I Do Not Understand People Who Drop Out of Residency

[Lemont]

Unless it is for health reasons or some very pressing family issue, I do not understand how somebody can drop out of residency and leave medicine altogether when they have worked so hard to get to where they are (studied hard in undergrad to get good grades, studied for the MCAT, went through all that hard work during the first 2 years of med school, did all those LONG HARD days during 3rd year, studied for all the USMLEs, and so on). And then decide to pack it in sometime during residency. Won't they look back one day with regret that they didn't finish what they started? That they quit before the end when they had already invested so much time and money in it? It is like running a marathon and quitting a couple miles before the end because you gave up mentally.

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[Hockeyguy]

i think the problem is the set-up of most medical schools. you really have to make a career choice based on somewhat limited information. i never did optho untill last month - didn't think i would be interested. but i loved it - too bad the boat has pretty much sailed seeing as they start interviewing soon. i am happy (going into anesth) but it did get me to thinking what else have i not seen that i think would be cool? in addition to that most schools don't start you on real hospital work until 3rd year. i have to admit it wasn't what i thought. but oh well - what are you going to do, quit?

 

[mosche]

I agree -- WE DON'T UNDERSTAND. I think that that is the point. Unless we've been through what others have been through, we can't possibly understand their circumstances. We can, however, encourage them and assure them that they--like others--can get through it. Disparaging remarks,however, only serve to reinforce the doubts/anxiety that they are already endureing. This is not a sport. Insinuating that someone is a quitter is naive/simplistic.

BTW, Lemont where are you at in your residency training (i.e. PGY I, PGY II, etc...)?

 

[Lemont]

So help me understand. What could be so bad that it is worth sacrificing all those years of hard work for?

 

[mosche]

I can't help you understand -- I don't understand either. But if someone is in a situation that I've never been in, I realize that it is not my place to pass judgement (i.e. calling them a "quitter"). I am only a fourth year. I do remember my M1 year, however. Many people were very overwhelmed, to say the least; but, that was just med school. I am sure that PGY I is much more intense than that was; however, I don't know -- I've never been through it (give me a year ) But, if you are a resident then you can enlighten me.

You are a resident aren't you?

I ask again: PGY I, PGY II,...?

 

[Anasazi23]

So help me understand. What could be so bad that it is worth sacrificing all those years of hard work for?

A lifetime of misery in a job they know they'll eternally hate.

 

[Gauss]

The people I know who quit residency or didn't even do residency for that matter are all happier and some are even wealthier than 99% of the attendings I have worked with.
Granted this was way before average debt topped 100k
Why is it important for you to understand?
to each his own

 

[Lemont]

I am MSIII. I would like to understand why they drop out. They've done so much already, why not stick it out and finish the last couple of years or however much time you have left? We had a surgery resident drop out during his last year with about 6 months to go. That to me is incomprehensible since he had already done 4.5 years of residency. That's like dropping out of med school in the middle of 4th year.

 

[mosche]

I am MSIII. I would like to understand why they drop out. They've done so much already, why not stick it out and finish the last couple of years or however much time you have left? We had a surgery resident drop out during his last year with about 6 months to go. That to me is incomprehensible since he had already done 4.5 years of residency. That's like dropping out of med school in the middle of 4th year.

This post seems sincere. When I read your original post, it seemed that you were coming across as judgemental -- maybe I overreacted. Anyway, my point is that it can be quite intimidating to go from being a big fish in a small pond, to a small fish in a big pond. In med. school we are surrounded, for the most part, with peers. In residency we will be surrounded with suPEERiors (misspelling intended ). Suddenly we will be expected to perform on their level. I am sure that that will be intimidating. Further, as Anasazi alluded to, we are expected to choose a specialty based on minimal exposure. How unnerveing. Based on a 4 or 6 week exposure, we are expected to decide what we want to do with the rest of our lives -- I know 40 year olds who are undecided even though they have had way more experiences than I have had. Yet, based on that minimal exposure, we make our choice, spend thousands of dollars, and enter our chosen field. Well I would expect that many of our decisions would be faulty. I say,"Kudos for realizing it early in residency".

Again, this is just my OPINION. I'm just now beginning to go through the whole residency match process myself. I hope/pray that in a year I will still not totally grasp their dilemma; but if I do, I hope that others will try to understand/support me.

 

[APACHE3]

I think the minimum age to start med school should be 26-27. That would MAKE someone do something else for a while and see what the REAL world has to go through. I was a stockbroker before going to med school. Sound fancy huh? Just a salesman on the phone, thats all, doing 60 hour weeks trying to sell stock to strangers. And of course not making any money at it, running up all my credit cards trying to "expand my business" etc...I couldn't go to a party without my business cards and some idea to trap an unsuspected attendee into buying stocks..it just sucked. SO when its 3 am and I'm getting paged by the nurse about the prn Tylenol for the pt, I'll just smile and thank god I'm not hearing the phone being slammed down for the umpteenth time and the echo of "stop calling me you sob" echo through the receiver...man that job sucked!!!

