Is this normal?

[Womb Raider]

In IM , the ACGME says you get 2weeks if vacation...

Can you show me where the ACGME says this? I've been searching the ACGME requirements for vacation but having trouble finding anything online.

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[Womb Raider]

There seems to be a lot of false information in this thread where people are assuming that everyone's residency works the same. Especially in regards to when I can take vacation and how it relates to call.

At my prelim IM residency we get 3 weeks of vacation and we can take them whenever we want, as long as it doesn't conflict with the other interns' schedules (e.g. everyone didn't get Christmas because of its popularity). The rotation we would be on makes no difference, nor does call. The program has a small group of people assigned every week specifically to cover people that would be absent (i.e. people taking vacation, sick days, etc...). The PGY1s have a group, as do the PGY2s and 3s. When it's your turn to be "covering" for others, you expect to be covering someone else's shift 100% of the time.

Moreover, there seem to be a good deal of people on here that keep alluding to how medicine works in private practice, or as an attending, or some other environment that isn't the same as residency. I'm an employee, a trainee, someone that does NOT have full medical privileges and am not responsible for individual patients on my own - I have very little responsibility and I am certainly "replaceable" in the sense that someone else can 100% effectively cover my job for a week when I'm gone, whether it be another resident or one of the many PAs/NPs that work alongside us to help the attendings - unlike many attendings or private practice physicians. So the comparisons are inane and not productive to the discussion. I'm not interested in "preparing" for the "real world." In MOST corporate jobs that give employees PTO, you are not required to make up the time you take off after vacation by working extra hours. Yes, if you have a unique position where you and only you are capable of completing said task, then you will be making up extra work upon your return, but that is not the case for residents as every single one of you knows very well.

Another intern and I in the same situation contacted the ED scheduling chief just to make sure this was not a mistake. The reply was snarky, and the justification boiled down to a single point: the ED residents work more shifts than 18/month so it was "reasonable" to expect us to work the full 18 shifts. Which, I felt was a bit hypocritical since the ED residents at this program work 44 hours a week and 22 shifts a month (much less than the limit), and they don't require their residents to work extra days when they take vacation. I mean the surgical residents at my program work on average, literally more than twice as many hours as the ED residents and get 4 days off a month.

Anyway, the worst part about all of this is how all of this is how easily it could have been avoided. Make the expectations known and transparent and the problems go away. I work >70hrs/week on IM wards so obviously IDGAF about working 18 shifts. If it's a "you need x # of shifts to fulfill your requirements" thing, then don't allow vacations during the month and let us work out shifting schedules around ourselves. It's the deception and lack of transparency that's frustrating.

 

[Piebaldi]

There seems to be a lot of false information in this thread where people are assuming that everyone's residency works the same. Especially in regards to when I can take vacation and how it relates to call.

At my prelim IM residency we get 3 weeks of vacation and we can take them whenever we want, as long as it doesn't conflict with the other interns' schedules (e.g. everyone didn't get Christmas because of its popularity). The rotation we would be on makes no difference, nor does call. The program has a small group of people assigned every week specifically to cover people that would be absent (i.e. people taking vacation, sick days, etc...). The PGY1s have a group, as do the PGY2s and 3s. When it's your turn to be "covering" for others, you expect to be covering someone else's shift 100% of the time.

Moreover, there seem to be a good deal of people on here that keep alluding to how medicine works in private practice, or as an attending, or some other environment that isn't the same as residency. I'm an employee, a trainee, someone that does NOT have full medical privileges and am not responsible for individual patients on my own - I have very little responsibility and I am certainly "replaceable" in the sense that someone else can 100% effectively cover my job for a week when I'm gone, whether it be another resident or one of the many PAs/NPs that work alongside us to help the attendings - unlike many attendings or private practice physicians. So the comparisons are inane and not productive to the discussion. I'm not interested in "preparing" for the "real world." In MOST corporate jobs that give employees PTO, you are not required to make up the time you take off after vacation by working extra hours. Yes, if you have a unique position where you and only you are capable of completing said task, then you will be making up extra work upon your return, but that is not the case for residents as every single one of you knows very well.

Another intern and I in the same situation contacted the ED scheduling chief just to make sure this was not a mistake. The reply was snarky, and the justification boiled down to a single point: the ED residents work more shifts than 18/month so it was "reasonable" to expect us to work the full 18 shifts. Which, I felt was a bit hypocritical since the ED residents at this program work 44 hours a week and 22 shifts a month (much less than the limit), and they don't require their residents to work extra days when they take vacation. I mean the surgical residents at my program work on average, literally more than twice as many hours as the ED residents and get 4 days off a month.

Anyway, the worst part about all of this is how all of this is how easily it could have been avoided. Make the expectations known and transparent and the problems go away. I work >70hrs/week on IM wards so obviously IDGAF about working 18 shifts. If it's a "you need x # of shifts to fulfill your requirements" thing, then don't allow vacations during the month and let us work out shifting schedules around ourselves. It's the deception and lack of transparency that's frustrating.

I had a similar snarky response from ED scheduling chief when they scheduled me for various holidays in a row but other interns weren't. Sadly this will be a lesson to learn that you will be screwed at various points in residency. The good news is that residency is a limited timeframe and you can have much more flexibility once you are an attending.
If the other intern also got screwed, there is nothing to be done. However it would be wise for you to let your program know and other residents know that if you take vacation in this rotation you will not truly get the full vacation. Others will be warned and this issue will not happen hopefully in the future.

 

[Mass Effect]

I think it depends on the specialty.

Let's look at the typical IM service in the hospital - given that's what I know best. A team is usually structured as 1 attending, 1 senior, 1-2 interns, some number of medical students. There's lots of variants on this same structure, but I think that's most common. They can see (by ACGME mandate) a maximum of 16 (for 1 intern teams) to 20 patients (for 2 interns). Now, those are caps - I'd say a typical team probably averages 13-17 patients, with some days being more and others being less. Usually, but not always, the attending is *exclusively* on that inpatient service when he's on service. Some places do have an attending cover more than 1 team (particularly for weekends/holidays) or they may have a more traditional GIM practice where they have their own clinic schedule as well, but usually it's just 1 attending, 1 team, no other responsibilities.

What would happen if all the residents disappeared for a day? Well... you'd be left with the attending and 13-17 patients. Guess how many patients a community hospitalist sees in a given workday by themselves? Hint: The average is usually around 15.

