Is residency really that bad?

[Trismegistus4]

---

Members don't see this ad.

Hi, everyone. I've been lurking in these forums for a few months now, and found them to be a great source of information. I'm a 26-year-old corporate IT employee who is just now beginning to feel the urge to really DO something with his life, and I've been thinking about looking into medicine.

I'm not exactly the most active or energetic person you'll ever meet, though, and while I think I'd find medical education fascinating, one of the things I have to ask myself is whether I could physically and emotionally handle a residency (or the 2nd two years of med school, for that matter), given its reputation as being extremely grueling, not to mention that I'd be in my 30s by the time I got there. I've recently learned that my uncle, a physician and one of the most stoic human beings I've ever known, who views anyone who doesn't get up at 5AM every morning and run 8 miles a day as a supreme wimp, used to phone his wife from the hospital during residency and say things like "I don't know if I can do this," "I can't take it anymore," etc. I've seen the 120-hour-a-week figure bandied about a lot, and heard/read stories of people who haven't seen their families in a week and live with permanent dark circles under their eyes.

I have to wonder, though, might there be some exaggeration going on? I was browsing FRIEDA and looking at the "Average hours on duty per week" figures (during PY1) for various specialties. Some examples:

Internal Medicine: 64.9
Anesthesiology: 58.9
Radiology-Diagnostic: 50.0
Surgery-General: 78.6

Of those figures, the one for surgery is the most daunting, but even that is nowhere near 100-120. But, you say, 120 is the maximum, not the average? Okay, but in that case, for every 120 hour week, there'd have to be a 37.2 hour week to keep the average at 78.6. Or take the anesthesiology figure: if an anesthesiology resident works, say, an 80 hour week, he also must work a 37.8 hour week to maintain the given average.

People have posted figures anywhere from 45 to 100 in the How Many Hours do You Work a Week thread. I'm not accusing anyone of lying--Lord knows you people know infinitely more about medicine and medical education than I do at this point--nor of making unjustified complaints; I can only imagine how difficult residency must be (my company has never required me to come in for a full day of work and work straight through until the next morning!) I just realize that to some degree, everyone has a case of "the grass is always greener on the other side" syndrome when it comes to their jobs. If those numbers from FRIEDA are accurate, then, yeah, people might be working the odd 120 hour week here and there, but to make up for it they're also working weeks of fewer hours than I'm working now! I'd like to conduct an informational interview with my uncle, and find out what the next step for me to take would be, but before I do that I want to make sure he's not going to just laugh at me. 🙂 Is residency something that anyone who wants to do it badly enough, and makes the decision to apply himself, can handle? Is it true a resident has NO life outside of medicine? Is it really so exhausting that it truly "breaks" you, even brainwashes you in a sense, or is it possible to maintain one's humanity throughout it?

 

[AJM]

A couple of things:

1. What's posted on FREIDA is what the residency program directors report their resident's hours as -- that is rarely based on any sort of reality, since they actually want people to come to their programs.

2. Life as a resident in 2003 is vastly different than what your uncle went through. Residency training used to be much harsher than it is now -- most middle-aged or older physicians have awful horror stories from their residency years, many of which would never happen in the present day

3. With the new 80-hour workweek/30-hour continuous shift restrictions, things are going to be very different than even this last year. Yes, there are many programs that are out of compliance with the new regulation, however once the ACGME actually starts penalizing programs that are not in compliance (which I believe they will), most programs will find themselves in compliance very soon -- definitely by the time you would start residency.

4. Resideny is difficult, but not impossible. You can have a life outside of residency. You can see your family, and maintain your relationships. Residency will (probably) not "break you". Sure, there are programs out there that advertize a "110%" divorce rate among their residents, but those programs are easily avoidable. The programs that allow you to maintain your humanity are much more numerous than the ones that can break you.

 

[Foxxy Cleopatra]

I agree with AJM regarding FREIDA- it's what directors report, so not accurate. Where I am in residency, some services are roughly ~80 hours a week, others more. I have never worked less than about 75 hrs/week.