 

[mksup]

Because residency can confront you with all kinds of issues that (trust me) being a med student does not. You truly do not know what it is to be a doctor until you hit residency and sometimes, people realize that it is not at all what they expected or what they ultimately want from their life.
While I do wonder about the person who quit with just 6 months to go (having presumably been through all the toughest parts) when you come to a realization that what you are doing with your life is not at all what you WANT to be doing with your life - why keep doing it?

In life, you will see (for those of us who are compulsive enough to have entered the medical profession) that there is always some reason to push forward to the next goal, or the next level (if for no other reason than the fact that you've "invested so much already")- and it can be very hard to stop and realize that if you do that you can find yourself 30 yrs down the road having lived a life that was not truly what you wanted.

That being said, sticking it out thru at least internship might be a good idea just b/c it might give you more alternative options. But if you know what you want in life and its not what you are doing - go for it b/c u only live once!

I am MSIII. I would like to understand why they drop out. They've done so much already, why not stick it out and finish the last couple of years or however much time you have left? We had a surgery resident drop out during his last year with about 6 months to go. That to me is incomprehensible since he had already done 4.5 years of residency. That's like dropping out of med school in the middle of 4th year.

 

[Lemont]

This post seems sincere. When I read your original post, it seemed that you were coming across as judgemental -- maybe I overreacted. Anyway, my point is that it can be quite intimidating to go from being a big fish in a small pond, to a small fish in a big pond. In med. school we are surrounded, for the most part, with peers. In residency we will be surrounded with suPEERiors (misspelling intended ). Suddenly we will be expected to perform on their level. I am sure that that will be intimidating. Further, as Anasazi alluded to, we are expected to choose a specialty based on minimal exposure. How unnerveing. Based on a 4 or 6 week exposure, we are expected to decide what we want to do with the rest of our lives -- I know 40 year olds who are undecided even though they have had way more experiences than I have had. Yet, based on that minimal exposure, we make our choice, spend thousands of dollars, and enter our chosen field. Well I would expect that many of our decisions would be faulty. I say,"Kudos for realizing it early in residency".

Again, this is just my OPINION. I'm just now beginning to go through the whole residency match process myself. I hope/pray that in a year I will still not totally grasp their dilemma; but if I do, I hope that others will try to understand/support me.

I already get that feeling as an MSIII. It always seems like what you know is not enough. The senior residents and attendings can always find holes in your medical knowledge. That being said, I am not sure if you are expected to perform on their level when you start residency (intern year). But as you move up, you are obviously expected to get better and better so that you can function as an attending once you are through. That is afterall the point of residency --- to train you from a medical student to an attending who can take care of patients without supervision. That being said, I don't think "intimidation" is a main reason people drop out of residency. But I may be wrong on that since obviously I haven't started residency.

 

[mosche]

I already get that feeling as an MSIII. It always seems like what you know is not enough. The senior residents and attendings can always find holes in your medical knowledge. That being said, I am not sure if you are expected to perform on their level when you start residency (intern year). But I may be wrong on that since obviously I haven't started residency.

True.

 

[Winged Scapula]

As a senior resident who has questioned my path in life, I cannot speak for others but can say that medicine is not always what you thought it would be.

People leave residency for all sorts of reasons but perhaps the most common is the experience of doing something you dislike, day in and day out and knowing that you will never be happy doing it for the rest of your life. For some people, this experience leads them to switch residencies (ie, surgery for anesthesia); for others, it is not a particular field which makes them unhappy but the practice of medicine in itself. They often come to the conclusion that they would be happier doing something else. And while it might seem difficult to imagine leaving after putting in so much work, unless you've been THAT miserable, you cannot fathom how little all that means when your happiness or even life (at the risk of being overly dramatic), is at stake.

Bear in mind that people enter medicine also for all sorts of reasons. Unrealistic ideas, doing it for other people, etc. are generally reasons why the attrition rate can be so high. For many, being a physician is NOT a lifelong dream nor is it the be all and end all. They can find many other things to fulfill them. If you've lived your life dreaming of being a physician, and all the "glory and glamour" it entails, it can be awfully disappointing to find out it ain't all that its cracked up to be. OTOH, it can be hard to understand how someone would feel that way when it seems the best thing you've ever experienced.

I chose medicine for myself but because I found so many other things interesting it was fairly easy to imagine myself not practicing, or even quitting residency. Everyone tells you internship is supposed to be miserable, but when that misery keeps going, day after day, it can be pretty draining. It was a personal crisis which made me question what I was doing and whether or not it made me happy. In the end I decided to finish my residency, but don't necessarily envision myself practicing for the rest of my life. Too many other things I want to do.

