Is Gen Surg as bad as people make it out to be?

[DOVinciRobot]

This isn’t directed to the OP or anything but I’ve also noticed that one shouldn’t ask surgery professors “work life balance” questions in real life. Most of the time, the professors seem annoyed when this question is asked because
1. They’ve probably answered it 1000 times
2. It shows a lack of dedication and or somebody who wants to have their cake and eat it too (ie high paying prestigious job but wants to be on the golf course Fridays at 4pm)
3. I think residency used to be much worse before acgme limits. So comparatively, it may already seem “easier” to them

I wouldn’t say that. For many of us our definition of “work life balance” is just different. I want a good work life balance and am actively working to make that happen once I’m an attending, but many people mean derm hours which just isn’t realistic.

Anyone who's lived it feel free to correct me. Every surgery resident I've talked to complains of scut work and inefficiency in their training. Not exclusive to surgery obviously. Seems like even a small investment in increasing efficiency of training opportunities would go a long way. There will never be a day when we're training surgeons on 40 hour weeks. I'd imagine you could build a good workforce on 60 hour weeks and some mix of 5 and 4+1 or 4+2 programs for specialties. The catch is you'd have to invest in strategies to get more quality time. That means hospitals would have to stop using residents as cheap labor. So I'm not betting on it.

The problem is that the scut work is often far more educational than you realize in the moment. Man I hated being on nights as the intern and having to respond to every floor page about Tylenol or “so and so pulled out their NG tube” or “hey X is delirious and climbing on the walls.” But looking back, it was taking those calls over and over that taught me how to trouble shoot the common management issues that arise without running to my chief everytime.

We already have integrated programs for the specialties that could be shortened.

I do agree with residents being cheap labor for hospitals, which needs to change. But that isn’t going to change hours worked.

---

Members don't see this ad.

 

[operaman]

I’ve thought about the hours and training inefficiency quite a bit and there’s definitely some room for improvement, but not much.

At its baseline, you have to see your patients every day, usually twice, and start operating at 7am. This means your M-F is usually 5am-7pm give or take. That’s 70 hours a week just looking at M-F, and those tend to be fairly packed and productive hours with scheduled cases and clinics.

Outside of those hours the learning gets more inefficient but it’s there. As an intern and junior it’s learning to manage periop patients and this often happens between 7pm and 5am. There’s often some down time so these hours aren’t as fruitful as the daytime hours. Adding more overnight call has diminishing returns, especially if it takes away from your high yield time in terms of post call days, etc. As you progress you start seeing consults and taking a more active role in managing acute surgical emergencies which do tend to happen at off hours.

And don’t forget about weekends too - probably gotta work at least one day a weekend so that’s another 8-12 hours depending on how your program does it.

As you can see, it’s very easy to go over 80 hours. The best place for targeted reductions would be in the overnight call because this time is much less bountiful. I hear older surgeons talk about their q2-3 call but there weren’t that many cases going overnight. Looking back at my own training, if I had doubled my overnight call I would have maybe boosted my overall case numbers by <5%.

I think the best opportunities for improving QOL in training come from adjusting call so you’re better rested. A number of programs in my field have done this by switching to a night float system where you just a couple months of nights and then take no call the rest of the year. This gives you lots of exposure to overnight issues while giving you a better QOL, though you still have 12-14 days for 5-6 days a week. It’s just never going to the 8:30-4 M-F derm hours no matter what you do.

 

[Wordead]

It’s seems clear you are to me. If I wanted an easy path I never would have chosen medicine. Someone wanting improvements doesn’t equal wanting an easy path. Not wanting to work insane hours after already sinking so much time, effort, pain (sacrificing everything outside of education) into this path already isn’t the same as wanting an easy path. That’s such an odd conclusion to come to. I’m pushing 30 and I haven’t even graduated med school yet. I’m not some young adult that has forever to build a family. The age of the average matriculant is getting higher as more and more gap years are necessary to be competitive for med school. You seem out of check with reality. The average suicide rate of med students is 3x higher than the population. The average suicide rate of physicians is 2x higher, in fact last I read it’s the highest of any profession. Y’all really think medical training has nothing to do with that? Harsh medical school demands and then hop into residency which is arguably worse. Spending 10+ years in which you’re unable to dedicate any time to a personal life essentially? Low pay in residency for long hrs? Barely being able to afford a place of your own as a grown ass adult with a MD? Barely having time to finally start building a life outside of medicine despite the pain and sacrifice already given? This is something y’all have an issue with people complaining about? Nothing needs to change? It’s so odd to see so many medical professionals promoting an unhealthy life balance for such an extended period of time that we would never promote to anyone else for their own sanity/mental health.

It's pretty overdramatic to say you can "barely afford a place of your own" on a 55K+ salary. And you're saying there's no time for a personal life but I had plenty of time to date and a large majority of single people end up meeting significant others during residency. You're just setting up strawmen to knock down. And if you think that making residency 50 hours a week is going to fix suicide rates, we'll have to agree to disagree.

You seem to be coming to the realization that no, people can't have it all. To be a successful general surgeon that then matches into pediatric surgery, plus build the family of your dreams, plus whatever other goals you have - is not easy. Some people can do it, some people can't. I probably would not have done well if I had kids during residency. There's only so many hours in a week. But those residency hours are necessary. As said above, what residents think is "scut" is often necessary to patient care. If you want to just operate and do nothing else patients are going to have poor care.

 

[DarkBluMage]

It's pretty overdramatic to say you can "barely afford a place of your own" on a 55K+ salary. And you're saying there's no time for a personal life but I had plenty of time to date and a large majority of single people end up meeting significant others during residency. You're just setting up strawmen to knock down. And if you think that making residency 50 hours a week is going to fix suicide rates, we'll have to agree to disagree.

You seem to be coming to the realization that no, people can't have it all. To be a successful general surgeon that then matches into pediatric surgery, plus build the family of your dreams, plus whatever other goals you have - is not easy. Some people can do it, some people can't. I probably would not have done well if I had kids during residency. There's only so many hours in a week. But those residency hours are necessary. As said above, what residents think is "scut" is often necessary to patient care. If you want to just operate and do nothing else patients are going to have poor care.

It’s “over dramatic” yet residents need multiple roommates as highly educated grown ass adults to afford living in a decent area when training in HCOL areas. People talking about pulling 100+hr weeks like that’s normal but you wana talk about having plenty of free time. Some serious cognitive dissonance going on or living in delusion. Lmbo I’m not about to argue with y’all or respond further.

 

[yeasports]

It’s “over dramatic” yet residents need multiple roommates as highly educated grown ass adults to afford living in a decent area when training in HCOL areas. People talking about pulling 100+hr weeks like that’s normal but you wana talk about having plenty of free time. Some serious cognitive dissonance going on or living in delusion. Lmbo I’m not about to argue with y’all or respond further.

This was common for everyone I knew in NYC who was trying to pursue law or finance as well.

Residency is hard for a reason and it will change you; I think for the better. I was able to laugh at how naive I was in medschool. There is a difference between wisdom and intelligence and residency jams you with the former.