I am also 26 and I finished medical school this spring- I'm now in a surgical residency. I have also went through "the grass is greener" ideas- I wondered if I would be better off had I gotten a degree from undergrad, entered the professional world, and went on with my life.

In regards to not being the most energetic individual, I think there are fields of medicine for all sorts of personalities. I found things like neurology and internal medicine to be much more contemplative where surgery and OB/GYN were much more action-packed. Though quite different, all are much-needed fields.

And, though I often work around 15 hours a day and take call about every 3rd night, I still do have time for a life; going out to coffee shops, getting a drink with friends, going out to the park for a jog. I am a true coffee addict. If you're single, dating is possible, though it works best with someone who is very patient regarding an irregular schedule.

Looking back, I think it is worth it if there is something about medicine that really motivates you. It'll help you get through the b.s.

 

[supercut]

Heck, I was 38 when I STARTED med school. I'm now a surgery intern. (Surgery traditionally has the worst hours of any residency) While I have been unhappy with many aspects of the program I'm at now, I have never, never once regretted my decision to pursue surgery as a career.

The program I am at does do a very good job of limiting work hours to 80 a week. The first couple weeks, most of the interns were over, but that was because we were very ineffieicent at getting things done, being unfamiliar with the hospital, the computer system, and the role of the intern. There are still a few glitches, too, like one of the private hopitals we rotate at isn't below the 80 hours yet.

I went to school at a different place and the surgery residents there did work 120 hours a week on some rotations. In fact, as a student my hours were often worse than they are now that I'm a resident. (For example trauma surgery was 24 hours on and 24 hours off...referred to as q 2 call...with a post call clinic once a week) It was not at all unusual for me to be up 32-36 hours. And it wasn't that bad. However, as a student you change rotations frequently so you don't do those kind of hours all the time.

You'll also find hours vary for the students in the clinical year depending on the school. Again, comparing where I am now for residency with where I went to school, the students here have it very easy. They take no overnight call at all. They are only expected to see 2-3 pts a day each. And what they do during the day is minimal. In fact, a student who is meeting the average expectations here would have been at risk of failing the rotation where I went to school becuase the expectations were much higher.

There are LOTS of older people in med school. We arent all athletes, either. I work out now, but I really only started about 6 months ago. I have been a couch potato most of my life. I'm not a fireball, either...I'm more of the calm, laid back type.

Your uncle is just one of the many personality types who can have successful careeers as surgeons. I know surgeons who are triathelets and ultramarathon runners. I also know surgeons who are overweight, out of shape, smokers who would never dream of setting foot in the gym.

Bascially, I think of residency (for surgery, anyway) as being like working two jobs, hours wise (assuming they come reasonbly close to complying to the 80 hours rule). By the time you get there, the 80 hour rule should be firmly in place.

Go to oldpremeds.com. There you will find that many people go to med school as "older" students, and they go into a variety of residencies.

Your first step is to decide if you want to do this bad enough to make the financial and time sacreficies necessary. Don't worry about the age thing...you're just a kid to some of us!

 

[Trismegistus4]

Sorry if it bothers anyone that I'm bumping this thread, but I wanted to thank the few who posted, and post some follow-up questions, and I thought it would be better to continue this thread than post a new one.

What you've said about FREIDA makes perfect sense--I never would have thought of that. I've also browsed scutwork.com, and many of the reviewers there report their day being over by 5pm. Do any of them have a reason to be deceptive?

Is there some sort of FAQ out there that explains all of this medical education lingo? I'm specifically wondering about this 'q' business. q2, q3, q4, etc. OK, q2 means 24 hours on and 24 off... what do other numbers after a 'q' mean?

