ENT and Ortho residency hours

[crazyABCD]

I'm a current MS1 who is very interested in surgery. However I would like some semblance of a work life balance. I know hours are for more flexible after residency, but while in residency how are the weekly hours for ENT and Ortho residents? I would love a breakdown of the years as I've heard hours ease up after intern year. Thanks!

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[OnePunchBiopsy]

I'm not an ENT or ortho resident, just general surgery.

Residency is going to be a lot of hours for any surgical specialty. While GS is typically considered one of the residencies where you spend more nights in the hospital, I've frequently seen both the ENT and Ortho residents up late with me.

Work life balance in a surgical residency will depend more on the institution where you're training and the culture of the program.

 

[CidHighwind]

Typically 60-80 hours a week depending on rotation, call schedule, etc.

 

[VincentAdultman]

I'm a current MS1 who is very interested in surgery. However I would like some semblance of a work life balance. I know hours are for more flexible after residency, but while in residency how are the weekly hours for ENT and Ortho residents? I would love a breakdown of the years as I've heard hours ease up after intern year. Thanks!

As an ortho resident I would frequently be home by five on hand and sports rotations.

On trauma, home before 8 was a good day.

 

[FalconSlice]

I'm a current MS1 who is very interested in surgery. However I would like some semblance of a work life balance. I know hours are for more flexible after residency, but while in residency how are the weekly hours for ENT and Ortho residents? I would love a breakdown of the years as I've heard hours ease up after intern year. Thanks!

"Residency" is not your life as an attending physician. Lifestyles vary a lot in different positions higher up the totem pole you go. Also depends on institutional infrastructure, if it's private practice, etc. In other words, the "work/life balance" of residency may not be the best indicator of your life as a physician in that field

 

[operaman]

Can’t speak for Ortho but I would imagine it’s similar. For ent it varies entirely by program. For all fields it varies somewhat by your own efficiency.

For me, in 5 years I’ve maybe gone over the 80 hour limit a handful of times and never once gotten close to breaking that rule when averaged over 4 weeks. Most weeks are 60-70 hours.

intern year varies by the rotation you’re on. For some I would have to come in 4:30ish to get ready; most we’re more like 5:15-30 to prep for rounds at 6. Days generally went until signout which was at 5-6pm except some rotations that let you go home some days right after rounds and morning floor work. Call was q4-6 in house Which meant leave immediately after rounds the next morning. Overall a busy but pretty manageable year. People that ran afoul of hours either had poor scheduling by their chiefs or were inefficient and arrived too early and stayed too late to get things done.

PGY2 - busiest year in most surgical subs. For me, days were usually 5:45am to 6-7pm M-F. Call was q8–10 home call which means you still work the next day and those hours aren’t counted in the 24+4 rule. Most small surgical subs do “home” call to make things work. It means some rough days pushing through fatigue. For us most weekends are golden and as a 2 i worked probably 1 weekend a month on average. It’s the busiest year by far as you have not only intern floor work and pages to deal with but also operative and clinic duties.

PGY3- chillest year ever. Similar hours to 2nd year but you’re more efficient so you sleep more. Call becomes more q10-12 but still primary.

PGY4- similar hours - maybe even a bit longer as you’re in bigger cases. Home before 7 is a good day. Call is backup home call which is amazing because most nights you just take phone calls and never go in. Overall a busy but hugely rewarding year. Worked only 6 weekends for the whole year.

PGY5- you have more admin duties so more off hours work to do. Similar in house hours. 4 weekends for the year; rest are golden. I’ve worked longer hours in general because I give myself the most interesting cases but that’s kinda my call. Basically I feel like I get to mooch off all my attendings who still have to slog away in clinic 2-3 days a week while I’m just cherry picking all the best cases.

So that’s my general experience. Our program is pretty awesome and qol is amazing. There are others that are rougher for sure. Even so, I work a lot more then my friends in other more lifestyle specialties where they don’t have inpatients and their days are more 7am-5pm with a nice lunch break.

 

[slowthai]

Can’t speak for Ortho but I would imagine it’s similar. For ent it varies entirely by program. For all fields it varies somewhat by your own efficiency.

For me, in 5 years I’ve maybe gone over the 80 hour limit a handful of times and never once gotten close to breaking that rule when averaged over 4 weeks. Most weeks are 60-70 hours.

intern year varies by the rotation you’re on. For some I would have to come in 4:30ish to get ready; most we’re more like 5:15-30 to prep for rounds at 6. Days generally went until signout which was at 5-6pm except some rotations that let you go home some days right after rounds and morning floor work. Call was q4-6 in house Which meant leave immediately after rounds the next morning. Overall a busy but pretty manageable year. People that ran afoul of hours either had poor scheduling by their chiefs or were inefficient and arrived too early and stayed too late to get things done.

PGY2 - busiest year in most surgical subs. For me, days were usually 5:45am to 6-7pm M-F. Call was q8–10 home call which means you still work the next day and those hours aren’t counted in the 24+4 rule. Most small surgical subs do “home” call to make things work. It means some rough days pushing through fatigue. For us most weekends are golden and as a 2 i worked probably 1 weekend a month on average. It’s the busiest year by far as you have not only intern floor work and pages to deal with but also operative and clinic duties.

PGY3- chillest year ever. Similar hours to 2nd year but you’re more efficient so you sleep more. Call becomes more q10-12 but still primary.

PGY4- similar hours - maybe even a bit longer as you’re in bigger cases. Home before 7 is a good day. Call is backup home call which is amazing because most nights you just take phone calls and never go in. Overall a busy but hugely rewarding year. Worked only 6 weekends for the whole year.