 

[nofliesonme]

I'm always curious what people think is scut work. It seems to cover a very wide range of tasks many of which actually are things doctors need to be able to do.

"Scut work" is defined a non-clinical yet essential tasks that do not require a doctor's degree or expertise. Dear attendings, is your practice free of scut work?

 

[VA Hopeful Dr]

"Scut work" is defined a non-clinical yet essential tasks that do not require a doctor's degree or expertise. Dear attendings, is your practice free of scut work?

I'll need examples.

 

[ACSurgeon]

It’s “over dramatic” yet residents need multiple roommates as highly educated grown ass adults to afford living in a decent area when training in HCOL areas. People talking about pulling 100+hr weeks like that’s normal but you wana talk about having plenty of free time. Some serious cognitive dissonance going on or living in delusion. Lmbo I’m not about to argue with y’all or respond further.

I don’t know why you feel like it has to be argument. No one said you have to love working hard for many years. You just have to be willing to do it without hating your life. If you detest the concept you’re going to hate it and burn out. If you can overlook the training period, you can get through and become a surgeon. The point of contention here is what’s realistic vs not. You don’t HAVE to do pediatric surgery. However, if you decide to go down that path, then you must jump through the hopes that other people will gladly jump through.

I wanted to do pediatric surgery as an intern. Then I met a PGY 10 reapplying to pediatric surgery for the 3rd time. At that point, I lost the desire to do peds surgery despite how amazing the surgeries were. The trade off wasn’t worth it to me, but it is for countless others. Only you can decide what’s reasonable for you. You can change the goal, not so much the path to get there.

 

[ACSurgeon]

I'll need examples.

Writing notes

 

[Wordead]

"Scut work" is defined a non-clinical yet essential tasks that do not require a doctor's degree or expertise. Dear attendings, is your practice free of scut work?

I do plenty of scut work. At times, I will call to get patients appointments with medonc, radonc, etc when my nurses cant get them in quickly enough. I make sure that it happens. Because guess what - the secretaries and nurses aren't the ones that are going to look bad when your cancer patient doesnt get an appointment and doesnt get treatment in a timely fashion. I write and addend my notes for stupid insurance reasons so patients can get the imaging/procedures they need. None of this crap needs my training. But nobody else is going to do it either and your patients suffer when it doesn't get done.

 

[operaman]

It’s “over dramatic” yet residents need multiple roommates as highly educated grown ass adults to afford living in a decent area when training in HCOL areas. People talking about pulling 100+hr weeks like that’s normal but you wana talk about having plenty of free time. Some serious cognitive dissonance going on or living in delusion. Lmbo I’m not about to argue with y’all or respond further.

This is exactly why I either didn’t apply or ranked lower any high col program. If not having roommates is important, then that’s what you may have to do. I’m not sure that the issue in those cases is a salary that’s too low, but rather expectations that are too high.

Even when you’re making an attending salary, you still have to make choices. Sure, I can afford a 2m mortgage, but then I’d have to give up some other things I like. It’s not that doctor salaries are too low, just the reality of life.

Frankly I think the key areas where training needs to change are in how they prioritize the training itself. Hospitals and schools need to incentivize and reward faculty who actually teach well, especially in the OR. God bless the older surgeons Who took the time to teach me how to operate, especially now that I’m on the other side and faced with similar productivity expectations and limited time.

I’d like the see more structured integration of junior residents into the operative setting. There’s such a large scut/floor burden that makes it hard to get meaningful early operative experience, and again you need the extra time and patience from faculty to take those initial steps.

I’d like to see more opportunities for true autonomy as a chief. VA and county hospitals have gotten stricter in recent years and it’s harder to find those times to spread your wings while you still have help. Fellowship was remarkably good in this way because I had attending privileges and my own clinic as well so I got a nice balance of total autonomy while also working closely with my mentors. I’d love to find a way to bring more of that experience to the chief year. Some programs have found ways to do it, but I think others could do more.

Fewer hours and better pay may get more likes on Twitter, but I think it wouldn’t do anything to make better surgeons and may even make them worse. I’d rather see us focus reform efforts on things that will improve education and training.

 

[DOVinciRobot]

This is exactly why I either didn’t apply or ranked lower any high col program. If not having roommates is important, then that’s what you may have to do. I’m not sure that the issue in those cases is a salary that’s too low, but rather expectations that are too high.

Even when you’re making an attending salary, you still have to make choices. Sure, I can afford a 2m mortgage, but then I’d have to give up some other things I like. It’s not that doctor salaries are too low, just the reality of life.

Frankly I think the key areas where training needs to change are in how they prioritize the training itself. Hospitals and schools need to incentivize and reward faculty who actually teach well, especially in the OR. God bless the older surgeons Who took the time to teach me how to operate, especially now that I’m on the other side and faced with similar productivity expectations and limited time.

I’d like the see more structured integration of junior residents into the operative setting. There’s such a large scut/floor burden that makes it hard to get meaningful early operative experience, and again you need the extra time and patience from faculty to take those initial steps.

I’d like to see more opportunities for true autonomy as a chief. VA and county hospitals have gotten stricter in recent years and it’s harder to find those times to spread your wings while you still have help. Fellowship was remarkably good in this way because I had attending privileges and my own clinic as well so I got a nice balance of total autonomy while also working closely with my mentors. I’d love to find a way to bring more of that experience to the chief year. Some programs have found ways to do it, but I think others could do more.

Fewer hours and better pay may get more likes on Twitter, but I think it wouldn’t do anything to make better surgeons and may even make them worse. I’d rather see us focus reform efforts on things that will improve education and training.

I agree with all of this, especially the chief part. The concept of a true chief year needs to come back.

I disagree about pay. Residents should be paid double what they currently are. Burnout doesn’t come from the hours worked, it comes from the systemic abuse, and pay is a part of that.

 

[dienekes88]

People really put down gen surg online, especially mentioning the residency being unbearable. My goal right now is ENT, would I be better off doing anesthesia over gen surg if plan A doesn't work out?

General surgery is tough, but I wouldn't say its the roughest residency. General surgery residents enjoy the badge of honor, and like to promote the concept that gen surg residency is unbearable, because it is something to bond with each other over. In many respects, I support this.

Having said that, I did a decent amount of general surgery and thought it was pretty fun. They're often reasonably staffed, so many rotations can be shift work. While I don't like the shift work mentality. I did like getting out at a consistent time.

 

[Neopolymath]

THIS
I’m not even responding anymore at this point. Graduate medical training is not as efficient as it could be and it negatively affects residents to the extreme. It’s delusional to say that there’s nothing wrong and things couldn’t be changed for improvement.

Once again nice straw man. No one said that.

 

[guytakingboards]

This isn’t directed to the OP or anything but I’ve also noticed that one shouldn’t ask surgery professors “work life balance” questions in real life. Most of the time, the professors seem annoyed when this question is asked because
1. They’ve probably answered it 1000 times
2. It shows a lack of dedication and or somebody who wants to have their cake and eat it too (ie high paying prestigious job but wants to be on the golf course Fridays at 4pm)
3. I think residency used to be much worse before acgme limits. So comparatively, it may already seem “easier” to them

The annoyance, as seen in this thread, is more just frustration with the lack of understanding on the neophyte's part.

