't be an upper level on nights, etc.).

We also have a resident who made arrangements to work "part-time" for mental health and family reasons. She basically works two weeks on, two weeks off on ICU and clinic rotations but still has to complete ward months in their given month since it would throw everyone's schedules completely off to do those part time. Even though these accommodations were made, I can tell you that it has definitely affected her relationships with other residents and attendings because it means everyone else has to do more work to cover the areas she isn't working (like they're one resident short 2 weeks out of a month). Also, many programs are only allowed to have so many residents because they're accredited for X number of residents based on the amount of patients they see and education they can provide. If you stay in the program for an extra year, they will have to have one less person in the class below you (which will likely mean they'll have one less resident at some point in time); how much that affects the program depends on its size.

As people have said above, think long and hard before you take this on. It's one thing to go in with the mindset of "I'm going to try to tough it out and ask for accommodations if absolutely necessary" and a completely different one to go in ready to fight the system and planning for all of these accommodations that may or may not be reasonable to make (and if they are made, will likely make you quite unpopular with your coworkers). Medicine is exhausting, physically, mentally, and emotionally. It's completely draining on someone who is completely healthy, and I can only imagine how much more difficult it would be with a disability.

Just some things to think about.

Just out of curiosity, what field are you doing your residency in? I believe the attitudes towards accommodations and part time work are very different depending on the field. I have a hunch that in psychiatry, where 1/3 of docs work part time and mental health issues are pretty common, disability accommodations are more common. Not so much in internal medicine or surgery. Fortunately, psych residents only do 6 months in internal medicine. I can handle shorter periods at full time and even above, just as long as it is not all the time.

 

[Gastrapathy]

Fatigue is a symptom for which you will encounter people who feel little or no empathy. This isn't necessarily because they are bad physicians. Patients who complain of fatigue are really tough to manage. They tend to be high utilizers, have high rates of other frustrating diagnoses (fibromyalgia, IBS, mental health problems, chronic pain, etc), polypharmacy and dissatisfaction with their physicians.

To make matters worse, your coresidents and attendings have been really tired and never received an accommodation.

None of this invalidates your rights or their requirements but you will have to expect resentment. Resentment can translate into worse treatment in ways that even a reformed lawyer couldn't prove.

Shared/part time residencies tend to be full speed when on and off when off. Scheduling an 80% resident is really hard.

I know you said you want to do medicine but you actually want to work in mental health. That's one of the few areas that you can practice and make a meaningful difference through other paths. With your disability, med school and residency may be pretty miserable. I think you need to make sure it's worth it.

 

[bashwell]

Thanks for the well thought out reply. I appreciate some of the insight you provided. I am not taking this lightly, which is why I posted my question. However, I have already re-done my undergrad and gotten my clinical experiences so I can go, so it's unlikely I will pursue something different just based on potential issues. While I am cognizant that it can be hard to accommodate someone, it is the right thing to do and also the law, therefore I do not believe people receiving these accommodations (like the colleagues you mentioned), should be viewed as some sort of burden on the system. It takes a lot to get through any advanced field and there are challenges along the way, more so for people dealing with health issues. I don't think we should be dissuading such people from pursuing their chosen careers based on perceived inconveniences to the rest of us. Having a disability is hard enough on the affected person, I don't think worrying about what others think should be high on your priority list if you're disabled. While I don't plan to "take the system on", I need to do what is best for my health and for my ability to get through the program. Not making the requests up front risks worsening my condition and jeopardizing patient care even more than having a slightly understaffed department for a few hours a day. If someone does not need an accommodations, they should not be requesting it, but I don't think people should be reluctant to make the request based on what others may think of them. I made that mistake in the past and it cost me, so it's not something I would repeat. Again, thanks for your thoughts.

It's true someone with a disability shouldn't be viewed as a burden. But unfortunately the reality of how people will treat you might be quite different. Obviously no one will come out and say so. That'd be illegal and they'd be in big trouble if they did. But if, for example, they rejected you from their school or program, it could easily be chalked up to something like, "The person wasn't the right fit to our school or program".

In any case, I could be wrong, but I don't think @girlofgrace7 is trying to "dissuade" you or is otherwise suggesting you should be "reluctant to make the request" about accommodations for your disability. Instead it sounds to me like she's pointing out the realities of how difficult all this is going to be. For one thing, the patient basically always comes first. If push comes to shove, then the patient is going to receive priority over you despite your disability. Patient care shouldn't be compromised. That's just how it is, I'm afraid. But of course you have to do what you have to do, and hopefully there will be a school or program that will accommodate you.

Just out of curiosity, what field are you doing your residency in? I believe the attitudes towards accommodations and part time work are very different depending on the field. I have a hunch that in psychiatry, where 1/3 of docs work part time and mental health issues are pretty common, disability accommodations are more common. Not so much in internal medicine or surgery. Fortunately, psych residents only do 6 months in internal medicine. I can handle shorter periods at full time and even above, just as long as it is not all the time.