PGY5- you have more admin duties so more off hours work to do. Similar in house hours. 4 weekends for the year; rest are golden. I’ve worked longer hours in general because I give myself the most interesting cases but that’s kinda my call. Basically I feel like I get to mooch off all my attendings who still have to slog away in clinic 2-3 days a week while I’m just cherry picking all the best cases.

So that’s my general experience. Our program is pretty awesome and qol is amazing. There are others that are rougher for sure. Even so, I work a lot more then my friends in other more lifestyle specialties where they don’t have inpatients and their days are more 7am-5pm with a nice lunch break.

If you don't mind me asking, do you plan to do a fellowship? If you do, do you have an idea of how busy it'll be?

 

[rulerkk]

Can’t speak for Ortho but I would imagine it’s similar. For ent it varies entirely by program. For all fields it varies somewhat by your own efficiency.

For me, in 5 years I’ve maybe gone over the 80 hour limit a handful of times and never once gotten close to breaking that rule when averaged over 4 weeks. Most weeks are 60-70 hours.

intern year varies by the rotation you’re on. For some I would have to come in 4:30ish to get ready; most we’re more like 5:15-30 to prep for rounds at 6. Days generally went until signout which was at 5-6pm except some rotations that let you go home some days right after rounds and morning floor work. Call was q4-6 in house Which meant leave immediately after rounds the next morning. Overall a busy but pretty manageable year. People that ran afoul of hours either had poor scheduling by their chiefs or were inefficient and arrived too early and stayed too late to get things done.

PGY2 - busiest year in most surgical subs. For me, days were usually 5:45am to 6-7pm M-F. Call was q8–10 home call which means you still work the next day and those hours aren’t counted in the 24+4 rule. Most small surgical subs do “home” call to make things work. It means some rough days pushing through fatigue. For us most weekends are golden and as a 2 i worked probably 1 weekend a month on average. It’s the busiest year by far as you have not only intern floor work and pages to deal with but also operative and clinic duties.

PGY3- chillest year ever. Similar hours to 2nd year but you’re more efficient so you sleep more. Call becomes more q10-12 but still primary.

PGY4- similar hours - maybe even a bit longer as you’re in bigger cases. Home before 7 is a good day. Call is backup home call which is amazing because most nights you just take phone calls and never go in. Overall a busy but hugely rewarding year. Worked only 6 weekends for the whole year.

PGY5- you have more admin duties so more off hours work to do. Similar in house hours. 4 weekends for the year; rest are golden. I’ve worked longer hours in general because I give myself the most interesting cases but that’s kinda my call. Basically I feel like I get to mooch off all my attendings who still have to slog away in clinic 2-3 days a week while I’m just cherry picking all the best cases.

So that’s my general experience. Our program is pretty awesome and qol is amazing. There are others that are rougher for sure. Even so, I work a lot more then my friends in other more lifestyle specialties where they don’t have inpatients and their days are more 7am-5pm with a nice lunch break.

Can I also follow up to ask, how many cases do you get to assist/lead in per day as an ENT resident? What’s your case log look like per year for various surgeries/procedures?

 

[Dave1980]

I think they are both tough. Ortho trauma is probably the hardest. One of my friends told me a story of him during his trauma block of driving into work at 4:30 am in tears because he was so exhausted.

 

[operaman]

If you don't mind me asking, do you plan to do a fellowship? If you do, do you have an idea of how busy it'll be?

Yep doing a fellowship starting in July. It Should be pretty busy but probably a little more chill than residency. I would estimate probably 250-300 cases over the next year. Probably 3 days of clinic a week, 2 OR or procedure days on average. I think it’s 5 weeks of attending call during the year taken 1 week at a time. Past fellows there have said it isn’t that bad so hopefully that holds true!

 

[Gilakend]

Also M1, but spoken with multiple ortho residents. From what they told me: most days they're home by 4-6ish. Trauma is a completely different story (bad).

Honestly, after talking to them the lifestyle seemed better than what others make it seem. They were all happy.

 

[Matthew9Thirtyfive]

Yep doing a fellowship starting in July. It Should be pretty busy but probably a little more chill than residency. I would estimate probably 250-300 cases over the next year. Probably 3 days of clinic a week, 2 OR or procedure days on average. I think it’s 5 weeks of attending call during the year taken 1 week at a time. Past fellows there have said it isn’t that bad so hopefully that holds true!

What fellowship are you doing?

 

[Wordead]

ENT - head and neck service is rough. 80-120 hours when I was a PGY2. Most other services are reasonable ~60-70 hours a week.

 

[operaman]

Can I also follow up to ask, how many cases do you get to assist/lead in per day as an ENT resident? What’s your case log look like per year for various surgeries/procedures?

Sheer case numbers can be a bit misleading. If you’re doing tubes and tonsils you might bang out 10-20 in a day; if you’re doing a big head and neck cancer case it may be one case but be 8-12 hours long. There are countless cases that fall in between and some that go even longer. It will also vary widely by rotation as some are more OR heavy than others.

the per year numbers will vary by program too and when they do which rotations


verrrrrry generally speaking though:

pgy1- minimal OR exposure compared to other years. Lots of clinic. Most OR comes on things like peds where you start learning things like tubes and tonsils and airway. Some head and neck exposure with trachs and small soft tissue cases. General surgery rotations are half the year and operative time varies. Lots of soft tissue work though. Over the year our interns probably get about a case per day where they’re really doing it. Definitely the lightest OR year because that’s not really what intern year is for. Probably 200-300 cases total for the year.

Pgy2- much more OR than intern year but still quite a bit of clinic too. Peds is the most heavy OR with tubes tonsils airway neck masses etc. These are cases with the resident either doing the whole case or with the attending assisting. On the adult side you’re doing lots of endoscopic airway work, simpler neck surgeries like trachs and lymph node excisions. Our 2s get a brief exposure to ears and sinus work but not a ton — just the way our rotations fall. Probably 600-800 cases for the year. In my 2 year I also saw about 500 consults while on call. It’s the busiest year by far.

