Are fellowship hours similar to the hours residents put in during the 3-5 years on general surgery? Do fellows take the same amount of call? When I spent a week on a Plastics elective, the fellows put in tons of hours (not sure about call and weekends), but since they were doing exclusively Plastics and Reconstructive stuff, they seemed very satisfied. I only worked a week, however, so I have no idea if that week was representative.
First, lets clear up some terminology.
Fellowship is generally used to designate someone who has finished their training in a specialty and is now sub-specializing. One would think that if you finished 5 years of general surgery (or ENT, OMFS, etc.), then you would be doing a plastic fellowship. While technically its true, the ACGME still considers you a resident, not a fellow. I know it seems like splitting hairs, and Im as guilty as the next about interchanging terms, but you can get into trouble by referring to yourself as the wrong thing (personal experience). I have also seen folks from the combined/integrated programs refer to themselves as fellows after they finish their 3 years of general surgery, and that really pisses of the attendings, especially the ones that did 5 years of general.
I generally refer to my plastic surgery training as a fellowship, but this is more just a shortcut way of telling someone that I did the 5 years of general surgery.
Once you finish plastics and decide to do something else, like craniofacial, you are considered a fellow by the ACGME (if you are in an ACGME accredited program. More on this below). Interestingly, if you finish general surgery and decide to do a hand fellowship, that is considered a fellowship and not a residency. Go figure.
In a plastics residency, whether you are combined/integrated or independent (after 5 years of training elsewhere), as a resident you are subject to the 80 hour work week. In reality most of the residents I know, including myself, ignore this to some extent. Plastic surgery tends to be populated by highly motivated people and they usually need to be told to go home. For me, even though I came through most of general surgery before the duty hour restriction, I worked harder and read more during my plastics time. I dont think I was ever honest about the hours I logged on my timesheet and neither were my co-residents. It was sort of an unspoken rule that we just did the work until it was done. There was also a lot of stuff to learn and we loved our jobs. I was on first call 50% of the time during year one and second call 50% of the time during year two. Since it was classified as home call, it was easier to get around the 80 hour thing.
On to the fellowship portion.....
There are fellowships that are ACGME approved and those that are not. My craniofacial fellowship is one of the approved ones and is therefore subject to all the rules and regulations therein. I think I may have put in an 80 hour week once during the past year. I have residents on the service who take care of most of the housekeeping. I round on the patients I operate on, but they do all the paperwork. Im treated pretty much like junior faculty and I have a lot more time dedicated to operating, reading, writing papers, going to meetings and looking for jobs. I take very little call and its all back-up call.
For non-ACGME fellowships, the hours and duties can be highly variable. Some are good programs while in others you are basically somebodys indentured servant until your year is up. Some you will get to operate, others youre just going to watch the attending. In some the call is reasonable, in some youre going to be taking all the ER call for your attending. This isnt a problem for plastics residencies because theyre all ACGME.
I just find it interesting how the two fields that are usually 1-2 in terms of difficulty matching are so different in terms of lifestyle. (At least as a resident, not that residency lifestyle should in any way influence a decision on what to do with the remainder of one's career)
