Hours/physical involvement of residency?

[EHP]

I'm currently considering path as a specialty, but (because of physical issues) hours/physical requirements and stress are very important to me long. So far I've come across some contradictory opinions about path residency (ie its a 'lifestyle' specialty with good hours vs residents have to work at carving out personal time during residency, have hugely stressful boards, study round the clock outside of 'on duty' hours, etc). Basically, my questions is--does Path residency feel 'hard' (not intellectually), or is it 'great and awesome' like most Rads residents will go on and on about.

I was strongly considering Rads, but I think that the required medical intern year is going to be too brutal for me to get through. Path doesn't require a separate medicine intern year, but do Path residents have to do long rotations with the general medicine service? Or are they primarily doing exactly what they would be doing in later years (slides, autopsies, etc)?

How physical does a typical day get throughout all of the years of residency? Obviously sitting at a microscope is chill, but do you have to spend a significant amount of time running to or waiting in ORs for specimens or other stuff of that nature? Path is generally brought up as a good specialty for people with physical disabilities, but autopsies seem like they are pretty physical--does anyone have any thoughts on the ease of modifying those tasks (i.e. sitting up high while performing the autopsy instead of standing--a sterile no-no, but ok in path??).

Sorry for the huge amount of questions, but I've been wandering around on the boards and the links, and haven't really found much info on this particular topic. Thanks in advance for sharing your experience

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[deschutes]

The most physically-demanding rotations are probably going to be surgical pathology (particularly on a high-volume service), cytopathology and hematopathology (the latter if you do bone marrow biopsies). These areas also tend to be what most people go into pathology planning to do.

Path residents don't generally do long rotations with the general medicine service.

The thought process in diagnostic pathology is more similar to medicine than surgery, I think. I felt that on my surgery rotations, I actually had mental downtime waiting for a case to start, or while closing. Sitting at a scope may not seem "physically" tiring, but every case is a patient and oftentimes the smaller the biopsy, the higher the stress. There is a lot of information to be gleaned (or missed) when pathologists pore over their slides, and to be "with it" on every case is mentally AND physically demanding.

Coupled with high-volume surgical pathology where you're standing (some places have high chairs available, most don't) and cutting in cases every other day or every third day, it can be quite physically tiring. High-volume surg path is about being "on" all the time and being almost ruthlessly efficient between 8 and 5pm when techs are around and clinicians want callbacks and there are conferences to attend.

Unfortunately I don't have any direct experience with modifying the autopsy procedure to allow for sitting while performing it. I do know though, that residents are generally expected to have a hand in helping move the body, particularly in places that don't have hydraulic lifts.

Cytopathology will involve running around the hospital a lot, either carrying a toolkit or pushing a cart with fine-needle aspiration supplies and microscope on it.

Hemepath is physically demanding in terms of doing bone marrow biopsies. Coupled with a busy service, it can get pretty similar to surg path in terms of energy demands.

That being said, you'll still get 15 minutes to eat lunch and you'll still get to sleep in your own bed every night.

Your best bet is probably to do a rotation and get exposed to as many facets of the job as possible.

 

[112641]

I'm currently considering path as a specialty, but (because of physical issues) hours/physical requirements and stress are very important to me long. So far I've come across some contradictory opinions about path residency (ie its a 'lifestyle' specialty with good hours vs residents have to work at carving out personal time during residency, have hugely stressful boards, study round the clock outside of 'on duty' hours, etc). Basically, my questions is--does Path residency feel 'hard' (not intellectually), or is it 'great and awesome' like most Rads residents will go on and on about.

I was strongly considering Rads, but I think that the required medical intern year is going to be too brutal for me to get through. Path doesn't require a separate medicine intern year, but do Path residents have to do long rotations with the general medicine service? Or are they primarily doing exactly what they would be doing in later years (slides, autopsies, etc)?

How physical does a typical day get throughout all of the years of residency? Obviously sitting at a microscope is chill, but do you have to spend a significant amount of time running to or waiting in ORs for specimens or other stuff of that nature? Path is generally brought up as a good specialty for people with physical disabilities, but autopsies seem like they are pretty physical--does anyone have any thoughts on the ease of modifying those tasks (i.e. sitting up high while performing the autopsy instead of standing--a sterile no-no, but ok in path??).

Sorry for the huge amount of questions, but I've been wandering around on the boards and the links, and haven't really found much info on this particular topic. Thanks in advance for sharing your experience

I've seen residents and doctors with pretty serious diabilities do most specialties. I think the only one I haven't seen someone with a disability in is surgery - but I don't think that's because it's impossible. Even though I can't really imagine how someone could do that while not being able to walk (which you didn't really specifically say is your issue anyway) I've seen people come up with ingenious ways to get around myriad obstacles. I think that deschutes gave a pretty good description of what pathology residency is like but I would suggest you're coming at this problem from the wrong direction.