PGY3- most chill year. Long research block for us. During mine I picked up lots of ear cases when there were uncovered ORs but that was optional. We do our first official ear and sinus rotations. Probably 2-3 OR days per week on each, 3-4 cases per day. Resident participation is more graduated as you acquire skill with the endoscope and the microscope.

PGY4– operate your face off. Minimal clinic. On peds you’re doing the bigger ear, sinus, neck mass, clefts, etc and generally doing the whole case or at least most of it. You start really doing the big open neck surgeries too as well as facial plastics stuff, facial trauma, etc.You get some of these earlier but as a 4 you really start doing them yourself.

PGY5- whatever you make it. Mine has been pretty OR heavy though doesn’t have to be. You’re pretty much doing the cases and attendings are there for support and guidance and moving things along faster unless they’re more advanced cases. At this point I feel comfortable doing just about anything in our field that doesn’t require a fellowship for credentialing so I try to be fair and give the other residents on service good cases. Sometimes that means I’m in clinic but i want everyone to get a good experience. I’ll also double scrub with more junior folks and retract/assist for them because I want to get better at being in that teaching role.

Resident participation in cases is something we’re very conscious of. I like to put people in cases where they are ready to do it. I see little value in putting a pgy2 in a big case that’s beyond their ability where they’re just gonna hold hook; better that case go to a 4 who will get to do it while the attending holds hook for them.

 

[rulerkk]

Sheer case numbers can be a bit misleading. If you’re doing tubes and tonsils you might bang out 10-20 in a day; if you’re doing a big head and neck cancer case it may be one case but be 8-12 hours long. There are countless cases that fall in between and some that go even longer. It will also vary widely by rotation as some are more OR heavy than others.

the per year numbers will vary by program too and when they do which rotations


verrrrrry generally speaking though:

pgy1- minimal OR exposure compared to other years. Lots of clinic. Most OR comes on things like peds where you start learning things like tubes and tonsils and airway. Some head and neck exposure with trachs and small soft tissue cases. General surgery rotations are half the year and operative time varies. Lots of soft tissue work though. Over the year our interns probably get about a case per day where they’re really doing it. Definitely the lightest OR year because that’s not really what intern year is for. Probably 200-300 cases total for the year.

Pgy2- much more OR than intern year but still quite a bit of clinic too. Peds is the most heavy OR with tubes tonsils airway neck masses etc. These are cases with the resident either doing the whole case or with the attending assisting. On the adult side you’re doing lots of endoscopic airway work, simpler neck surgeries like trachs and lymph node excisions. Our 2s get a brief exposure to ears and sinus work but not a ton — just the way our rotations fall. Probably 600-800 cases for the year. In my 2 year I also saw about 500 consults while on call. It’s the busiest year by far.

PGY3- most chill year. Long research block for us. During mine I picked up lots of ear cases when there were uncovered ORs but that was optional. We do our first official ear and sinus rotations. Probably 2-3 OR days per week on each, 3-4 cases per day. Resident participation is more graduated as you acquire skill with the endoscope and the microscope.

PGY4– operate your face off. Minimal clinic. On peds you’re doing the bigger ear, sinus, neck mass, clefts, etc and generally doing the whole case or at least most of it. You start really doing the big open neck surgeries too as well as facial plastics stuff, facial trauma, etc.You get some of these earlier but as a 4 you really start doing them yourself.

PGY5- whatever you make it. Mine has been pretty OR heavy though doesn’t have to be. You’re pretty much doing the cases and attendings are there for support and guidance and moving things along faster unless they’re more advanced cases. At this point I feel comfortable doing just about anything in our field that doesn’t require a fellowship for credentialing so I try to be fair and give the other residents on service good cases. Sometimes that means I’m in clinic but i want everyone to get a good experience. I’ll also double scrub with more junior folks and retract/assist for them because I want to get better at being in that teaching role.

Resident participation in cases is something we’re very conscious of. I like to put people in cases where they are ready to do it. I see little value in putting a pgy2 in a big case that’s beyond their ability where they’re just gonna hold hook; better that case go to a 4 who will get to do it while the attending holds hook for them.

Amazing, thank you for such a detailed response.

I’m actually surprised by the amount of hospital duties when not on busy clinics (60-70hrs). How much time would you say as an ENT or other surgical sub specialist resident is spent at home preparing for the next day’s cases, tricky inpatient management, keeping up on literature, etc?

 

[sharkbyte]

ENT - head and neck service is rough. 80-120 hours when I was a PGY2. Most other services are reasonable ~60-70 hours a week.

That's crazy. What is it like to work 100+ hours? Are you just a zombie at that point? I feel like I would be getting home and grabbing my sheets as hard as I could soaking up every second that I was able to lie in bed lol

 

[Wordead]

That's crazy. What is it like to work 100+ hours? Are you just a zombie at that point? I feel like I would be getting home and grabbing my sheets as hard as I could soaking up every second that I was able to lie in bed lol

You get used to it. Yes I felt chronically tired and like crap all the time and my personal life kinda went to ****. But it all passes.

Now Im a senior taking backup call and I feel weak - I go in once for an OR case and feel sleepy the day after.

Being busy is good in residency - you dont want to graduate and be uncomfortable. Then you end up that guy that only does tubes and tonsils and a septum or two.

 

[operaman]

Amazing, thank you for such a detailed response.

I’m actually surprised by the amount of hospital duties when not on busy clinics (60-70hrs). How much time would you say an ENT or other surgical sub specialist resident is spent at home preparing for the next day’s cases, tricky inpatient management, keeping up on literature, etc?

