Internship = Misery

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IdRatherBeFlyin

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Hey guys, I'm a PGY-1 general surgery resident and for the past two months, since the start of residency, I have been completely miserable. Undoubtedly, these have been the worst months of my life. I know internship year is supposed to be difficult, especially as a general surgery resident, but this is just ridiculous.

I've spoken with my PD about this, and he gave me the expected "it'll get better, just stick it out, and you'll feel better later" spiel. My colleagues tell me a slightly different story, that it'll get both better and worse. I don't know what to think, except that I am always frustrated, angry, unhappy, and bitter every day all day.

I'm not sure if it's the program or the specialty that's causing me this much pain, but something needs to change...and soon, or I'm simply going to go crazy. Is it normal to be this miserable during intern year?

I've thought about transferring/swapping to a different gen surg program, but it sounds to me like it's quite a difficult process to accomplish. Any suggestions??

Any and all help/suggestions would be greatly appreciated. Thanks.
 
Hey guys, I'm a PGY-1 general surgery resident and for the past two months, since the start of residency, I have been completely miserable. Undoubtedly, these have been the worst months of my life. I know internship year is supposed to be difficult, especially as a general surgery resident, but this is just ridiculous.

I've spoken with my PD about this, and he gave me the expected "it'll get better, just stick it out, and you'll feel better later" spiel. My colleagues tell me a slightly different story, that it'll get both better and worse. I don't know what to think, except that I am always frustrated, angry, unhappy, and bitter every day all day.

I'm not sure if it's the program or the specialty that's causing me this much pain, but something needs to change...and soon, or I'm simply going to go crazy. Is it normal to be this miserable during intern year?

I've thought about transferring/swapping to a different gen surg program, but it sounds to me like it's quite a difficult process to accomplish. Any suggestions??

Any and all help/suggestions would be greatly appreciated. Thanks.

What exactly makes you unhappy? What parts are you having problems with? That can help to answer your question a bit better.
 
With new work hour restrictions I can't imagine it being this awful. Try and articulate for us what the issues are specifically if you can.
 
I definitely found that I was getting a little down at the 2 - 3 month mark of PGY1. I think it has to do with the transition from med student to resident, and the accompanying responsibility/expectations/criticisms, etc.

Definitely stick it out. As a General Surgery resident, I found that as the PGY1 year went by, I enjoyed it more and more. Now, as an R5, I can definitely say that each year has been much better than the previous. The increased knowledge/skils, the decreasing scutwork, and closing in on completing the residency all contribute.
 
My intern year was admitedly not that bad. However, being in an osteopathic program I had to do a traditional year so actually only had 6 months of surgery and took medicine call. This year it has been a big step to all of a sudden be taking solo gen surg call, acuity is definitely much higher! Regardless, the amount of scut has decreased tremendously and I definitely feel more comfortable in my own shoes. I say stick it out for at least another few months.

Survivor DO
 
With new work hour restrictions I can't imagine it being this awful. Try and articulate for us what the issues are specifically if you can.

The way we implemented it at my program actually makes the schedule suck more for the interns. It used to be a set number of long days and spending the night on call (then usually being able to leave early the next morning unless there was a case you got to do or it was really busy) while the rest of the days typically getting you out at signout and occasionally getting to leave early if your team wasn't on call. Now you get to swing between night shifts (each being 13 hrs and sometimes you need to stay later than that to finish your stuff) and day shifts (which since the night person isn't there means you are busier so our interns have routinely been staying well past signout to get their stuff done) and overall are working more hours than we used to. Don't know if this is true for other programs, but we are small and the loss of that intern before they are on at night really affects things.
 
As for whether intern year has to equal misery, I think a lot of it comes from your own perspective on things. If you were coddled as a med student and had limited work hours and responsibilities, then intern year will be a huge change that can be hard to adjust to, particularly if you never worked before(since the rigors of a job with set hours and whatnot is different than the rigors of school). Your expectations can also set you up for unhappiness.

I went into intern year many years ago with the expectation that things would suck, I would never see the light of day, that I wouldn't have any personal time, and that I would be more tired than ever before (and having been through Army basic training I had been pretty exhausted but had to stay awake before). On the bad days it was never worse than what I expected so I never got really down about it, and the good days were so much better than I would have thought possible so overall I didn't think it was too bad.
 
