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IM vs Surgery residency intensity

Discussion in 'General Residency Issues' started by HMSBeagle, Dec 14, 2008.

  1. HMSBeagle

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    Hi I have a question for people who may have a better insight at this than me. I know both these residencies work very very hard but which is more intense in terms of call, hours worked and what is expected of you, IM or surgery? I'm not asking this because I will somehow base my future decisions on this but because I want some other opinions.
     
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  3. Law2Doc

    Law2Doc 5K+ Member
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    More surgery programs will regularly max out the 80 hour average work week than IM.
     
  4. michaelrack

    michaelrack All In at the wrong time
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    Surgery is much more intense than internal medicine
     
  5. randomedstudent

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    FWIW, at my institution (where I'm an IM resident) the IM residents rarely work over 80 hours while the surgery residents rarely, if ever, work under 80 hours and often over 100. Yes, working over 80 hours is still quite wide spread, particularly in the surgical fields. But many surgery residents will tell you that they are ok with that as they feel they wouldn't get adequate training otherwise.
     
  6. dragonfly99

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    General surgery and neurosurgery are definitely going to be more intense than IM.
    If you are at an intense IM program, the intern year can be pretty darn hard and working Q3-Q4 overnight for almost all months of the year and working 80 hrs/week wouldn't be uncommon. However, the call tends to decrease with every year of your residency and it's only a 3 year residency.
    For the surgeons, the hell never ends for 5 years or so...LOL!
    There are some surgical fields that are fairly cush, like urology, but they still have to do a surgical intern year which is pretty much sucky, hours and intensity-wise.
     
  7. Agree with all of the above posts.
     
  8. Pilot Doc

    Pilot Doc SDN Angel
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    Surgery. By orders of magnitude. No comparison.
     
  9. doc20

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    lot of surgery programs will make residents put on paper they are working 80 hrs but they actually work much more, and the calls are definitely more stressful!
     
  10. FatPigeon

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    I find this difficult to understand. Everyone on this board swears by the brutal nature of the surgical residency, surgical interns call me aside and urge me to run toward a different field as quickly as possible, and yet looking at scutwork.com it appears as if both IM and surgery start their day at 6am and leave around 6pm. What accounts for this opinion everyone has about how awful surgery is? What gives?

    I've developed an interest in things vascular, inching toward IM--> cards on account of residents and attendings warning the [email protected]# out of me. BUT I'd rather do vascular surgery if I'm otherwise going to start with IM only to learn (regretfully) that it's just as intense as surgery...
     
  11. Law2Doc

    Law2Doc 5K+ Member
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    I don't think anyone in this thread is saying surgery is awful, but I think you need to read scutwork more critically if your take-home message is that IM and surgery work the same hours. Most surgeons have been at work for a while by the time 6am rolls around. It's an early morning field because the ORs tend to start up early and there's rounding etc to be done before OR. And because of the nature of surgeries and surgical emergencies, the days rarely end nicely at a fixed time -- if the operation that was supposed to start at noon actually starts at 3pm and then goes 8 hours due to unforeseen complications, then you are staying until 11pm. And this can often end up being the norm rather than the exception. And call can be more frequent in surgery on top of this.

    Short answer is that you can expect to max out the 80 hour average work out limit pretty regularly in surgery (even more if the program isn't in "strict" compliance), but are going to come in nicely under the 80 hour limit at a lot of IM programs.
     
  12. michaelrack

    michaelrack All In at the wrong time
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    When I did IM (before the work hour restrictions), it was pretty unusual to arrive before 6:30 am as an intern or 7 am as a resident. Usually left at around 5:30 pm when not on call.
     
  13. dragonfly99

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    drrack,
    It wouldn't be unusual for medicine interns to arrive before 6:30 a.m. at my hospital. In fact, quite a few attendings like to round at 7a.m. and all the patients have to be seen and have a plan and most or all to have notes by rounds, so if your attending is a 7a.m. rounding guy you'll definitely be there at 5:30 or 6.

    At our hospital the IM call was Q3 and Q4 so I don't think that's less frequent than surgical call @ most hospitals. The call frequency varies according to which IM program you are in...Q4 or Q5 seems to be the most common, but there are also "short call" days @most all programs.

    The definite difference with IM is that once you are no longer an intern, the having to get there at 6 a.m. every day is going to be quite infreqent. However, you are still going to need to be there around 7 a.m. or so, and sometimes at 6 if you are the one prerounding (intern @clinic, intern sick or gone, etc.). Staying until 6 p.m. vs. earlier or later would depend on the program, and whether you are on "short call" vs. not.