The professor thinks "you don't understand what I've done to get where I am.... or what it will take for you to accomplish what you say you want".

Imagine going to an NBA player, telling them you want to make the NBA but also asking if there is a way to cut down on the gym time.

 

[Future_Bone_Docta]

I agree with all of this, especially the chief part. The concept of a true chief year needs to come back.

I disagree about pay. Residents should be paid double what they currently are. Burnout doesn’t come from the hours worked, it comes from the systemic abuse, and pay is a part of that.

There is absolutely no reason residents shouldn't be paid midlevel salaries... especially considering they are still working double the hours in the majority of cases.

 

[emergentmd]

I am 20+ yrs out of residency before the 80 hr limit and agree or not, I think this to be 90% true.

#1 - A professor once told me, before you go into medical school you must choose if you want to be the best parent or the best physician because you can't be the best at both. This is 100% true. If you are going to be the best doc, you must sacrifice your family. Anyone who says otherwise, do not understand what being a great parent is.

#2 - Residencies suck. Being General surgery Suck but not the most difficult. As an ER doc, I rotated through OB, Peds, IM, Surg, Trauma, Ortho, NSG and would rate suck factor as NSG >>> OB>Gen Surg=Trauma>IM>ER=Ortho>Peds. Any specialty who complains about hours will never understand the depths of hell compared to the NSG residents pre hour restrictions. I did my 120/wk Q3 surg calls with 36 hr shifts. 36 on, 8 off, 12 on, 12 off, 12 on, 12 off, 36 on.......... The NSG did Q2 calls sometimes 4-6 months STRAIGHT.

#3 - Perceived Scut is a large gray area and will never change. Sometimes there is less, some is more, but bottom line is you learn alot about humility when you do the Scut. Very necessary part of being a doc IMO.

#4 - If you have kids during 90% of the residencies, you WILL be a missing parent. Bottom line. You will miss many of their activities, you will miss nights with them, you will miss waking up with them, you will miss times when they have a bad day needing Mommy/daddy, you will miss dinner with them, you will miss family functions, you will miss family vacations, you will miss their first steps, you will miss their first words, you will miss their first day at school, you will miss going to church with the family, you WILL MISS 90% of family functions. So if you have kids during residency, you will essentially be a missing parent for 3-7 yrs during their most vulnerable/impressionable years. If kids and a strong bond is important to you, then DO NOT have kids in residency/med school. You build bonds with kids during their pre school/elementary years and if you are not present you will not build that bond. When you are always tired, you will not build that bond. When they are in middle school/HS, you will not be able to create this trust/bond and when they are in college/adults, you have yourself to blame if they will not come to you when they need you. Don't wonder why some adults/college kids love coming home to their parents when your kids avoid coming home, Its because they have learned not to need you and that bond/trust was never built.

I am an ER doc, and scheduled my shifts from day one around my kids activities. I never miss any big events, family trips, family function. No way could I have done this during residency. Parents wonder why my middle school kids come to give me hugs during school while their kids avoid eye contact with them.

#5 - Best to have kids after residency and tailor your practice around your family if family is what is important. Same as #4. You can't be a surgeon, work 60 hrs a week, take call every 4th, and have the energy to build bonds with your family/kids. I know a surgeon couple with one kid. Sad to see this kid go to after school care every day when other parents come to get their kids. They have chosen career./financial success over family. All docs can choose family over their careers once they are attendings. There are plenty of mommy/daddy tracts where you work less, take no call, have a predictable schedule but make less $$$. I know of surgeons who went from a high paying/high hour career and transitioned to a 9-4 job 4 dys a week, no call doing elective surgery only. Its your choice but you will not have both.

Everyone should do what is best for their family, but don't lie to yourself that you can be a good parent when you are not around 75% of the time.

 

[Tangerine123]

We could cut hours in half and double the time of training if you would prefer. Much if medicine is about repetition, gotta put in the hours somehow. Most would prefer things compressed rather than drawn out as they are in Europe, where even qualification as a general practitioner can often take 5-6 PGY years.

Sure, 5-6 years in Europe, but:

40 Hour weeks
30 days PTO
Up to 6 weeks worth of sick "days"
1-2 Shifts per Month (or more if you want). And you get to chose when, I usually just go for day shifts on Saturday/Sunday because I hate nights.
Up to 3 years of maternal/paternal leave

Idk why so many people are allergic to this concept

 

[astrobean]

THIS
I’m not even responding anymore at this point. Graduate medical training is not as efficient as it could be and it negatively affects residents to the extreme. It’s delusional to say that there’s nothing wrong and things couldn’t be changed for improvement.

Overall agree with your sentiments and concerns. I think once you're on rotations you'll see one of the issues though, which is that, similar to this thread, most surgical residents essentially agree with the need for many many hours and cases. I was at a unionized residency and often the surgical fields would push back against our efforts to have shorter shift lengths, less 24 h call, lower work hour limits or even increasing the number of residents to get those things done because they were truly concerned they would not get the training they needed and wanted, mostly in the form of fewer cases. They said this in safe spaces, away from their PDs and superiors, and I don't think were in a hostage situation. Are there inefficiencies, yes, but some of those "inefficiencies" like actually talking to patients, dressing changes, consenting, etc, are necessary. Surgeons really do have to do more because they both need to learn to be clinicians AS WELL AS surgeons. I'm not a surgeon but it seems like most good surgical fields already have far more NPs than non-surgical fields who largely field alot of the day to day clinical work inpatient like discharges, talking to family, answering pages about constipation, etc. So I think most good programs are aware of this and trying to outsource time intensive things to free up OR time for the residents.

If you don't have a partner who can shoulder the brunt of caregiving while you are in residency through time, or through money (independently wealthy, doesn't need to work, or makes alot of money and can pay for child care) your vision of a happy life I feel will be hard to achieve in a surgical specialty. You'll be applying to residency pretty soon so I don't think there will be paradigm shifts before you matriculate. It's not right, but if you can't imagine having on average 2 hours of free time a night with your kids, and 4 days off a month for 5 years (research years are what bring you to 7, and though alot of people do additional shifts and moonlighting then, my understanding those years are pretty low key) theny. you should probably not do surgery. But do the rotations and see what happens.

 

[voxveritatisetlucis]

Sure, 5-6 years in Europe, but:

40 Hour weeks
30 days PTO
Up to 6 weeks worth of sick "days"
1-2 Shifts per Month (or more if you want). And you get to chose when, I usually just go for day shifts on Saturday/Sunday because I hate nights.
Up to 3 years of maternal/paternal leave

Idk why so many people are allergic to this concept

And doctors in Europe make like 80k USD per year. Maybe even less now that the euro has fallen so much

There’s probably a reason for that.