This probably varies a good bit. Personally I try to aim for about an hour each night of reading. Sometimes its zero and sometimes it’s more, but I try to look at something each day.

The prep burden also varies by service and by comfort level. If I’m scrubbing an unusual case then there may be a lot of prep and reading; if it’s one I’ve done 100 times then prep is usually just reviewing the chart and scans.

The amount of inpatient floor work has evolved a lot during my own residency. We’ve since hired a number of NPs who work With our inpatient teams and have been an incredible addition and take a huge burden off the intern and pgy2. That said, it’s still very difficult for the juniors who are expected to cover clinics and ORs while also seeing consults and fielding floor pages. That’s all part of the learning though as they become efficient and learn to triage their time.

 

[operaman]

That's crazy. What is it like to work 100+ hours? Are you just a zombie at that point? I feel like I would be getting home and grabbing my sheets as hard as I could soaking up every second that I was able to lie in bed lol

For others reading I’ll just add that this is another area that’s highly program dependent and a good thing to ask about when interviewing. In Med school the head and neck free flaps would always go from 7am to 8-10pm, sometimes later. In my residency we do 4-5 big free flaps a week but most are done by 3pm. Some programs have many smaller cases booked well into the night while others don’t book elective stuff after hours at all. The in house policies for things like flap checks also play a big role. Some require the on call resident to do them while others like us only have MD flap checks on AM and PM rounds and nurses do the rest.

There are many other examples but all add up to saying that the service burden will vary significantly by program. It’s also hard to discern educational value from hours worked. Some hours just aren’t educational at all. If the same case takes my staff 8 hours but another place takes 14 for the same case, I don’t think the resident learns or does anything different despite spending an extra 6 hours in the OR that day. On the other hand, if those hours are spent doing additional cases then there may be additional educational value.

 

[longhaul3]

For others reading I’ll just add that this is another area that’s highly program dependent and a good thing to ask about when interviewing. In Med school the head and neck free flaps would always go from 7am to 8-10pm, sometimes later. In my residency we do 4-5 big free flaps a week but most are done by 3pm. Some programs have many smaller cases booked well into the night while others don’t book elective stuff after hours at all. The in house policies for things like flap checks also play a big role. Some require the on call resident to do them while others like us only have MD flap checks on AM and PM rounds and nurses do the rest.

That's awesome. I feel so bad for the ENT resident when I read a note that says q1h flap checks.

 

[rulerkk]

@operaman @Wordead

Are there any upcoming ENT tech or basic science advances in care that y’all are excited for?

 

[operaman]

@operaman @Wordead

Are there any upcoming ENT tech or basic science advances in care that y’all are excited for?

Oh yeah tons. ENT is definitely a wide open field just crying out for physician scientists to come in and do high level research. We all joke that it seems like all our landmark papers are retrospective reviews with an N of 25. An exaggeration of course, but not terribly far off. If someone wants to come in and make huge contributions, we have a lot of unanswered questions.

On the basic science side, there's a lot of exciting work on the mechanisms of sinusitis and translational and drug development work looking at new therapeutics. Within head and neck cancer there's a lot of work looking at HPV related oropharyngeal tumors since that's really the new epidemic in our field and it's impacting people like us - middle aged healthy affluent professionals including a number of physician faculty members. There are new biomarkers and screening protocols as we look for ways to get ahead of this, basic science work looking at new therapeutics to treat it, and of course public health work with vaccines to prevent it going forward. In H&N cancer in general there's work looking at new new immunoTx agents and combining those with other agents. There's stem cell work looking at cochlear regeneration and other treatments for hearing loss. Lots of labs looking at ways to regenerate or artificially reconstruct the lamina propria of the vocal fold. Lots of exciting work on rare airway diseases that have historically been challenging to manage.

On the tech side, our whole field is basically looking and operating in tiny holes that are bordered by high value anatomy. As such, lots of advanced in robotics with ever smaller robots that expand what we can do endoscopically. There are cool 3D exoscopes and endoscopes. Augmented reality is gradually overlaying image guidance info onto live endoscopic views. Image guided cochlear implantation is pretty cool and may one day become more widespread. Like every other field we are rapidly applying machine learning and deep neural networks to clinical problems. Cochlear implants themselves keep getting better and better yet only about 5% of eligible US patients actually have one which still blows my mind, so lots of room in the marketplace for more surgeons to do these. There are vestibular implants on the near horizon as well. Kind of a combo tech/basic, but non-vital organ transplant is probably coming soon. There have been a few laryngeal transplants already and FDA has approved more that are awaiting patients. Laryngeal pacers have FDA approval for clinical trial offering an alternative to trach for bilateral cord paralysis. 3D printed airways have already been done and are in the works to do more.

There are probably a lot more but that's what springs to mind offhand.

 

[Wordead]

@operaman @Wordead

Are there any upcoming ENT tech or basic science advances in care that y’all are excited for?

I dont particularly care for basic science research so Ill refer you to operamans pretty good overview of the hot things that are going on. Im not smart enough to keep abreast of it all.

Im personally excited for further developments in implantable hearing aids and middle ear implants/transducers in addition to cochlear implants. Im otherwise a bit of a curmudgeon and think a lot of the robot and exoscopes and stuff is cool but a waste of time and money overall. I hate robot cases especially.

 

[rulerkk]

I dont particularly care for basic science research so Ill refer you to operamans pretty good overview of the hot things that are going on. Im not smart enough to keep abreast of it all.

Im personally excited for further developments in implantable hearing aids and middle ear implants/transducers in addition to cochlear implants. Im otherwise a bit of a curmudgeon and think a lot of the robot and exoscopes and stuff is cool but a waste of time and money overall. I hate robot cases especially.