Same for us. I was an intern in the "old" system, and a PGY2 in the new (meaning that I had to spend a couple of months as "re-tern" taking intern call.

It sucked. Way more day/night transitions, the interns never get golden weekends anymore, and most importantly, it has completely eliminated the early day.

It used to be that if it were a slow day and your service was tucked in, you could sign out to the on-call intern and duck out a bit early. We all did this and payed each other back in kind, and the on-call guy was stuck there either way, so it would a nice break where you got out at 2 or 3 pm.

Now in the new schedule, sign out is standardized and there is no one to sign out to if you get done early. You are just stuck there until the night intern shows up at 6 or 7pm (or 8 at some programs apparently!)

It's not like this at my program. Ducking out early means the possibility of a home call before 1730 in which case you have to go back should there be issues but most of the time this doesn't happen and it's absolutely wonderful to be able to leave when the team splits for the day. And we get every other weekend off just don't get to leave early for the true "golden" weekend.
 
Interns are not allowed to take home call in the new regulations...

I am sure it isn't listed as home call on the calendar, and since the plan is for them to come back to the hospital if anything comes up I think that covers the supervision part (which is why the ACGME doesn't want home call for interns). It would be mean to make all the interns stay if there wasn't anything for them to do. It is one of those things that you pretend isn't happening at the program level. I think most people would agree that it is better than hanging out waiting for work that might need to be done.
 
Interns are not allowed to take home call in the new regulations...

This is one of the regulations that I think is fairly appropriate. Taking home call means you have some ability to distinguish what can be handled over the phone, and what needs to be seen in person. That's not an easy thing, even for a mid-level resident, and I think it's safer just to avoid having an intern be put in the situation.
 
http://www.mc.vanderbilt.edu/reporter/index.html?ID=1910


I felt the same way 4 years ago even lost over 50 lbs and had bad anxiety. I felt like quitting everyday I went to work because I could not understand how a good medical student got so dumb. Then I realize how u learn in residency is different.

Forget about reading for a while.. Learn your system and take care of the patients.

Write down everything ur senior resident tell you and get it done donot be afraid to ask for help.

Rest when you can

Eat when u can

Sleep when u can
Find time to relax during difficult rotation

Once you get a hold on the management of the pt then u start reading

I did this and score > 95 on absite. Finished intern of the year. Now have the most cases amongst the chiefs and publications

Hang in there
 
Completely agree.

I also think it closes a loophole on a big source of duty hours abuse: A number of programs assign their interns to take "home call" - conveniently ignoring the fact that 90% of that time will be spent in the hospital covering busy services, and thus freeing the interns to stay as long as the program needs them to the next day without being subject to post-call restrictions.

Agreed. Then as a senior resident...then fellow...then attending, you'll be on home call almost every night. And then the pain begins.
 
Prescription to cure intern misery:idea:

1 slump buster QPM repeat PRN
 
Man..there is no bigger cock-block than starting internship. That in and of itself is pretty miserable lol. Does that part at least get better?
 
i agree with the original topic. i find intern year to be pretty damn miserable so far. i'm in a gen surg intern year (subspecialty residency), and i hate going into work every day. one thing that i find frustrating is that the other interns around me don't seem to think it's that bad. am i missing something? i'm a really hard worker, and have always enjoyed the hospital, etc., but find it to be so strange that i'm the only one in the group of interns I know who thinks it sucks this bad. my guess is that it has to do with the work hour regulations, since we work 4-5am to 6-8pm most days, and only get those "24 hrs off" when we switch to a random night shift (5pm to 5pm off). they can also average hours over a month-long period, to the point where you work 12 days in a row (sometimes 24 if your 12 days was on a prior rotation). my first rotation of intern year i was in the hospital every day for 31 days, with my only days "off" being the night shift change. it's not like i expected to have a life in intern year, but it still is terrible.

guess i'll just keep chuggin along, but glad to see this forum so that I know other interns feel the same way 🙂
 
Don't really find it all that bad. My schedule has essentially been what the poster above described. Part I dis-like is it's not really what I want to be doing (Anesthesia intern). Though I do remind myself that I could be rounding for several hours everyday. . .
 