    I wouldn't rely on scutwork.com for reliable accounts of work hours, but you can assume that most surgical residents work more hour than most IM residents. There are definitely "cush" months during 2nd and 3rd year IM (i.e. could be several months/year with little or no overnight call) that won't exist during surgery residency unless you are doing a research year.

    If you want good work hours and not so frequent call, neither surgery nor IM would be near the top of my list of potential specialties. Conversely, if you really have an extreme passion for something, you'll probably just decide to suck it up no matter what the residency is like.
     
  14. gutonc

    gutonc No Meat, No Treat
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    This is probably the key difference between IM and Surgery wrt work hours. In IM, even the most malignant/intense programs will have 1/3 to 1/2 of the R2 and R3 years as "non-call" months (consult, outpt clinic, elective, etc). You may do Q3 o/n the rest of the year but you'll have some months with a reasonable/humane schedule to balance this out.

    Contrast this with the vast majority of Gen Surg programs where there's no such thing as a non-call month and even if you're on something relatively chill like a plastics rotation, you're probably still going to be in the call pool for the inpt service and therefore on call Q3-4 depending on the size of the program.
     
  15. Dr. V

    Dr. V Senior Member
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    Surgery doesn't have a "cap". No "ok I have my admissions for this call I'm going to bed". Most of the medicine programs I know of have caps and once they cap they are done.

    In surgery if you admit 20 patients you just admit 20, the traumas keep coming and the consults keep flowing.

    So as a general rule, even if the call nights are the same in frequency they are much more intense as well.
     
  16. michaelrack

    michaelrack All In at the wrong time
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    I guess we just started kind of late in the morning at my hospital.
     
  17. Long Dong

    Long Dong My middle name is Duc.
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    If you like vasular then go rads then interventional, forget IM and surgery.
     
  18. Samoa

    Physician Pharmacist 10+ Year Member

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    Problem is, the surgical specialties are all trying to take back the catheter-based interventions for their organ system, and interventional rads depends on referrals from the specialties in question. So referrals may significantly decrease in the future as more surgeons acquire the skills needed to treat the problem themselves.

    And if you're looking at a strictly cardiac practice, you're better off in medicine, since the CV surgeons depend on referrals from the cardiologists.
     
  19. Law2Doc

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    While referral dependence is a valid argument, in the end, in any technologically driven field, the department who owns the machines generally wins. As a result the growth of IR programs has been much more dramatic than the growth of vascular programs over the past few years.
     
  20. bluealiendoctor

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    I know transistional years can differ greatly, but my friend is doing his ENT surgery transitional year....by far the easiest internship year I've ever heard of. He averages less than 40hrs/week.....on call about Q7/8. Even when doing his surgery month he only worked 55 hours and complained to no end about how tired he was. For the past 4 months his schedule has been 9am-4pm 3 days a week and 7:30am-3:30pm two days a week...of course it's absurd that he ever works any weekends. I don't what his life was like as a student..but I can't understand how he thinks his schedule is so demanding. I'm wondering if his next 4 years are going to be that easy? Is he in for a rude awakening?
     
  21. Samoa

    Physician Pharmacist 10+ Year Member

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    Vascular surgery is poised to take off like a rocket in the next few years, now that the fastest pathway to practice--even to a solely interventional practice, is through the integrated surgical residency. And there's no reason that the surgeons can't build their own interventional suites. Or better yet, use the ORs to which they already have access and the radiologists don't.

    I'm not trying to pick a fight, but it's pretty easy to see the road ahead.
     
  22. FatPigeon

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    Yea it kills me that there are only about six of those programs. I sort of wish I were applying five or six years from now... :mad:
     
  23. Samoa

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    There are sixteen of them as of today. Six new ones opened up in just the last three months.
     
  24. Law2Doc

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    I don't know - when I did that rotation the surgeons indicated they were being attacked on multiple fronts between IR and better medical management/ new vascular meds in the pipeline. They actually predicted the latter would impinge on their business more than the former in the not too distant future but in either case suggested that their turf was more of a battleground than most other surgical specialties. So I don't know if the road is as easy to see to everyone in the field. :confused:
     
  25. DarthNeurology

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    While some surgical residencies break the 80 hour work week rules, some try not to, I think this has lead to an increased popularity of general surgery among medical students who might not have considered a surgical residency in the past and resulted in it being more competitive.

    I think that the nature of the work and pace is different in medicine and surgery. In surgery often times there are significant mortality/morbidity rates associated with various procedures and surgical attendings/surgical senior residents can be *very* harsh with interns and junior residents, so you have to have a somewhat of a thick skin.

