how bad can residency get?

[sweetsaja]

What's a typical day like? What was the worst rotation? Describe your worst day. What's the longest you've gone without calling your family? Etc... i just want to know whats the worst I can expect. Thanks!

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[group_theory]

What's a typical day like? What was the worst rotation? Describe your worst day. What's the longest you've gone without calling your family? Etc... i just want to know whats the worst I can expect. Thanks!

Try weekend night (and you've been at work all week putting in long hours each day with 30 hr shifts in between) ... you'r on call, and have been up for 16 hrs with another 14 to go (at least), you are covering 50-80 patients, your pager is going off every 1-2 minute ... you are getting paged about mundane stuff (someone is in pain, someone is constipated, someone has insomnia, someone is agitated), stupid stuff (family wants to know what's the long term plan for the patient you are cross-covering), scary stuff (patient unresponsive, patient hypoxic, patient complaining of chest pain, patient asymptomatic with BP of 220/110, patient with peak T waves with K of 9), while trying to do admissions ... all by yourself (or with only 1 or 2 other residents to help) ... and you are getting paged every 1-2 minutes because you are covering 50-80 patients (and the occasional errant page where you get paged on a patient you are not covering)

... so while you are attending to a sick or unstable patient, you are getting paged every 1-2 minutes for mundane, stupid, and scary issues (along with angry pages about wanting admission orders on the newly admit guy you haven't seen yet because you are attending to the patient who has CP/STEMI or stroke, getting paged that a family member is angry that they haven't seen the doctor yet) ... or getting a nice lecture from someone (who has never carried a pager or know what it is like) how it is important to return pages in a timely manner


you have no time to stop for lunch, dinner, or snack ... your pager goes off even when you're in the bathroom


and in the morning when the rest of the team arrives, people will question why you didn't order this or that on the new patient, follow-up lab results on another patient


Fortunately it hasn't happened to me yet (the call from hell) but i've seen other residents get BURN with this scenerio

 

[Excelsius]

Try weekend night (and you've been at work all week putting in long hours each day with 30 hr shifts in between) ... you'r on call, and have been up for 16 hrs with another 14 to go (at least), you are covering 50-80 patients, your pager is going off every 1-2 minute ... you are getting paged about mundane stuff (someone is in pain, someone is constipated, someone has insomnia, someone is agitated), stupid stuff (family wants to know what's the long term plan for the patient you are cross-covering), scary stuff (patient unresponsive, patient hypoxic, patient complaining of chest pain, patient asymptomatic with BP of 220/110, patient with peak T waves with K of 9), while trying to do admissions ... all by yourself (or with only 1 or 2 other residents to help) ... and you are getting paged every 1-2 minutes because you are covering 50-80 patients (and the occasional errant page where you get paged on a patient you are not covering)

... so while you are attending to a sick or unstable patient, you are getting paged every 1-2 minutes for mundane, stupid, and scary issues (along with angry pages about wanting admission orders on the newly admit guy you haven't seen yet because you are attending to the patient who has CP/STEMI or stroke, getting paged that a family member is angry that they haven't seen the doctor yet) ... or getting a nice lecture from someone (who has never carried a pager or know what it is like) how it is important to return pages in a timely manner


you have no time to stop for lunch, dinner, or snack ... your pager goes off even when you're in the bathroom


and in the morning when the rest of the team arrives, people will question why you didn't order this or that on the new patient, follow-up lab results on another patient


Fortunately it hasn't happened to me yet (the call from hell) but i've seen other residents get BURN with this scenerio

Am I wrong to assume that every student will have a different residency based on a chosen field? From what you described, it seems that you are talking about ER residents. But someone who is going into pathology or surgery will at most just do a rotation in ER, if even that, right? For anyone to be able to do that high pressure stuff in the ER the person must really like the field. I can't imagine a pathology or psychology student handling all that ER stress. There is a reason why different students go into different fields. Please correct me if I am wrong.

 

[SoCuteMD]

Am I wrong to assume that every student will have a different residency based on a chosen field? From what you described, it seems that you are talking about ER residents. But someone who is going into pathology or surgery will at most just do a rotation in ER, if even that, right? For anyone to be able to do that high pressure stuff in the ER the person must really like the field. I can't imagine a pathology or psychology student handling all that ER stress. There is a reason why different students go into different fields. Please correct me if I am wrong.

No, he's pretty much describiing anything BUT an EM resident! EM residents don't have pagers, and they get to keep all their patients in the same part of the hospital, so no nurses paging - just multiple people directly in front of you vying for your attention.

 

[smq123]

Am I wrong to assume that every student will have a different residency based on a chosen field? From what you described, it seems that you are talking about ER residents. But someone who is going into pathology or surgery will at most just do a rotation in ER, if even that, right? For anyone to be able to do that high pressure stuff in the ER the person must really like the field. I can't imagine a pathology or psychology student handling all that ER stress. There is a reason why different students go into different fields. Please correct me if I am wrong.

