Hating Unpredictableness

[vicinihil]

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I hate the unpredictable nature of 3rd year. Does anyone else feel like they NEED to be in control of their day. People think I'm crazy but 2nd year for me was sooooo much better than 3rd year. Mostly because of the absolutely hold I had over my day. Does this make me a bad future doctor? Today I was so happy I had clinic, then at 4pm when clinic ended, my resident told me to scrub in on an OR case. I was about to flip.

I know that surgery is definitely not the field for me because I hate hierarchy and I need to be able to schedule my day. I'm thinking Rads, Derm, Path would be a good fit for me. Any and all inputs appreciated. Is this an unusual feeling or adjustment? 😕

 

[ZagDoc]

It's all a matter of keeping perspective. Pretty much no matter what field you go into (with some exceptions), residency is going to be filled with late cases, clinic add-ons, and last-minute consults/admits. I try to keep a 2 hour buffer after when I'm "supposed" to get off for scheduling things in the evening and even then I have to occasionally cancel plans (led to the end of relationship, actually).

That being said, after residency as an attending you gain a much greater deal of control over your schedule. You can give or take clinical responsibilities (scheduling in clinic, days spent in the OR) to better control your hours (though often at the expense of income potential). You can negotiate call responsibilities with your contract. It's hard to get a sense of what your career can potentially be after residency (especially in private practice) when almost all our time is spent with house staff in academic centers. We become very biased as a result.

 

[cabinbuilder]

I hate the unpredictable nature of 3rd year. Does anyone else feel like they NEED to be in control of their day. People think I'm crazy but 2nd year for me was sooooo much better than 3rd year. Mostly because of the absolutely hold I had over my day. Does this make me a bad future doctor? Today I was so happy I had clinic, then at 4pm when clinic ended, my resident told me to scrub in on an OR case. I was about to flip.

I know that surgery is definitely not the field for me because I hate hierarchy and I need to be able to schedule my day. I'm thinking Rads, Derm, Path would be a good fit for me. Any and all inputs appreciated. Is this an unusual feeling or adjustment? 😕

Need to get used to it. You change rotations every month all the way through residency too. It never ends. Have to learn to be flexible. Expect to have to be late and if you get off early that day then it's a plus.

 

[metallo]

I hate the unpredictable nature of 3rd year. Does anyone else feel like they NEED to be in control of their day. People think I'm crazy but 2nd year for me was sooooo much better than 3rd year. Mostly because of the absolutely hold I had over my day. Does this make me a bad future doctor? Today I was so happy I had clinic, then at 4pm when clinic ended, my resident told me to scrub in on an OR case. I was about to flip.

I know that surgery is definitely not the field for me because I hate hierarchy and I need to be able to schedule my day. I'm thinking Rads, Derm, Path would be a good fit for me. Any and all inputs appreciated. Is this an unusual feeling or adjustment? 😕

Rads is not necessarily predictable. You never know how much you're going to have to read at the beginning of the day. New studies just keep getting added to your list as the day goes on. I did a rotation with a neuroradiologist, and he would get slammed with things at 4:30... just as he was getting ready to head home.

 

[McGillGrad]

From what I have seen, most residents, even in cush specialities have little control over their hours EXCEPT psych for some odd reason...lol

 

[glade]

Welcome to adult world. Time to lose the diapers and start acting like a grown up. Either that or get a job as a nurse or other union employee.

 

[peppy]

From what I have seen, most residents, even in cush specialities have little control over their hours EXCEPT psych for some odd reason...lol

Psych has a lot of variation. There are places where psych interns rotate in the ICU (yes, really) and places where psych interns push the limits of 80 hours (or at least did; not sure how they will change things next year). On the other extreme, there are programs where the service doesn't require residents to function and they don't require any overnight call ever.
I definitely agree that if having a reasonable schedule is important to you that psych is a specialty that might fit the bill. I definitely hope that people don't go into it just for the hours though since the work itself can be very stressful if you don't enjoy working with the mentally ill. You might even say that mentally ill patients can be unpredictable. 🙂

 

[BigRedBeta]

I've said this in other threads, but you really nail the point home.

Absolutely the biggest difference between 2nd year and 3rd year (and by extension 4th year and residency) is that you no longer have control over your time. You have to be where they want you to be, when they want you to be there. The sooner you get over this fact, the more enjoyable third year (and by extension...) will become.

While you've said very clearly it's a "time" issue, I think you need to tease that out a little further. Is it really just knowing when you're going to be ending, or is it perhaps that you just don't like surgery, so the thought of spending any more time than you have to doing it is horrible? There's a big difference between the two. Or is it even bigger than that and you just don't like not being in control/not knowing what or how to do things?