Pick what you WANT to do first .. then find residencies that seem best able and willing to accomodate whatever disability you have. If you've gotten through your rotations in medical school I don't see why you couldn't also manage to get through a residency in whatever you chose to do as well. If you're only considering pathology because of the physical demands then the disability of not really being interested in pathology will far outweigh any disability you have physically.

 

[EHP]

I've seen residents and doctors with pretty serious diabilities do most specialties. I think the only one I haven't seen someone with a disability in is surgery - but I don't think that's because it's impossible. Even though I can't really imagine how someone could do that while not being able to walk (which you didn't really specifically say is your issue anyway) I've seen people come up with ingenious ways to get around myriad obstacles. I think that deschutes gave a pretty good description of what pathology residency is like but I would suggest you're coming at this problem from the wrong direction.

Pick what you WANT to do first .. then find residencies that seem best able and willing to accomodate whatever disability you have. If you've gotten through your rotations in medical school I don't see why you couldn't also manage to get through a residency in whatever you chose to do as well. If you're only considering pathology because of the physical demands then the disability of not really being interested in pathology will far outweigh any disability you have physically.

Well, getting through rotations involved a lot of 'getting out of things' that you are not allowed to do during residency. Further, accommodations for disabilities is not as easy of a thing to achieve (regardless of program) as one might think. Also, as I mentioned, my physical issues have a large component of fatigue in them, so its not just about finding a way to not do a specific thing--if I worked 36 hours a day, even sitting in chair, I would be non-functional in about a week. What I 'wanted to do' was be a neurosurgeon, which clearly is off the table as I am uninsurable. I like radiology, and I like the academic parts of path I have been exposed to. Regardless of whether I like a path rotation when I do it, that doesn't address the work environment issues that one would have as a resident (for example--pysch residents do 6 months on the medicine floor which you don't see as a med student, rads do a full intern year). This is why I'm specifically asking about residency, because it is not 'enough' for me to just pick something I'm interested in. Having a chronic disabling disease is kind of like having a mortgage or several kids to support--you don't make decisions in the same 'what would I most like to do' way, there are other more important factors that rule your choices.

Thanks for the responses so far.

 

[Pathpathpath]

Look into CP-only residency. No cutting, no autopsies, and if you can find a program that only has you do a few required bone marrow bxs, you should be good-to-go. Note that you will not have private practice as a career option, but the academic CP attendings (mostly) aren't living in squalor.

 

[112641]

Well, getting through rotations involved a lot of 'getting out of things' that you are not allowed to do during residency. Further, accommodations for disabilities is not as easy of a thing to achieve (regardless of program) as one might think. Also, as I mentioned, my physical issues have a large component of fatigue in them, so its not just about finding a way to not do a specific thing--if I worked 36 hours a day, even sitting in chair, I would be non-functional in about a week. What I 'wanted to do' was be a neurosurgeon, which clearly is off the table as I am uninsurable. I like radiology, and I like the academic parts of path I have been exposed to. Regardless of whether I like a path rotation when I do it, that doesn't address the work environment issues that one would have as a resident (for example--pysch residents do 6 months on the medicine floor which you don't see as a med student, rads do a full intern year). This is why I'm specifically asking about residency, because it is not 'enough' for me to just pick something I'm interested in. Having a chronic disabling disease is kind of like having a mortgage or several kids to support--you don't make decisions in the same 'what would I most like to do' way, there are other more important factors that rule your choices.

Thanks for the responses so far.

Hmm that's too bad.. at least you have some interest in pathology then.. speaking for my program I could have done 95% of my residency on a stool or sitting.. not much walking was required even though I worked it into my schedule anyway to keep from being at my desk. The grossing stations can be worked on with a stool, all the clinical rotations can be done at a desk or bench. I never worked overnight on required things (only a couple optional things involving tissue harvesting for neuropath that were completely optional) Longest weeks only occured in the last couple months when I chose to stay there to study after work (close to 70 hours maybe once... 50 hours was much more typical).

 

[BierstiefelAndy]

I think pathology should be OK for you. Sure, cutting and doing autopsies require some element of manual labor but these "obstacles" may not be huge for you. You can sit during these tasks...there's nothing wrong with not standing up while doing these things. Although, I will make a disclaimer that I don't know exactly the nature of your physical issues.

I didn't do a whole lot of running around during path residency. That's what transport people are for should you want to send a sample to flow cytometry, molecular labs, etc. This you can get around.

Hours-wise, I thought first year residency was tough (attributable to growing pains). Since then, my hours were pretty easy. Once I hit fellowship, I had all of my weekends off.