So if the residents disappeared for a day or two, the daytime inpatient medicine services would function just fine. The attendings would be stuck doing all of the work themselves - but they'd also have no education to do (for obvious reasons). Now, their schedules would be all kinds of messed up - academic attendings tend to have radically different schedules than community hospitalists - namely that they *typically* take fewer days off due to the less intense nature of their work (though likely more weekends). But it would work just fine. And the staff would be miserable. But the residents are only "necessary" to give the attendings the relatively cush life that allows them to accept the smaller salary (and lets them take time for teaching, QI, whatever else they like to do).

Nights gets a bit hinky, because most places just have residents operating semi-autonomously at night with home attending backup. So for facilities that don't have a night in house attending, they'd have to screw around with the schedules even more - but again, the attendings should be perfectly capable of triaging night calls and admissions on their own. At least for a few days before they all up and quit.

What about consult services? Same story, though there the schedules would be even more screwed up. The residents allow the subspecialists to likely see more patients than they otherwise would - or spend less time doing consultations and more time doing whatever procedures/clinic/whatever they would rather be doing.

The ICU would be a bit more touch and go, particularly at night - but even at the program where I did residency that had ridiculous ICU volume, I think the actual attendings could manage on their own for a few days before they all quit.

Clinics get more of a questionmark, because an attending is often supervising 4 individual residents with their individual schedules. Now, none of them is as busy as a full attending on their own - but even if they were only a third as busy as an attending, that's still 1.3X a clinic schedule.

I think it would be a lot less tenable for someone like a surgeon if the residents disappeared - because there's often no other built in mechanism for first assists and so much of the grunt work done by the residents saves the surgeons time and allows them to increase case volumes.

Basically, I'd say that most academic hospital services *could* function *briefly* if the residents up and disappeared, but that would require the attendings to work at full clinical volume on their own and that could not be sustainable due to the overall staffing not being built for that.

Attendings would not do the work of residents at most academic institutions in most programs. I'm psych and our attendings even griped when we had a protected didactic day and they ran the services. It's well-known the trade-off for the low salaries academic medicine has to offer is that you more teaching and less note-writing. Most academic centers are resident-run.

 

[Piebaldi]

Attendings would not do the work of residents at most academic institutions in most programs. I'm psych and our attendings even griped when we had a protected didactic day and they ran the services. It's well-known the trade-off for the low salaries academic medicine has to offer is that you more teaching and less note-writing. Most academic centers are resident-run.

I would agree with you. Private practice attendings tend to do all/most of the work themselves, even if they have residents/fellows. Academics are mostly resident run absolutely.

 

[Mass Effect]

Seems like it in my specialty, glad it's not the only one. And here we are talking about one off-service resident. And yet here I am made to appear lazy for stating that a likely already overworked resident should be able to take what in the real world people call vacation. To be clear, I understand the other perspective, but what OP is describing is simply not a vacation, so it would behoove programs to consider it one if they want to appear like an institution that actually cares about its residents. To go full circle, that's what I'm looking for in a program. Apparently, it's not as common as I'd have thought and even worse, it's considered entitled.

Are you aware of jobs that are 7 days on, 7 days off? When someone takes a two-week vacation during those jobs, do you know what happens? They work 14 days on in order to have 14 days off. The end result is they still work 14 days per month, every month. They don't have less time at work just because they took a vacation. That's how those jobs are set up, much like ED rotations.

In a world of RVUs, if you plan to do outpatient medicine of any kind, you should be aware that while you can take vacation time, that isn't considered protected time in many places. So if your target for RVUs is x number, the 4 weeks you took as vacation means you have 48 weeks in which to obtain that number.

In a sales job, your work is still waiting for you after your vacation. If you're expecting to meet a sales quota, the quota doesn't change just because you're out for two weeks (or even a week). You just have to do more work while you're here to make up for the time you're out.

This is kind of how the real world runs. It does such that the OP burns a week of vacation that he wouldn't if he had just swapped with others to get 7 days in a row off, but that's what he should have done. He said himself, this is what's happened to other residents on this exact same rotation.

 

[Mass Effect]

It's not abuse per say but it's unfair. If someone takes vacation during a regular month for example, you wouldn't be expected to do anything residency related during that time. So if there was a week of call or whatever you wouldn't be expected to do it - bc u are on vacation. So it's unfair for OP to have to do all the shifts if he's off for 1 week. Abuse? no. Unfair?yes.

I think some have a very unrealistic opinion about what actually happens/is supposed to happen in a job. Is that what happened during your residency, where if you had call, you got out of it if you were you on vacation? Because it sure doesn't happen at 99% of other residencies I know. Everyone does the same amount of call. Everyone.

If you're pregnant and need maternity leave or you're a new dad and need paternity leave, you either fulfill your call requirement for the months you'll be out before you go or when you get back. You don't just magically get a lower call requirement. If you're required to take a Friday 24-hour shift every month and you're taking a one-week vacay that month, then you better do your Friday 24 on one of the remaining three Fridays.

That's just real-life folks and not in any way, shape, or form abusive. It's actually an insult to true abuse in medicine to even suggest this is in any way similar.

 

[Piebaldi]

Are you aware of jobs that are 7 days on, 7 days off? When someone takes a two-week vacation during those jobs, do you know what happens? They work 14 days on in order to have 14 days off. The end result is they still work 14 days per month, every month. They don't have less time at work just because they took a vacation. That's how those jobs are set up, much like ED rotations.

In a world of RVUs, if you plan to do outpatient medicine of any kind, you should be aware that while you can take vacation time, that isn't considered protected time in many places. So if your target for RVUs is x number, the 4 weeks you took as vacation means you have 48 weeks in which to obtain that number.

In a sales job, your work is still waiting for you after your vacation. If you're expecting to meet a sales quota, the quota doesn't change just because you're out for two weeks (or even a week). You just have to do more work while you're here to make up for the time you're out.

This is kind of how the real world runs. It does such that the OP burns a week of vacation that he wouldn't if he had just swapped with others to get 7 days in a row off, but that's what he should have done. He said himself, this is what's happened to other residents on this exact same rotation.

The point of the OP is that this is residency not attendinghood - I can sympathize. For those of us who got repeatedly screwed with time off in residency it's a sticking point.
Attendinghood is different. I used to hate working weekends as an attending. Now I get paid quite a chunk of change for covering weekends, so I have no problem covering weekends. It's different.
What's hapepning to the OP is a technicality - it's not the end of the world, OP will survive, and will likely at some point get screwed again, but the point is that had he known he would not have scheduled this this way. Other residents will get more time off. It's kind of unfair.