I've been on a vacation so far in my subspecialty, but I think the rest of the year isn't going to be fun. My co-residents who are on the gen surg side work a lot harder than I do and have a lot more responsibility than I do. I don't doubt at all that it's going to suck hard, but I can tell just by talking to them that they're way ahead of where I am when it comes to managing patients and all of that. It sucks, but there's clearly benefit to the suffering.
 
I am miserable in my internship, too. Although it is internal medicine internship, I am miserable.

I am an IMG, born and raised in China. This is my first time away from everything, family, friends, my own culture. People are different, on top of doing all that work, I feel alone and miserable. I have no friends and I'm tired, constantly. Last week, I cried everyday. I usually smile a lot but my face looks I aged by so much in just 3 short months.

My mother suggested that I come back home and get my bearings back and then reapply for the Match in a different field.

Would any program accept me after leaving my internship and applying this late into the Match?
 
Would any program accept me after leaving my internship and applying this late into the Match?

Unlikely.

If interns are really struggling mentally with the transition, and talks to the PD still don't alleviate some of the distress, there is usually counselling available through student/resident services. We've had a few residents use this service for varying reasons and have had excellent results. Oftentimes, you should be allowed to attending during work hours (for the hour per week). Talk it over with your PD or chair of GME at your hospital.
 
I'm very happy with residency. I start around 9am and finish by 4pm every day. Call is Q9. Couldn't ask for more. Oops, did I mention I'm in psychiatry?

What did you expect, it's surgery. Get out if you're miserable. Switch specialties. Life is short, and you're youthful years go in a flash.
 
I'm very happy with residency. I start around 9am and finish by 4pm every day. Call is Q9. Couldn't ask for more. Oops, did I mention I'm in psychiatry?

What did you expect, it's surgery. Get out if you're miserable. Switch specialties. Life is short, and you're youthful years go in a flash.

I'd think a psychiatrist would be a little more empathic than what is written above. There are numerous reasons why someone can be miserable in internship. Some are related to the work, hours, chief/senior residents, nurses, diet changes, lack of exercise, changes in sleep patterns, being away form friends and family, etc, etc etc.

It could be an adjustment disorder or even a major depressive episode.

I'd suggest to seek help and then evaluate where you are at. Some CBT or ACT therapy may be of benefit, as may meds, if needed.

While some may advocate getting out ASAP (like the helpful comment above) - that really should be the last step since once crossed, that door is closed forever.
 
I'd think a psychiatrist would be a little more empathic than what is written above. There are numerous reasons why someone can be miserable in internship. Some are related to the work, hours, chief/senior residents, nurses, diet changes, lack of exercise, changes in sleep patterns, being away form friends and family, etc, etc etc.

It could be an adjustment disorder or even a major depressive episode.

I'd suggest to seek help and then evaluate where you are at. Some CBT or ACT therapy may be of benefit, as may meds, if needed.

While some may advocate getting out ASAP (like the helpful comment above) - that really should be the last step since once crossed, that door is closed forever.

I don't think he was trying to be mean spirited. I think he was just showing an alternative that is still an option for someone one year out of med school.
 
Hang in there and know that it will pass. The reward is far greater than the sacrifice.
 
I am miserable in my internship, too. Although it is internal medicine internship, I am miserable.

I am an IMG, born and raised in China. This is my first time away from everything, family, friends, my own culture. People are different, on top of doing all that work, I feel alone and miserable. I have no friends and I'm tired, constantly. Last week, I cried everyday. I usually smile a lot but my face looks I aged by so much in just 3 short months.

My mother suggested that I come back home and get my bearings back and then reapply for the Match in a different field.

Would any program accept me after leaving my internship and applying this late into the Match?

Hi boulevard84, I'm sorry to hear your first months here have been so difficult. I am a surgeon & the associate program director at a large general surgery residency. We often have multiple preliminary interns from other countries and hearing what you said made me think of some of the struggles they have shared with me over the years. I believe transitioning into training is difficult for many though the challenges when you are coming from a completely different culture can be more profound.