Based on what she wrote, I'm going to say peds. 🙂

 

[deleted480308]

Thanks for the well thought out reply. I appreciate some of the insight you provided. I am not taking this lightly, which is why I posted my question. However, I have already re-done my undergrad and gotten my clinical experiences so I can go, so it's unlikely I will pursue something different just based on potential issues. While I am cognizant that it can be hard to accommodate someone, it is the right thing to do and also the law, therefore I do not believe people receiving these accommodations (like the colleagues you mentioned), should be viewed as some sort of burden on the system. It takes a lot to get through any advanced field and there are challenges along the way, more so for people dealing with health issues. I don't think we should be dissuading such people from pursuing their chosen careers based on perceived inconveniences to the rest of us. Having a disability is hard enough on the affected person, I don't think worrying about what others think should be high on your priority list if you're disabled. While I don't plan to "take the system on", I need to do what is best for my health and for my ability to get through the program. Not making the requests up front risks worsening my condition and jeopardizing patient care even more than having a slightly understaffed department for a few hours a day. If someone does not need an accommodations, they should not be requesting it, but I don't think people should be reluctant to make the request based on what others may think of them. I made that mistake in the past and it cost me, so it's not something I would repeat. Again, thanks for your thoughts.

It's likely the law is on your side, but make no mistake, that it is a burden to tell a residency director that you only work 35hrs/wk. You will be resented by colleagues even if they won't say it to your face. You can do what you will with that knowledge but you should approach the situation with your eyes wide open.

 

[Jc2008]

Fatigue is a symptom for which you will encounter people who feel little or no empathy. This isn't necessarily because they are bad physicians. Patients who complain of fatigue are really tough to manage. They tend to be high utilizers, have high rates of other frustrating diagnoses (fibromyalgia, IBS, mental health problems, chronic pain, etc), polypharmacy and dissatisfaction with their physicians.

To make matters worse, your coresidents and attendings have been really tired and never received an accommodation.

None of this invalidates your rights or their requirements but you will have to expect resentment. Resentment can translate into worse treatment in ways that even a reformed lawyer couldn't prove.

Shared/part time residencies tend to be full speed when on and off when off. Scheduling an 80% resident is really hard.

I know you said you want to do medicine but you actually want to work in mental health. That's one of the few areas that you can practice and make a meaningful difference through other paths. With your disability, med school and residency may be pretty miserable. I think you need to make sure it's worth it.

 

[Jc2008]

It's true someone with a disability shouldn't be viewed as a burden. But unfortunately the reality of how people will treat you might be quite different. Obviously no one will come out and say so. That'd be illegal and they'd be in big trouble if they did. But if, for example, they rejected you from their school or program, it could easily be chalked up to something like, "The person wasn't the right fit to our school or program".





Based on what she wrote, I'm going to say peds. 🙂

 

[bashwell]

Thanks for your input, your comments are fair. If I wanted to work in psychology, I could have done it without doing 3 years of pre-med and a second bachelors degree. My parents are doctors, so I know what it takes. I am fully expecting the experience to be miserable and seeing some of the attitudes (on here), it is clear that there will be some resentment. I will likely be getting the same resentment in law or any other competitive field where people are over worked and where they suspect others may be trying to gain undeserved advantages. In my case, that is not the case. My issue is not fatigue per se. It is fatigue due to a chronic anxiety disorder. I am well aware of the stigma/resentment associated with that...i have been dealing with it for a long time. The point to me, isn't that it is going to be hard or even miserable, it's about whether it's possible. If there is any chance I can come out the other end as a physician, the gamble may be worth taking. As a lawyer, you work ~60-70 hours per week- until you retire....i am not liked there b/c of accommodations and that won't change anywhere I go.

I don't think most people here are "resenting" you, are they? Respectfully, perhaps you are a bit overly sensitive about your disability and taking all this too personally? I think people are just trying to give you some realistic advice about what to expect. Anyway I do hope you'll find a med school and later a residency program that will actually accommodate you. I hope you'll find colleagues who are understanding rather than resentful. It's tough but hopefully you'll make it if it's really what you want.

 

[bashwell]

Those are very valid points...which is why I'm looking into this. Unfortunately this is an issue for someone with a disability in any field that is competitive (I have to deal with it in law). I m not sure if makes any difference if the people resenting me are the partners at my firm or the physicians in the residency. There's some law to protect those with issues like this, and they're not perfect my any means, but at least it's something you can fall back on if you feel like you are being discriminated against. As a note on your comment- this is not something that is revealed before getting into a program so the issue is not whether you get in as much as whether you get the accommodation after you get in. If I don't, then I have to do my best until I either succeed somehow or fail out. And there are the legal recourses if they fail to make a good faith effort to accommodate. These are not fun things to deal with while trying to train in a field, I agree. I wish there was a simpler way. That is why this feedback I'm getting here can be useful if for no other reason, in order to inform me of the attitudes I may run into along the way.

Oh, I was only saying that because you had said "Not making the requests up front risks worsening my condition..." which I thought meant you were going to tell them "up front". Of course, if you don't tell them "up front," and it's not something that's physically obvious, then no one will know, that's true. Fair enough. Anyway, I do wish you the best, good luck to you, OP.

 

[Jc2008]

I don't think most people here are "resenting" you, are they? Respectfully, perhaps you are a bit overly sensitive about your disability and taking all this too personally? I think people are just trying to give you some realistic advice about what to expect. Anyway I do hope you'll find a med school and later a residency program that will actually accommodate you. I hope you'll find colleagues who are understanding rather than resentful. It's tough but hopefully you'll make it if it's really what you want.