Again attendinghood is different. As an attending, if you don't hit your RVUs you may not get a bonus, or you may need to work harder at a different point in time to hit your mark. In a sales job or any other job you take the time off and someone else typically does your job or your job can wait.

 

[Mad Jack]

Have a rotation that's 18 shifts in 1 month. Pretty nice I know.

Had 1 week vacation during this month. I found out I still am scheduled for 18 shifts, they're just compressed into 3 weeks rather than 4. Is this normal practice? Can't think of many jobs that basically ignore your vacation week and just pile on the work to the rest of your schedule.

I will say I know this isn't a coincidence ("maybe you were scheduled for that entire week off coincidentally since you only worked 18 days") because everyone I've talked to that had their vacation fall on this rotation had the same thing happen to them, and those that worked the entire month never had an entire week off straight.

Anyway, not really a big deal just curious to hear other people's response to this. Sounds like BS exploitation of residents to me but not enough to actually do something about it.

For some required rotations in my specialty you specifically need a certain number of FTEs. This essentially ends up making vacation on those rotations impossible unless the rest of the rotation is compressed into the remaining time. The only other option would be extending your training.

 

[Piebaldi]

I think some have a very unrealistic opinion about what actually happens/is supposed to happen in a job. Is that what happened during your residency, where if you had call, you got out of it if you were you on vacation? Because it sure doesn't happen at 99% of other residencies I know. Everyone does the same amount of call. Everyone.

If you're pregnant and need maternity leave or you're a new dad and need paternity leave, you either fulfill your call requirement for the months you'll be out before you go or when you get back. You don't just magically get a lower call requirement. If you're required to take a Friday 24-hour shift every month and you're taking a one-week vacay that month, then you better do your Friday 24 on one of the remaining three Fridays.

That's just real-life folks and not in any way, shape, or form abusive. It's actually an insult to true abuse in medicine to even suggest this is in any way similar.

No my residency was grossly unfair. I have said this many times. There was no "number" per say of call or anything. Like I said initially I had like 17 call days, some other residents had like 11. I was like wha??? I was told "it doesn't have to be fair." So I complained, and that was fixed.
I had one of the highest number of inpatient rotations which caused major burn out. Some residents didn't have consult months for 2 years in a row. Others had a bunch. Some residents had like 4-6 EXTRA weeks off during residency bc attendings would be off and so the resident would be off - and they wouldn't be put in a different rotation or truly be expected to cover.
Some residents took most/all holidays, others took minimal/none.
Grossly unfair.

 

[Mass Effect]

Not in IM...Because you don’t get to take vacation on months that you are on call...and when you are on an elective and you are back up...you don’t get to take vacation when you are on back up....and it’s not like you get to skip being on back up.

In IM , the ACGME says you get 2weeks if vacation...if you are getting extra weeks, the the program has decided to give you extra weeks...and the ACGME doesn’t mandated that you as the resident gets to choose when you get to take the weeks off...heck there are programs out there that just schedule your weeks off and that’s all you get.

I'm psych and was in, perhaps, one of the cushest programs in the country. Everyone did the same amount of call and being on vacay didn't mean you didn't make up that call week (if it was approved in the first place). What that poster is suggesting -- that if you're on call, you should be excused from call to go on vacay without making it up -- is actually not a thing. To any med students or premeds reading, you're going to get your heart broken if you believe this nonsense.

 

[Piebaldi]

I'm psych and was in, perhaps, one of the cushest programs in the country. Everyone did the same amount of call and being on vacay didn't mean you didn't make up that call week (if it was approved in the first place). What that poster is suggesting -- that if you're on call, you should be excused from call to go on vacay without making it up -- is actually not a thing. To any med students or premeds reading, you're going to get your heart broken if you believe this nonsense.

REmember not all programs are different. There was no "number" of call in my program. People were scheduled randomly. And frequently led to unfairness.
I disagree with you.

 

[Mass Effect]

but the point is that had he known he would not have scheduled this this way. Other residents will get more time off. It's kind of unfair.

But the OP said specifically that this has happened to others on this same rotation, so he is not being singled out. Others should have passed down the info. It's now up to the OP to tell juniors not to take vacay during this month. But the standards have not changed from resident to resident. They are treating all residents equal on this month -- those who want vacay still work the 18 shifts.

In a sales job or any other job you take the time off and someone else typically does your job or your job can wait.

Um, how many sales jobs have you worked? While technically someone else will "cover" your jobs (much like you will cover others patients when they're out on vacay during outpatient medicine), you still have to meet your quota at the end of the month. If you're required to sell, say $10K (just a random figure) a month, and you decide to take a 2-week vacation, then you only have 2 weeks in which to meet that quota. If you don't, it counts against you and arguing you were on vacay for 2 weeks is not an excuse.

 

[Mass Effect]

No my residency was grossly unfair. I have said this many times. There was no "number" per say of call or anything. Like I said initially I had like 17 call days, some other residents had like 11. I was like wha??? I was told "it doesn't have to be fair." So I complained, and that was fixed.
I had one of the highest number of inpatient rotations which caused major burn out. Some residents didn't have consult months for 2 years in a row. Others had a bunch. Some residents had like 4-6 EXTRA weeks off during residency bc attendings would be off and so the resident would be off - and they wouldn't be put in a different rotation or truly be expected to cover.
Some residents took most/all holidays, others took minimal/none.
Grossly unfair.

Then why are you giving inaccurate advice. I don't know of a single residency that excuses you from scheduled call (and lets you do less call) because you're on vacay. Not a single one. So why would you post that and make people think that if a residency doesn't allow you to take less call on vacay months, they're doing something wrong?

 

[Piebaldi]

But the OP said specifically that this has happened to others on this same rotation, so he is not being singled out. Others should have passed down the info. It's now up to the OP to tell juniors not to take vacay during this month. But the standards have not changed from resident to resident. They are treating all residents equal on this month -- those who want vacay still work the 18 shifts.



Um, how many sales jobs have you worked? While technically someone else will "cover" your jobs (much like you will cover others patients when they're out on vacay during outpatient medicine), you still have to meet your quota at the end of the month. If you're required to sell, say $10K (just a random figure) a month, and you decide to take a 2-week vacation, then you only have 2 weeks in which to meet that quota. If you don't, it counts against you and arguing you were on vacay for 2 weeks is not an excuse.

