Junior Oto Resident here.
Maybe it's the low point of my residency and the 80-100 weeks, q3-4 call with fragmented sleep schedules and the following day with a head fog, getting a lot of the less favorable assignments in clinic and OR, and just generally being worked like a mule with admin work (things MAs should do IMO) and heavy clinical burden that's eroding my passion for this work, but I really could use some advice regarding one question: Does life get better in ENT after residency?
This is going to sound like a rant because it is. But I have a few examples from the past few weeks to highlight life as a resident:
Yesterday, in OR assigned to several routine type cases (that I am doing) and one advanced neck procedure with Attending, Chief, and me. Chief was only planning to come in for the one procedure as he had a mastoid in another room he was supervising a PGY4 through it. He told me to grab him when patient gets to OR so he can scrub out and join us. Walks in the room when patient is being bag masked. Attending says loudly in front of everyone: "You come in expecting to operate but you haven't even met the patient and are showing up to OR late, you can go ahead and leave the room if I'm going to be your fellow today".
Same OR, a few days before, we have 7 cases, most tubes/tonsils, one endoscopy with a flexible scope. For all the cases, per usual, I have prepped everything by printing ahead of time and then getting the consents from parents day of surgery, ensuring they have orders already placed and pended, H&Ps on file and uploaded, emailed a brief case summary to the attending days in advance, and ensured all patients have home instructions, home meds, and follow up appointments. That day, after already AM rounding on their postop patients and discharging them, I forgot to grab a flexible scope for the portion of the first case, and get told coldly "You cant just expect to operate and have everyone else grab things for you and do all the work for you". Later that day, I ask if a patient needs admit orders to floor or intermediate care, and attending says "I already placed that order beforehand, if you had an idea of whats going on you would know that". (when we place literally 99.9% of the orders for them).
Another one: On several occasions, I've gotten pages or calls from the intern in clinic for new consults, which we typically get 5 or so during the day, which I casually run by the attending on call right then and there saying "Hey , FYI we have a consult just so you know" and I often get "don't tell me about it until youve seen and worked it up [and only if they have good insurance]" kinda grumble, otherwise they get stressed in clinic it seems. The other day, I get a page around 3pm, for hearing loss, put it off towards end of a busy clinic, see patient around 530 pm, staff with Chief on call around 6 pm, then they call attending around 7pm to staff it. Next day, I get sternly spoken to about not telling them about the consult the prior afternoon, since they had to come in to see the consult within 24 hours (to bill for it), which forced them to come in during their personal admin time (at least 1 days per week of admin time).
Next: took a biopsy of a mass in clinic, which the MAs proceed to mistakenly lose from transport to pathology submission despite it being placed in the bag with an active tissue exam order. This was found only after waiting 5 days for results which never came through, then calling path for an update. I am forced to present at M&M this issue for "patient care issues/delay of diagnosis".
Next: MAs in clinic rarely put in what which exam room they put patients in, what the chief complaint is under Rooming tab. Or if they do, they put "New patient" or "Ear" or "Nose" for reason of the appointment when there is ZERO referring information or uploaded documents. I brought these minor issues up with Attendings, and get reprimanded that I need to be "self sufficient" and figure it out even tho we are scheduled for a NP 20 min double booked appointments, which the residents see the majority of the new patient visits.
The list goes on and on and on. I know most of it is petty and does not change the end product of my surgical training, which is why most of the time I say "Yes sir, I am sorry" and not fight about it. At the end of the day, I enjoy being an ENT resident. I have made forward progress with dealing with clinical issues, working up ENT problems in clinic and in the hospital, and getting more operations under my belt. I would never leave or quit. But I need some advice saying that this type of stuff goes away after you leave academic residency programs. I know I still need guidance, but I feel like an abused stepchild on most days. I think its the autonomy to make my own decisions that I am looking forward to. At the end of the day, I am so tired of being treated like a child after working so hard to get here.
Appreciate any advice from those who have been here before.