 

[Wordead]

Sure, 5-6 years in Europe, but:

40 Hour weeks
30 days PTO
Up to 6 weeks worth of sick "days"
1-2 Shifts per Month (or more if you want). And you get to chose when, I usually just go for day shifts on Saturday/Sunday because I hate nights.
Up to 3 years of maternal/paternal leave

Idk why so many people are allergic to this concept

Idk probably because I dont want to be a resident for 10 years which is what you're talking about for surgical residencies? There are many european residencies like that - you are a Registrar or whatever for years and years. F that.

 

[JMS54]

The disrespect and confrontation in the way you write is not going to help you in any specialty let alone one as demanding as surgery. Residency will be long and difficult no matter the specialty. If you want to do something as complicated as pediatric surgery of any type you have to put in the time. You have to have the humility to be appreciative for the opportunity to be there in the first place when many others would take your spot in a millisecond. GME is far from perfect but you have to respect the work and maturity needed to practice this type of work. Gotta pay your dues my man.

I have 2 kids and I’m a 4th year applying Ortho… I’m in my early 30’s and my wife is a saint…. I do what I do because I love it and it will one day pay off… I think you need to do some soul searching and decide what you want and how hard your willing to work for it

I do wish you the best of luck and please DM me if you would like any more advice.

 

[ChordaEpiphany]

The problem is that the scut work is often far more educational than you realize in the moment. Man I hated being on nights as the intern and having to respond to every floor page about Tylenol or “so and so pulled out their NG tube” or “hey X is delirious and climbing on the walls.” But looking back, it was taking those calls over and over that taught me how to trouble shoot the common management issues that arise without running to my chief everytime.

We already have integrated programs for the specialties that could be shortened.

I do agree with residents being cheap labor for hospitals, which needs to change. But that isn’t going to change hours worked.

I can definitely see this. I'd argue a lot of the specialties aren't all that integrated. For instance, integrated thoracic is basically 100% oriented towards cards. General advice for the general thoracic pathway is to do a 5+2 or 5+3. Then if you want to go academic and work on lung cancer as a surgeon (or if you want surg onc or peds surg), you're looking at 7+2 or even 7+3. That's more than neurosurgery... Also, seems like a heavy focus on a particular area in a chief year would do the same as another year of specialty training in a lot of the 1 year fellowships, especially when you consider that general surgeons with no extra training or emphasis at all handle a whole lot of vascular, breast, endocrine, skin and soft tissue surgeries when they practice in areas with few specialists. But the integration is a step in the right direction.

I do agree with a lot of the sentiment in this thread around peds surgery though. Some things are just nuts. Peds surgery is one of those things, right along with neurosurgery, cardiac surgery, etc... No one ever minced words about those paths. You get to be indispensable, wealthy, and rare. The price has always been a bad home life. Cardiac surgeons used literally live at the hospital, and neurosurgery's lifestyle is infamous. OP, you have options, and one of those options is not doing peds surgery and instead doing 5-6 years of training to become some other type of surgeon. I'm a little pissed about the general thoracic pathway because I think general thoracic is dope. If I wanted peds I'd quit whining.

Sure, 5-6 years in Europe, but:

40 Hour weeks
30 days PTO
Up to 6 weeks worth of sick "days"
1-2 Shifts per Month (or more if you want). And you get to chose when, I usually just go for day shifts on Saturday/Sunday because I hate nights.
Up to 3 years of maternal/paternal leave

Idk why so many people are allergic to this concept

I think what's missing between Europe and the US is the inefficiency of college/med school. I have a number of European colleagues in the lab trying to do some research pre-match. They're distraught over being "so old" because they'll finish med school around 27 due to taking several years for research. We could trim the fat and develop more 6 and 7 year integrated MD programs, and we could stop normalizing research years for people who figured out halfway through 3rd year they wanted something competitive. It's just a dumb practice that needs to stop. Is the applicant good or not? What could demonstrate more dedication to the specialty than applying into it? Everyone starts intern year an incompetent idiot. Research years and prior work experience won't change that. I've now done 7 years of oncology research counting undergrad and PhD. If I go into heme/onc I'd still start fellowship an incompetent idiot.

 

[Mad Jack]

Sure, 5-6 years in Europe, but:

40 Hour weeks
30 days PTO
Up to 6 weeks worth of sick "days"
1-2 Shifts per Month (or more if you want). And you get to chose when, I usually just go for day shifts on Saturday/Sunday because I hate nights.
Up to 3 years of maternal/paternal leave

Idk why so many people are allergic to this concept

For surgery you're looking at 10 years. After medical school. Most people would rather cram it and not miss out on 2 million dollars from the opportunity cost alone.

 

[Dantes]

I think I would take the salary hit and better work-life balance in European residencies if it also meant I wouldn't be staring down a quarter million dollars+ in debt.

 

[Lawpy]

People really put down gen surg online, especially mentioning the residency being unbearable. My goal right now is ENT, would I be better off doing anesthesia over gen surg if plan A doesn't work out?

The internet amplifies the negative aspects of any specialty because frustrated people will take the time to bash the specialty online

The people who actually like a specialty usually won’t be spending the time posting full lengthy defenses unless they have a lot of downtime

 

[VA Hopeful Dr]

I think I would take the salary hit and better work-life balance in European residencies if it also meant I wouldn't be staring down a quarter million dollars+ in debt.

I would not.

 

[ChordaEpiphany]

The internet amplifies the negative aspects of any specialty because frustrated people will take the time to bash the specialty online

The people who actually like a specialty usually won’t be spending the time posting full lengthy defenses unless they have a lot of downtime

To add to this, it's program dependent. I know in my city the top programs are known for being much more cush while the safety net hospital programs are sink or swim. I know some prelim IM residents who had much worse intern years than categorical surgery residents.

Also, most people waste enough time that just getting your act together can make 80 hours much more reasonable. I work a consistent 60 now and easily waste 20 hours on things that are not fulfilling and leave me drained instead of fulfilled (e.g., right now). In residency I plan to set up my life in a much more fulfilling way (e.g., closer to family, living with partner instead of roommates, home gym, minimize commute). When I have really tough weeks (up to 90 hours/week), following strict rules (e.g., get to the gym at 6 am, no coffee after 10 am, pomodoro timer for desk work, strict to do lists) improves my efficiency enough that I actually tend to spend more time with friends/family.

 

[Lawpy]

I think I would take the salary hit and better work-life balance in European residencies if it also meant I wouldn't be staring down a quarter million dollars+ in debt.

I can at least understand largely because US med school debt is a scam aggressively exploited by med school admins

 

[Lawpy]

To add to this, it's program dependent. I know in my city the top programs are known for being much more cush while the safety net hospital programs are sink or swim. I know some prelim IM residents who had much worse intern years than categorical surgery residents.

Also, most people waste enough time that just getting your act together can make 80 hours much more reasonable. I work a consistent 60 now and easily waste 20 hours on things that are not fulfilling and leave me drained instead of fulfilled (e.g., right now). In residency I plan to set up my life in a much more fulfilling way (e.g., closer to family, living with partner instead of roommates, home gym, minimize commute). When I have really tough weeks (up to 90 hours/week), following strict rules (e.g., get to the gym at 6 am, no coffee after 10 am, pomodoro timer for desk work, strict to do lists) improves my efficiency enough that I actually tend to spend more time with friends/family.