 

[Annette]

. . . I do not understand how somebody can drop out of residency and leave medicine altogether when they have worked so hard to get to where they are (studied hard in undergrad to get good grades, studied for the MCAT, went through all that hard work during the first 2 years of med school, did all those LONG HARD days during 3rd year, studied for all the USMLEs, and so on). And then decide to pack it in sometime during residency. . . . It is like running a marathon and quitting a couple miles before the end because you gave up mentally.

ABSOLUTELY NOT!

Residency is NOTHING like pre-med/medical school. I've been told by many practicing physicians (I'm a resident) that practice is nothing like residency!

While the best thing if you want to leave, is to leave after your first year, so you can always work as a physician somewhere to pay off the loans and put food on the table. It also leaves more doors open than just having the MD degree, career-wise.

 

[wastoute]

You said this person "dropped out" in their last year. It may not have been as voluntary as you suggest. This person may have dropped out instead of being dismissed. I was asked in my PGY-6 year "if there wasn't something else I would rather do" than Neurosurgery. There wasn't, I went to med school to do neurosurgery and loved it, even the last crappy few months they put me through fighting them through the appeals. This individual may have just decided he didn't love it enough to fight for it.

 

[GenSurg]

Yeah, residency sucks and medicine definitely isn't what I thought it would be.

That being said, after accruing as much debt as I have, and spending years of my life getting here, I could not quit medicine outright.

There are so many different fields that you can get into. Even if your first choice doesn't pan out, you can always choose another field. If you don't want to work 80 hours a week and be tied to a pager, or even take care of patients, there is a field you may enjoy.

http://ipods.freepay.com/?r=20049323

 

[Laryngospasm]

It might help you understand their position if you had completed a residency yourself. You know what they say about walking in other peoples shoes.

 

[shivalrous]

It might help you understand their position if you had completed a residency yourself. You know what they say about walking in other peoples shoes.

Maybe that's true, but it's awfully tough to the person who wasn't able to get that residency and would have gone through with it until the end.

 

[Lemont]

I see where you guys are coming from, but nobody has yet given concrete reasons as to why people most often decide to drop out of residency (except for health reasons or pressing family issues). Is it boredom? Too much time commitment?

Also, how does residency differ from 3rd year, except for the fact that you have more responsibility as a resident and are expected to know more?

 

[edfig99]

i don't think there is a reason why "most people leave". people leave for any number of reasons. One of my classmates started residency and just hated being a clinician...realized it just wasn't his calling. did he wish he would have known sooner? sure, but it didn't. he ended up working in venture capital and he's in love with what he does. another guy was months away from finishing residency and just didn't like the person medicine was making him become.

people leave (voluntarily) for health reasons, family issues, financial concerns, a variety of very personal reasons. As other posters have said, many simply realize that medicine just isn't something they want to wake up every morning to do. it's not about "quitting" or "finishing". ultimately, medicine is no different than any other career -- you have to love what you do.

and residency doesn't compare to third year med school...not even in a family medicine residency where it seems like the entire residency is an expanded med school third year. the time commitment, the job demands, the patient load, the self-directed learning, the learning by humiliation. there's just no comparison. you're an ms3, right? so you should really be talking to your residents on your rotations and see if they can describe for you what the difference is between what they're doing and what you're doing.

 

[Blade28]

As Kim already said, two common reasons people leave surgery is to (1) switch to a more lifestyle-friendly field, like gas or rads, or (2) to leave medicine altogther (much rarer, from what I've witnessed).

For others, it's not the lifestyle (long hours) that they dislike - it's that the field just isn't what they'd imagined all those years. There can be very little encouragment, recognition or gratitude by patients, etc...not quite what you'd pictured going into med school. Dealing with difficult settings in county hospitals, having frustrating patients who just don't seem to want to help themselves, having even just one or two abusive senior residents/attendings - these can all make you feel miserable and question your chosen profession.

Don't forget that many other people also feel that this is a "permanent" job - that once you start residency, you've basically chosen your job until you retire. That can be scary, and if you feel that things aren't going well, maybe it's time to move on.

 

[Mirror Form]

I see where you guys are coming from, but nobody has yet given concrete reasons as to why people most often decide to drop out of residency (except for health reasons or pressing family issues). Is it boredom? Too much time commitment?

A lot of med students who are not happy as med students still manage to slug it through school, and even excel, based on the idea that "there's a light at the end of the tunnel." Thats what we were told afterall.

Unfortunately, for some fields, once you start residency you realize that you're going to be absolutely miserable for the entire duration. That's five more years you won't get back. Then you realize that most of your attendings are unhappy too. So some people just finally decide to cut their losses and get out while they still can.

As a side note, I'm a transitional intern rotating through gen surg right now and I was surprised to find out that the misery of the residents seems to increase with the years. That is, our interns are the least depressed, and the chief residents are by far the most downtrodden and miserable.