I agree that OP said that I guess another intern or something on the same rotation had this happened to them so it seems that in that regard, they are treating both the same. And again yes OP should disseminate this info so that other residents in the future don't have the same problem and don't take vacay.
I have not worked a sales job, but know many people who work all sorts of different jobs. Generally if you have a quota of x amount per month, if you take time off, there is a "prorating" for that time.
Kind of like rent - if you start a rental in the middle of a month you are not expected to cover the whole month right? You will pay x portion of the rent.

 

[Piebaldi]

Then why are you giving inaccurate advice. I don't know of a single residency that excuses you from scheduled call (and lets you do less call) because you're on vacay. Not a single one. So why would you post that and make people think that if a residency doesn't allow you to take less call on vacay months, they're doing something wrong?

Mine did. Can't speak for yours or others, I can only speak for mine. It's not inaccurate. You shouldn't speak about generalities when you don't know the reality of all programs. Even in my internship program, sometimes back up or something would have to fill in if someone was on vacation during a call week.

 

[Mass Effect]

I have not worked a sales job, but know many people who work all sorts of different jobs. Generally if you have a quota of x amount per month, if you take time off, there is a "prorating" for that time.
Kind of like rent - if you start a rental in the middle of a month you are not expected to cover the whole month right? You will pay x portion of the rent.

As someone who HAS worked in sales and is married to someone in sales, you are wrong.

 

[Piebaldi]

As someone who HAS worked in sales and is married to someone in sales, you are wrong.

I disagree. You cannot make a general statement based on your experience or the experience of those around you.

 

[rokshana]

I agree that OP said that I guess another intern or something on the same rotation had this happened to them so it seems that in that regard, they are treating both the same. And again yes OP should disseminate this info so that other residents in the future don't have the same problem and don't take vacay.
I have not worked a sales job, but know many people who work all sorts of different jobs. Generally if you have a quota of x amount per month, if you take time off, there is a "prorating" for that time.
Kind of like rent - if you start a rental in the middle of a month you are not expected to cover the whole month right? You will pay x portion of the rent.

So it’s kinda like you stayed at a holiday inn?

Yeah we get it....you feel that your residency is the most malignant, unfair program and personally had it out for you...you post that over and over...and over...

And no, if you are in a sales job that had a quota that determines your pay, you don’t get a bye because you took time off...it’s like being a doctor and you have an rvu goal to determine your income, you have to meet the goal regardless of the time off you take...you do make it up...see more pts a day or have an extra clinic to make it up...they don’t say you can work less and still make the same money.

 

[rokshana]

I disagree. You cannot make a general statement based on your experience or the experience of those around you.

Why? You do it all the time.

 

[Piebaldi]

Why? You do it all the time.

As do you.

 

[dpmd]

I agree that OP said that I guess another intern or something on the same rotation had this happened to them so it seems that in that regard, they are treating both the same. And again yes OP should disseminate this info so that other residents in the future don't have the same problem and don't take vacay.
I have not worked a sales job, but know many people who work all sorts of different jobs. Generally if you have a quota of x amount per month, if you take time off, there is a "prorating" for that time.
Kind of like rent - if you start a rental in the middle of a month you are not expected to cover the whole month right? You will pay x portion of the rent.

If you move in and then take a two week vacation you still pay rent for the whole month though.

 

[Piebaldi]

So it’s kinda like you stayed at a holiday inn?

Yeah we get it....you feel that your residency is the most malignant, unfair program and personally had it out for you...you post that over and over...and over...

And no, if you are in a sales job that had a quota that determines your pay, you don’t get a bye because you took time off...it’s like being a doctor and you have an rvu goal to determine your income, you have to meet the goal regardless of the time off you take...you do make it up...see more pts a day or have an extra clinic to make it up...they don’t say you can work less and still make the same money.

You don't make the same money if you don't meet your RVU goal - you simply make LESS money. Have you ever worked at the VA? Va physicians for example cancel their clinics not infrequently for multiple reasons - personal time, sick time, conferences, etc etc. Do they "make them up"? Nope.
I am married to someone in finance - when he goes on vacation, he's off - he doesn't "make up" anything. My mother is a therapist - when she goes on vacation, she is off - she doesn't "make up" her clinic days - patients are simply not scheduled. She doesn't "make up" her RVUs.
Simply bc some things work one way in a place doesn't mean it's the same in other places.

 

[rokshana]

As do you.

No I do not...generally I have evidence to back up most things and if I am posting about my experience , I state that at the beginning...you are colored by the bad experiences you have had...some may be because of the situation, bu either you are THE unluckiest person In the world or how you deal with situations allows you to be taken advantage of you...

Like the saying goes...one person around you is an a$$, they are probably an a$$...everyone around you is an a$$, then the real a$$ may be you...maybe you need to re-evaluate how you handle things.

 

[dpmd]

There seems to be a lot of false information in this thread where people are assuming that everyone's residency works the same. Especially in regards to when I can take vacation and how it relates to call.

At my prelim IM residency we get 3 weeks of vacation and we can take them whenever we want, as long as it doesn't conflict with the other interns' schedules (e.g. everyone didn't get Christmas because of its popularity). The rotation we would be on makes no difference, nor does call. The program has a small group of people assigned every week specifically to cover people that would be absent (i.e. people taking vacation, sick days, etc...). The PGY1s have a group, as do the PGY2s and 3s. When it's your turn to be "covering" for others, you expect to be covering someone else's shift 100% of the time.

Moreover, there seem to be a good deal of people on here that keep alluding to how medicine works in private practice, or as an attending, or some other environment that isn't the same as residency. I'm an employee, a trainee, someone that does NOT have full medical privileges and am not responsible for individual patients on my own - I have very little responsibility and I am certainly "replaceable" in the sense that someone else can 100% effectively cover my job for a week when I'm gone, whether it be another resident or one of the many PAs/NPs that work alongside us to help the attendings - unlike many attendings or private practice physicians. So the comparisons are inane and not productive to the discussion. I'm not interested in "preparing" for the "real world." In MOST corporate jobs that give employees PTO, you are not required to make up the time you take off after vacation by working extra hours. Yes, if you have a unique position where you and only you are capable of completing said task, then you will be making up extra work upon your return, but that is not the case for residents as every single one of you knows very well.