Oh, I was only saying that because you had said "Not making the requests up front risks worsening my condition..." which I thought meant you were going to tell them "up front". Of course, if you don't tell them "up front," and it's not something that's physically obvious, then no one will know, that's true. Fair enough. Anyway, I do wish you the best, good luck to you, OP.

I appreciate your advice 🙂 What type of residency are you doing, if I may ask?

 

[bashwell]

I appreciate your advice 🙂 What type of residency are you doing, if I may ask?

I'll PM you. 🙂

 

[nlax30]

Not to dwell on this, and please don't take this personally or me trying to dissuade you.... but if this anxiety and fatigue is so debilitating despite current treatment that can't be changed, then are you sure this path is in your best interest? (More of rhetorical question, don't have to answer it here). Something you need to discuss with you psychiatrist.

Trust me, I'm not playing down you diagnosis or anything but I've known physicians with no previous mental health issues have serious mental health breakdowns either during training or during practice. I think in some cases it can unmask some underlying predisposition to mental illness but to come into it with a significant/debilitating illness is just asking to put your mental health/sanity at jeopardy.

I know Law is demanding as well. My significant other is a lawyer and I saw what she went through during law school, the bar and now practice, though she's told me numerous times it was nothing like what I experienced in med school and residency/fellowship after now watching me go through those.

Again, don't take any of this personally or an attack. Just trying to be realistic and blunt as that's what I'd want someone to be to me if I had similar questions. Honestly I wish I knew what I know now back when I was applying as I would've thought harder about this whole path as the debt, time in training has certainly taken a toll on my health.

 

[Raryn]

In order to get through medical school and residency, I would likely be requesting an accommodation consisting of a reduced course load (maybe one class less per term), while in medical school. I would also be requesting reduced hours during residency (likely around 35 per week). In my chosen specialty, psychiatry, the average residency work week is 45 hours...so I would not be working that much less than full time.

Ignoring the ethics and legal discussions above, this would be *extremely* difficult to schedule. Outside of the Caribbean (which offers multiple terms a year), most schools have a strict progression of coursework.

Most of them these days are mixed block schedules, with multiple mixed subjects done concurrently. That is, there's a "cardiac" block with cardiac anatomy/physiology/histology/whatever all done at once. The August M1 block is offered in August and only in August. The September M1 block is offered in September. You can't just take a few hours less a week of coursework in August and make it up in September.. that course isn't offered. And they tend to build up on each other, so you'd run into problems taking things out of order. Even the most traditional preclinical curriculums that have a strict separation between courses and an independent anatomy course, physiology course, etc generally require all the first year subjects to be done before second year.

Realistically, at *best* you'd end up taking two years for each of the two preclinical years. So that's two extra years to start. Clerkships are a whole nother bargain: They're one "course" at a time where you work anywhere from 30-80 hours a week and each medical student has to hit all the requirements. So your school may require 6 weeks of medicine, or surgery, or whatever else. You can theoretically ask for accommodations to limit your maximum hours... but this is going to be significantly disruptive to your ability to function in a team setting, and may lead to poor evaluations. Even despite the ADA.

Residency will only get worse. Even psychiatrists have to do months of medicine, and good luck doing 35 hours a week as an intern on medicine wards. It's not possible. ADA only requires "reasonable accommodations".

 

[RangerBob]

I'm a PM&R resident and used to talking with my patients with disabilities about limitations at work, in life, etc. I'm always optimistic with them, but I also encourage them think about what things they can enjoy/excel at. And there are times when I have to be clear that certain activities/jobs would either be extremely difficult or possibly very dangerous given their conditions. I'm a firm believer that most people can do pretty much whatever they want if they have enough drive, devotion, and resources. However, whether they will be happy doing it with their limitations is another matter.

Medical school will be very difficult if you're going at a different pace than the others, and your clinical rotations would requite a lot of accommodations as well, but it sounds like you already know that. Residency is really the tough portion--as others said, you'll have a lot of long days. I've never heard of a part-time residency where the resident just worked fewer hours per week--the only ones I've heard of are something to the tune of two weeks on, two weeks off, or four weeks/four weeks. Most psych residencies are lighter in hours--many average closer to 40hrs/week, but many are over 60. Of course, you can control what residency programs you apply to and rank highly, and given that most programs don't have part-time positions, you may have to apply to a lot of programs. You will also need to talk program directors into hiring two part-time residents instead of one (often you need to find the other half-time applicant). Maybe there are specific part-time positions out there, but my understanding is most are created when an applicant expresses a desire for a part-time residency and the program is interested enough in that applicant to accommodate them.

Just keep in mind that would turn a 4-year psych residency into 8 years, plus however long medical school takes. I think medical school/residency are certainly possible with enough drive, but whether it'll be worth it in the end is something only you can answer.

Honestly, if I were in your shoes and really set on the medical field but limited to 35hrs a week, I'd apply to PA/NP programs and not look back. Psychiatrists are in such high demand and short supply these days that PA/NP's more and more are picking up the slack (as with FM/IM and most fields in medicine). Whether they do it as well as DO/MD's do is something debated ad nauseam on these forums, but the truth is if you're smart enough to get a JD/MBA, the odds are you could make yourself an indispensable psych PA/NP. I'm sure a lot of people will disagree with my advice as many people here are quite opinionated against mid-level practitioners, but the reality is their future is only looking brighter and brighter. In my mind it's something worth considering if you haven't already.