Also, how does residency differ from 3rd year, except for the fact that you have more responsibility as a resident and are expected to know more?

It totally depends on the program and type of residency.

 

[beyond all hope]

People change fields of practice all the time in the real world outside of medicine, so why not medicine? Yes, you have an enormous committment to medicine in residency, but that doesn't mean you're stuck for life.

Lots of folks decide that either clinical medicine isn't right for them or they just can't put up with the abuse.

Clinical medicine in the U.S. can really suck. I sent good people home without definative diagnoses to follow up with their 'primary doctor' whom they can't get hold of. I do lots of tests that aren't indicated just to protect myself from lawsuits.

Residency can be pretty abusive, and it does change you. I'm a much harder person since I became a doctor.

Just the other day, one of the nursing started joking in the middle of a code and we all started laughing. We were trying to resuscitate a dead person, and we were laughing about his crack pipe. Pretty callous, eh? That kind of stuff happens in residency.

I didn't drop out. 98% of residents don't. But I understand the ones that do.

 

[VentdependenT]

You can always try and switch fields before you give up outright. However, I think if we werent in $100,000-200,000 in debt there would be a ton of drop outs.

Not me though. I'm doing it for the glory and the prestige! Its just like the TV shows only we are better looking.

 

[Strength&Speed]

When you hate what you do, it doesnt matter what you put into it. I frankly think not ENOUGH people quit. They would likely be much happier. I dont appreciate profoundly bitter people as my attg's and snr residents. As for what makes you quit---you can find plenty of reasons. dont like patient care, incessant pages, feel like a lackey, colleagues/superiors are mean, dont like defensive medicine, intolerable documentation, poor nursing care, the long hours, burnout. Etc, etc.

 

[TheThroat]

I know a resident who changed from oto to path at the end of her third year, basically "wasting" two years of oto residency (didn't have to repeat internship). I know another, who, in the middle of his intern year, after doing an ER rotation, decided that he wanted to do ER medicine instead of oto. The reason people change residencies are pretty easy to understand, as posters above have noted how little information we base our decisions on.

 

[Smurfette]

When I was a MS3, one of my classmates made the comment that "med students work way harder than the surgery residents". The rest of us stared at him wondering how delusional he was and how the heck he could truly believe that...

I'm an intern...as someone who just a few months ago was still a student, I will try to explain the difference between a student and an intern. So one day, there you are, receiving your med school diploma...next thing you know, you are in a brand new place, brand new hospital and with a group of 20 patients all of which YOU are taking care of. Most med students don't actively follow, write notes and write orders for 20 patients and be familiar with all of their medical problems and hospital course. Nurses page you all day (and night) about all of these patients. Your orders no longer have to be co-signed. As a student I was often annoyed when I had to get an order cosigned, but now as an intern I am very conscious that if a patient has a bad reaction to something I prescribe or if I give the wrong dose, it is MY fault and solely my fault since it is MY name on the order. Or give two medicines that cross-react with each other. The patients ask you questions that you, as the doctor, have to answer to the best of your abilities...you can no longer defer to your residents to explain things. If there is something wrong with one of my patients, they call me first, and if that patient is crumping, I can't necessarily leave the patient to go get help and am the one in charge until someone senior gets there (and if everyone else is in the OR, help may not get there in time) which means I need to know what to do or do the best that I can (and not let it show to the patient that I am not confident in what I am doing or that I may be completely panicked in my head). And that's not because I'm not competent as an intern, it's simply because I've never before had to deal with situations without having backup; and as an intern, there's many scenarios I have not yet been exposed to that I have to deal with. How many students have to run a code on their patients? Or read the EKG of a patient without someone else's input? Or have to decide which of three calls from nurses about different patients in distress/"don't look right" is the one you should go to first? Or have to decide what you have to do NOW to fix or evaluate SOB/CP/hypotension/tachycardia? As an intern, there's a lot of stuff I feel like I *should* know but don't or have forgotten. I still mentally feel like a student, yet am no longer considered one. I was a student one day and an MD the next, which is a weird adjustment. When I'm on call, I take care of 60+ patients---the ones not on my service I know only their diagnosis and any active problems that the regular intern signs out to me.

I don't get to leave the floor to go to lecture, or go scrub in on interesting surgery cases as an intern. I don't get to read during the day since I am too busy trying to dictate, write orders, give discharge instructions, write transfer orders, see consults and new admits and write H&Ps, pull/place tubes, check labs, draw labs, supervise students, answer questions from students and answer pages in between seeing my ~20 patients. I don't get to go home until somebody arrives to cover my patients when I leave the hospital. As I "advance" in residency, I get to supervise multiple interns, meaning I will directly or indirectly be supervising care on 100+ patients when on call including ICU patients. And I will gain other responsibilities.