Now, FREIDA is inaccurate: still, I'm really puzzled by the numbers people throw around. It's not just that it sounds grueling to work 80-120 hours a week; it's that it sounds IMPOSSIBLE. Honestly, how does one do it? There are only 168 hours in a week! Let me create a hypothetical scenario here (which will sound ridiculous since I don't know what I'm talking about.) Let's say you had Sunday off, and start at 6 AM Monday morning. You have call that night, so you work straight through until noon the next day. (Is that realistic for a night on call?) That's 30 hours. You then get to go home and sleep. Wednesday is then a 'regular' day, so let's say 12 hours. You've now worked 42 hours this week. Thursday night you have call again, so you work from 6 AM Thursday to noon Friday, for another 30 hours. The total is now 72. This sounds like a horrible week already, but let's say Saturday is another 'regular' day, so add another 12 hours for a total of 84. I'm assuming you get an average of one day a week off (though maybe that's presumptuous of me) so the week is now over. If you didn't have a day off, add another 12 hours, bringing the grand total for the week to 96. That's still 24 less than 120, and the week's schedule as it stands looks gruesomely inhumane to me. I mean, I pulled a few all nighters in college, and I was dead on my feet after 24 hours awake, and even now at age 27 I've noticed I can't stay up as easily as I could then. I honestly believe I would pass out long before 30. Are most residents on speed? 🙁 Do you really work straight through those nights on call, or is it slow much of the time overnight and you get to sleep? And I understand not having a life is part and parcel of becoming a doctor, but please... forget having a life; with the schedule I outlined, when do you even go grocery shopping, or balance your checkbook, or do laundry? When do you take your car to the mechanic, or look for a new apartment when your intern year is coming to a close and you're getting ready to move to a different city where you're doing the rest of your residency? Isn't there a lecture/didactic element to residency? So when do you study?

Yikes... I didn't mean to get so carried away there. 😀 I'm not trying to be negative. Many of the posts I've read here and on OldPreMeds have been quite inspirational! I simply want to understand what life is like for a resident. The way people often describe it, it sounds, not merely difficult, but literally impossible to me. That can't be true, since real people are actually doing it... right?

Oh, and Foxxy: you ARE getting on with your life. 🙂 Would you be happy if you had taken some corporate cubicle-dwelling job and cast aside your interest in medicine? Remember that many of us who are living out Dilbert are wracked with doubts about our choices, and wondering whether we should take on something more challenging like medicine instead.

 

[Jim Picotte]

Well, I'm a radiology resident and things aren't so bad for me. I would say between 50-55 hours a week so far for me depending on rotation and call schedule. Really not bad. It's bad during our angio month when we take q4 call, but it's home call and we're not up all night.

A q2 schedule would be on call Monday, Wednesday, Friday, Sunday. (15 overnight calls a month)

A q3 would be on call Monday, Thursday, Sunday, Wednesday. (10 overnight calls a month)

A q4 would be on call Monday, Friday, Tuesday, Saturday. (7-8 overnight calls a month)

The 120 hour week probably doesn't exist at MOST places now with the new rules. During my transitional year (intern year) I did put in on average 80 hours a week during my surgery and some of the tougher medicine floor months. I was able to get some sleep during Medicine but on all but one of my surgery calls, I never had time to even get my overnight bag out of my locker. It can be that hard. For me I used lots of caffeine and I knew it would be over soon so I just pushed on. I don't know how the surgeons do it to be honest.

When I was in medical school we had q3 overnight call in surgery and never went home before 5p.m. post call. So this is a typical week with a black weekend (no day off).

Start of the week, Monday, start at 5 a.m., stay there until 5p.m. Tuesday (36 hours), go in Wednesday from 5-5 (12 hours), Thursday from 5 a.m until 5 p.m. Friday (36 hours), then Saturday from 5a.m. till 5 p.m. (12 hours), Sunday 5 a.m till 5 p.m. Monday. Since our week started at 5a.m. Monday we'll say (24 hours) for this day. Add it up and you have 120 hours. I did several weeks of this in mecial school and sometimes you couldn't leave at 5 p.m.

For the absolute nightmarish months, like when someone was on vacation, you could do q2 call for a week or two and basically you're home for a total of three 12 hour blocks to sleep during that week for a total of a whooping 36 hours out of the hospital.

