Post IM residency blues .... look out !

[alphagamma]

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Hi there, I'm (the husband of) a post residency doc in IM, working my first job. Here is a brief description - say 40 hours 8:30-5 M-F in the clinic/hospital/nursing home seeing patients, plus two weekday nights a week 'on call' from 5pm to 8am where I might get 40 calls, sometimes I get to sleep, sometimes not, and we're not done yet, one weekend a month, Sat and Sun, I'm 'on call' at the hospital, i.e. I'm there, 8 to 5.

Is this reasonable? Expected? Normal? What is the norm for an IM working in a private clinic. Where to get info on this topic?

Residency was a breeze compared to this !

 

[Medstudentquest]

Hi there, I'm (the husband of) a post residency doc in IM, working my first job. Here is a brief description - say 40 hours 8:30-5 M-F in the clinic/hospital/nursing home seeing patients, plus two weekday nights a week 'on call' from 5pm to 8am where I might get 40 calls, sometimes I get to sleep, sometimes not, and we're not done yet, one weekend a month, Sat and Sun, I'm 'on call' at the hospital, i.e. I'm there, 8 to 5.

Is this reasonable? Expected? Normal? What is the norm for an IM working in a private clinic. Where to get info on this topic?

Residency was a breeze compared to this !

I am personally confused by your post. Are you the husband and asking for your wife, or are you an IM residency grad and asking whether the schedule posted is average? Also, you are typically not on call twice during the week, and usually unless you are a hospitalist, you are not at the hospital on call but rather at home and residents or whoever call you.

 

[alphagamma]

I'm the husband, asking for my wife. The weeknight 'on calls' she's at home, taking calls on the telephone. Up to 40 ! The weekend 'on calls' she's at the hospital during the day.

 

[Medstudentquest]

I'm the husband, asking for my wife. The weeknight 'on calls' she's at home, taking calls on the telephone. Up to 40 ! The weekend 'on calls' she's at the hospital during the day.

It seems odd to me that your wife would have to take call twice during the week from home, and that she would be at the hospital for weekend call. Calls are definitely common and can get a ton, depending on patient volume, emergencies, admissions, etc. etc. When you say she's at the hospital during the day, do you mean the whole day? Or rounding in the am?

 

[45408]

Residency was a breeze compared to this !

Sounds like a nice residency...

 

[gutonc]

Sounds like a nice residency...

Or just a really sh***y job.

Likely a combination of the two.

 

[alphagamma]

I When you say she's at the hospital during the day, do you mean the whole day? Or rounding in the am?

Referring to the weekend 'on calls', she's only done a few so far, as approvals had to obtained, etc.; they have been for the full day.

Expanding, here is a typical week - she works 8 hours Monday, is on call from 5mp to 8am Monday night, and works 8 hours Tuesday. She is off Tues night. She works Wed, is on call Wed night, and works Thurs.

Is that reasonable? Commonplace? Expected?

Note: the contract is for 1 year. The main honcho is fond of saying at meetings ... "If you're not happy with the way things are, go elsewhere" so I'm not anticipating flexibility.

 

[Sol Rosenberg]

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[Sol Rosenberg]

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[smq123]

Hi there, I'm (the husband of) a post residency doc in IM, working my first job. Here is a brief description - say 40 hours 8:30-5 M-F in the clinic/hospital/nursing home seeing patients, plus two weekday nights a week 'on call' from 5pm to 8am where I might get 40 calls, sometimes I get to sleep, sometimes not, and we're not done yet, one weekend a month, Sat and Sun, I'm 'on call' at the hospital, i.e. I'm there, 8 to 5.

Is this reasonable? Expected? Normal? What is the norm for an IM working in a private clinic. Where to get info on this topic?

Residency was a breeze compared to this !

Whether or not this is "reasonable" or "expected" depends. What is she getting paid? Where do you guys live?

If she's getting paid in the $170K+ range (possibly more or less, depending on which region of the country you live in), then yes, this can be considered somewhat "reasonable" and certainly expected. For a general IM doctor, who doesn't do a lot of procedures, making that much money fresh out of residency is going to require a fair amount of work. A lot of Family Medicine jobs that have similar job requirements/descriptions pay pretty well for primary care ($180K on the very low end of the range).

If she's getting paid in the $110K-$150K range, then she is getting completely gypped. That is way too much work for that amount of money. If she's not getting a productivity bonus or a cut of the practice, she's also getting completely gypped.

Also, I'm confused. Is she working 5 days a week routinely? Is any part of those 5 days considered admin or flex time? Very few outpatient jobs that I looked at required that you be in the office 5 full days a week - most have you seeing patients 4 or 4.5 days a week, with the rest being flex time.

 

[alphagamma]

Whether or not this is "reasonable" or "expected" depends. What is she getting paid? Where do you guys live?