I am not trying to sound bitter, b/c I'm not. It's just that the patient care responsibility is much more significant in residency than as a student. Everyone knows that intern year sucks and that it gets better after that. But some people hang in there waiting for it to get better and discover that they don't like what the job evolves into, so I am not shocked when people quit halfway or more through residency. Some people had two specialty choices and may pick one due to family pressure or lifestyle reasons rather than because their heart was in the one they matched into. Others couldn't get into what they wanted and "settled" for something else or simply didn't feel as though they were good at doing what their chosen field does and decide to jump ship before fiinishing it out. Quitting in the last 6 months, I agree with an above poster that there was probably some extenuating circumstances such as family issues, illness or being "suggested" to leave.

 

[Blade28]

Smurfette, that's a well-written, thought-provoking and (unfortunately) accurate description of a G Surg intern's busy life.

 

[bulletproof]

When I was a MS3, one of my classmates made the comment that "med students work way harder than the surgery residents". The rest of us stared at him wondering how delusional he was and how the heck he could truly believe that...

I'm an intern...as someone who just a few months ago was still a student, I will try to explain the difference between a student and an intern. So one day, there you are, receiving your med school diploma...next thing you know, you are in a brand new place, brand new hospital and with a group of 20 patients all of which YOU are taking care of. Most med students don't actively follow, write notes and write orders for 20 patients and be familiar with all of their medical problems and hospital course. Nurses page you all day (and night) about all of these patients. Your orders no longer have to be co-signed. As a student I was often annoyed when I had to get an order cosigned, but now as an intern I am very conscious that if a patient has a bad reaction to something I prescribe or if I give the wrong dose, it is MY fault and solely my fault since it is MY name on the order. Or give two medicines that cross-react with each other. The patients ask you questions that you, as the doctor, have to answer to the best of your abilities...you can no longer defer to your residents to explain things. If there is something wrong with one of my patients, they call me first, and if that patient is crumping, I can't necessarily leave the patient to go get help and am the one in charge until someone senior gets there (and if everyone else is in the OR, help may not get there in time) which means I need to know what to do or do the best that I can (and not let it show to the patient that I am not confident in what I am doing or that I may be completely panicked in my head). And that's not because I'm not competent as an intern, it's simply because I've never before had to deal with situations without having backup; and as an intern, there's many scenarios I have not yet been exposed to that I have to deal with. How many students have to run a code on their patients? Or read the EKG of a patient without someone else's input? Or have to decide which of three calls from nurses about different patients in distress/"don't look right" is the one you should go to first? Or have to decide what you have to do NOW to fix or evaluate SOB/CP/hypotension/tachycardia? As an intern, there's a lot of stuff I feel like I *should* know but don't or have forgotten. I still mentally feel like a student, yet am no longer considered one. I was a student one day and an MD the next, which is a weird adjustment. When I'm on call, I take care of 60+ patients---the ones not on my service I know only their diagnosis and any active problems that the regular intern signs out to me.

I don't get to leave the floor to go to lecture, or go scrub in on interesting surgery cases as an intern. I don't get to read during the day since I am too busy trying to dictate, write orders, give discharge instructions, write transfer orders, see consults and new admits and write H&Ps, pull/place tubes, check labs, draw labs, supervise students, answer questions from students and answer pages in between seeing my ~20 patients. I don't get to go home until somebody arrives to cover my patients when I leave the hospital. As I "advance" in residency, I get to supervise multiple interns, meaning I will directly or indirectly be supervising care on 100+ patients when on call including ICU patients. And I will gain other responsibilities.

I am not trying to sound bitter, b/c I'm not. It's just that the patient care responsibility is much more significant in residency than as a student. Everyone knows that intern year sucks and that it gets better after that. But some people hang in there waiting for it to get better and discover that they don't like what the job evolves into, so I am not shocked when people quit halfway or more through residency. Some people had two specialty choices and may pick one due to family pressure or lifestyle reasons rather than because their heart was in the one they matched into. Others couldn't get into what they wanted and "settled" for something else or simply didn't feel as though they were good at doing what their chosen field does and decide to jump ship before fiinishing it out. Quitting in the last 6 months, I agree with an above poster that there was probably some extenuating circumstances such as family issues, illness or being "suggested" to leave.

I am a lowly M3 who has wondered about this med student vs. Doctor ( almost overnight ) transition quite a bit. This is the first post i have read which seems to accurately portray the "holy ****....so this is whats its really like to play doctor" scenario. Thank you for the unromanticised account. This should be posted in the pre-med forum under the title " because i want to help people"

 

[docemesis]

"I'm an intern...as someone who just a few months ago was still a student...
...directly or indirectly be supervising care on 100+ patients "

I thought interns (1st year residents) are not allowed to treat patients unsupervised.

How can you be given free range on patients ?

 

[theD.O.C.]

How can you be given free range on patients ?

I wonder if those free range interns are also fed with organic feed?

 

[toofache32]

I wonder if those free range interns are also fed with organic feed?