Top programs can afford to be cush because they know they can attract the best faculty who care about a good training environment. Many programs unfortunately don’t have that choice

 

[VA Hopeful Dr]

Idk probably because I dont want to be a resident for 10 years which is what you're talking about for surgical residencies? There are many european residencies like that - you are a Registrar or whatever for years and years. F that.

Yep. In the UK at least its competency based with specialty training being a minimum of 7 years but can easily be longer.

 

[DOVinciRobot]

I am 20+ yrs out of residency before the 80 hr limit and agree or not, I think this to be 90% true.

#1 - A professor once told me, before you go into medical school you must choose if you want to be the best parent or the best physician because you can't be the best at both. This is 100% true. If you are going to be the best doc, you must sacrifice your family. Anyone who says otherwise, do not understand what being a great parent is.

#2 - Residencies suck. Being General surgery Suck but not the most difficult. As an ER doc, I rotated through OB, Peds, IM, Surg, Trauma, Ortho, NSG and would rate suck factor as NSG >>> OB>Gen Surg=Trauma>IM>ER=Ortho>Peds. Any specialty who complains about hours will never understand the depths of hell compared to the NSG residents pre hour restrictions. I did my 120/wk Q3 surg calls with 36 hr shifts. 36 on, 8 off, 12 on, 12 off, 12 on, 12 off, 36 on.......... The NSG did Q2 calls sometimes 4-6 months STRAIGHT.

#3 - Perceived Scut is a large gray area and will never change. Sometimes there is less, some is more, but bottom line is you learn alot about humility when you do the Scut. Very necessary part of being a doc IMO.

#4 - If you have kids during 90% of the residencies, you WILL be a missing parent. Bottom line. You will miss many of their activities, you will miss nights with them, you will miss waking up with them, you will miss times when they have a bad day needing Mommy/daddy, you will miss dinner with them, you will miss family functions, you will miss family vacations, you will miss their first steps, you will miss their first words, you will miss their first day at school, you will miss going to church with the family, you WILL MISS 90% of family functions. So if you have kids during residency, you will essentially be a missing parent for 3-7 yrs during their most vulnerable/impressionable years. If kids and a strong bond is important to you, then DO NOT have kids in residency/med school. You build bonds with kids during their pre school/elementary years and if you are not present you will not build that bond. When you are always tired, you will not build that bond. When they are in middle school/HS, you will not be able to create this trust/bond and when they are in college/adults, you have yourself to blame if they will not come to you when they need you. Don't wonder why some adults/college kids love coming home to their parents when your kids avoid coming home, Its because they have learned not to need you and that bond/trust was never built.

I am an ER doc, and scheduled my shifts from day one around my kids activities. I never miss any big events, family trips, family function. No way could I have done this during residency. Parents wonder why my middle school kids come to give me hugs during school while their kids avoid eye contact with them.

#5 - Best to have kids after residency and tailor your practice around your family if family is what is important. Same as #4. You can't be a surgeon, work 60 hrs a week, take call every 4th, and have the energy to build bonds with your family/kids. I know a surgeon couple with one kid. Sad to see this kid go to after school care every day when other parents come to get their kids. They have chosen career./financial success over family. All docs can choose family over their careers once they are attendings. There are plenty of mommy/daddy tracts where you work less, take no call, have a predictable schedule but make less $$$. I know of surgeons who went from a high paying/high hour career and transitioned to a 9-4 job 4 dys a week, no call doing elective surgery only. Its your choice but you will not have both.

Everyone should do what is best for their family, but don't lie to yourself that you can be a good parent when you are not around 75% of the time.

I disagree with this whole heartedly.

whole lot of vascular, breast, endocrine, skin and soft tissue surgeries when they practice in areas with few specialists.

Yes, but you should be learning the basics of those in general surgery residency.

Top programs can afford to be cush because they know they can attract the best faculty who care about a good training environment. Many programs unfortunately don’t have that choice

It’s not about faculty, it’s about money to pay for massive teams of midlevels and have fully staffed departments.

 

[Banco]

As someone in surg residency right now, it takes a specific mindset to thrive in it. How "bad" or "good" it is is dependent on how the residents do in it. In my own program many love it, some are indifferent, some hate it, it's just hard to generalize. Probably 10% wouldn't choose it again.

But I will say we all have to work very hard, more emergencies, longer hours, sicker patients, more consults etc. We also do the primary patient care for hospitalized patients in comparison to other surgical specialties, and definitely the most amount of critical care/ICU. So if you want to operate AND take care of patients in difficult situations, it's a good field; you still get to maintain a lot of your "medicine" knowledge and apply it. If you go into it with the mindset "I embrace this challenge and I'll come out better on the other side," you're likely to thrive in it. Of course there is also a lot of BS associated with residency in general that can make life harder (this applies to all residencies).

In reality I've gone over 80 hours probably 15% of the time, and average around 70.

For the OP, ENT, gen surg, and anesthesia are all very cool but very different fields. You need to explore them all to get a good understanding of what it entails to practice them. Anesthesia is actually pretty awesome as you get a lot of critical care/procedures in through it; they have a really good mastery of physiology and work closely with general surgeons both in the OR and in the ICU. ENT is also cool but very specialized/niche all things considered.

 

[ChordaEpiphany]

Top programs can afford to be cush because they know they can attract the best faculty who care about a good training environment. Many programs unfortunately don’t have that choice

I don't think that's really true. Top faculty don't care about a good training environment. If anything, top hospitals/universities make advancing very difficult, so faculty tend to be a little more aggressive, demanding, and selfish. Also, in academia the top sort of selects for selfishness and pushiness. If we really want to go deep we can start at the complainers in undergrad who demanded a regrade for every non-A+ grade. Those people turn into complainers who push for a co-first authorship on a paper they contributed relatively little to. Then those people turn into faculty who string along trainees and hold people in the "instructor" position for 10+ years. The top systems can be very malignant.

It’s not about faculty, it’s about money to pay for massive teams of midlevels and have fully staffed departments.

This is the actual answer. The safety net hospital relies on residents, and the patients there don't know or care who's treating them. The logical thing to do for the admin is to ride the residents for everything they can squeeze out of them. The top university has a reputation to maintain, and that means not only training good residents but also providing really high quality care (or at least appearing to do so). If the Cleveland Clinic or Mayo went south and started throwing residents/fellows into the deep end, they'd probably lose their stranglehold on executive care and the donations that come with it. If MGH/Hopkins lost their reputations, they'd stop getting high profile patients from overseas who donate tens of millions after a good experience.

 

[emergentmd]

I disagree with this whole heartedly.

You are still a resident with bright rainbow glasses on which is great. But eventually reality sets in, priority changes, and people who thinks they can have it all find out they can't.

As in sports, Dependability is Availability and Availability is more important than Ability. If you are a resident working 60-80 hrs a week, No matter your ability you will lack the availability.

A child's bond is created from you being around all the time rather than the episodic times when you around but a superstar parent.