If she's getting paid in the $170K+ range (possibly more or less, depending on which region of the country you live in), then yes, this can be considered somewhat "reasonable" and certainly expected. For a general IM doctor, who doesn't do a lot of procedures, making that much money fresh out of residency is going to require a fair amount of work. A lot of Family Medicine jobs that have similar job requirements/descriptions pay pretty well for primary care ($180K on the very low end of the range).

If she's getting paid in the $110K-$150K range, then she is getting completely gypped. That is way too much work for that amount of money. If she's not getting a productivity bonus or a cut of the practice, she's also getting completely gypped.

Also, I'm confused. Is she working 5 days a week routinely? Is any part of those 5 days considered admin or flex time? Very few outpatient jobs that I looked at required that you be in the office 5 full days a week - most have you seeing patients 4 or 4.5 days a week, with the rest being flex time.

She's getting 170, great city in FL. That's all good.

So, I'm kind of getting the picture. But to me the idea of working 8 hours, being on call for the next 15 (5pm to 8am) hours and getting up to 40 calls, and then working another 8 hours, all this without a break, is ridiculous. And this happens twice a week. Sometimes she does get some sleep on the on call night, others no. This strikes me as absurd !

There ain't no flex time on this job, and she is in the clinic, in the hospital, and in nursing homes during the 8 hour day (not all on the same day), there are plenty of patients. The moving around is good, being in one place all day, especially the clinic or a nursing home, would be too much bear, I think. It's only the sleepless nights that's gumming things up. It is irrational !

Another thing is that she is good but has drawbacks (not so great English) but is absolutely confident and routine in dealing with calls, no drama. Amazing to me.

 

[Buzz Me]

But to me the idea of working 8 hours, being on call for the next 15 (5pm to 8am) hours and getting up to 40 calls, and then working another 8 hours, all this without a break, is ridiculous. And this happens twice a week. Sometimes she does get some sleep on the on call night, others no. This strikes me as absurd !

Didn't you see what her schedule was during residency? 😕

 

[Winged Scapula]

Didn't you see what her schedule was during residency? 😕

Remember the IM schedule generally gets *better* as you move up the food chain (no in house call, etc.). So perhaps hubby thought that attending-ship would be even better.

If his wife is working as a hospitalist or is the low woman on the totem pole, I can see that the schedule provided with that kind of salary is not unreasonable. Some of those junior hospitalizes work pretty long hours.

 

[alphagamma]

Her schedule was nothing like this during residency, and it was at a place in NY that has a bad reputation, but didn't live up to it thankfully. After the first year it wasn't bad. The third year was a breeze, typical 8-5 days with many easy clinic shifts, 2 2-week night shifts which were bad, 2 months spent at an affiliat4ed U which was good.

Anyhow, thanks for the input, I'm getting the idea that her current situation is not entirely unique.

 

[Buzz Me]

The third year was a breeze, typical 8-5 days with many easy clinic shifts, 2 2-week night shifts which were bad, 2 months spent at an affiliat4ed U which was good.

Wow, had no idea it could be so cush!

 

[dragonfly99]

Her residency sounds like it was cushy (toward the end).
I do think 2 nights/week of busy clinic phone call/home calls is pretty busy.
She could probably get an all-outpatient job, but that wouldn't pay as well.

 

[45408]

Wow, had no idea it could be so cush!

Welcome to a life outside of surgery residency...

 

[Buzz Me]

Welcome to a life outside of surgery residency...

The concept of "ward months" (and, therefore, "non-ward months") still blows my mind.

 

[45408]

The concept of "ward months" (and, therefore, "non-ward months") still blows my mind.

We have some off-service rotations (e.g., other surgical specialties), but they're particularly few and far between as a PGY-2 like me, and we're most definitely used as weekend help for being on call. I can't imagine a rotation that was only 9-5 during weekdays with no weekend responsibilities...

 

[LucidSplash]

We have some off-service rotations (e.g., other surgical specialties), but they're particularly few and far between as a PGY-2 like me, and we're most definitely used as weekend help for being on call. I can't imagine a rotation that was only 9-5 during weekdays with no weekend responsibilities...

Similarly, we have a specific rotation (repeated a few times during the coarse of residency) where, during the week, you only round on the patients you operate on. Call is home call and typically once or twice a week plus two weekends a month. That's about as close to cush as it gets in surgery I think (though personally I dislike home call weekends).

 

[IlDestriero]

She should have gone into anesthesia. Call is often in at 3p-7a and off the next day. 👍 Usually a few hours of sleep, even on a bad night. Your wife's call schedule is horrible. I take one a month and one weekend every 2, and I give away my weekday call frequently. They need to hire a PA or NP to manage the routine BS overnight. 40 calls would probably become <10. My neighbor is a hospitalist, she works less for more and has no clinic. Take a look.

Cheers!