Ha! Now that's the funniest thing I've read on here in a long time.

 

[blue2000]

"I'm an intern...as someone who just a few months ago was still a student...
...directly or indirectly be supervising care on 100+ patients "

I thought interns (1st year residents) are not allowed to treat patients unsupervised.

How can you be given free range on patients ?

Sure, you are supervised, in terms of the fact that there is an upper level resident and attending above you, keeping an eye on things. What I think Smurfette is referring to is that as the intern, you are expected to enact first line treatment for everything you get called about. Sure, if the first couple of things you try don't work, call your upper, but SOB/hypotension/vomitting/hypertension/abd pain, etc etc etc, you treat and then call, and sometimes depending on the way the day is going for the entire team, the back up may not come for hours.

Smurfette's post totally echoed how I feel about my life as an intern. I had a patient anaphylax to either morphine or reglan (which she had gotten, literally hundreds of times since she'd been admitted). I was on the floor, the uppers were in the OR. It was my call what to give her, whether to repeat things, whether to call the ICU, because if she was going south, there would have been no time for anything else. I'm sure there are med students reading this, thinking, jesus anaphylaxis, the treatment is really clear, what's the problem with blue (I probably thought that) but there is a huge difference between talking about it, and being responsible for the patient as she is reacting, and worrying about which direction she is going to go.

 

[Laryngospasm]

Also, how does residency differ from 3rd year, except for the fact that you have more responsibility as a resident and are expected to know more?

The reality of the situation is that until youve done it YOU WILL NOT UNDERSTAND! Almost all med students are cocky and think "Not me" when they hear how hard residency can be and the mental toll that it takes on the individual residents..When youve completed youre internship get back to us here and let us know what youve learned. I promise you will learn a lot. Not the least of which is that residency in NO WAY SHAPE OR FORM RESEMBLES THE MEDICAL SCHOOL EXPERIENCE.

 

[Lemont]

The reality of the situation is that until youve done it YOU WILL NOT UNDERSTAND! Almost all med students are cocky and think "Not me" when they hear how hard residency can be and the mental toll that it takes on the individual residents..When youve completed youre internship get back to us here and let us know what youve learned. I promise you will learn a lot. Not the least of which is that residency in NO WAY SHAPE OR FORM RESEMBLES THE MEDICAL SCHOOL EXPERIENCE.

Laryngospasm, don't you think you are exagerrating when you claim internship in 'NO WAY SHAPE OR FORM RESEMBLES THE MEDICAL SCHOOL EXPERIENCE'? 3rd year rotations and 4th year sub-Is in medicine/surgery must have some resemblance.

 

[edfig99]

Laryngospasm, don't you think you are exagerrating when you claim internship in 'NO WAY SHAPE OR FORM RESEMBLES THE MEDICAL SCHOOL EXPERIENCE'? 3rd year rotations and 4th year sub-Is in medicine/surgery must have some resemblance.

not as much as you would hope. as a 3rd year or 4th year subI, there is too much of a safety net. it's more like a safety net, with extra thick cushions all over the place, . i.e. interns and other residents checking up on your EVERY move. you are given very measured responsibility as a subI...you're responsible for much fewer patients than an intern would generally have, and that's not counting cross-coverage. it's known that the subI is rotating because they need the audition subI to match at the residency, or may be seeking a particular grade, or is just required to do a sub. The intern has no choice when doing a rotation. they gave up all form of choice the day they submitted a match list to ERAS.

 

[toofache32]

Laryngospasm, don't you think you are exagerrating when you claim internship in 'NO WAY SHAPE OR FORM RESEMBLES THE MEDICAL SCHOOL EXPERIENCE'? 3rd year rotations and 4th year sub-Is in medicine/surgery must have some resemblance.

Med school is about showing up on time and acting interested. There are absolutely NO responsibilities. If the med students didn't show up one day, the world would go on. If the residents didn't show up, it would come to a screeching halt.

 

[Blade28]

Laryngospasm, don't you think you are exagerrating when you claim internship in 'NO WAY SHAPE OR FORM RESEMBLES THE MEDICAL SCHOOL EXPERIENCE'? 3rd year rotations and 4th year sub-Is in medicine/surgery must have some resemblance.

Unfortuately, no, they're more dissimilar than they are similar. I think it's just the feeling that you can always say "ask the intern/resident, I'm just a med student" when problems arise while on clinical rotations in med school. (You can always think that, too..."oh, it's OK if I don't know this, I'm only a med student.")

When crap happens on the floors, either with a crashing patient, new admission, ER consult, or while doing a cross-cover during a call night, and you're the only one there until backup arrives in god-knows-how-long - now THAT'S internship.

 

[Smurfette]

Smurfette, that's a well-written, thought-provoking and (unfortunately) accurate description of a G Surg intern's busy life.