Its hard for people to accept that being a resident and having kids is a selfish act placed on a child by an adult who wants everything. No matter how you rationalize that you are a good parent, from the child's eye you are a missing parent working 60-80 hrs/wk.

Look, I chose to have kids after residency b/c no matter what, I was working 80-100 hrs most weeks and sleeping another 40 hrs. And when I had kids, I worked 30 hrs/wk so I could be present as much as possible. Even then, there were times when my kids wondered why I worked so much on weeks when I had shift clumping.

What you perceive as being present is not how a child sees it which is all that matters.

 

[voxveritatisetlucis]

I am 20+ yrs out of residency before the 80 hr limit and agree or not, I think this to be 90% true.

#1 - A professor once told me, before you go into medical school you must choose if you want to be the best parent or the best physician because you can't be the best at both. This is 100% true. If you are going to be the best doc, you must sacrifice your family. Anyone who says otherwise, do not understand what being a great parent is.

#2 - Residencies suck. Being General surgery Suck but not the most difficult. As an ER doc, I rotated through OB, Peds, IM, Surg, Trauma, Ortho, NSG and would rate suck factor as NSG >>> OB>Gen Surg=Trauma>IM>ER=Ortho>Peds. Any specialty who complains about hours will never understand the depths of hell compared to the NSG residents pre hour restrictions. I did my 120/wk Q3 surg calls with 36 hr shifts. 36 on, 8 off, 12 on, 12 off, 12 on, 12 off, 36 on.......... The NSG did Q2 calls sometimes 4-6 months STRAIGHT.

#3 - Perceived Scut is a large gray area and will never change. Sometimes there is less, some is more, but bottom line is you learn alot about humility when you do the Scut. Very necessary part of being a doc IMO.

#4 - If you have kids during 90% of the residencies, you WILL be a missing parent. Bottom line. You will miss many of their activities, you will miss nights with them, you will miss waking up with them, you will miss times when they have a bad day needing Mommy/daddy, you will miss dinner with them, you will miss family functions, you will miss family vacations, you will miss their first steps, you will miss their first words, you will miss their first day at school, you will miss going to church with the family, you WILL MISS 90% of family functions. So if you have kids during residency, you will essentially be a missing parent for 3-7 yrs during their most vulnerable/impressionable years. If kids and a strong bond is important to you, then DO NOT have kids in residency/med school. You build bonds with kids during their pre school/elementary years and if you are not present you will not build that bond. When you are always tired, you will not build that bond. When they are in middle school/HS, you will not be able to create this trust/bond and when they are in college/adults, you have yourself to blame if they will not come to you when they need you. Don't wonder why some adults/college kids love coming home to their parents when your kids avoid coming home, Its because they have learned not to need you and that bond/trust was never built.

I am an ER doc, and scheduled my shifts from day one around my kids activities. I never miss any big events, family trips, family function. No way could I have done this during residency. Parents wonder why my middle school kids come to give me hugs during school while their kids avoid eye contact with them.

#5 - Best to have kids after residency and tailor your practice around your family if family is what is important. Same as #4. You can't be a surgeon, work 60 hrs a week, take call every 4th, and have the energy to build bonds with your family/kids. I know a surgeon couple with one kid. Sad to see this kid go to after school care every day when other parents come to get their kids. They have chosen career./financial success over family. All docs can choose family over their careers once they are attendings. There are plenty of mommy/daddy tracts where you work less, take no call, have a predictable schedule but make less $$$. I know of surgeons who went from a high paying/high hour career and transitioned to a 9-4 job 4 dys a week, no call doing elective surgery only. Its your choice but you will not have both.

Everyone should do what is best for their family, but don't lie to yourself that you can be a good parent when you are not around 75% of the time.

This should be stickied imo

 

[VA Hopeful Dr]

You are still a resident with bright rainbow glasses on which is great. But eventually reality sets in, priority changes, and people who thinks they can have it all find out they can't.

As in sports, Dependability is Availability and Availability is more important than Ability. If you are a resident working 60-80 hrs a week, No matter your ability you will lack the availability.

A child's bond is created from you being around all the time rather than the episodic times when you around but a superstar parent.

Its hard for people to accept that being a resident and having kids is a selfish act placed on a child by an adult who wants everything. No matter how you rationalize that you are a good parent, from the child's eye you are a missing parent working 60-80 hrs/wk.

Look, I chose to have kids after residency b/c no matter what, I was working 80-100 hrs most weeks and sleeping another 40 hrs. And when I had kids, I worked 30 hrs/wk so I could be present as much as possible. Even then, there were times when my kids wondered why I worked so much on weeks when I had shift clumping.

What you perceive as being present is not how a child sees it which is all that matters.

I think you overestimate how kids see things

My dad was an optometrist but also a huge gym guy so M-F he was out of the house 730am-630/7pm and on Saturday worked 8-1 and then the gym until 3 or so. Not full resident 80 hour weeks but this wasn't a temporary thing either. However, when he was home he was 100% present as a dad. At no point do I remember thinking that he wasn't around enough.

 

[VA Hopeful Dr]

This should be stickied imo

I disagree. The overall point is OK (you will miss some things as a parent due to residency) but its a bit too black and white to be universally true.

 

[emergentmd]

I think you overestimate how kids see things

My dad was an optometrist but also a huge gym guy so M-F he was out of the house 730am-630/7pm and on Saturday worked 8-1 and then the gym until 3 or so. Not full resident 80 hour weeks but this wasn't a temporary thing either. However, when he was home he was 100% present as a dad. At no point do I remember thinking that he wasn't around enough.

Nothing said should be universally true even if it come across this way. I think its just common sense that there are always exceptions. But I stand by this for the majority of households.

I think you have made my point. Your dad structured his extracurricular activities around your schedule which worked for you. I structure my extracurricular activities around my kids life. When they have sports activities, I take off. When they have school events, I schedule off.

But as a resident, You are not allowed to schedule your work life around your kids but the other way around which is completely different.

This note was given to me before I went to work by my then 8 yr old daughter, "Dear Dad, Have a nice day at work. Thank you for taking time out of your time to be with us. Thank you for coming to XXXX. I'm So thankful to have you as a father. Have a good Monday. Love, XXXX"

 

[ACSurgeon]

I am 20+ yrs out of residency before the 80 hr limit and agree or not, I think this to be 90% true.

#1 - A professor once told me, before you go into medical school you must choose if you want to be the best parent or the best physician because you can't be the best at both. This is 100% true. If you are going to be the best doc, you must sacrifice your family. Anyone who says otherwise, do not understand what being a great parent is.

#2 - Residencies suck. Being General surgery Suck but not the most difficult. As an ER doc, I rotated through OB, Peds, IM, Surg, Trauma, Ortho, NSG and would rate suck factor as NSG >>> OB>Gen Surg=Trauma>IM>ER=Ortho>Peds. Any specialty who complains about hours will never understand the depths of hell compared to the NSG residents pre hour restrictions. I did my 120/wk Q3 surg calls with 36 hr shifts. 36 on, 8 off, 12 on, 12 off, 12 on, 12 off, 36 on.......... The NSG did Q2 calls sometimes 4-6 months STRAIGHT.