Luckily with the 80 hour week and 30 hour straight on call limit it's not nearly as bad and if the above two scenarios happened for a week, you'd have a nice easy week to make up for it. Most places are q4 call (7-8 a month) and with one full weekend off, one full weekend working and one weekend day off for the other two weeks for a total of 4 off. Medicine residents typically do between 5-9 months of call a year with the lesser amount of call as you become a senior resident. Surgical residents can do 9-12 months of q4 or worse call a year.

For me I always thought that the post call day clinic was the worst. I found it hard to be polite and civil when I was thoroughly exhausted and still getting paged from the hospital with patients to take care of there as well.

Yes, we also have to study. I didn't read much at all during those call months but now I read maybe 1-2 hours a day and some more on weekends and some weekends I don't read at all just depends. We have 1-2 hours of lecture a day as well, with maybe once every couple months for a whole day of conference and my call is q8 right now and I only stay until 10 p.m. while on call. It's not bad, but surprisingly it's still very busy. My wife likes my schedule much more now than before, although I've been filling up some of those free hours with some moonlighting.

It's really not that terrible and remember you can pick your specialty and program. You should be able to find your niche with a schedule you can live with and a job you'll enjoy. Don't despair too much. You still have time to work out, do the laundry, clean your house. You'll also get some vacation time. We get 3 weeks a year and a week of conference plus some days off around the holidays.

 

[tussy]

Originally posted by Jim Picotte
For me I always thought that the post call day clinic was the worst. I found it hard to be polite and civil when I was thoroughly exhausted and still getting paged from the hospital with patients to take care of there as well.
.

Nope, worse still is the post call family meeting. The "Grandpa is going to die soon" speech is hard to give when your eyelids are drooping, you're wearing yesterday's underwear and all you can think about is lying down on a nice soft bed ...

 

[sweetfynesse]

Originally posted by tussy
Nope, worse still is the post call family meeting. The "Grandpa is going to die soon" speech is hard to give when your eyelids are drooping, you're wearing yesterday's underwear and all you can think about is lying down on a nice soft bed ...

Or even worse...you're cross-covering and you have to give the "Grandpa is dying speech" on a patient you don't even really know...

 

[pelican]

Trismegistus4 --

Jim did a pretty good job of explaining the lingo.

And there are still loopholes in this 80-hour work week -- it's called "home call."

Last month I was on a vascular surgery rotation on a q2 home call schedule (I'm an intern). So I was on call M,W,Sa,Su, then T,Th,F that way we had every other weekend off -- but you paid for it hard. For much of this rotation "home call" turned into "in-house" call. You just CANNOT manage 12 ICU patients from home especially if 1 or 2 are trying really hard to die each night. So the hours are really easy to rack up -- we stopped counting after 100 as it got too depressing.

And I'm making up for it now. I've been on an anesthesia rotation with no essential/critical role so I'm working only about 35-40 hours per week with call one night a week to give those on the gen surg rotation a bit of a break.

And yup, and there is time to sneak in a semblence of a social life, but it takes a lot of effort. As important as sleep is, playing is important too. You just end up giving up other things like reading, watching the tele, or even cooking. But you gotta remember to feed the cat. =)

Good luck with your decisions!

 

[Winged Scapula]

Trismegistus4...

Just to add a few thoughts.

If you read the designation for the reviewers on Scutwork, you will see many of them are students. Students are not always required to put in the same hours as residents. In addition, residents on outpatient rotations will have better hours. And finally, as noted above, the schools post their own data and often do not update it, on FREIDA. I have first hand knowledge that some of the stuff is wildly inaccurate.

The stories you hear about 120-130+ hr weeks are true unfortunately, but with the 80-hour work week they are not as common as it once was. But it is entirely possible to work that much when you come in at 4:30 am, don't leave until after 8 pm each night, and do a q2 call (please note that as above, q2 doesn't mean 24 hrs on/24 off) and don't go home early. Before the 80-hour workweek, the earliest I went home post call was probably 5:30 or 37 hours later. Couple that with sometimes coming in both weekend days, often staying around until early afternoon and the hours really add up.

Things are better than they used to be, and we are trying ti find ways to cut the wasteful time - time just sitting around, posting on SDN! 😉