If you enjoy pathology, just go for it. Don't let your physical issues get in the way because you will find a way to adapt.

Just as an aside, to put your situation in context, I just witnessed a 20 year old blind Japanese pianist win the Van Cliburn piano competition last night.

You will be fine. Most of pathology is intellectual anyway.

Best of luck!

I'm currently considering path as a specialty, but (because of physical issues) hours/physical requirements and stress are very important to me long. So far I've come across some contradictory opinions about path residency (ie its a 'lifestyle' specialty with good hours vs residents have to work at carving out personal time during residency, have hugely stressful boards, study round the clock outside of 'on duty' hours, etc). Basically, my questions is--does Path residency feel 'hard' (not intellectually), or is it 'great and awesome' like most Rads residents will go on and on about.

I was strongly considering Rads, but I think that the required medical intern year is going to be too brutal for me to get through. Path doesn't require a separate medicine intern year, but do Path residents have to do long rotations with the general medicine service? Or are they primarily doing exactly what they would be doing in later years (slides, autopsies, etc)?

How physical does a typical day get throughout all of the years of residency? Obviously sitting at a microscope is chill, but do you have to spend a significant amount of time running to or waiting in ORs for specimens or other stuff of that nature? Path is generally brought up as a good specialty for people with physical disabilities, but autopsies seem like they are pretty physical--does anyone have any thoughts on the ease of modifying those tasks (i.e. sitting up high while performing the autopsy instead of standing--a sterile no-no, but ok in path??).

Sorry for the huge amount of questions, but I've been wandering around on the boards and the links, and haven't really found much info on this particular topic. Thanks in advance for sharing your experience

 

[Cloaca]

The amount of physical exercise you do in path residency will vary widely with the program. Our program is more physically demanding for AP/CP than others because our medical complex is HUGE and our department spread out over several buildings. And our transport services are not what they should be. So we end up doing a lot of legging around. Also, we have pretty rough grossing days where you are there for 12 to 15 hours, sitting, but still it's hard on your back. Signing out can be rough with some attendings when you are sitting for hours without a break. But considering all residencies, path is probably less physically demanding than most. Rads is probably even less demanding.

Agree with above poster about CP only. These programs are physically chill but intellectually challenging and lead to a lot of projects and publications.

 

[KluverB]

... Rads is probably even less demanding....

Not sure about that. First of all there is that intern year. And after that, most rad programs require some amount of interventional rads, quite a bit of call of one form or another, plus some other procedures such as CT-guided FNAs, etc. All of these could potentially be physically demanding.

Then again, CP-only can also be fairly tough, depending on the rigors of the transfusion medicine service.

Still, as a couple of other people on this forum have mentioned, try as much as you can to go with what you really want to pursue, rather than what you think a particular program would be willing to accommodate for you. I have seen residents, fellows, and attendings with all manner of disabilities, in all different specialties, doing seemingly quite well for themselves. I'm sure they did have to work harder than most, I can't deny this, but they have nevertheless overcome their issues.

 

[Cloaca]

Hmmm...yes, I keep forgetting about the radiology intern year. But otherwise, they don't seem to do TOO much running around. I feel we do a lot more, with frozens, hemepath, etc. But again I think it has more to do with the physical layout of the place you're working. If everything is in the same building it wouldn't be too bad.

 

[Toochie]

I think most surg path/ cytology/ autopsy services will be demanding. Depending on the grossing station, you may have to stand. On cytology, you run around to do FNA's, CT guided bx, back to office. On autopsy service, most places have helpers but you have to be able to get block out and dissect (which may take take in beginning roughly 3 hrs). Regardless, most work days are 8-6 pm and a little bit later on surg path. Overall most rotations do not top more than 65 hrs and CP is hard pressed to reach 40.

As far as outside studying, you will have to do that. I liken pathology residency to med school on crack. You will be constantly studying. In the beginning just to stay alive and not look dumb in front of your attendings/ at conferences and then to get ready for boards. This can all be very exhausting mentally and physically.

CP only is a great thought and some transfusion medicine rotations require very limited trips to floors/ blood donation services. Also not as popular, so may have easier time getting in.

As someone with a chronic illness, you have to make sure to do your best and make your collegues understand your problem. Otherwise, I have also seen people being resented for their problems when you have to take off work for health reasons. It sucks but its true.

Good luck and I think path is the best.

 

[Cloaca]

Just spent the entire freakin' day on my feet doing frozen after frozen after GD frozen. My back is killing, my dogs are barking and my head is screaming. I'm going home to lie down and cry.

So yes, sometimes pathology can be physically exhausting.

Thank GOD this is my last frozen rotation.