Another intern and I in the same situation contacted the ED scheduling chief just to make sure this was not a mistake. The reply was snarky, and the justification boiled down to a single point: the ED residents work more shifts than 18/month so it was "reasonable" to expect us to work the full 18 shifts. Which, I felt was a bit hypocritical since the ED residents at this program work 44 hours a week and 22 shifts a month (much less than the limit), and they don't require their residents to work extra days when they take vacation. I mean the surgical residents at my program work on average, literally more than twice as many hours as the ED residents and get 4 days off a month.

Anyway, the worst part about all of this is how all of this is how easily it could have been avoided. Make the expectations known and transparent and the problems go away. I work >70hrs/week on IM wards so obviously IDGAF about working 18 shifts. If it's a "you need x # of shifts to fulfill your requirements" thing, then don't allow vacations during the month and let us work out shifting schedules around ourselves. It's the deception and lack of transparency that's frustrating.

No one is making you work "extra days" during your vacation so complaining that the ed doesn't make their residents work "extra days" is nonsensical. Are you meaning to say that when the ed residents take vacation during ed months they work fewer than the 22 shifts?

 

[dpmd]

You don't make the same money if you don't meet your RVU goal - you simply make LESS money. Have you ever worked at the VA? Va physicians for example cancel their clinics not infrequently for multiple reasons - personal time, sick time, conferences, etc etc. Do they "make them up"? Nope.
I am married to someone in finance - when he goes on vacation, he's off - he doesn't "make up" anything. My mother is a therapist - when she goes on vacation, she is off - she doesn't "make up" her clinic days - patients are simply not scheduled. She doesn't "make up" her RVUs.
Simply bc some things work one way in a place doesn't mean it's the same in other places.

The point being made was that you must make up the work to remain at the same pay. The fact you realize that if you work less you will get paid less means you are so very close to understanding that point.

 

[Piebaldi]

If you move in and then take a two week vacation you still pay rent for the whole month though.

No I do not...generally I have evidence to back up most things and if I am posting about my experience , I state that at the beginning...you are colored by the bad experiences you have had...some may be because of the situation, bu either you are THE unluckiest person In the world or how you deal with situations allows you to be taken advantage of you...

Like the saying goes...one person around you is an a$$, they are probably an a$$...everyone around you is an a$$, then the real a$$ may be you...maybe you need to re-evaluate how you handle things.

I see. So it's victim blaming eh?
So let's see - let's take a simple example. I'm a brand spanking new PGY-2 at my residency program (in the past). Knew none of the other senior residents yet I was scheduled for 17 calls, most of my classmates were scheduled for 11-13 or so. I was the ONLY PGY-2 scheduled to work a Friday (all Fridays were covered by PGY-3s). Explain that to me.
Or before starting residency (again knew NO ONE) so it's impossible for anyone not to have liked me, we were sent the schedule. I was scheduled to work fourth of july, Christmas, Thansksgiving, no other PGY-1 was scheduled to work all those holidays - in fact most were off.
I was put on nightfloat as a PGY-4 bc a snowflake PGY-2 had "issues" - despite me being sick and needing surgery that month. Never happened in the history of the program before.
That's just a snippet.
It's just my fault eh?
Perhaps understand that some people are more prone to bullying than others - in my case, perhaps because of a multiplicity of things - because I am introverted, short, conservative, who knows? I am more picked on than others.

 

[VA Hopeful Dr]

You don't make the same money if you don't meet your RVU goal - you simply make LESS money. Have you ever worked at the VA? Va physicians for example cancel their clinics not infrequently for multiple reasons - personal time, sick time, conferences, etc etc. Do they "make them up"? Nope.
I am married to someone in finance - when he goes on vacation, he's off - he doesn't "make up" anything. My mother is a therapist - when she goes on vacation, she is off - she doesn't "make up" her clinic days - patients are simply not scheduled. She doesn't "make up" her RVUs.
Simply bc some things work one way in a place doesn't mean it's the same in other places.

VA doctors are salaried with a defined number of days off. If they exceed that number of days, they will pay for it one way or another.

 

[Piebaldi]

The point being made was that you must make up the work to remain at the same pay. The fact you realize that if you work less you will get paid less means you are so very close to understanding that point.

Again fits the point of the OP - this is residency, not attendinghood.
Same as if we choose to work more and hit our bonus vs if we work less and are in "lazytown" and perhaps not hit our bonus.

But for residents everything should be roughly fair - so let's say that in this program you have to work 18 shifts in ED. So residents are off 12 days in a 30 day month. Residents also take 3 weeks vacation, so let's say 15 working days. That's 27 days off.
If this resident still has to take 18 shifts, he (I am assuming it's a he, sorry if I am wrong), he will only have 22 days off - since 5 of his vacation days are gobbled up essentially in the ED rotation. So he will ultimately get LESS time off than his other residents.
I see OP's point.

 

[Womb Raider]

No one is making you work "extra days" during your vacation so complaining that the ed doesn't make their residents work "extra days" is nonsensical. Are you meaning to say that when the ed residents take vacation during ed months they work fewer than the 22 shifts?

Yes, that's exactly what I'm saying... Hence the reason I was surprised it was happening to me. ACGME caps us working at 80hrs/week and 6d/week averaged over a month - the ED residents have plenty of extra time they could work if they weren't being hypocritical.

Every residency schedule I'm aware of in my program, when you take vacations, you don't have to make up those hours. Usually this is because it would be impossible to make those hours up without going over ACGME requirements (at least in the specialties that work long hours and weekends). But even my derm and radiology buddies that work M-F aren't required to start working weekends to make up time when they take vacation. It's built into the schedule. It's planned for. It isn't a surprise to anyone.

 

[Piebaldi]

Yes, that's exactly what I'm saying... Hence the reason I was surprised it was happening to me. ACGME caps us working at 80hrs/week and 6d/week averaged over a month - the ED residents have plenty of extra time they could work if they weren't being hypocritical.

Every residency schedule I'm aware of in my program, when you take vacations, you don't have to make up those hours. Usually this is because it would be impossible to make those hours up without going over ACGME requirements (at least in the specialties that work long hours and weekends). But even my derm and radiology buddies that work M-F aren't required to start working weekends to make up time when they take vacation. It's built into the schedule. It's planned for. It isn't a surprise to anyone.

I completely see your point and agree with you.
But btw - Radiology residents work PLENTY of weekends AND take overnight and evening call also.

however, this is likely a losing battle for you - I would bring it up to your PD in non-whiny way, and perhaps the easiest solution going forward is to let residents know that they won't be able to take vacay during this month.