    You have to know internal medicine very well as you must make decisions about who goes to surgery and managing complicated post-op patients, almost anyone can learn the surgical technique involved, but some residents can't seem to put it all together or aren't hardworking enough and get creamed by attendings on a regular basis, or so at least it apearred to me as a student.

    The work is different as it helps to be good at multi-tasking and the patient population can be sicker. In any residency, especially internship, you will be working hard when you are in the hospital.

    In internal medicine many patients after admission and initial workup are pretty stable and you can wait until morning to discuss further management with the attending while some patients during the night are found to be less stable and need more observation/care and shift you into a higher level of alertness. So I think internal medicine can be stressful as you don't know when you have to start really worrying about one of your patients.

    In surgery there is less time to catch your breath as all surgical patients could go south as any moment and you are basically in emergency mode from when you start to when you end you day, so think while a surgery residency may have marginally more hours (at least in the future with 80 hour work week, and at least less than in the past), the pace is much different in surgery. There is a lot of worry concerning a good percentage of patients on a genera surgery service, with good reason due to what I think are higher rates of mortality/morbidity. The good thing is that you will always have to be "on your toes". Internal medicine requires that you pick up a seriously underlying situation in a patient in the ER after eating a leisurely half hour dinner with fellow residents and having only 5 patients on service.

    When things are slow on a IM service residents basically knock on wood that everything stays that way. However, on surgery the work just keeps on coming, at least in my limited experience. I think that if you like procedures and are very goal oriented in terms of patient care then a surgical residency might actually be preferable to an internal medicine residency.

    Some surgical attendings, especially in academics, have reasonable lifestyles, and vascular surgeons basically do very similar work day in and day out, and are pretty comfortable with what they are doing. What is more stressful, being an internal medicine attending and seeing 30 patients on multiple teams in one day or being a vascular surgeon and doing 5 or less procedures a day and being on call for your patients?? I think that life as an internal medicine attending is harder than an internal medicine resident (more patients and responsibilities), while I get the impression that life *can* be much be better for surgical attendings than surgical residents, especially surgeons that specialize after general surgery residency.

    I think if you can see yourself as an internist and like diagnostic problems and managing treatment then internal medicine might be a good fit, whereas if you loved your surgery rotation and don't mind getting patients that are more or less worked up and diagnosed, but love multitasking and being in the OR then toughing it out through a surgical residency might be worth it.

    I am not a surgeon, so somebody should asked Winged Scapulae if she thought her surgical residency training was "worth it" in terms of doing work she likes now . . .
     
    #24 DarthNeurology, Dec 31, 2008
    Last edited: Dec 31, 2008
  26. Long Dong

    Long Dong My middle name is Duc.
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    I don't know about that, but I do know when I was a med student and a TY I'd see the vascular fellow being taught by the IR guys, not the other way around. Who knows the IR guys taught the cards guy and now they stole caths/angioplasty from them. I was telling the guy who wants to vascular stuff to do rads then IR cause it's more chill then surgery or IM/cards. You know us dermies we like the more chill path, or like "an electron take the path of least resistance."
     
  27. Long Dong

    Long Dong My middle name is Duc.
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    I don't understand this one, I thought ENTs are supposed to do a surgical internship or they have a staight 5 year program. I didn't know they had to do an internship or could even do a TY.
     
  28. dynx

    dynx Yankee Imperialist
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    Just to add some points.
    Surgery, harder by far, far, far. Surgeon's lie about thier hours (round down) to seem compliant and attract applicants. IM lies about thier hours (round up) because they don't want to seem soft.

    And a cap? WTF is a cap? I've told an er doc to call IM to admit some patient that they called a BS surgical consult on and the IM intern had the f*cking balls to page me and ask me if i could just admit him and they would consult in the AM since they were "capped" for the night...im sure the next 3 hours of thier "call night" (they were afterall in the "call" room...after they admitted this patient anyway) were counted towards thier 80 hour max.
     
  29. Samoa

    Physician Pharmacist 10+ Year Member

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    That's exactly the stimulus for the integrated programs--more and dedicated training in medical management of cardiovascular disease to augment the surgical training. The intent is to become the one-stop shop for vascular diseases.
     
  30. michaelrack

    michaelrack All In at the wrong time
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    Is that the way caps are working these days? I thought that if an IM resident, intern, or team was capped, there was supposed to be either an upper level IM resident or a physician on a "non-teaching" service availabe to admit the patient.
     
  31. dynx

    dynx Yankee Imperialist
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    It works per team but she felt bad calling in the next team.
     

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