That description doesn't sound like an ER resident's call. ER residents don't get paged to "put in admission orders," since they're not the ones who admit people. ER residents also rarely carry pagers, and certainly don't cross-cover other services.

Path residents don't do ER rotations. There's absolutely no reason for them to do so.

Different residencies have more stress than others. It also partly depends on the program - even a pathology residency is going to be very stressful if you're forced to do janitorial work as part of your daily work (i.e. cleaning up the morgue, doing the work that normally a PA or a diemer would do, etc.)

Every residency, though, isn't going to pay you that much. There's always the stress of watching your debt accumulate.....

 

[RTrain]

Am I wrong to assume that every student will have a different residency based on a chosen field? From what you described, it seems that you are talking about ER residents. But someone who is going into pathology or surgery will at most just do a rotation in ER, if even that, right? For anyone to be able to do that high pressure stuff in the ER the person must really like the field. I can't imagine a pathology or psychology student handling all that ER stress. There is a reason why different students go into different fields. Please correct me if I am wrong.

And I don't mean to harp on this post, but 1) psychology is not a medical specialty, it is a completely separate field with different education and training, 2) residents are not students; they are still learning, but they are no longer students enrolled in a degree program, and 3) in general, people go into different fields because they enjoy them, not because they don't have "what it takes" to do more stressful work. And as smq points out, every residency has a lot of stress - just different kinds of stress.

 

[Excelsius]

And I don't mean to harp on this post, but 1) psychology is not a medical specialty, it is a completely separate field with different education and training, 2) residents are not students; they are still learning, but they are no longer students enrolled in a degree program, and 3) in general, people go into different fields because they enjoy them, not because they don't have "what it takes" to do more stressful work. And as smq points out, every residency has a lot of stress - just different kinds of stress.

Sorry, I probably should have said psychiatry instead of psychology. Could anyone describe a typical day in one of the surgical subspecialty residencies (cardio, ortho, neuro, ...) and then describe the most stressful scenarios and their frequency?
I agree that if you love something, the stress is much less noticeable. I think that surgery residents would hate to do the rotations that group_theory described above, yet someone mentioned here that almost all residence have to do that.

 

[dragonfly99]

The description above is pretty on mark for a "call from hell" for an intern on medicine, although the frequency of paging is about every 5 minutes-10 minutes (usually not every 1-2 minutes, though it sometimes seems to be so).
If someone does neurology they will have to do a whole year of medicine internship first, so yes, they would have to take such calls. Psych only does 3 months of internal medicine I think.

ER docs don't crosscover/take care of other people's patients at night, nor usually carry pagers, as described above. They also generally don't work >8-12 hours on a shift, except when they are rotating through different areas of the hospital, like internal medicine or surgery.

Ortho surgery wouldn't be getting many calls about chest pain or some of the other stuff, but all interns (except pathology, and maybe a couple of other specialties) get middle of the night nurse pages about patients being constipated, patient can't sleep, can you come fix this chart at 3a.m. that has something unclear that someone else wrote, can you come talk to this patients 4th family member who just showed up here at the bedside at 10pm while you're admitting some other patient...

Trauma and general surgery have some of the worst/longest work hours and most stress of any residency, and will deal with many emergencies and some of the sickest patients in the hospital. Internal medicine has to deal with a lot of mundane stuff, lots of paperwork, lots of patient admissions, some very sick patients (especially in the ICU and oncology and cardiac wards).

Most medical specialties require an intern year where you will have calls like the one described above (but generally not as bad as that scenario). There are a few things that don't (i.e. pathology) but still require more hours than a "normal job".

 

[dragonfly99]

It's Duke?!
Don't you guys have a better backup system/procedure than that?
What ever happened to (other) surgeons sucking it up?
I never took a sick day in 3 years of IM residency, or asked someone to come in on backup call for me. I mean, there are times that it is unavoidable, but they are few and far between.
I'm wondering where the other surgery attendings/chief residents/senior residents are in this scenario. Why don't they man up (and/or "woman up").

Sorry for you. That sucks.

 

[Jimmy1]

"ER docs don't crosscover/take care of other people's patients at night, nor usually carry pagers, as described above. They also generally don't work >8-12 hours on a shift, except when they are rotating through different areas of the hospital, like internal medicine or surgery."

um, what? I would say the vast majority of ER residents work 12 hour shifts. But the rest is true.

A bad day in residency is covering the entire ICU, plus doing multiple admissions, plus running down to the ER to manage the crashing ICU patient who is boarded down there for hours, plus answering the million pages about someone's urine output dropping 10cc, the family wants to talk to you, etc.

 

[dragonfly99]

sorry, I didn't mean to insult ER. It can be very stressful...I mean when you have trauma patients, etc. come in to the ER. I know that b/c I moonlight in an ER.

I was just judging by the ER residents who are PGY1 at my teaching hospital...they only work 8 hour shifts. After that year it increases to 12 hour shifts.

 

[medicinesux]

Play the following video while reading this thread, wait until 0:45 till it starts getting really good and you have my answer to the OP's question!

[youtube]G1A6_dOqldM[/youtube]