getting surgery during residency?

[mbach003]

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Hello all! I was wondering if anyone has had major surgery during residency, specifically one that kept them out of work or below optimal function for a month or more? How did your residency handle this? I may need to get major shoulder surgery in the next few months and will be starting residency in June or July so I want to know what my options may be. Thanks!

 

[DoctwoB]

Obvious answer first. Get your surgery now so you're as recovered as possible before you start. Failing that, get in touch with your new PD asap so that an appropriate schedule can be created which front loads easier and lighter duty months. If you're in a residency with more physical demands like surgery this could be more difficult.

If you truly need this surgery, your program is required to accommodate you, but it's better for all parties involved to give as much advance notice as possible.

 

[Winged Scapula]

Obvious answer first. Get your surgery now so you're as recovered as possible before you start. Failing that, get in touch with your new PD asap so that an appropriate schedule can be created which front loads easier and lighter duty months. If you're in a residency with more physical demands like surgery this could be more difficult.

If you truly need this surgery, your program is required to accommodate you, but it's better for all parties involved to give as much advance notice as possible.

True, but he's not a resident yet.

If he is not available and ready to work July 1, this could be considered a match violation. They are not required to make accommodations for someone who isn't an employee yet.

Otherwise as you note, best to have the procedure done NOW (not in a few months), and notify the PD so that any accommodations they wish to make can be arranged.

 

[Smurfette]

Also, be aware that:

1. Time off during residency could result in delayed graduation from residency, depending on the length of time you'd be off. If you are doing a TY or prelim year, you need the minimum number of required weeks done and completed before being able to start your advanced/categorical position. This also could affect fellowship start date.
2. Depending on specialty, taking too much time off in any single residency year could cause problems with board certification (this is true for surgery where you essentially need to have 48 weeks each year of clinical rotations) which could mandate repeating an entire year to be board eligible depending on the eligibility requirements.
3. If you take off a month to recover from a surgery during internship, odds are you will get no additional vacation for the remainder of intern year due to #1 and 2 above.
4. If you are able to go back on "light duty", you need to talk to your PD ASAP (once you know where you matched) about what accommodations you may need and when, to allow proper scheduling. Some programs/fields have more flexibility than others. You also need a back up plan if there is a complication that delays your return.
5. If you are able to have surgery before starting residency, it'll make your life much easier. Especially if you don't bounce back as fast as you'd like...you'll have more flexibility and rest before residency starts. End of 4th yr is kind of an ideal time to do it. Once July rolls around, you'll have plenty of stress and adjustment to deal with as it is.

 

[ImNotBritish]

I agree with the fact that you should get your surgery now if at all possible. I tore my ACL in winter of 4th year, had surgery in April, and even then I was still pretty sore in July/August being on my feet so much. I think I would have had some serious trouble working if I had had surgery during, or closer to, the start of my intern year. Also, moving while recovering sucks. Plan to recruit some extra help with that.

 

[mbach003]

Thanks! I just had the injury to my shoulder a few days ago that basically tipped the scales for me requiring surgery vs. non operative treatment, so I am scrambling to find an ortho doc to assess me and line up a surgery by April so I can get into PT before my med student insurance runs out. Based on my own research, the surgery I will likely get requires around 6 weeks of TOTAL immobilization, followed by 6 weeks of regaining ROM/flexibility, followed by 3 months of easing back to preinjury activities all with regular PT visits...so I would give myself 2-2.5 months post op before I could even do basic resident duties (given no complications). That would be June/July...

I know that it would be best to get it before residency, but I have a light rotation in April that may or may not let me take the whole month off...I am just trying to see what all my options are...

I will be IM categorical (not surgery thank God), so by Friday I can look into contacting the PD about accommodations, etc.

 

[Raryn]

Thanks! I just had the injury to my shoulder a few days ago that basically tipped the scales for me requiring surgery vs. non operative treatment, so I am scrambling to find an ortho doc to assess me and line up a surgery by April so I can get into PT before my med student insurance runs out. Based on my own research, the surgery I will likely get requires around 6 weeks of TOTAL immobilization, followed by 6 weeks of regaining ROM/flexibility, followed by 3 months of easing back to preinjury activities all with regular PT visits...so I would give myself 2-2.5 months post op before I could even do basic resident duties (given no complications). That would be June/July...

I know that it would be best to get it before residency, but I have a light rotation in April that may or may not let me take the whole month off...I am just trying to see what all my options are...