I completed a 5 year general surgery residency several years ago and subsequently 2 years of fellowship. A few of those years were very difficult and in retrospect, I believe internship was probably the hardest; not necessarily because of work volume, but probably the combination of multiple things. There were a times in my training that I definitely questioned why I was putting myself through this, but now 10+ years after my internship, I am quite glad that I chose to stick with it. Not to say every day now is perfect, but I overall very much enjoy the practice of medicine.

Is there an attending, associate program director, senior resident, or other person in the department that you think you can talk with? I can say after having been in program leadership for a few years that I've heard just about everything, and you may be surprised to find other people who can relate to what you are going through. If one of my residents approached me with what you just said, I would be able to connect them with people in the program (who they probably didn't realize) had the same feelings and could help.

Whether you are a categorical or a preliminary I would definitely encourage you to finish the year in good standing. If there are program-specific things you do not like, at least having one year successfully completed under your belt will make it much easier to find a job elsewhere.

Take care, -ajlmd
 
I had some great times in intern year. Made some great friends, learned a ton. Scrubbed every case I could. But I do remember some terrible times as well...

*Having senior residents/chiefs/attendings not "believe" in the whole concept of the post-call day, so routinely going home at 9 pm after being up all night.

*Being on services where the chief resident didn't even care to learn my name. Just called me "'tern."

*Being expected to manage complex hand injuries by myself, at night, in the ER. This involved things like bedside finger amputations.

*No nearby parking available, so had to walk almost a mile from the designated parking lot to the hospital each morning.

*4 am prerounds, to prepare for 5 am team rounds on several services.
 
I had some great times in intern year. Made some great friends, learned a ton. Scrubbed every case I could. But I do remember some terrible times as well...

*Having senior residents/chiefs/attendings not "believe" in the whole concept of the post-call day, so routinely going home at 9 pm after being up all night.

*Being on services where the chief resident didn't even care to learn my name. Just called me "'tern."

*Being expected to manage complex hand injuries by myself, at night, in the ER. This involved things like bedside finger amputations.

*No nearby parking available, so had to walk almost a mile from the designated parking lot to the hospital each morning.

*4 am prerounds, to prepare for 5 am team rounds on several services.

Where did you do residency?
 
I'd think a psychiatrist would be a little more empathic than what is written above. There are numerous reasons why someone can be miserable in internship. Some are related to the work, hours, chief/senior residents, nurses, diet changes, lack of exercise, changes in sleep patterns, being away form friends and family, etc, etc etc.

Almost everything you wrote are related to the horrendous work hours. Why is it so damn hard for surgeons to admit the hours suck and accounts for much of the misery?

This isn't healthy and with declining reimbursements, who the hell is going to keep doing it? A BART train station attendant in SF makes $100k a year working 40 hrs a week plus 80% pension after 25 years, all with a high school degree. We're all idiots trying to justify our awful hours, and with the way inflation is going, will eventually have not even a respectable salary to show for it.
 
Almost everything you wrote are related to the horrendous work hours. Why is it so damn hard for surgeons to admit the hours suck and accounts for much of the misery?

This isn't healthy and with declining reimbursements, who the hell is going to keep doing it? A BART train station attendant in SF makes $100k a year working 40 hrs a week plus 80% pension after 25 years, all with a high school degree. We're all idiots trying to justify our awful hours, and with the way inflation is going, will eventually have not even a respectable salary to show for it.

Holy crap. I think that does beat surgery... no college, med school or residency = 13 years income --> 1.3 million. No debt is an extra 400k --> 1.7 million. Then you work 12 more years and get 80k for life? Seriously they are working 1/2 the hours and end up with around the same income after 25 years with a guaranteed 80k per year for life?

wow

I agree, no one will do surgery in another 10 years. Salaries driving down in all of medicine with the amount of work expected won't match in a decade.
 
Almost everything you wrote are related to the horrendous work hours. Why is it so damn hard for surgeons to admit the hours suck and accounts for much of the misery?

This isn't healthy and with declining reimbursements, who the hell is going to keep doing it? A BART train station attendant in SF makes $100k a year working 40 hrs a week plus 80% pension after 25 years, all with a high school degree. We're all idiots trying to justify our awful hours, and with the way inflation is going, will eventually have not even a respectable salary to show for it.

Come on dog....no body wants to hump a BART train attendant....but they do surgeons...they make TV shows about it .👍 ....and you save way more people than you knock off.
 
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