 

[girlofgrace7]

I am indeed in peds. And we tend to be one of the most accommodating fields (ample maternity leave, people leaving to breast feed, leaves of absence for personal health and family stuff, etc.), and despite being in a HIGHLY accommodating program, this schedule that you suggest would be near impossible if not downright turned down. Just speaking realistically, people will come to resent you. As mentioned above, it may not be to your face, but it will reflect in evaluations and in the willingness of others to help you out with additional things (for instance, the girl who has arranged a part-time residency during her second year, everyone gets kind of angry when she asks people to cover her team when she has a dentist/doctor's appointment given that she has 2 out of every 4 weeks off during which she could make said appointments, etc.). This is not meant to dissuade you from medicine but merely to help you understand how this will affect your grading in med school, evaluations in residency, letters of rec, and relationships with peers and attendings.

As Raryn said above, even the preclinical schedule would not be straight-forward (despite it being easier to arrange in theory) since each block is only offered once a year and mostly builds on the one before. Also, PBL-based learning would make that even more difficult as would labs, clinical skills classes, and dissections that require group work. Even if it could be arranged (take some classes the following year, etc.) as suggested above by stretching each preclinical year out to two years, I'm pretty sure every medical school (or at least a whole lot of them) requires you to complete medical training in no more than 6 years or you can't enroll further... basically, this would leave you with no wiggle room to stretch out 3rd or 4th year or to fail a class or board.

 

[Jc2008]

I'm a PM&R resident and used to talking with my patients with disabilities about limitations at work, in life, etc. I'm always optimistic with them, but I also encourage them think about what things they can enjoy/excel at. And there are times when I have to be clear that certain activities/jobs would either be extremely difficult or possibly very dangerous given their conditions. I'm a firm believer that most people can do pretty much whatever they want if they have enough drive, devotion, and resources. However, whether they will be happy doing it with their limitations is another matter.

Medical school will be very difficult if you're going at a different pace than the others, and your clinical rotations would requite a lot of accommodations as well, but it sounds like you already know that. Residency is really the tough portion--as others said, you'll have a lot of long days. I've never heard of a part-time residency where the resident just worked fewer hours per week--the only ones I've heard of are something to the tune of two weeks on, two weeks off, or four weeks/four weeks. Most psych residencies are lighter in hours--many average closer to 40hrs/week, but many are over 60. Of course, you can control what residency programs you apply to and rank highly, and given that most programs don't have part-time positions, you may have to apply to a lot of programs. You will also need to talk program directors into hiring two part-time residents instead of one (often you need to find the other half-time applicant). Maybe there are specific part-time positions out there, but my understanding is most are created when an applicant expresses a desire for a part-time residency and the program is interested enough in that applicant to accommodate them.

Just keep in mind that would turn a 4-year psych residency into 8 years, plus however long medical school takes. I think medical school/residency are certainly possible with enough drive, but whether it'll be worth it in the end is something only you can answer.

Honestly, if I were in your shoes and really set on the medical field but limited to 35hrs a week, I'd apply to PA/NP programs and not look back. Psychiatrists are in such high demand and short supply these days that PA/NP's more and more are picking up the slack (as with FM/IM and most fields in medicine). Whether they do it as well as DO/MD's do is something debated ad nauseam on these forums, but the truth is if you're smart enough to get a JD/MBA, the odds are you could make yourself an indispensable psych PA/NP. I'm sure a lot of people will disagree with my advice as many people here are quite opinionated against mid-level practitioners, but the reality is their future is only looking brighter and brighter. In my mind it's something worth considering if you haven't already.

Hi RangerBob, I've considered PA instead but the pre-reqs and clinical experience are different enough to where it would require quite a bit of additional work. NP would require almost as much additional school as MD + residency b/c I'd have to get a background /bachelor's in nursing first plus the Phd part. But PA is certainly an option if I decided against /or fail out of medical school. thanks for your reply.

 

[Jc2008]

I am indeed in peds. And we tend to be one of the most accommodating fields (ample maternity leave, people leaving to breast feed, leaves of absence for personal health and family stuff, etc.), and despite being in a HIGHLY accommodating program, this schedule that you suggest would be near impossible if not downright turned down. Just speaking realistically, people will come to resent you. As mentioned above, it may not be to your face, but it will reflect in evaluations and in the willingness of others to help you out with additional things (for instance, the girl who has arranged a part-time residency during her second year, everyone gets kind of angry when she asks people to cover her team when she has a dentist/doctor's appointment given that she has 2 out of every 4 weeks off during which she could make said appointments, etc.). This is not meant to dissuade you from medicine but merely to help you understand how this will affect your grading in med school, evaluations in residency, letters of rec, and relationships with peers and attendings.