I'm curious about your thoughts on how the robot/exoscope work are not useful. I shadow a laryngologist who occasional deals with the disgruntled patient that feels the video-laryngoscope is "just a way for [the ENT] to grab more money from [them]". I find them super-cool but it would be interesting to hear someone in the field's hot-take. I haven't been lucky enough to shadow on a robot case yet (just an M1 who spends a fair amount of time in ENT clinic)

 

[The Knife & Gun Club]

I'm a current MS1 who is very interested in surgery. However I would like some semblance of a work life balance. I know hours are for more flexible after residency, but while in residency how are the weekly hours for ENT and Ortho residents? I would love a breakdown of the years as I've heard hours ease up after intern year. Thanks!

Where I am ortho PGY1-2 are hell. They’re always over duty hours, do tons of 36 hour runs, 18hrs/day x6/week, and get stuck in the OR long after their “shift” end. PGY 3-5 they usually get down to around 80/week or a little less. Same with GS obviously.

ENT is tamer but not by a ton. Still gonna be pushing 80 for the majority of the years.

All those surgical residencies are going to be pushing 80/week for at least the first few years.

If you’re looking for surgery-ish fields, IR has a better (but not good) residency lifestyle.

Em is also very procedural, but not operative, and caps at 60hrs/week. But you need to deal with all the uniquely frustrating garbage that comes with being an EM doc.

 

[operaman]

I’ll point out for students who may not be aware. Most surgical subs have “home call” which means those hours do NOT count the same as if you were actually in the hospital. Even if you’re called in and spend all night awake and in house, those hours do not count toward what would otherwise be a 24 hour shift. This is how you hear about these 36 hour stretches and programs aren’t getting docked. Hours you work still count toward the 80 hour rule but that ends up being harder to hit at some programs.

There are programs that have in-house call or a night float system so those shifts are counted like you’re probably used to where you can work 24 straight but then you must have a day free from duty with a 4 hour transition period for patient care Issues. Home call programs you will frequently still work 24 straight but then you’re expected to work the next day as well and it is not an hours violation to do so. This allows smaller programs to cover their service needs with a small number of residents, though clearly it gets abused quite frequently.

 

[Aleaz]

As. retired trauma surgeon, talking about time OFF as a MS1 means, honestly, to me? You'd never make it in ANY surgical residency. Surgeons are driven, spend the longest hours in house of any residency, work the hardest, and any surgical specialty works hard. If that is where your concern is--as in time off? I would, w/o trying to insult you--find another route of training. When you finally hit 3-4 year clinical rotations you will in all probability find where you belong. As an ex., we had a student wanting Peds from the get-go, and at his first Peds rotation he collapsed...because he could not handle the dying children. He thought it would be al roses...so EXPERIENCE... Surgery is your LIFE while in training. It is a critical field and while training you are not responsible at the end--the Attending or higher Resident is...so mistakes will be made...but you learn. Once out? It is all on YOU. So training is paramount! That comes FIRST, life second. Balance means running at lunch or any time you have some extra time, working out in the hospital PT lab after hours...doing what you can to stay healthy and balanced (learn meditation...anything you can do in a short time)

Hope that makes sense to you. In other words, many THINK they know as a MS-1; most do not. Experience will answer that for you.

 

[sharkbyte]

Sheer case numbers can be a bit misleading. If you’re doing tubes and tonsils you might bang out 10-20 in a day; if you’re doing a big head and neck cancer case it may be one case but be 8-12 hours long. There are countless cases that fall in between and some that go even longer. It will also vary widely by rotation as some are more OR heavy than others.

What's the single longest case you've ever been a part of as a resident?

 

[ChiDO]

If you are not taking call or doing cases then you are not learning in residency. If you are asking the question, Ortho is not for you.

But to answer your question, Intern year is pretty easy except when on Ortho.

Intern (on Ortho): 80-120
PGY-2: 80-120
3: 60-80
4: 60
5: 40-60

Attending: 40-120

Think my longest shift I worked was PGY3 year, 5am-6pm following day. Rounds, Eduction, all day OR, followed by busy call night with no sleep), rounds, education, followed by all day OR (then sleep for 12 hours). I could "go home" post-call, but then I'd miss a full day of OR.

Again, as I stated above, I tried to work a lot of hours, took "extra" call with non-teaching attendings when they were on call. Did extra cases when off service or with other surgeons. 5 years is a short time to learn ortho and you see a TON of new stuff as an attending your first few years. Most of us graduated with 2.5k surgeries (we were an operative heavy program). We have a text chain of weird and interesting cases with my classmates. New cases and questions on how to treat on almost a daily basis (and we're 2-3 years post fellowship).

 

[operaman]

What's the single longest case you've ever been a part of as a resident?

sorry missed this the other day.
Hmmm not easy to say! Probably 16 hours for a microtia/atresia case. Very program dependent though. Free flaps in Med school went longer sometimes - just depends.

As a resident it’s much easier to pop out for a bathroom break or to grab a quick bite. It’s not as bad as being a Med student when you’re having to think about impressing.

 

[Oso]

I'm a peds resident with some downtime on a night shift right now and somehow stumbled upon this thread. Obviously not going into a surgical field but ended up reading this whole thread because your responses were so interesting and detailed (esp. the research part), @operaman! Always great to see someone take the time to provide such thoughtful responses.
Best of luck with your fellowship

 

[OrthoTraumaMD]

Also M1, but spoken with multiple ortho residents. From what they told me: most days they're home by 4-6ish. Trauma is a completely different story (bad).

Honestly, after talking to them the lifestyle seemed better than what others make it seem. They were all happy.