 

[Womb Raider]

I completely see your point and agree with you.
But btw - Radiology residents work PLENTY of weekends AND take overnight and evening call also.

Oh I know, but at some programs as an R1 you don't work weekends since you don't know enough to take call. Those were the ones I spoke to about this.

 

[Mass Effect]

I disagree. You cannot make a general statement based on your experience or the experience of those around you.

You're right, much better to make generalizations out of thin air.

 

[rokshana]

I see. So it's victim blaming eh?
So let's see - let's take a simple example. I'm a brand spanking new PGY-2 at my residency program (in the past). Knew none of the other senior residents yet I was scheduled for 17 calls, most of my classmates were scheduled for 11-13 or so. I was the ONLY PGY-2 scheduled to work a Friday (all Fridays were covered by PGY-3s). Explain that to me.
Or before starting residency (again knew NO ONE) so it's impossible for anyone not to have liked me, we were sent the schedule. I was scheduled to work fourth of july, Christmas, Thansksgiving, no other PGY-1 was scheduled to work all those holidays - in fact most were off.
I was put on nightfloat as a PGY-4 bc a snowflake PGY-2 had "issues" - despite me being sick and needing surgery that month. Never happened in the history of the program before.
That's just a snippet.
It's just my fault eh?
Perhaps understand that some people are more prone to bullying than others - in my case, perhaps because of a multiplicity of things - because I am introverted, short, conservative, who knows? I am more picked on than others.

So of course you would see any criticism as victim blaming...how about taking personal responsibility?? I know it seems to be an antiquated notion to the average millennial, but there it is...if you are always allowing people to take advantage of you, people being people will take advantage of you...while not introverted , am short, female, and of color...but, in general, didnt get treated differently and still don’t.

 

[Piebaldi]

So of course you would see any criticism as victim blaming...how about taking personal responsibility?? I know it seems to be an antiquated notion to the average millennial, but there it is...if you are always allowing people to take advantage of you, people being people will take advantage of you...while not introverted , am short, female, and of color...but, in general, didnt get treated differently and still don’t.

Again I gave you examples, I'm happy to hear what I did "wrong" and how I could have done something better in the above. I don't "allow" anyone to take advantage of me - I bring up issues in a timely fashion when there is screwage - as OP did. And reason whhy I can sympathize.

Again - since you stated that you back your statements up - please let me know what I could have done better/what I did wrong in the examples I gave above. I find it surprising that you didn't address that point?

And interestingly, you are ASSUMING something once again about me - how do you know how old I am? Do you know if I am a millenial? How would you know that? And are you GENERALIZING to ALL millenials? are ALL millenials incapable of taking responsibility? Wow, there are millions of millenials - seems like a gross generalization to me.

What you are saying here is - if you get screwed, you "MUST" have done something wrong. Vs - sometimes people are bullied, mistreated, screwed - that's life.

Kindly back up your statements about what "I" did wrong to have the above mentioned experiences. And no I am not a millenial, but thank you for assuming something that is incorrect.

 

[Mass Effect]

Again fits the point of the OP - this is residency, not attendinghood.
Same as if we choose to work more and hit our bonus vs if we work less and are in "lazytown" and perhaps not hit our bonus.

But for residents everything should be roughly fair - so let's say that in this program you have to work 18 shifts in ED. So residents are off 12 days in a 30 day month. Residents also take 3 weeks vacation, so let's say 15 working days. That's 27 days off.
If this resident still has to take 18 shifts, he (I am assuming it's a he, sorry if I am wrong), he will only have 22 days off - since 5 of his vacation days are gobbled up essentially in the ED rotation. So he will ultimately get LESS time off than his other residents.
I see OP's point.

Then the OP shouldn't have taken vacay during this month. It's really not that hard not to schedule a vacation during a month in which you're only working 18 shifts OR try to swap with others to get 7 days in a row off. This is how every resident is treated on this rotation, so I would argue if they made an exception for the OP, it would be unfair to all other residents who were charged a week of vacation during this month.

Yes, that's exactly what I'm saying... Hence the reason I was surprised it was happening to me. ACGME caps us working at 80hrs/week and 6d/week averaged over a month - the ED residents have plenty of extra time they could work if they weren't being hypocritical.

Every residency schedule I'm aware of in my program, when you take vacations, you don't have to make up those hours. Usually this is because it would be impossible to make those hours up without going over ACGME requirements (at least in the specialties that work long hours and weekends). But even my derm and radiology buddies that work M-F aren't required to start working weekends to make up time when they take vacation. It's built into the schedule. It's planned for. It isn't a surprise to anyone.

That's because you're generally working more than 18 days, which is a ridiculously low amount. When you're working 18 days, you're not "making up" for days you'll miss. You're simply not being excused from the days you're scheduled in order to pass the rotation.

 

[Piebaldi]

Then the OP shouldn't have taken vacay during this month. It's really not that hard not to schedule a vacation during a month in which you're only working 18 shifts OR try to swap with others to get 7 days in a row off. This is how every resident is treated on this rotation, so I would argue if they made an exception for the OP, it would be unfair to all other residents who were charged a week of vacation during this month.



That's because you're generally working more than 18 days, which is a ridiculously low amount. When you're working 18 days, you're not "making up" for days you'll miss. You're simply not being excused from the days you're scheduled in order to pass the rotation.

Again, going forward I believe the easiest solution is indeed to let residents know that they CAN'T take vacation during that month - but it's unclear whether OP knew this or not before. And if he couldn't really take vacation he should have been informed of this by ED chief.

 

[Mass Effect]

Again I gave you examples, I'm happy to hear what I did "wrong" and how I could have done something better in the above. I don't "allow" anyone to take advantage of me - I bring up issues in a timely fashion when there is screwage - as OP did. And reason whhy I can sympathize.

Again - since you stated that you back your statements up - please let me know what I could have done better/what I did wrong in the examples I gave above. I find it surprising that you didn't address that point?

And interestingly, you are ASSUMING something once again about me - how do you know how old I am? Do you know if I am a millenial? How would you know that? And are you GENERALIZING to ALL millenials? are ALL millenials incapable of taking responsibility? Wow, there are millions of millenials - seems like a gross generalization to me.

What you are saying here is - if you get screwed, you "MUST" have done something wrong. Vs - sometimes people are bullied, mistreated, screwed - that's life.