As Raryn said above, even the preclinical schedule would not be straight-forward (despite it being easier to arrange in theory) since each block is only offered once a year and mostly builds on the one before. Also, PBL-based learning would make that even more difficult as would labs, clinical skills classes, and dissections that require group work. Even if it could be arranged (take some classes the following year, etc.) as suggested above by stretching each preclinical year out to two years, I'm pretty sure every medical school (or at least a whole lot of them) requires you to complete medical training in no more than 6 years or you can't enroll further... basically, this would leave you with no wiggle room to stretch out 3rd or 4th year or to fail a class or board.

Tell me, regarding the pre clinical years- are there classes during the summer or is that time used by students to get experience or take a break? I have been in part time programs before and been able to make up classes during the summer. Not sure how realistic this would be for medical school and whether any med schools have summer courses for people needing to catch up.

 

[Jc2008]

I'm a PM&R resident and used to talking with my patients with disabilities about limitations at work, in life, etc. I'm always optimistic with them, but I also encourage them think about what things they can enjoy/excel at. And there are times when I have to be clear that certain activities/jobs would either be extremely difficult or possibly very dangerous given their conditions. I'm a firm believer that most people can do pretty much whatever they want if they have enough drive, devotion, and resources. However, whether they will be happy doing it with their limitations is another matter.

Medical school will be very difficult if you're going at a different pace than the others, and your clinical rotations would requite a lot of accommodations as well, but it sounds like you already know that. Residency is really the tough portion--as others said, you'll have a lot of long days. I've never heard of a part-time residency where the resident just worked fewer hours per week--the only ones I've heard of are something to the tune of two weeks on, two weeks off, or four weeks/four weeks. Most psych residencies are lighter in hours--many average closer to 40hrs/week, but many are over 60. Of course, you can control what residency programs you apply to and rank highly, and given that most programs don't have part-time positions, you may have to apply to a lot of programs. You will also need to talk program directors into hiring two part-time residents instead of one (often you need to find the other half-time applicant). Maybe there are specific part-time positions out there, but my understanding is most are created when an applicant expresses a desire for a part-time residency and the program is interested enough in that applicant to accommodate them.

Just keep in mind that would turn a 4-year psych residency into 8 years, plus however long medical school takes. I think medical school/residency are certainly possible with enough drive, but whether it'll be worth it in the end is something only you can answer.

Honestly, if I were in your shoes and really set on the medical field but limited to 35hrs a week, I'd apply to PA/NP programs and not look back. Psychiatrists are in such high demand and short supply these days that PA/NP's more and more are picking up the slack (as with FM/IM and most fields in medicine). Whether they do it as well as DO/MD's do is something debated ad nauseam on these forums, but the truth is if you're smart enough to get a JD/MBA, the odds are you could make yourself an indispensable psych PA/NP. I'm sure a lot of people will disagree with my advice as many people here are quite opinionated against mid-level practitioners, but the reality is their future is only looking brighter and brighter. In my mind it's something worth considering if you haven't already.

That confirms that it is indeed possible. I don't need the accommodation to be less hours per week, it can be whatever will work including 2 weeks on and 2 weeks off. That helps also. I realize that this is not something that will be easy, but in my experience, programs and schools try to do their best to accommodate, if for no other reason than because it's the law.

 

[bashwell]

Hi RangerBob, I've considered PA instead but the pre-reqs and clinical experience are different enough to where it would require quite a bit of additional work. NP would require almost as much additional school as MD + residency b/c I'd have to get a background /bachelor's in nursing first plus the Phd part. But PA is certainly an option if I decided against /or fail out of medical school. thanks for your reply.

I don't think NPs need a PhD (that'd be a DNP I believe). As far as I'm aware NPs are a masters level degree at most and they don't have to go through residency, I don't think. Honestly being an NP isn't a bad gig like @RangerBob said. CRNA is another great route if you like the OR.

 

[Jc2008]

Ignoring the ethics and legal discussions above, this would be *extremely* difficult to schedule. Outside of the Caribbean (which offers multiple terms a year), most schools have a strict progression of coursework.

Most of them these days are mixed block schedules, with multiple mixed subjects done concurrently. That is, there's a "cardiac" block with cardiac anatomy/physiology/histology/whatever all done at once. The August M1 block is offered in August and only in August. The September M1 block is offered in September. You can't just take a few hours less a week of coursework in August and make it up in September.. that course isn't offered. And they tend to build up on each other, so you'd run into problems taking things out of order. Even the most traditional preclinical curriculums that have a strict separation between courses and an independent anatomy course, physiology course, etc generally require all the first year subjects to be done before second year.

Realistically, at *best* you'd end up taking two years for each of the two preclinical years. So that's two extra years to start. Clerkships are a whole nother bargain: They're one "course" at a time where you work anywhere from 30-80 hours a week and each medical student has to hit all the requirements. So your school may require 6 weeks of medicine, or surgery, or whatever else. You can theoretically ask for accommodations to limit your maximum hours... but this is going to be significantly disruptive to your ability to function in a team setting, and may lead to poor evaluations. Even despite the ADA.

Residency will only get worse. Even psychiatrists have to do months of medicine, and good luck doing 35 hours a week as an intern on medicine wards. It's not possible. ADA only requires "reasonable accommodations".

Do medical schools require students to take classes during summer? If not, what would be the obstacle in catching up on classes for 1st and 2 year during the summer, assuming some medical school somewhere offers summer courses.