I will be IM categorical (not surgery thank God), so by Friday I can look into contacting the PD about accommodations, etc.

Given that you're IM, you'll almost certainly be able to practice sans one shoulder. Maybe not do procedures, but if you tell your PD early enough you should be able to avoid having ICU early and that's really the only place procedures are that big of an issue. Hope your one handed typing skills are pretty good.

 

[mbach003]

I have been working with one shoulder this past week and I can type pretty well with both hands, (extra wrist motion and long fingers), as well as write, and short of that, I can probably find a way to do voice to text notes on a mobile device, as I have been doing when the soreness is too much to bear. I found I am pretty much capable of doing many basic daily activities one-handed, I just have to rest for periods of time so that I don't wear out my remaining shoulder. Still sucks though.

 

[hamstergang]

I'm right now sitting in bed after having ACL surgery last week. Using my sick time and vacation to take 3-4 weeks off (that's what I anticipate, anyway, but we'll see). But I'm in my child/adolescent psychiatry fellowship, and my current rotation is very accommodating for this time off, and when I get back it involves a lot of sitting/no running around. So I'd recommend waiting to do the surgery until you've switched into this wonderful field. Much simpler that way.

 

[RecombinantHuman]

I also just had ACL surgery (for the 2nd time) and am starting IM residency in July. I luckily only needed to take the day of my surgery off (and the weekend) so you might be fine for your April rotation. I wanted to get the surgery quickly so I could be well through my rehab before residency started. I haven't had shoulder surgery, but I imagine if you get your surgery and start rehab ASAP you should be fine for residency in July even if you aren't at 100% yet. By that point you can do a significant amount of your rehab at home too. I think you may be pleasantly surprised at how quickly things come along, but as suggested above if you are worried about procedures you could ask to not be in an ICU rotation to start.

 

[dpmd]

Unless your ortho thinks you can wait the three years it will take to finish residency, it would be best to do it ASAP. I was lucky enough to have to get my shoulder surgery while I was on a salary guarantee as an attending. I spent the first week only getting up from my recliner to go to the bathroom and after the numbness from my nerve block wore off it was not too fun so that week was spent in a drug induced haze. I think it wasn't until the second week that I even tried to bathe and just the act of coming out of my immobilizer to do so nearly made me pass out. It got a lot better after that until it was time to start PT, and I was able to do clinic stuff even in my immobilizer. I did a lot of PT (again luckily I was on a salary guarantee and I was able to leave during the day to do it) and things were sore afterward for several months. Tough part for you will be that when you start residency more PT might be good but you will have a hard time fitting it in (unless they have PT in house and can work you in there at random times). Will be important for you to at least do the exercises on your own because otherwise it will take forever to get back to good function (not sure what you are getting done, but for my surgery my ortho basically said I will always know that my shoulder was operated on so not to expect it to be "normal" again).

 

[Winged Scapula]

Shoulder surgery pain >>>>> ACL. @dpmd 's experience is typical.

 

[mbach003]

ACL surgery seems like cake compared to the shoulder surgery I need...I saw the ortho today, who of course strongly recommended surgery, and ordered an MRI arthrogram to assess the damage, which I know is bad.... he said I will be lucky if I can be out of the immobilizer by 4 weeks post-op...he is eager to do my surgery in April so I can start residency as recovered as possible.

@dpmd thanks for the insight! did you have any assistance at home when you were immobilized? If I get the surgery, I will probably get it in my home state so I can live at home and get help.

 

[dpmd]

ACL surgery seems like cake compared to the shoulder surgery I need...I saw the ortho today, who of course strongly recommended surgery, and ordered an MRI arthrogram to assess the damage, which I know is bad.... he said I will be lucky if I can be out of the immobilizer by 4 weeks post-op...he is eager to do my surgery in April so I can start residency as recovered as possible.

@dpmd thanks for the insight! did you have any assistance at home when you were immobilized? If I get the surgery, I will probably get it in my home state so I can live at home and get help.

I had my husband plus my parents, so between the two of them I literally did nothing for the first week and they took turns filling up the ice for my cooling sleeve and giving me food and meds. I am sure I could have figured things out if I had no one, but having someone is helpful. Also pretty key was the recliner. Lying down in a bed was not going to work for me the first couple of weeks, and even then things were uncomfortable for a while (with or without the immobilizer had its own issues), so being able to sleep in the recliner was good. If you don't have one now you might look into trying to get one wherever you will be recovering.