Kindly back up your statements about what "I" did wrong to have the above mentioned experiences. And no I am not a millenial, but thank you for assuming something that is incorrect.

I think you have a number of unresolved issues from residency that are likely more productively explored in therapy rather than on SDN. I'm not saying that to be snarky. You certainly wouldn't be the first resident to have had a bad/malignant experience in residency. But your situation is, in no way, shape, or form similar to the OP's. In fact, it's exactly the opposite. The OP is not being treated unfairly. He's being treated exactly like every other off-service resident who asked for time off during this rotation. This is a systems issue, not a resident being singled out, harassed, or treated unfairly. It has nothing to do with your situation.

 

[Piebaldi]

I think you have a number of unresolved issues from residency that are likely more productively explored in therapy rather than on SDN. I'm not saying that to be snarky. You certainly wouldn't be the first resident to have had a bad/malignant experience in residency. But your situation is, in no way, shape, or form similar to the OP's. In fact, it's exactly the opposite. The OP is not being treated unfairly. He's being treated exactly like every other off-service resident who asked for time off during this rotation. This is a systems issue, not a resident being singled out, harassed, or treated unfairly. It has nothing to do with your situation.

They are not "unresolved" as residency is in the past - I am talking about my experiences, and can sympathize with residents who are screwed. I think you as others well knwo that there is no "resolving" certain issues in residency.
I have nothing to explore in "therapy" as there is no resolution - I find it ridiculous that someone like rokshana would suggest that a resident would be to "blame" for being repeteadly screwed when it happens in just about every program.
I believe if what OP is saying is true that ED residents are allowed to take vacation during these core months and not counted against their shifts, that there is clealry a difference in how residents are treated. You don't have to agree.
Yes it does not have to do with "my" situation - but I can see OP's frustration.

I don't think we are going to agree on this issue.

 

[Womb Raider]

That's because you're generally working more than 18 days, which is a ridiculously low amount. When you're working 18 days, you're not "making up" for days you'll miss. You're simply not being excused from the days you're scheduled in order to pass the rotation.

And 22 days is ridiculously low compared to every surgical and medical resident, so why do they get a break? It does not feel like there's any rhyme or reason to these things, it's just whatever the scheduling chief resident feels at the time, which probably varies year to year. I figured there would be more thought put into these sorts of things.

Whether or not I need 18 shifts to pass or not may or may not be the case - we'll certainly never know because I'm sure as hell not going to ask. I would like to believe if that were the case the scheduler would have said so in his/her email to me. As I said earlier, this is mainly for my own curiosity posting here - I have no intention of burning bridges over a few measly days worked. I just find it ironic and comical the ED doc used the "we work more than you" justification since ED is almost certainly the easiest residency, all things considered.

 

[Mass Effect]

They are not "unresolved" as residency is in the past - I am talking about my experiences, and can sympathize with residents who are screwed. I think you as others well knwo that there is no "resolving" certain issues in residency.
I have nothing to explore in "therapy" as there is no resolution

The point of therapy is not to solve the program's problem. The point of therapy is to be at peace with what happened to you so that you can move on. The fact that you're imaginings similarities where there are none and have repeatedly referenced your own experience makes it pretty clear that this is an issue that is still painful for you. I can respect that (and resident mistreatment is something near and dear to me), but for your own sake, I think your experience is better handled in another venue so that you can speak freely about what happened and somehow, get some peace.

I believe if what OP is saying is true that ED residents are allowed to take vacation during these core months and not counted against their shifts, that there is clealry a difference in how residents are treated. You don't have to agree.
Yes it does not have to do with "my" situation - but I can see OP's frustration.

I don't think we are going to agree on this issue.

Of course ED residents are allowed to take vacation. It's THEIR service. They will get three years of ED work, so taking vacay with reduced shifts won't affect them. The OP is off-service and has literally 18 days of ED for the rest of his life. It's entirely different. To work on a service as an off-service resident and expect to be treated the same as on-service residents with regard to vacation is ridiculous. That's like me saying I should be allowed to take vacation during my 2 weeks on cards (and thereby only having one week on cards) because the cardiology fellow gets to take vacation that month. That's crazy.

 

[Piebaldi]

And 22 days is ridiculously low compared to every surgical and medical resident, so why do they get a break? It does not feel like there's any rhyme or reason to these things, it's just whatever the scheduling chief resident feels at the time, which probably varies year to year. I figured there would be more thought put into these sorts of things.

Whether or not I need 18 shifts to pass or not may or may not be the case - we'll certainly never know because I'm sure as hell not going to ask. I would like to believe if that were the case the scheduler would have said so in his/her email to me. As I said earlier, this is mainly for my own curiosity posting here - I have no intention of burning bridges over a few measly days worked. I just find it ironic and comical the ED doc used the "we work more than you" justification since ED is almost certainly the easiest residency, all things considered.

You are correct in that outside of certain established things, there is. a lot of variation from chief to chief yearly and that can cause significant changes in scheduling between the years.
I wouldn't say ED residency is "easiest" - that might be an exaggeration.

 

[Mass Effect]

And 22 days is ridiculously low compared to every surgical and medical resident, so why do they get a break?

The same way you get a break on your in-service months. The ED residents are doing 4 extra shifts than you and they will do these shifts for 3 years, so of course they get some vacation time. To even suggest otherwise is ridiculous. Wait until you're done with residency and revisit this thread.

 

[Piebaldi]

The point of therapy is not to solve the program's problem. The point of therapy is to be at peace with what happened to you so that you can move on. The fact that you're imaginings similarities where there are none and have repeatedly referenced your own experience makes it pretty clear that this is an issue that is still painful for you. I can respect that (and resident mistreatment is something near and dear to me), but for your own sake, I think your experience is better handled in another venue so that you can speak freely about what happened and somehow, get some peace.



Of course ED residents are allowed to take vacation. It's THEIR service. They will get three years of ED work, so taking vacay with reduced shifts won't affect them. The OP is off-service and has literally 18 days of ED for the rest of his life. It's entirely different. To work on a service as an off-service resident and expect to be treated the same as on-service residents with regard to vacation is ridiculous. That's like me saying I should be allowed to take vacation during my 2 weeks on cards (and thereby only having one week on cards) because the cardiology fellow gets to take vacation that month. That's crazy.