 

[Jc2008]

I don't think NPs need a PhD (that'd be a DNP I believe). As far as I'm aware NPs are a masters level degree at most and they don't have to go through residency, I don't think. Honestly being an NP isn't a bad gig like @RangerBob said. CRNA is another great route if you like the OR.

US now moving towards requiring all NP to have DNP which takes a long time to obtain. The lack of residency isn't necessarily a plus, either, because it just means you don't have a formalized way of getting your training and more opportunity to fall through the cracks. I do agree however that, outside of those things, NPs are not a bad choice. Unfortunately it would require another bachelor's degree (in nursing), which is not an option for me having just finished the regular med school pre-req track.

 

[Raryn]

Do medical schools require students to take classes during summer? If not, what would be the obstacle in catching up on classes for 1st and 2 year during the summer, assuming some medical school somewhere offers summer courses.

It is variable from school to school but a typical four year schedule has a single summer between M1 and M2. The second summer is a 6-8 week period used for board studying and a short break to decompress. And there is no summer for anyone after third year.

And trust me, the logistical issues with a modern intertwined schedule that is usually unique to each school would make it impossible to catch up over the summer. Even a traditional schedule, you'd find it extremely difficult after the first year and impossible after the second.

Basically, if I were you, especially given the professed interest in Psychiatry, I'd consider heavily a Psychology degree. You still probably won't finish on time, but it's a fair bit more flexible than most med schools these days.

 

[DrBowtie]

Do medical schools require students to take classes during summer? If not, what would be the obstacle in catching up on classes for 1st and 2 year during the summer, assuming some medical school somewhere offers summer courses.

Medical school isn't really structured like that. It's pretty much one start date each year and courses are only offered once each year. The curriculums are distinct enough that you can't just take classes elsewhere outside of the few remedial options available in the summers.

 

[Jc2008]

It is variable from school to school but a typical four year schedule has a single summer between M1 and M2. The second summer is a 6-8 week period used for board studying and a short break to decompress. And there is no summer for anyone after third year.

And trust me, the logistical issues with a modern intertwined schedule that is usually unique to each school would make it impossible to catch up over the summer. Even a traditional schedule, you'd find it extremely difficult after the first year and impossible after the second.

Basically, if I were you, especially given the professed interest in Psychiatry, I'd consider heavily a Psychology degree. You still probably won't finish on time, but it's a fair bit more flexible than most med schools these days.

That would be an interesting degree, except that you are not able to prescribe and to me, behavioral therapy alone is not worth it.

 

[Jc2008]

Everyone- I really appreciate all your guys feedback.

 

[Jc2008]

Medical school isn't really structured like that. It's pretty much one start date each year and courses are only offered once each year. The curriculums are distinct enough that you can't just take classes elsewhere outside of the few remedial options available in the summers.

DrBowtie, what is the nature of exams during the first two years of med school? Are there midterm or just finals? How many classes does one take per semester usually?

 

[bashwell]

Everyone- I really appreciate all your guys feedback. I would, however, prefer that you keep your feedback to the logistics aspect of making such an accommodation work. Some of you have done that and that is really helpful. I don't know much about how med school courses and residency is structured, so any input into that is useful for me in making an educated decision. I don't need much legal advice or personal advice (choosing another career or talking to my doctor). I actually already have, and for what it's worth, he thinks it's doable.

I am already aware that this is going to be very hard and I am resigned to the fact that it may not work out. And if it does not I will look into other options including PA, NP etc. . I am a little past the point of turning around, so the most help you can offer me is anything related to the logistics of the coursework/residency- this will help me make a more educated decision about what type of accommodations could be realistically granted and which could not. Of course, this will all depend on what the administration/GME dept is willing to grant (including no accommodations). If that ends up being the case, I will have to do my best and risk failing out if things don't work out.

I don't see failing out of med school as likely due to schools being reluctant to allow people to fail out (affects their stats/rankings). I think it's more likely that it will take me 5 years to finish. From what I've been told (outside of this forum), there are many people with this issue and the main risk is that you may have a hard time finding a residency. I can't control that much so I have to pick and choose what to worry about. If I cannot get into a residency here , I will try to look abroad and maybe practice in a different country. There are many options.

As for the residency, you are not allowed by law to ask whether someone requires an accommodation and as a disabled person you are not required (and you are actually advised against) disclosing during the interview process. Assuming I can get into a residency, there is a chance they won't approve the accommodations. Or it may get approved in some other form. Or I may find a part time residency (which apparently exist as somebody pointed out). In either case, I know this is somewhat of a gamble and depends on picking the right school, right residency, getting along with people etc. ... Also, resentment keeps coming up. I don't think anyone here is being resentful but some have mentioned that people may resent me for being part time. That unfortunate, but it's not a consideration, because resentment from some quarters will always exist towards someone requesting an accommodation. I've had people be resentful towards me at my current job and in law school. And I imagine this will keep happening throughout my life. If it affects my evals, then so be it- that's not something I can control right now. Maybe I won't get into a US residency and will end up doing something different with the MD degree or practice abroad.

Why not call your local med school, or a med school you're interested in, explain your situation, ask them the questions you're asking here, and see what they say? N=1 but at least it'd be a start.

 

[Jc2008]

Could someone fill me in on the schedule I should expect each year of med school.