Maybe it's the low point of my residency and the 80-100 weeks, q3-4 call with fragmented sleep schedules and the following day with a head fog, getting a lot of the less favorable assignments in clinic and OR, and just generally being worked like a mule with admin work (things MAs should do IMO) and heavy clinical burden that's eroding my passion for this work, but I really could use some advice regarding one question: Does life get better in ENT after residency?
This is going to sound like a rant because it is. But I have a few examples from the past few weeks to highlight life as a resident:
Yesterday, in OR assigned to several routine type cases (that I am doing) and one advanced neck procedure with Attending, Chief, and me. Chief was only planning to come in for the one procedure as he had a mastoid in another room he was supervising a PGY4 through it. He told me to grab him when patient gets to OR so he can scrub out and join us. Walks in the room when patient is being bag masked. Attending says loudly in front of everyone: "You come in expecting to operate but you haven't even met the patient and are showing up to OR late, you can go ahead and leave the room if I'm going to be your fellow today".
Same OR, a few days before, we have 7 cases, most tubes/tonsils, one endoscopy with a flexible scope. For all the cases, per usual, I have prepped everything by printing ahead of time and then getting the consents from parents day of surgery, ensuring they have orders already placed and pended, H&Ps on file and uploaded, emailed a brief case summary to the attending days in advance, and ensured all patients have home instructions, home meds, and follow up appointments. That day, after already AM rounding on their postop patients and discharging them, I forgot to grab a flexible scope for the portion of the first case, and get told coldly "You cant just expect to operate and have everyone else grab things for you and do all the work for you". Later that day, I ask if a patient needs admit orders to floor or intermediate care, and attending says "I already placed that order beforehand, if you had an idea of whats going on you would know that". (when we place literally 99.9% of the orders for them).
Another one: On several occasions, I've gotten pages or calls from the intern in clinic for new consults, which we typically get 5 or so during the day, which I casually run by the attending on call right then and there saying "Hey , FYI we have a consult just so you know" and I often get "don't tell me about it until youve seen and worked it up [and only if they have good insurance]" kinda grumble, otherwise they get stressed in clinic it seems. The other day, I get a page around 3pm, for hearing loss, put it off towards end of a busy clinic, see patient around 530 pm, staff with Chief on call around 6 pm, then they call attending around 7pm to staff it. Next day, I get sternly spoken to about not telling them about the consult the prior afternoon, since they had to come in to see the consult within 24 hours (to bill for it), which forced them to come in during their personal admin time (at least 1 days per week of admin time).
Next: took a biopsy of a mass in clinic, which the MAs proceed to mistakenly lose from transport to pathology submission despite it being placed in the bag with an active tissue exam order. This was found only after waiting 5 days for results which never came through, then calling path for an update. I am forced to present at M&M this issue for "patient care issues/delay of diagnosis".
Next: MAs in clinic rarely put in what which exam room they put patients in, what the chief complaint is under Rooming tab. Or if they do, they put "New patient" or "Ear" or "Nose" for reason of the appointment when there is ZERO referring information or uploaded documents. I brought these minor issues up with Attendings, and get reprimanded that I need to be "self sufficient" and figure it out even tho we are scheduled for a NP 20 min double booked appointments, which the residents see the majority of the new patient visits.
The list goes on and on and on. I know most of it is petty and does not change the end product of my surgical training, which is why most of the time I say "Yes sir, I am sorry" and not fight about it. At the end of the day, I enjoy being an ENT resident. I have made forward progress with dealing with clinical issues, working up ENT problems in clinic and in the hospital, and getting more operations under my belt. I would never leave or quit. But I need some advice saying that this type of stuff goes away after you leave academic residency programs. I know I still need guidance, but I feel like an abused stepchild on most days. I think its the autonomy to make my own decisions that I am looking forward to. At the end of the day, I am so tired of being treated like a child after working so hard to get here.
Appreciate any advice from those who have been here before.
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