Obviously if it's a specialty issue, then it's only a matter of time before you find the specialty that gets you fired up to stay late for unexpected issues. That's a great feeling when you find it.

If it's really just the time control issue, then you need to start looking towards fields that are heavily tilted toward shift work. ER obviously comes to mind, though be aware that as an ER resident you will do a variety of wards and ICU months to complete your training. And as a rule, the unexpected stuff is generally a really sick patient. Part of being a good physician is sacrificing for those who need your ability.

If it's a control issue, then you're just going to have to ride it out. Once you make it as an attending, you'll have a better (though still imperfect) level of control - and certainly some specialties lend themselves to that control better than others. Obviously you're also going to have to figure out how that inevitable lack of control bothers you. Perhaps the uncertainty of patient disease and severity in to the ER is tolerable so long as you have a set ending point for your day that you can look towards. Maybe as an internist or general pediatrician knowing what your clinic schedule looks like for all of next week makes the possibility of a late add-on more tolerable especially if it's an infrequent occurrence.

Lastly, this may just be a symptom of being a new third year student, and the fact that your presence is rather meaningless in the scheme of things. Perhaps as an intern, when it really is your responsibility and you're actively involved with the plan this won't be an issue. I can personally attest that as a 2nd year resident, I feel much more willing to stay late to help get work done because I'm more capable and confident in what I'm doing and I can help those trainees who are less experienced than I am (not to say I didn't want to stay late last year, it's just easier as an upper level).

 

[jackieMD2007]

Yeah, it sucks when you realize that other people get to make decisions for you that feel invasive, like how you're going to spend your time. This is similar to starting as the most junior person at a company, etc. Blah blah blah fancy explanation.

It is very hard for us Type-A people to not be in control. Bottom line. You will adapt 🙂

 

[Jolie South]

Most people with jobs aren't able to control their time. Welcome to the real world.

 

[Perrotfish]

What bothers me the most is not having control over my meals. I can deal with the rest of the random hours/schedules, but I never know if I'm going to get to eat lunch or dinner so I always need to overeat every breakfast/lunch. I'm gaining a lot of weight.

Most people with jobs aren't able to control their time. Welcome to the real world.

I disagree. Most people with jobs (including attending physicians) either work for very clearly definied hours or they have a certain amount of work to get done by a given deadline and other than needing to be in the office from 9-5 they pretty much set their own schedule. In the real world if, at 4 p.m., your boss suddenly tells you that he needs you to stay until 8 that's generally considered unacceptably bad. Even residents generally have a pretty set schedule/daily workload within a given one month rotation. This 'guess what you're doing today' crap is very much a medical school thing.

 

[xanthomondo]

I don't really mind the "being told what time to be where" issue rather than never knowing what your schedule is 6 weeks out. I wanted to go on a weekend vacation but it's impossible to coordinate because you don't know what weekends you're going to be working in the next block (which could be only a week away).

 

[Jolie South]

I disagree. Most people with jobs (including attending physicians) either work for very clearly definied hours or they have a certain amount of work to get done by a given deadline and other than needing to be in the office from 9-5 they pretty much set their own schedule. In the real world if, at 4 p.m., your boss suddenly tells you that he needs you to stay until 8 that's generally considered unacceptably bad. Even residents generally have a pretty set schedule/daily workload within a given one month rotation. This 'guess what you're doing today' crap is very much a medical school thing.

Yea, but if there's work to be done, you do it. That's the way it is, whether it's "unacceptably bad" is irrelevant. You don't tell your boss no. At least that's how it was at my old job.

Yea, residents may have a generally set schedule, but your patient may crash or have an issue while you're on the way out the door. Then guess what, you're staying until they're stabilized. This happened to me several times on medicine. If the attending was with us at the time, he/she stayed as well. My last month on the GI service we would get delayed all the time because endoscopy would take longer than expected or there was a hold up with getting started. A lot of times we would round much later than we thought we would. Sometimes, it would be after 5 pm. The attending didn't say "guess what guys it's after 5 I'm not staying."

While I agree that there was a set goal, there most definitely isn't a predictable time we'd leave on my 3 months of medicine. Surgery was a little more predictable with being done in the OR as the end goal and 5 usually the time we'd leave.

Also, how do residents have a set workload, but we as students rotating with said residents don't? That doesn't make any sense to me. You work for a month with them, so you have their hours. If their hours are predictable, then your hours are predictable. Granted you won't know prior to starting the month or rotation what those hours will be.