If you love what you do, the hours are tolerable enough for 5 years. We all survive. And I do the “bad” stuff for a living, for the rest of my life.

 

[bonemann]

do you guys this night float is generally easier on the residents? obv this depends on what the alternative call schedule would be q3, q4, etc... but on average does it improve resident wellbeing w/o hurting education?

 

[Wordead]

do you guys this night float is generally easier on the residents? obv this depends on what the alternative call schedule would be q3, q4, etc... but on average does it improve resident wellbeing w/o hurting education?

In my opinion, it's an amazing boost in terms of quality of life. I also think that there's no question education suffers somewhat. Our case numbers dipped once we started night float.

 

[operaman]

do you guys this night float is generally easier on the residents? obv this depends on what the alternative call schedule would be q3, q4, etc... but on average does it improve resident wellbeing w/o hurting education?

We've talked about a night float system but definitely worry about the impact on education as well as the inherent suckage of being stuck on nights for awhile since not much happens most of the time. I bring this up every time some graybeard surgeon whines about work hours - just pull up the past OR schedules and ask them to show me what cases I missed in those additional 40-50 hours that I would have been in house 30 years ago.

But I digress.... I think night float has worked very well at some programs. I think for ENT, Cincy and WUSTL both do it and their residents say they like it. A couple other programs have moved to it but I can't remember which ones they are.

There is probably a sweet spot in terms of program size and hospitals covered where night float makes the most sense. For us, our program is so big that we can do home call AND give people post call days if they get crushed while also allowing them to operate if it's a chill night, and call is q8-10 so it isn't bad anyhow. If a program is too small, the amount of night float would probably seriously compromise education.

 

[deleted393595]

As. retired trauma surgeon, talking about time OFF as a MS1 means, honestly, to me? You'd never make it in ANY surgical residency. Surgeons are driven, spend the longest hours in house of any residency, work the hardest, and any surgical specialty works hard. If that is where your concern is--as in time off? I would, w/o trying to insult you--find another route of training. When you finally hit 3-4 year clinical rotations you will in all probability find where you belong. As an ex., we had a student wanting Peds from the get-go, and at his first Peds rotation he collapsed...because he could not handle the dying children. He thought it would be al roses...so EXPERIENCE... Surgery is your LIFE while in training. It is a critical field and while training you are not responsible at the end--the Attending or higher Resident is...so mistakes will be made...but you learn. Once out? It is all on YOU. So training is paramount! That comes FIRST, life second. Balance means running at lunch or any time you have some extra time, working out in the hospital PT lab after hours...doing what you can to stay healthy and balanced (learn meditation...anything you can do in a short time)

Hope that makes sense to you. In other words, many THINK they know as a MS-1; most do not. Experience will answer that for you.

Halsted (the founder of surgery and who worked insane hours) took his M2 summer off go dick around at Block Island. He ended up doing just fine.

M1 and M2, in which you're spending most of your time in lecture, is boring because you're far removed from managing patients. I too felt the same way during my pre-clinical years and ended up extensively dicking around. On the other hand, I didn't sleep much on my surgery rotation not because of the hours, but because I spent most of my time choosing to read up on patients, procedures, etc. well beyond what was required because I thoroughly enjoyed it and wanted to go into it. Think I averaged 3-4 hours a night from the high. Being on surgical trauma was like doing crack cocaine while being hooked up to an amphetamine drip. It's not that I'm a Type A person. Far from it. I'm about as lazy and Type B as they come.

Imho, I find that you adapt to the demands of the field and the expectations your team members have. Once you're in the field that you want to do, your intrinsic motivation (or absolute fear of being incompetent when you become an attending flying solo) takes over. @Aleaz I doubt your work ethic and focus as an undergrad or pre-clinical student was anywhere close to what you developed as a resident and later as an attending. You developed it over time and so can the OP once they find their crack cocaine

 

[shent]

Can’t speak for Ortho but I would imagine it’s similar. For ent it varies entirely by program. For all fields it varies somewhat by your own efficiency.

For me, in 5 years I’ve maybe gone over the 80 hour limit a handful of times and never once gotten close to breaking that rule when averaged over 4 weeks. Most weeks are 60-70 hours.

intern year varies by the rotation you’re on. For some I would have to come in 4:30ish to get ready; most we’re more like 5:15-30 to prep for rounds at 6. Days generally went until signout which was at 5-6pm except some rotations that let you go home some days right after rounds and morning floor work. Call was q4-6 in house Which meant leave immediately after rounds the next morning. Overall a busy but pretty manageable year. People that ran afoul of hours either had poor scheduling by their chiefs or were inefficient and arrived too early and stayed too late to get things done.

PGY2 - busiest year in most surgical subs. For me, days were usually 5:45am to 6-7pm M-F. Call was q8–10 home call which means you still work the next day and those hours aren’t counted in the 24+4 rule. Most small surgical subs do “home” call to make things work. It means some rough days pushing through fatigue. For us most weekends are golden and as a 2 i worked probably 1 weekend a month on average. It’s the busiest year by far as you have not only intern floor work and pages to deal with but also operative and clinic duties.

PGY3- chillest year ever. Similar hours to 2nd year but you’re more efficient so you sleep more. Call becomes more q10-12 but still primary.

PGY4- similar hours - maybe even a bit longer as you’re in bigger cases. Home before 7 is a good day. Call is backup home call which is amazing because most nights you just take phone calls and never go in. Overall a busy but hugely rewarding year. Worked only 6 weekends for the whole year.

PGY5- you have more admin duties so more off hours work to do. Similar in house hours. 4 weekends for the year; rest are golden. I’ve worked longer hours in general because I give myself the most interesting cases but that’s kinda my call. Basically I feel like I get to mooch off all my attendings who still have to slog away in clinic 2-3 days a week while I’m just cherry picking all the best cases.