I'm glad that others in my situation echo my opinion.

Seriously, I think as a med student, especially toward the end of 4th year, you realize exactly how much you don't know...case in point, every spring tons of posts pop up with people freaking out about not knowing enough for residency. And then July 1 rolls around and you ARE the doctor. Being an intern is a huge leap in autonomy compared to being a med student.

 

[mosche]

I'm glad that others in my situation echo my opinion.

Seriously, I think as a med student, especially toward the end of 4th year, you realize exactly how much you don't know...case in point, every spring tons of posts pop up with people freaking out about not knowing enough for residency. And then July 1 rolls around and you ARE the doctor. Being an intern is a huge leap in autonomy compared to being a med student.

The end of fourth year? Please, I'm at the beginning of fourth year and am VERY aware of how much I don't know! I just keep hoping that next July will be a historically slow month in the state where I match!

 

[Blade28]

And then July 1 rolls around and you ARE the doctor. Being an intern is a huge leap in autonomy compared to being a med student.

Agreed.

I think the scariest things that are commonly seen on the floors are:

(1) Respiratory distress - when do you intubate?
(2) Unresponsive patient - cardiopulmonary event? overnarcotized? something else?
(3) Patient becoming septic - blood pressure bottoming out
(4) GI bleed
(5) (Relatively) sudden onset of acute abdomen

And when you're the first line of defense, and have to figure out what's going on and what to do until backup arrives...man that's scary. Great learning though.

 

[Smurfette]

Agreed.

I think the scariest things that are commonly seen on the floors are:

(1) Respiratory distress - when do you intubate?
(2) Unresponsive patient - cardiopulmonary event? overnarcotized? something else?
(3) Patient becoming septic - blood pressure bottoming out
(4) GI bleed
(5) (Relatively) sudden onset of acute abdomen

And when you're the first line of defense, and have to figure out what's going on and what to do until backup arrives...man that's scary. Great learning though.

(6) post op hypotension - bleeding out until proven otherwise

I haven't encountered all 5 of the above--yet. No active GI bleeders on the floor so far (knock on wood). But as you watch a pt in respiratory distress and wonder at what point to intubate, that's scary sh**. B/c if they decompensate you have no chance of getting a senior there before you have to do something.

And might I add, the WHEN to call back up. You don't want to look like a chump, or not have done the proper things beforehand, but you definitely don't want to wait TOO long.

 

[Blade28]

I follow what a senior resident once told me - if the thought of intubating crosses your mind, get the kit at the bedside and be prepared to do it.

 

[Teufelhunden]

I follow what a senior resident once told me - if the thought of intubating crosses your mind, get the kit at the bedside and be prepared to do it.

Are there hard and fast criteria to when you should intubate? Is there an algorithm that details how to approach resp distress? Thanks.

 

[mikki01]

As a second year medical resident, I have to agree completely with Smurfette's images of resident life. The biggest difference between med students and residents is the fact that you are responsible for people's lives! You make the decisions, sometimes while being tired or overwhelmed. As you progress with your training, you get even more responsiblity. I can't tell you how many nights I have spent lying in bed hoping that the order that I just wrote doesn't kill my patient!

If someone does leave before the end of their residency, you have to know that there could be many reasons that you may not be aware of. There are plenty of malignant programs out there. If a resident falls out of favor with the wrong people (believe me, it's not hard to do!) then they may end up being asked to leave. Remember, they aren't necessarily going to tell you that! They might just disappear or make up some excuse.

Whatever info you get out of these responses for your post, just keep in mind that life is complicated and you can't really understand what someone is going through until you get to the same point in your training. No one walks away from their dream without a very good reason.

 

[theD.O.C.]

as you watch a pt in respiratory distress and wonder at what point to intubate, that's scary sh**. B/c if they decompensate you have no chance of getting a senior there before you have to do something.

And might I add, the WHEN to call back up. You don't want to look like a chump, or not have done the proper things beforehand, but you definitely don't want to wait TOO long.

yeah, resp distress is probably the most dramatic acute presentation. Nothing else except maybe blood spewing out of orfices or massive wound dehiscence (both of these are _extremely rare_ on the floors) is quite as scary. Hate to sound snarky, but the best thing to do in acute resp distress is go back to the basics. Vitals (incld RR and pulse ox), assess responsiveness ( follows commands, can they tell you what's wrong).This should be gotten before you walk into the pt's room. That is, when the nurse says Mr. Jones ain't breathin right, the first words outta your mouth are a. is he awake? ( if not, get there _really_ quick) b. if yes then what are his vitals (if the answer is I don't know, then tell them to get them _now_ and you are on the way down post-haste).