 

[Promethean]

Medical school is going to be a bigger hurdle for you than residency.

There are limits to how long it can take. My understanding is that you can't stretch a medical degree out beyond 6 years. And sorry, but "1 class at a time" isn't going to get you done anywhere close to 4.5-5 years.

I sincerely doubt you will find a school that will be interesting in accommodating you. And if you make your needs known during the interview process, the likelihood that you will be accepted is pretty low. The admissions process is opaque enough, and there is such a flood of highly qualified applicants that no one will ever be able to prove that your disability is why you were not accepted.

If you don't disclose your disability up front, and the school finds you at all troublesome to accommodate... there are many interactions in which a medical student is subjectively evaluated. All they have to do is find some reason to declare you unprofessional and they can dismiss you. Burden of proof is going to be on you.

You aren't willing to consider an alternate career path. You aren't willing to make another go at modifying your treatment so that it does not impair you so much. The medical education system is not like undergrad. It is not flexible. You will hit a brick wall, probably several of them. I don't think that is what you want to hear, and if you are able to make it work, I'd love to hear the follow up.

 

[Jc2008]

.. (

 

[Jc2008]

Medical school is going to be a bigger hurdle for you than residency.

There are limits to how long it can take. My understanding is that you can't stretch a medical degree out beyond 6 years. And sorry, but "1 class at a time" isn't going to get you done anywhere close to 4.5-5 years.

I sincerely doubt you will find a school that will be interesting in accommodating you. And if you make your needs known during the interview process, the likelihood that you will be accepted is pretty low. The admissions process is opaque enough, and there is such a flood of highly qualified applicants that no one will ever be able to prove that your disability is why you were not accepted.

If you don't disclose your disability up front, and the school finds you at all troublesome to accommodate... there are many interactions in which a medical student is subjectively evaluated. All they have to do is find some reason to declare you unprofessional and they can dismiss you. Burden of proof is going to be on you.

You aren't willing to consider an alternate career path. You aren't willing to make another go at modifying your treatment so that it does not impair you so much. The medical education system is not like undergrad. It is not flexible. You will hit a brick wall, probably several of them. I don't think that is what you want to hear, and if you are able to make it work, I'd love to hear the follow up.

I'm sorry it's not working out so well for you. No need to be condescending to others because of it.

 

[Promethean]

Could someone fill me in on the schedule I should expect each year of med school assuming no accomodation? This would be helpful:
1) How many classes each semester, each year? In how many of those classes can I expect grading to be based on exams?
2) Are there finals + midterms or just finals?
3) What hours should I expect to be in class and what would my daily schedule look like?
4) What would my daily schedule look like during year 3 and 4? How many hours at each activity and total per week?

It's not a bad idea, but I think the answer would be pretty generic (depends on the circumstances and we can't comment until we received your request and medical documentation which you cannot give us until you are accepted).

1) I think we are at something like 30-40 credits a semester? That is like 7-9 classes of varying values. The exact curriculum will vary by school. We started out with 2-3 intense months of Anatomy, Histology, and Embryology. There were probably some other classes mixed in (Medical Jurisprudence, that sort of thing.) Anatomy was like 10-12 credits? Then we moved on into Biochem, Biostats, Microbiology, Immunology, Physiology, Pharmacology, Pathology in the second half of that first semester. During that first semester, I spent about 40 hours a week in either lecture or scheduled labs, plus another 40 hours a week studying on my own in the library or the lab. The second semester, we started up with systems and are still working through those now into 2nd year. My pathway is big on independent study, so now I am spending about 15-20 hours per week in scheduled labs or meetings, and 40-60 hours in independant study.

2) Mid terms... Finals? Immunology was covered in 8 calendar days. There was one exam. There might have been a quiz. Medical school isn't undergrad. You don't necessarily get 8-16 weeks with material.

There are other programs that have a different structure, but there are none that I'm aware of where you can make your own a la carte schedule like in undergrad. You get the schedule they give you.

3) Highly variable on the school. There are different styles of curriculum.

4) See 3 above. It would depend on the schedule each clinical rotation gave you. Most of them, you'd get started early in the morning and stay into the afternoon/evening. I hear that one of the attendings that I will rotate with expects his students to have done their first rounds a couple hours before he gets to the hospital at 6am, so that when they round with him, they know all there is to know about the patients. You do what he tells you until 4-6pm, whenever he lets you leave. So, 12-14 hour days.

Other, clinic based rotations may look a lot more like 9a-4p, because that is when those clinics have patients for you to see.

 

[bashwell]

Could someone fill me in on the schedule I should expect each year of med school assuming no accomodation? This would be helpful:
1) How many classes each semester, each year? In how many of those classes can I expect grading to be based on exams?
2) Are there finals + midterms or just finals?
3) What hours should I expect to be in class and what would my daily schedule look like?
4) What would my daily schedule look like during year 3 and 4? How many hours at each activity and total per week?

