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Family Friendly Residency

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Jolly Good

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Hi all,

I'm planning on going into Internal Med or Peds (not sure which yet) but will have many family responsibilities in the meantime. Are there residencies which give good (or at least decent) training but don't absolutely kill you on stress/hours? I'm worried about all of these horror stories of 80hrs/wk for 3 yrs with miserable, tired residents, and was just wondering if there are options to make things not quite so bad (i.e. certain private residencies or something).

Maybe another way to put it - are there any residencies that fall more in the 50hrs/wk category in IM or Peds that are still legit?

Thanks!
 

Winged Scapula

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Kent would you say that the OP's desire to find a program (regardless of the specialty, but including FM) working 50 hrs a week is unrealistic in almost all specialties?

The only ones I know that work that few hours would probably be Derm and Rad Onc, although they require a fair bit of studying at home. While some residencies may have rotations which hover around 50, I would think it be hard to find one with those hours on a regular basis unless it was a shared residency.
 

Blue Dog

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Most FM programs will push the 80-hour limit during the intern year. During second and third years, however, things improve considerably. 50 hours may be a little bit optimistic, but home call for some rotations isn't that unusual after the PGY-1 year. In general, FM programs are pretty non-malignant.
 

Jolly Good

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Thanks for the replies,

I guess my confusion and reason for my question is this:

On the one hand, there seem to be the residents in the "hard" academic IM/Peds programs that always seem tired and bitter, and many have complained about how there is no family time at all for most of the 3 years at these places. Several have then pointed out to me that their friends in other programs (typically at private hospitals rather than the busy county ones) had much nicer, more normal lives for most of the year.

I made me wonder whether there really are nice IM or Peds programs where, sure, you have your occasional bad q4 months, but which for most of the year were pretty stable ~50hr weeks.


Thanks!
 

gutonc

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I made me wonder whether there really are nice IM or Peds programs where, sure, you have your occasional bad q4 months, but which for most of the year were pretty stable ~50hr weeks.


Thanks!

N=1 here but....
My intern year (IM, academic, very good but not "Top 10" program) consisted of 7.5 call months (of 13...we do 4 week blocks). Of those, I would say 4 were 80h/wk months while the rest averaged more like 60-70. The rest of the year was 40-50 hrs/wk on consult and outpt rotations.

As an R2, I've done 2 outpt months where the hours were 9-6, M-F w/ a total of 3 o/n calls in 2 months, a consult month w/ 1wk of pager call (I've taken 4 calls and haven't gone in yet) and I'm out the door by 5 every day and an inpatient month that was 80+ hrs/wk. I have 4 more call months and the rest outpt and consult this year.

So to answer the question, yes, there are good, academic IM programs out there that, while being intense on the inpt months, don't butcher you for 36 solid months. There are others where you'll be q3-4 for 11/12 months as an intern and then 3 or 4 months a year as an R2/R3.

Good luck.
 

Jolly Good

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Thank you gutonc!

That's one of the only really candid assessments of a resident schedule that I've been able to find on the internet. Thanks again for that info! It will really help us intelligently plan how we're going to work with the family through this time. By any chance does this program seem typical of others from what you could tell?
 

gutonc

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Thank you gutonc!

That's one of the only really candid assessments of a resident schedule that I've been able to find on the internet. Thanks again for that info! It will really help us intelligently plan how we're going to work with the family through this time. By any chance does this program seem typical of others from what you could tell?

As a very general rule (and w/ many exceptions) the further west you move, the better things get in my experience. Having said that, I only have real experience w/ 2 programs, my med school (and that was just watching what the residents on my teams dealt with) on one coast and my residency program on the other coast.
 

Winged Scapula

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Conventional wisdom does have it that NE residency programs tend to be more malignant (whatever that means for you) and less flexible. Whether that is borne out in reality, I have no idea.

I think as far as family planning goes, what gutonc and Kent have said, echoes my observations as well. Pretty much any residency is going to be painful and long on hours during your intern year. What happens after that depends on your specialty, the amount of in house call, and likelihood of coming in when you are on home call. But you'll have to make sure you have babysitting backup when you are on home call because it is unexpected...there was a recent post here about a woman who has a RTC babysitter when she is on home call because her husband's job was busy and she couldn't depend on him being home when she needed to go back in. Some things to think about for the future.

The other option to really work fewer hours is sharing a residency which is much more common in things like FP, Peds, etc.
 

Jolly Good

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Thanks for the comments, everyone. And thanks for laying out what your R1 schedule was like! That was very helpful. I've never quite understood the difference between a malignant program and a non-malignant one in terms of what it actually does to you and the family. I'm not sure we could cope with a truly 80+hrs/wk every month for several years, as some seem to indicate. May as well be out of the country for several years at that point.

That just made me wonder how variable programs are. Some seem like they would virtually ensure divorce, etc... while others seem to foster fairly happy family people! So it's nice to see some examples of programs that don't aim to kill you!
 

Winged Scapula

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Thanks for the comments, everyone. And thanks for laying out what your R1 schedule was like! That was very helpful. I've never quite understood the difference between a malignant program and a non-malignant one in terms of what it actually does to you and the family. I'm not sure we could cope with a truly 80+hrs/wk every month for several years, as some seem to indicate. May as well be out of the country for several years at that point.

That just made me wonder how variable programs are. Some seem like they would virtually ensure divorce, etc... while others seem to foster fairly happy family people! So it's nice to see some examples of programs that don't aim to kill you!

"Malignancy" in terms of residency is really up to individual discretion. One might define that as working long hours, another might define it as having little faculty support or working with unpleasant people.

Frankly, I wouldn't define a program that had long hours as necessarily malignant, but rather one that fosters unhappy residents because of their lack of support, education and teaching by humiliation.
 
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