So that’s my general experience. Our program is pretty awesome and qol is amazing. There are others that are rougher for sure. Even so, I work a lot more then my friends in other more lifestyle specialties where they don’t have inpatients and their days are more 7am-5pm with a nice lunch break.

Do you mind if I ask what program this is? Would love to know because I'm applying next year and it sounds like a great balance

 

[Banco]

As. retired trauma surgeon, talking about time OFF as a MS1 means, honestly, to me? You'd never make it in ANY surgical residency. Surgeons are driven, spend the longest hours in house of any residency, work the hardest, and any surgical specialty works hard. If that is where your concern is--as in time off? I would, w/o trying to insult you--find another route of training. When you finally hit 3-4 year clinical rotations you will in all probability find where you belong. As an ex., we had a student wanting Peds from the get-go, and at his first Peds rotation he collapsed...because he could not handle the dying children. He thought it would be al roses...so EXPERIENCE... Surgery is your LIFE while in training. It is a critical field and while training you are not responsible at the end--the Attending or higher Resident is...so mistakes will be made...but you learn. Once out? It is all on YOU. So training is paramount! That comes FIRST, life second. Balance means running at lunch or any time you have some extra time, working out in the hospital PT lab after hours...doing what you can to stay healthy and balanced (learn meditation...anything you can do in a short time)

Hope that makes sense to you. In other words, many THINK they know as a MS-1; most do not. Experience will answer that for you.

?

Our med school gives like 8 weeks off after MS1, lots of people chill during it, who then subsequently go into surgical residencies. That's kind of an odd metric to determine dedication to surgery lol

 

[Matthew9Thirtyfive]

?

Our med school gives like 8 weeks off after MS1, lots of people chill during it, who then subsequently go into surgical residencies. That's kind of an odd metric to determine dedication to surgery lol

Also lol at the implication that it’s all on YOU as a surgeon but somehow not in any other specialty.

 

[slowthai]

Also lol at the implication that it’s all on YOU as a surgeon but somehow not in any other specialty.

I don't think that's what he was saying. I think that what he was trying to get at was the fact that as a trainee, you always have backup (your seniors and attendings), and that you should spend as much time as you can learning with that cushion in place because once you're out on your own, you won't have that. This is in light of his larger point that surgery isn't for you if you aren't willing to put in the time.

Personally, I don't think someone should immediately rule out surgery if they're concerned about time off, but they will have to weigh how much they care about time off vs their desire to do surgery. If work life balance (which is different for everyone of course) is of utmost importance, maybe consider ophtho (and maybe uro, depending on the program) instead. If ENT is a must, maybe try to gun for operaman's program, lol

 

[Matthew9Thirtyfive]

I don't think that's what he was saying. I think that what he was trying to get at was the fact that as a trainee, you always have backup (your seniors and attendings), and that you should spend as much time as you can learning with that cushion in place because once you're out on your own, you won't have that. This is in light of his larger point that surgery isn't for you if you aren't willing to put in the time.

Personally, I don't think someone should immediately rule out surgery if they're concerned about time off, but they will have to weigh how much they care about time off vs their desire to do surgery. If work life balance (which is different for everyone of course) is of utmost importance, maybe consider ophtho (and maybe uro, depending on the program) instead. If ENT is a must, maybe try to gun for operaman's program, lol

Yeah, that’s literally every specialty lol.

 

[slowthai]

Yeah, that’s literally every specialty lol.

What I'm saying is that you can afford to take more time off/work less hours in other fields and you'll still be fine to practice safely as attending. With surgery, you can't really do that unless you extend training. To reach minimum competency in the allotted 5-7 years, you need to spend more time working than you do in other fields.

 

[Lawpy]

As. retired trauma surgeon, talking about time OFF as a MS1 means, honestly, to me? You'd never make it in ANY surgical residency. Surgeons are driven, spend the longest hours in house of any residency, work the hardest, and any surgical specialty works hard. If that is where your concern is--as in time off? I would, w/o trying to insult you--find another route of training. When you finally hit 3-4 year clinical rotations you will in all probability find where you belong. As an ex., we had a student wanting Peds from the get-go, and at his first Peds rotation he collapsed...because he could not handle the dying children. He thought it would be al roses...so EXPERIENCE... Surgery is your LIFE while in training. It is a critical field and while training you are not responsible at the end--the Attending or higher Resident is...so mistakes will be made...but you learn. Once out? It is all on YOU. So training is paramount! That comes FIRST, life second. Balance means running at lunch or any time you have some extra time, working out in the hospital PT lab after hours...doing what you can to stay healthy and balanced (learn meditation...anything you can do in a short time)

Hope that makes sense to you. In other words, many THINK they know as a MS-1; most do not. Experience will answer that for you.

How do you view research years?

 

[Matthew9Thirtyfive]

What I'm saying is that you can afford to take more time off/work less hours in other fields and you'll still be fine to practice safely as attending. With surgery, you can't really do that unless you extend training. To reach minimum competency in the allotted 5-7 years, you need to spend more time working than you do in other fields.

Are people taking significant time off in other specialties without extending training? I mean in IM they are working 70-80 hours a week on inpatient months. It’s just for fewer years.

Like I get that surgical residencies are generally longer and probably more arduous than a lot of non-surgical specialties as far as overall time working goes, but it seems ludicrous to say that thinking about quality of life means you’re not fit to be a surgeon. That’s completely bonkers.

And the idea that somehow the surgeon is more on the hook for his specialty than other attendings is insulting. Literally every specialty has backup for trainees and then that backup goes away when you graduate.

 

[slowthai]

Are people taking significant time off in other specialties without extending training? I mean in IM they are working 70-80 hours a week on inpatient months. It’s just for fewer years.