The exact answers are going to vary by school. However, generally speaking, in M1-M2 you're going to have mostly lectures, practicals, exams, etc. I suppose med schools could require attendance of everything, but in my experience the lectures weren't usually mandatory. Many people skipped lectures and instead watched them from home (streaming or recorded) or got notes from the school or used their time to study in other ways (e.g., watching Pathoma videos). Different schools will have different ways to assign grades. If you're not in school, then you should be studying. For example, you could have classes etc in the morning, then study the rest of the day until late at night, taking only breaks for lunch and dinner. M3-M4 (mostly M3) are tougher in terms of time commitment because you're on rotations and some rotations (e.g., surgery) can last 12+ hours. Most usually around 8-10 hrs I'd say. But then you're studying outside those hours. Take a look at the table of contents for First Aid to the USMLE Step 1 and Step 2CK if you want to see what kind of classes and rotations you'll have (e.g., anatomy, physiology, pathology, pharmacology, etc. for M1-M2; internal medicine, pediatrics, psych, family medicine, etc. for M3-M4).

 

[Promethean]

Sour grapes because of your accelerated 3 year program? I'm sorry it's not working out so well for you. No need to be condescending to others because of it.

I'm not being condescending. I'm giving you honest insight into what you are considering getting into. Glad you know how to look at a post history. I didn't tell you any of the extra stuff that goes along with my 3 year program, which I assure you that I have no "sour grapes" about. I modeled my answer off an understanding of what an average 4 year student does at my school. The schedule I described to you is not accelerated. That is what my 4 year classmates were doing. On top of that, I was also spending a day a week in a physician's office as some of my extra stuff.

Look, you can not want to hear it, but you are likely to not be accommodated. I'm not telling you that to be mean, or condescending, or whatever.

I understand that you think it is illegal. And that you believe that you will be able to have your rights enforced. You won't be the first who finds out how hard that is in fact compared to how easy it sounds in theory. The last thing you ever want to do as a medical student / resident is to sue your school / program. That doesn't go well for you. Medicine is a very small world, and you need the good will of those ahead of you to advance in it. You might win a lawsuit and still lose your career.

 

[Gastrapathy]

US now moving towards requiring all NP to have DNP which takes a long time to obtain. The lack of residency isn't necessarily a plus, either, because it just means you don't have a formalized way of getting your training and more opportunity to fall through the cracks. I do agree however that, outside of those things, NPs are not a bad choice. Unfortunately it would require another bachelor's degree (in nursing), which is not an option for me having just finished the regular med school pre-req track.

There are accelerated BSN degrees for people with BAs that take a little over a year.

 

[Promethean]

I had read your "maybe one class less per term" as "maybe one class per term." That was where I initially got the sense that you were not being realistic.

 

[Gastrapathy]

Med school is such a structured stepwise process that I'm not sure they would accept that an 80% schedule is reasonable. I'm just not sure how it would work short of creating 1 on 1 classes just for you. Maybe they have summer classes set up for studs who need to remediate.

 

[Raryn]

Could someone fill me in on the schedule I should expect each year of med school assuming no accomodation? This would be helpful:
1) How many classes each semester, each year? In how many of those classes can I expect grading to be based on exams?
2) Are there finals + midterms or just finals?
3) What hours should I expect to be in class and what would my daily schedule look like?
4) What would my daily schedule look like during year 3 and 4? How many hours at each activity and total per week?

It's not a bad idea, but I think the answer would be pretty generic (depends on the circumstances and we can't comment until we received your request and medical documentation which you cannot give us until you are accepted).

Look, between MD and DO schools, we're at >150 different curricula. Some of them (like Duke's) are quite unique. But to generalize, a traditional medical school curriculum is 2 years "preclinical" and 2 years "clinical".

For the "preclinical" years, a typical arrangement typically falls into one of two overarching themes: Subject based or organ based. Some schools do a mix of the two.

Subject based is most similar to college. You have four semesters of M1/M2, and they'll do something like semester 1 you take biochemistry, anatomy, and intro to psych. Semester 2 you take physiology, cell biology, and neuroscience. etc. These are typically graded with some mixture of exams (3-4 per semester per course is probably normal), lab practicals (especially in anatomy), and small group discussions (this is becoming more and more common). Then at some point in there you take an interviewing course, a physical exam course, a medical ethics course, and the rest of the smorgasbord of stuff expected to get done the first two years. If you can find a school that still has this traditional subject based curriculum, it would probably be the most amenable to your preferred method of accommodations. The big problem you'll run into is that typically the second year subjects require you to have completed the first year ones, but perhaps you could find a way to do the two years in 3 if you had a sufficiently accommodating school. My med school used to allow people to do that if they were struggling, back when it had a subject based curriculum.

Unfortunately for you, most schools these days are integrating their curriculums, which will make that nigh-on impossible. The organ-based curriculums are something like a block every 2-6 weeks where you learn all of the anatomy/physiology/histology/whatever of the blank system. Then you have some amount of exams on that system. Then you move on to the next system. Doing a partial block is pretty much impossible. People who struggle in this curriculum (which they say has better outcomes for actually remembering stuff, but I wouldn't personally know) end up inevitably having to completely repeat a year, because it cannot feasibly be slowed down.

For hours expected to be in class, this is also absurdly variable from school to school. In a curriculum with minimal small group learning and recorded lectures, you could potentially get away with being expected to be in class for <10 hours/week (primarily for the smorgasbord of random stuff), listening to the lectures in your pajamas at your own pace. In a curriculum where everything is based on small group learning, you could be required to be in class 20++ hours/week.

M3/M4 is even more variable