Sorry, we simply disagree.
I can respect that you are in Psych and you view comments about mistreatment, etc. as needs for therapy. I view it differently - I talk about my experiences to let others know that it happens and bc i can sympathize. I spoke up about my experiences at my program and it led ultimately to firing of multiple rotten apples and a much better program for residents going forward, and massive improvement to the wellbeing of many residents.
Positive change takes time and speaking up.
Don't worry I am not crawled up underneath my bed sobbing and typing my experiences. I have learned to speak up about abuse. Medicine is sadly a very toxic environment - and if we don't speak about it, there won't be positive change. I am an advocate for positive change.
I have seen for example Dr. Pamela Wibble made fun of multiple times bc of her advocacy campaign against physician suicide. I'm glad she speaks out about it, and exposes all the toxic culture of medicine, and how it harms people. It's important for people to sepak up about crap. I do the same. While obviously not anywhere near the extent of the situation the OP is experiencing, again I can understand why they are frustrated.

Only speaking up about things can positive change be brought about.
As a Psychiatrist/Psych resident, you should understand that.

 

[dpmd]

Yes, that's exactly what I'm saying... Hence the reason I was surprised it was happening to me. ACGME caps us working at 80hrs/week and 6d/week averaged over a month - the ED residents have plenty of extra time they could work if they weren't being hypocritical.

Every residency schedule I'm aware of in my program, when you take vacations, you don't have to make up those hours. Usually this is because it would be impossible to make those hours up without going over ACGME requirements (at least in the specialties that work long hours and weekends). But even my derm and radiology buddies that work M-F aren't required to start working weekends to make up time when they take vacation. It's built into the schedule. It's planned for. It isn't a surprise to anyone.

How many fewer days do they work if they take a vacation on an ed month?

 

[Piebaldi]

How many fewer days do they work if they take a vacation on an ed month?

Also let's not forget ED rotations are "core" rotations for ED residents. ED residents do other than just ED rotations just like any other residency program. Most residents don't take vacation in their core rotations. So it would be reasonable for ED residents to take vacation during non ED months/electives.

 

[dpmd]

Also let's not forget ED rotations are "core" rotations for ED residents. ED residents do other than just ED rotations just like any other residency program. Most residents don't take vacation in their core rotations. So it would be reasonable for ED residents to take vacation during non ED months/electives.

I am going somewhere with this question.

 

[Mass Effect]

Sorry, we simply disagree.
I can respect that you are in Psych and you view comments about mistreatment, etc. as needs for therapy. I view it differently - I talk about my experiences to let others know that it happens and bc i can sympathize. I spoke up about my experiences at my program and it led ultimately to firing of multiple rotten apples and a much better program for residents going forward, and massive improvement to the wellbeing of many residents.
Positive change takes time and speaking up.
Don't worry I am not crawled up underneath my bed sobbing and typing my experiences. I have learned to speak up about abuse. Medicine is sadly a very toxic environment - and if we don't speak about it, there won't be positive change. I am an advocate for positive change.
I have seen for example Dr. Pamela Wibble made fun of multiple times bc of her advocacy campaign against physician suicide. I'm glad she speaks out about it, and exposes all the toxic culture of medicine, and how it harms people. It's important for people to sepak up about crap. I do the same. While obviously not anywhere near the extent of the situation the OP is experiencing, again I can understand why they are frustrated.

Only speaking up about things can positive change be brought about.
As a psychiatrist/Psych resident, you should understand that.

Wait, what? Don't turn this around on me. I very rarely say such a thing, but when a person hijacks a thread and literally posts over and over and over and over ad nauseum about being "picked on" during residency when it has nothing whatsoever to do with this thread, I think they need an outlet in which to discuss their experience and that outlet should not be this thread.

You don't get to criticize me with statements such as your last one when you're the one who's out of line here. You've managed to take a thread about a systems issue within a program and make it all about yourself on some ill-informed crusade to end resident abuse when no such abuse exists in this thread. Maybe take a break and start your own thread if you want, but don't monopolize and complicate a thread due to your unresolved issues as a trainee.

And FYI, I'm an attending. This isn't the first time I've had to clarify that for you. Not sure why you always assume those who disagree with you must be your professional junior. Last summer, you thought I was a med student and told me that I'd likely get terminated from residency when I get there if I didn't stop disagreeing with my seniors. Is that what you mean by challenging abuse in medical/graduate medical education?

 

[mestielest]

Have a rotation that's 18 shifts in 1 month. Pretty nice I know.

Had 1 week vacation during this month. I found out I still am scheduled for 18 shifts, they're just compressed into 3 weeks rather than 4. Is this normal practice? Can't think of many jobs that basically ignore your vacation week and just pile on the work to the rest of your schedule.

I will say I know this isn't a coincidence ("maybe you were scheduled for that entire week off coincidentally since you only worked 18 days") because everyone I've talked to that had their vacation fall on this rotation had the same thing happen to them, and those that worked the entire month never had an entire week off straight.

Anyway, not really a big deal just curious to hear other people's response to this. Sounds like BS exploitation of residents to me but not enough to actually do something about it.

A common situation for the first years of residency. I wish you a good vacation

 

[rokshana]

They are not "unresolved" as residency is in the past - I am talking about my experiences, and can sympathize with residents who are screwed. I think you as others well knwo that there is no "resolving" certain issues in residency.
I have nothing to explore in "therapy" as there is no resolution - I find it ridiculous that someone like rokshana would suggest that a resident would be to "blame" for being repeteadly screwed when it happens in just about every program.
I believe if what OP is saying is true that ED residents are allowed to take vacation during these core months and not counted against their shifts, that there is clealry a difference in how residents are treated. You don't have to agree.
Yes it does not have to do with "my" situation - but I can see OP's frustration.

I don't think we are going to agree on this issue.

Funny how mass effect...the psychiatrist makes a statement of you having unresolved issues and somehow it’s my comments that are an issue...maybe my comments stick because there is some sense of truth that hits home...

If what and how you post on here is how your are irl, then it’s quite obviously you still have not come to terms with what happened to you in your first residency, your second residency, and your fellowship...just sayin’... it’s basically all you post about and you interject how you were constantly screwed over as a resident...there is nothing wrong with seeking help through therapy.

And many have posted,me included, residents constantly truly getting screwed isn’t really what happens in programs....not sure why you have the desire to make people think that programs are out to get their residents...people that I know that are in Academics truly have a desire to teach and nurture the next generation of physicians and don’t take enjoyment from making residents miserable.