#3 - Perceived Scut is a large gray area and will never change. Sometimes there is less, some is more, but bottom line is you learn alot about humility when you do the Scut. Very necessary part of being a doc IMO.

#4 - If you have kids during 90% of the residencies, you WILL be a missing parent. Bottom line. You will miss many of their activities, you will miss nights with them, you will miss waking up with them, you will miss times when they have a bad day needing Mommy/daddy, you will miss dinner with them, you will miss family functions, you will miss family vacations, you will miss their first steps, you will miss their first words, you will miss their first day at school, you will miss going to church with the family, you WILL MISS 90% of family functions. So if you have kids during residency, you will essentially be a missing parent for 3-7 yrs during their most vulnerable/impressionable years. If kids and a strong bond is important to you, then DO NOT have kids in residency/med school. You build bonds with kids during their pre school/elementary years and if you are not present you will not build that bond. When you are always tired, you will not build that bond. When they are in middle school/HS, you will not be able to create this trust/bond and when they are in college/adults, you have yourself to blame if they will not come to you when they need you. Don't wonder why some adults/college kids love coming home to their parents when your kids avoid coming home, Its because they have learned not to need you and that bond/trust was never built.

I am an ER doc, and scheduled my shifts from day one around my kids activities. I never miss any big events, family trips, family function. No way could I have done this during residency. Parents wonder why my middle school kids come to give me hugs during school while their kids avoid eye contact with them.

#5 - Best to have kids after residency and tailor your practice around your family if family is what is important. Same as #4. You can't be a surgeon, work 60 hrs a week, take call every 4th, and have the energy to build bonds with your family/kids. I know a surgeon couple with one kid. Sad to see this kid go to after school care every day when other parents come to get their kids. They have chosen career./financial success over family. All docs can choose family over their careers once they are attendings. There are plenty of mommy/daddy tracts where you work less, take no call, have a predictable schedule but make less $$$. I know of surgeons who went from a high paying/high hour career and transitioned to a 9-4 job 4 dys a week, no call doing elective surgery only. Its your choice but you will not have both.

Everyone should do what is best for their family, but don't lie to yourself that you can be a good parent when you are not around 75% of the time.

Yea medical students/doctors are high achievers and wanna think they can be excellent at multiple things at the same time. I agree that parenting is time, energy and emotionally consuming. I did 6 years of surgery/critical and then spent six years raising kids. Residency was a cake walk hands down in comparison.

Parenting is an experiment. You don’t know the results until 20-25 years later. Some kids turn out great with overbearing parents who are always present and available. Some become spoiled and lazy. Some kids turn out great with strict parents or parents who are busy with their careers. Some rebel. I think it’s simplistic to make it seem like availability is all that matters. Although it’s a huge part I know. I’m not arguing with you, just reflecting as a parent who always feels conflicted as to where the right balance falls.

Finally, we currently live in a very selfish society. People have kids that they want even if they’re too busy for them. Family ties are disrupted and siblings are usually scattered and aging parents often have no one around. Young adults feel entitled to do what they want and think it’s their right to stick it to their parents. Parents maybe think it’s not worthwhile to sacrifice their career or desires for their kids, because they realize these kids will grow up to be independent and distant from the parent. Just my reflections.

 

[emergentmd]

Kids definitely is an experimental crapshoot where you, at the end of the day, do not an iron clad control of the outcome. Great parents have crappy kids. Crappy parents have mature productive kids.

But your chance of a better outcome/relationship has a direct correlation to being present. Just like everything in life. The effort and time matters.

 

[DOVinciRobot]

You are still a resident with bright rainbow glasses on which is great. But eventually reality sets in, priority changes, and people who thinks they can have it all find out they can't.

As in sports, Dependability is Availability and Availability is more important than Ability. If you are a resident working 60-80 hrs a week, No matter your ability you will lack the availability.

A child's bond is created from you being around all the time rather than the episodic times when you around but a superstar parent.

Its hard for people to accept that being a resident and having kids is a selfish act placed on a child by an adult who wants everything. No matter how you rationalize that you are a good parent, from the child's eye you are a missing parent working 60-80 hrs/wk.

Look, I chose to have kids after residency b/c no matter what, I was working 80-100 hrs most weeks and sleeping another 40 hrs. And when I had kids, I worked 30 hrs/wk so I could be present as much as possible. Even then, there were times when my kids wondered why I worked so much on weeks when I had shift clumping.

What you perceive as being present is not how a child sees it which is all that matters.

I just disagree. Not just based on my own experiences but surgeon families that I know personally, outside of training. I have always found the critique of surgeons and their parenting almost always comes from non-surgeons. I have no rainbow glasses on, I am far more “established” in life than the average resident.

I simply disagree with your entire premise that you should only have kids when you can dedicate all your time to them. I find that perspective extremely jaded, cynical and quite frankly not much grounded in the reality of most parents. Most parents work, and most work at least 40 hours a week and are not as present as you insinuate. Availability means many different things, and it’s not just being around constantly.

 

[VA Hopeful Dr]

I just disagree. Not just based on my own experiences but surgeon families that I know personally, outside of training. I have always found the critique of surgeons and their parenting almost always comes from non-surgeons. I have no rainbow glasses on, I am far more “established” in life than the average resident.

I simply disagree with your entire premise that you should only have kids when you can dedicate all your time to them. I find that perspective extremely jaded, cynical and quite frankly not much grounded in the reality of most parents. Most parents work, and most work at least 40 hours a week and are not as present as you insinuate. Availability means many different things, and it’s not just being around constantly.

Agreed. I had a good friend growing up whose father was a surgeon (this was the 80s/90s). There were 6 kids total. They've all turned out pretty well.

 

[Mad Jack]

I think you overestimate how kids see things

My dad was an optometrist but also a huge gym guy so M-F he was out of the house 730am-630/7pm and on Saturday worked 8-1 and then the gym until 3 or so. Not full resident 80 hour weeks but this wasn't a temporary thing either. However, when he was home he was 100% present as a dad. At no point do I remember thinking that he wasn't around enough.

What's a dad?

Really though, my dad was a pipefitter that worked on the road. He would be gone for 2-4 weeks at a time then get a few days to come home before the next project began. Was always nice to have him home and he did a fine enough job, taught me the value of hard work and sacrifice. Took enough time to teach me all the things I needed to be taught at that age when he was free. Never felt all that bad or upset by the situation, that was just life. I knew other kids growing up who had dads that were truckers, soldiers, traveling contractors, oil workers, and the like who were all in the same boat. Honestly most of them ended up pretty well adjusted and successful, while the more spoiled kids tended to struggle with the hard realities of life when they were out of the home.

 

[emergentmd]

I am not disputing that kids can turn out well with parents working 80 hrs/wk. I am not disputing that kids can turn out well in a single parent home who works all the time. I am not disputing that having parents physically present all the time doesnt equate to being a good parent.