Then when you get there, look in on the patient, see what's being done, tip: if their bagging him that's usually a bad sign, get the code cart to the room. Grab the chart and pay close attn to admitting dx (pulm reason? Cardiac reason?) and recent procedures (endoscope? Bronch? Surg (ie recent intubation)?, anti coags?, long period of inactivity?). Re-assess pt. check following cmds and mental status, consider cont.pulse ox and maybe redo vitals if you feel like you need it. Get an ABG. Then call the senior if you still think you need to.


If at any time the pt. changes his mental status, desat's really low compared with his baseline, jack's his bp or pulse, or starts breathing really fast (ie if you breathe like he's doing you get dizzy and tired very quickly). Think about intubating on the spot _or_ calling a code/medical response.

That's the kind of info a senior would like to have when the intern calls. Don't ever hesitate to call if you need help. At worst, they'll just yell or give you a a version of the above speech.

Good luck

 

[Laryngospasm]

If at any time the pt. changes his mental status, desat's really low compared with his baseline, jack's his bp or pulse, or starts breathing really fast (ie if you breathe like he's doing you get dizzy and tired very quickly). Think about intubating on the spot _or_ calling a code/medical response.

That's the kind of info a senior would like to have when the intern calls. Don't ever hesitate to call if you need help. At worst, they'll just yell or give you a a version of the above speech.

Good luck

Please keep in mind that if you plan to intubate, or have any confusion as to the need to do so, talk to your senior and get it figured out quickly. Do not wait until the last minute and then try it yourself, or even have your senior resident try it..this is a procedure that in many patients is very difficult for seasoned anesthesiologists and anesthesia residents. If you can mask the patient (almost all patients can be masked with proper technique) do not attempt to intubate the patient. Emergencies are not a time for interns to learn how to intubate, or third year medicine residents for that matter. If you try and intubate and are unsuccesful it is possible for the airway trauma from your unsuccessful attempt to make it next to impossible for the anesthesiologist to intubate, this is not a good situation. Also the use of drugs to intubate a critical patient is a very tricky situation. It takes hundreds of intubations to get good at it, so please dont think to yourself "I did anesthesia as a student and did X number of successful intubations, so I can do this." This is purely for the patients safety. If there are not any anesthesia personnel available I wish you luck.

 

[theD.O.C.]

Please keep in mind that if you plan to intubate, or have any confusion as to the need to do so, talk to your senior and get it figured out quickly. Do not wait until the last minute and then try it yourself, or even have your senior resident try it..this is a procedure that in many patients is very difficult for seasoned anesthesiologists and anesthesia residents.... If you try and intubate and are unsuccesful it is possible for the airway trauma from your unsuccessful attempt to make it next to impossible for the anesthesiologist to intubate, this is not a good situation. Also the use of drugs to intubate a critical patient is a very tricky situation. It takes hundreds of intubations to get good at it, so please dont think to yourself "I did anesthesia as a student and did X number of successful intubations, so I can do this." This is purely for the patients safety. If there are not any anesthesia personnel available I wish you luck.

Good point and very very true. Any time you intubate emergently it's most likely a code blue. Get anesthesia involved if your on the wards. In the place where I trained, an anesthesiologist was part of the code team.

 

[Dragonfly411]

To the OP: I have a very close friend who is in her first year of residency (for family practice), and she feels that she already wants to resign from medicine. As another poster said, a resident, as opposed to a student, takes on incredible responsibility in caring for the patient. Despite the eighty-hour per week limit, my friend works considerably more than that, often 90-100 hours because she has to attend to all her patients and will not leave the hospital until she completes all of her tasks for the day (for the other students who do work within the eighty-hour limit, they end up pushing back their responsibilities to the following days.... my friend didn't want to do that). Even when she goes home, she is still "working," checking the vitals of her patients on her computer, making sure they're okay.

She always comes home exhausted. A few times, she almost fell asleep on the wheel during her 45-minute commute from the hospital. Throughout the day, she is so busy with her patients that she doesn't even have time to eat, so she frequently skips meals. And, of course, if she isn't on call or doesn't have to be in the hospital, she sleeps because all of her energy has been drained. This means, she's left with barely any time for meeting her personal needs, e.g., going out with friends, reading a book, watching a movie, etc., and we all know that balance in our lives is important for our personal happiness. She's been a resident for two months, and I can see that this experience has taken a tremendous toll on her body and mind, especially since she feels that she wants to retire from medicine as soon as possible after completing her training. Goodness, from the way she's described things to me, she is almost like a slave in the hospital.

Granted, she also said residency gets *relatively* easier as the years pass, since the more experienced residents will have become more accustomed to their work and won't be as meticulous as she is now. Hopefully, she'll feel different in years to come. Who knows.

All in all, my friend has lost her idealism along the way (throughout medical school and now residency). As another poster said, being in the hospital "day in and day out" attending to other people's needs with barely meeting your own, can make a person cynical and want to leave medicine.

So maybe it's just a question of trying to achieve balance in one's life, but it seems that's always been an issue with those working in the medical field. Anyhow, I hope this answers your question in some way.