 

[vicinihil]

Thanks guys for all the helpful responses. The SDN community rocks even though some of you are brutally honest. I enjoy clinic duty where I can see where the last pt is set to arrive and for the most part can hope to be out when the last pt is seen. I also like attendings that round at a set time in the afternoon depending on their preference. I guess in a way that is a "predictable" schedule. I hope you guys are right that this is just a 3rd year thing and it'll get better from here because it sucks being told what to do without really knowing why you're going or the educational value. But heck, half of 3rd year have been a waste of time.

For the weight gaining thing....I'm sorry. I try to fit in workouts when I can. If you run 2-3 miles a few times a week and instead of doing just a straight run at 7mph you can try doing something called High Intensity Training which is a workout where you vary your intensity in 30s to 1min intervals (alternate between 7 to 9mph). That way you end up burning more calories in less time. My workout at the gym lasts 20 minutes and I burn upwards of at least 300 calories. I found this works and takes almost no time to do. Packing snacks will also help. Trail mix, energy bars, or granola is pretty small and satisfying.

 

[naus]

Most people with jobs (including attending physicians) either work for very clearly definied hours or they have a certain amount of work to get done by a given deadline and other than needing to be in the office from 9-5 they pretty much set their own schedule. In the real world if, at 4 p.m., your boss suddenly tells you that he needs you to stay until 8 that's generally considered unacceptably bad.

Depends on the job. What you say is definitely true for union jobs, government jobs and private sector $50k jobs. However, private sector $160k+ jobs like biglaw lawyers and bankers don't really have much control over their time. In those jobs it's actually common for the boss to tell you that you need to pull an all-nighter to finish something by tomorrow at 8am, even when you're on vacation. I know one lawyer friend who was called back from his vacation in South America midway through the trip. He wasn't even compensated for the bookings.

The dirty secret is that union and government jobs with cushy pensions aren't really the real world. In the real world, the world is not divided neatly into 8 hours a day where you can just walk away afterwards. There are things that just needs to get done.

If everyone had a union attitude, nothing would get done in this country.

Most of the modern advances in our civilization came from people who were driven to burn the midnight oil regularly, and not from those working 9 to 5 and out the door.

 

[2012mdc]

Yea, but if there's work to be done, you do it. That's the way it is, whether it's "unacceptably bad" is irrelevant. You don't tell your boss no. At least that's how it was at my old job.

Yea, residents may have a generally set schedule, but your patient may crash or have an issue while you're on the way out the door. Then guess what, you're staying until they're stabilized. This happened to me several times on medicine. If the attending was with us at the time, he/she stayed as well. My last month on the GI service we would get delayed all the time because endoscopy would take longer than expected or there was a hold up with getting started. A lot of times we would round much later than we thought we would. Sometimes, it would be after 5 pm. The attending didn't say "guess what guys it's after 5 I'm not staying."

While I agree that there was a set goal, there most definitely isn't a predictable time we'd leave on my 3 months of medicine. Surgery was a little more predictable with being done in the OR as the end goal and 5 usually the time we'd leave.

Also, how do residents have a set workload, but we as students rotating with said residents don't? That doesn't make any sense to me. You work for a month with them, so you have their hours. If their hours are predictable, then your hours are predictable. Granted you won't know prior to starting the month or rotation what those hours will be.

Um we definitely did not have a set workload while the residents did. At least that's how it was on Surg. The work limits did not apply to us. We were required to get there much earlier than the residents to get notes in 1st, we did not get to leave a certain time post call, lectures were often rescheduled and we often were in class while the residents went home, if the OR went late or got behind schedule all the students who were around were usually required to stay while only the residents operating stayed.

They figured that since we don't have any true responsibility in patient care the students could afford to be extremely overworked

 

[coup de chance]

Yep, gotta let go some control over being told what to do all the time. But still, you can adapt and be quite comfy:

• stuff your pocket with at least 1 high-protein bar (your kidneys are hopefully still young and healthy and can take the abuse).
• load up your PDA/Smart with Skyscape and the like (portable reading for whenever, wherever
• print out a few pages of reading and stuff that in your pocket too

All this stuff should be able to fit comfortably in your scrub pant pocket. Overflow can be put in your scrub shirt pocket.

Surg was where I had to pack the lightest because I had to put my white coat in the lockers. And the hours were the longest.

 

[Cruzinman]

Embrace unpredictability. RW Emerson said that "Consistency is the foolish hobgoblin of little minds". Oscar Wilde says that consistency belongs to those who are unimaginative".