It is just my opinion that you can not be a good parent if you are not present. If you are a resident and work 80 hrs/wk, you are not present as much as you would like to rationalize it. All things being equal, a parent who works 40 hrs/wk and spend an extra 40 hrs/wk with their kids will in general have better connections with their kids than a parent who works 80hrs/wk.

 

[ChordaEpiphany]

I am not disputing that kids can turn out well with parents working 80 hrs/wk. I am not disputing that kids can turn out well in a single parent home who works all the time. I am not disputing that having parents physically present all the time doesnt equate to being a good parent.

It is just my opinion that you can not be a good parent if you are not present. If you are a resident and work 80 hrs/wk, you are not present as much as you would like to rationalize it. All things being equal, a parent who works 40 hrs/wk and spend an extra 40 hrs/wk with their kids will in general have better connections with their kids than a parent who works 80hrs/wk.

Where this logic falls flat for me is the part where parents working 40 hours/week are spending an extra 40 hours with their kids. First, the vast majority of decently paid jobs now require 50 hours/week. Most residents are going to be in the 60-70 range (worse in internship), and surgical residents will be in the 70-80 range consistently. So you're losing ~20-30 hours/week compared to a more typical working professional. In terms of lifestyle, this is massive. It feels smaller in terms of absolute time spent with children, especially if you make them the priority.

If you tracked a normal, responsible parent's time with their kid, I bet they take plenty of time for themself. My friends with office jobs and young kids are still putting hours into gaming, hobbies, fitness, and seeing friends (albeit some of these do suffer).

It seems like the hardest part of being a resident and a parent would be the lack of control over your hours and the strain you'll put on others. You'd probably be bleeding money from the daycare/sitter expenses. You'd be relying heavily on your spouse (and potentially parents or in-laws if they're local). If being a parent was your #1 priority, I think you could do fine on total hours. You'll probably just find yourself exhausted, out of shape, and disconnected from friends. If your marriage wasn't strong before, it would probably suffer quite a bit through something like this.

 

[DOVinciRobot]

It is just my opinion that you can not be a good parent if you are not present. If you are a resident and work 80 hrs/wk, you are not present as much as you would like to rationalize it. All things being equal, a parent who works 40 hrs/wk and spend an extra 40 hrs/wk with their kids will in general have better connections with their kids than a parent who works 80hrs/wk.

So all surgery residents and surgeons are bad parents.. that’s…. Quite the take..

Again, being present means a lot of things. I know surgeons far more present for their kids than some stay at home parents….

 

[NotAProgDirector]

Although quantity of time with kids is important, quality is more important. Regular, dependable, quality time is the key.

Could I be at every kindergarten play that my child was in? No, and it doesn't really matter. It seems like it matters at the time, but it doesn't.

But I made sure to get home before bedtime most days. And no matter how tired I was, when I got home it was Daddy Time. Bedtime reading, dinner, etc. I would leave work with some stuff still undone, spend time with my kids, get them into bed, and then get back to work.

As my kids got older, it became clear that my efforts were best focused on homework help.

Days off were kid focused.

And on call weekends? Also kid focused. Would bring them to work with me. They would color pictures with the nurses. I pulled them around in a wagon in the hospital. And then we went to the cafeteria, which they thought was the coolest restaurant ever. Then Mom came and picked them up.

My wife spent many more hours with them than I did, but I'd happily wager that my relationship with them is stronger than hers. (That's not the type of wager you ever make though, much like not deciding which child you like most).

 

[emergentmd]

So all surgery residents and surgeons are bad parents.. that’s…. Quite the take..

Again, being present means a lot of things. I know surgeons far more present for their kids than some stay at home parents….

I never said all surgery residents and surgeons are bad parents. But if you are a surgery resident working 80hrs/wk, you will be an absent parent. Being an absent parent makes the chance of you being a good parent extremely difficult.

We will just have to disagree. But when I were a resident doing 80-120hrs/wk, in no way could I be a present or good parent if I saw my kid 10 hrs a wk and slept the rest.

There is 168 hrs in a week. If I worked 100 on avg, that leaves 68 hrs. Even if I can live off 6 hrs of sleep a day, that leaves 24 hrs a week to do something. Even if I did nothing else but be at home and play with the kids, half the time they would be alseep/school. So At most I would see them 2 hrs a day if I am lucky and many weeks maybe not at all.

I will stand by my opinion that anyone who works 80-100 hrs wk in residency will not be present and be very hard pressed to have a connection with their kids.

I am sure Michael Jordan would have been a great basketball player if he spent 1/5th of the time at his craft compared to most other NBA players. But with all things being equal, Michael Jordan spending 60 hrs a week practicing basketball would be a better player than MJ spending 10 hrs practicing.

Look at surgery. If you spent 50 hrs wk operating vs someone spending 10 hrs wk operating, my money on who would have better skills would be the 50 hrs a wk resident. Sure there are some superstar 10 hr wk surgeons and some crappy 50 hrs a week residents but being present matters.

 

[catlady87]

I’m a resident in a surgical sub specialty, not gen surg, although our intern year is half gen surg type rotations, so we get a little exposure.

Hours wise, I’m not convinced the gen surg residents truly work more than us, although their call is structured differently. There seems to be a general unhappiness or sense of mistreatment in their program compared to ours. Satisfaction seems lower, and people complain that there are more toxic personalities. This is similar to my sub specialty vs gen surg where I went to med school too. Just something to be aware of - aside from the question of hours, there still seems to be some culture issues with gen surg programs. Not trying to stereotype here, but just what I’ve seen from working more closely with gen surg and their residents in residency.

On the issue of parenthood, I have two children (and I’m a woman). I agree that parenthood is at some point about being present - there’s only so much quality you can squeeze into any amount of time. But I don’t so far feel that surgical residency is prohibitive to being a good parent. I suppose one reason is I’m not working 100 hours per week. Hours average more like 70. A lot of these extra hours happen during times my kids would be asleep anyway. Whether I leave my house at 7 am or 4 am, I won’t see my kid awake - so I’ll leave at 4 and get extra work done so I can come home before bedtime.

For example, If I work from 5 am to 6 pm 5 days a week, that’s a 65 hour work week. I see my kids one hour in the evening before bedtime, 5 hours per week. Someone who works 40 hours per week (let’s call it 8-5 with a one hour lunch) might see their kid for 1 hour in the am getting ready for the day and one extra hour in the evening, so 15 hours per week. So I’m working 25 extra hours but only losing 10 with my kids. If I take call one night, I add another 11 hours (6 pm to 5 am) and now I’m working 76 hours but have lost no extra hours with kids. So it’s simply not the case that someone who works 40 hours a week spends 36 extra hours with their kids than someone who works 76 hours.

I mostly don’t work weekends and do nothing but spend time with my kids all weekend - zero personal activities or hobbies while kids are awake. When I take a vacation, it’s all about making it fun and memorable for my kids.

My children are little and I’m very new at this. Certainly residency puts on strain on home life, more on spouse than kids I would say, but on the whole family. However, between me, my spouse and other people who love and care for my children, I don’t feel they are being shortchanged, at least for now.