Like I get that surgical residencies are generally longer and probably more arduous than a lot of non-surgical specialties as far as overall time working goes, but it seems ludicrous to say that thinking about quality of life means you’re not fit to be a surgeon. That’s completely bonkers.

And the idea that somehow the surgeon is more on the hook for his specialty than other attendings is insulting. Literally every specialty has backup for trainees and then that backup goes away when you graduate.

They aren't, but I'm pretty sure they aren't working similar hours to surgery, on average. From what I recall, they work about 60-70 hours a week, compared to about 70-80 hours a week in surgery.

I agree with you. That's what I said in my second to last post. It's an extreme take.

I really don't think that's what he was trying to say. He was just saying that you need to be as prepared and ready as possible to be independent as an attending, and not putting in that time as a trainee wil decrease your chances of being ready. Unlike other fields, surgery requires those hours. If you don't put in the time, you won't be a safe surgeon. That is why he is discouraging anyone that appears to be unwilling to put in the time.

 

[clackson323]

Can’t speak for Ortho but I would imagine it’s similar. For ent it varies entirely by program. For all fields it varies somewhat by your own efficiency.

For me, in 5 years I’ve maybe gone over the 80 hour limit a handful of times and never once gotten close to breaking that rule when averaged over 4 weeks. Most weeks are 60-70 hours.

intern year varies by the rotation you’re on. For some I would have to come in 4:30ish to get ready; most we’re more like 5:15-30 to prep for rounds at 6. Days generally went until signout which was at 5-6pm except some rotations that let you go home some days right after rounds and morning floor work. Call was q4-6 in house Which meant leave immediately after rounds the next morning. Overall a busy but pretty manageable year. People that ran afoul of hours either had poor scheduling by their chiefs or were inefficient and arrived too early and stayed too late to get things done.

PGY2 - busiest year in most surgical subs. For me, days were usually 5:45am to 6-7pm M-F. Call was q8–10 home call which means you still work the next day and those hours aren’t counted in the 24+4 rule. Most small surgical subs do “home” call to make things work. It means some rough days pushing through fatigue. For us most weekends are golden and as a 2 i worked probably 1 weekend a month on average. It’s the busiest year by far as you have not only intern floor work and pages to deal with but also operative and clinic duties.

PGY3- chillest year ever. Similar hours to 2nd year but you’re more efficient so you sleep more. Call becomes more q10-12 but still primary.

PGY4- similar hours - maybe even a bit longer as you’re in bigger cases. Home before 7 is a good day. Call is backup home call which is amazing because most nights you just take phone calls and never go in. Overall a busy but hugely rewarding year. Worked only 6 weekends for the whole year.

PGY5- you have more admin duties so more off hours work to do. Similar in house hours. 4 weekends for the year; rest are golden. I’ve worked longer hours in general because I give myself the most interesting cases but that’s kinda my call. Basically I feel like I get to mooch off all my attendings who still have to slog away in clinic 2-3 days a week while I’m just cherry picking all the best cases.

So that’s my general experience. Our program is pretty awesome and qol is amazing. There are others that are rougher for sure. Even so, I work a lot more then my friends in other more lifestyle specialties where they don’t have inpatients and their days are more 7am-5pm with a nice lunch break.

Can I/you PM me? I’m currently interviewing for ENT and have some questions! Thanks

 

[baltimoreman]

Ortho hours can be rough in residency. There are definitely some easier rotations as mentioned above, but there are many where you are working 80 hours per week. I would say that as a junior resident, you will be working about 80 hours per week for at least 75% of the time.

 

[AnatomyGrey12]

They aren't, but I'm pretty sure they aren't working similar hours to surgery, on average. From what I recall, they work about 60-70 hours a week, compared to about 70-80 hours a week in surgery.

The difference between surgery and other specialties isn’t 70 vs 80 hours a week. It’s that in other specialties you will have some off service or lighter rotations. In IM this may be ID, Allergy, etc. Surgery doesn’t have lighter months like that. Even on the breast service you’re working the full 80 hours a week the majority of the time.

I think that one post you two are discussing has a lot of flaws, but the general idea that people who go into surgery aren’t usually the type whose first thought is “I wonder how much time off I’ll get because I want lots of time off” is true.

disclaimer: I haven’t read the thread in lots of detail, so if I have mischaracterized an argument or whatever then disregard this.

 

[Matthew9Thirtyfive]

first thought is “I wonder how much time off I’ll get because I want lots of time off” is true.

Totally agree with your post, but the OP just asked about hours and said he wanted some semblance of work life balance. That’s hardly asking for lots of time off like that post made it seem.

 

[Scrubs101]

The difference between surgery and other specialties isn’t 70 vs 80 hours a week. It’s that in other specialties you will have some off service or lighter rotations. In IM this may be ID, Allergy, etc. Surgery doesn’t have lighter months like that. Even on the breast service you’re working the full 80 hours a week the majority of the time.

I think that one post you two are discussing has a lot of flaws, but the general idea that people who go into surgery aren’t usually the type whose first thought is “I wonder how much time off I’ll get because I want lots of time off” is true.

disclaimer: I haven’t read the thread in lots of detail, so if I have mischaracterized an argument or whatever then disregard this.

May just have been my limited experience, but 80hrs a week seemed to be a light week too depending on the service (especially for the programs that did home call knowing full well you’d be there most of the night most nights and thus rolling 36hrs straight with no post call). So I don’t even think it’s IMs worst at 70 vs surgeries worst at 80, it’s more like 100-120 vs 60-80hrs on IM inpatient months. Which is like adding another full time job on top of already working 2 full time jobs.
Obvi theres chiller setup/rotations, but if we’re comparing worst to worst