Regular sleep as a resident?

[randombetch]

How hard is it to get regular sleep as an internal medicine resident? I heard they often do 30 hour shifts and then take the entire next day off?

My sleeping pattern gets thrown off really easily, so I was wondering how hard it is for residents to get the normal 8 hours a day. Anyone with any insight?

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[group_theory]

How hard is it to get regular sleep as an internal medicine resident? I heard they often do 30 hour shifts and then take the entire next day off?

My sleeping pattern gets thrown off really easily, so I was wondering how hard it is for residents to get the normal 8 hours a day. Anyone with any insight?

entire next day off

What q4 calls mean with 30 hr calls

Day 1: Start work at 6AM
Day 2: Finish work at 12PM (from Day 1)
Day 3: Return to work at 6AM, but finish at 6-7PM (best case scenerio)
Day 4: Work from 6AM-6/7PM
Day 5: Start work at 6AM
Day 6: Finish work at 12PM (from Day 5)

Rinse and repeat.

Per ACGME guidelines, you should have roughly 4 days off in a 4 week period (doesn't necessarily mean 1 day off per week - it may be clumped together at the end and would still technically follow the rules)

The 80 hr per week is averaged over 4 weeks. So if you have 4 days off at the very end, you can have a very busy (>80 hrs/week) for the first 3 week and then have a < 80 hr week on week 4 (and if it averages out to around 80 hrs/week, the program is still following the rules). They can have you work 95 hrs/week for the first 3 weeks, then put in 12 hr days for 3 days (and then give you the 4 days off as required) on week 4, and still be within the 80 hr/week, 4 days off/4 week rule.

Of course, not all rotations or programs do this (and this is worse case scenerio for a program that follow the rules). If there is enough manpower, the schedule won't be as rough. Of course there are programs who violate the rules

 

[tremulousNeedle]

Having a regular sleep pattern during residency will be difficult, but this is specialty specific. During an IM residency there are mainly two types of month-long rotations you can do, outpatient and inpatient medicine.

Outpatient medicine is usually during the daytime hours, 9ish to 5ish.

Inpatient medicine varies from program to program, but the most common schedule is ~30 hour call every 3rd or 4th night (In on Monday at 6am, out on Tuesday at noon, back again on WEDNESDAY and Thursday for a regular days work: 7ish - 5ish, then another 30 shift on Friday to Saturday). Some programs have night rotators that cover the overnights, so the residents put in 12 - 16 hour days, but don't stay overnight and usually have a couple more days off during the month. The caveat here is that each resident takes turns being the night rotators, so at some point you would be require to cover a string of night shifts (this is ranges from 1-4 weeks at a time depending on the program).

Something to consider is that the ACGME (the governing body for residency programs), is reviewing its policy on work hour restrictions. The biggest talked-about change will be the addition of a mandatory 5 hour nap (yes I said nap) for residents working the 30 hour shift (there are other suggested changes too).

-admissions committee interviewer / senior medical student (12 days left)

 

[drizzt3117]

My brother's program (surgical specialty) had the students sign a waiver from the acgme saying they didn't follow the 80 hr work week the first day they started and that they'd work 88 or less hours (some sort of loophole), not sure this is common.

 

[ILikeDrugs]

The biggest talked-about change will be the addition of a mandatory 5 hour nap (yes I said nap) for residents working the 30 hour shift (there are other suggested changes too).

lol @ nap time. Will a nurse be there to tuck us in?

 

[skiddoc]

lol @ nap time. Will a nurse be there to tuck us in?

I wouldn't mind tucking her in, if you know what I mean

 

[austinap]

My brother's program (surgical specialty) had the students sign a waiver from the acgme saying they didn't follow the 80 hr work week the first day they started and that they'd work 88 or less hours (some sort of loophole), not sure this is common.

You can opt-out of the 80 hour/wk regulations?? That sounds odd to me...

 

[tremulousNeedle]

You can opt-out of the 80 hour/wk regulations?? That sounds odd to me...

Not w/o violating ACGME rules. The ACGME does allow for programs to increase work hours / week by 10%, which explains the 88 hrs/wk. Averaging above 88 hr/wk for any program is a violation.

 

[drizzt3117]

You can opt-out of the 80 hour/wk regulations?? That sounds odd to me...

Idk, apparently. Apparently harvard figures they can do whatever they want 🙄

 

[ILikeDrugs]

Not w/o violating ACGME rules. The ACGME does allow for programs to increase work hours / week by 10%, which explains the 88 hrs/wk. Averaging above 88 hr/wk for any program is a violation.

Most of the docs that I've shadowed with laughed at the 80-hour cap when I brought it up. Apparently it's just a formality and residents just go along with whatever is happening with their schedule. It's kind of like being in the military, if you see something that there is something wrong that could get your superiors in trouble you keep quiet, brush it aside, and be a good little soldier boy. I wouldn't be surprised if their is some strong-arming and intimidation. People in medicine can be pretty vengeful since a lot are power hungry monkeys and bitter divorces with huge alimony/child support payments.

 

[RogueUnicorn]

yea.. pretty sure what happens if you actually clock in at over 80, the PD will call you in and say everyone else is doing all their work in 80 hrs (since they know to not say they're over 80) so you need to get more efficient..

 

[Xinlitik]

I have always thought this was incredibly strange. Of all people, you'd think a society of physicians would understand that peoples' performance (read: medical errors) decreases dramatically with sleep deprivation.

 

[whoknows2012]

Most of the docs that I've shadowed with laughed at the 80-hour cap when I brought it up. Apparently it's just a formality and residents just go along with whatever is happening with their schedule. It's kind of like being in the military, if you see something that there is something wrong that could get your superiors in trouble you keep quiet, brush it aside, and be a good little soldier boy. I wouldn't be surprised if their is some strong-arming and intimidation. People in medicine can be pretty vengeful since a lot are power hungry monkeys and bitter divorces with huge alimony/child support payments.

I doubt that those regulations are just a formality....

 

[Law2Doc]

Idk, apparently. Apparently harvard figures they can do whatever they want 🙄

You can't opt out of the 80 hour work week, and no waiver is going to save a program. What you do see happening sometimes is that programs have residents fill out time cards and if the numbers come back too high, the less scrupulous programs browbeat the residents into resubmitting time cards that are within compliance, regardless of whether true. Honestly, at most programs the 80 hour duty hour restriction is abided to with most residents working closer to a 75 hour work week, thanks to inventions like night float.

As for the initial question about regular sleep patterns as a resident, you can forget it. There are LOTS of variations on the theme, but none give the typical intern a 7 hour/night regular sleep schedule. You either see q3-q5 type calls (see the q4 schedule that group_therapy posted above, which is pretty typical, with 30 hour long call), or you have night float. The way night float tends to work is that you come in at 6pm and leave at 7am for 6 nights in a row, with your day off usually falling on a weekend. The downside is that since you are leaving at 7am on your "day off" you are actually in the hospital for some time every single day. The up-side is that if everyone in the program does a month of night float, you don't have to have nearly as much overnight call the rest of the year. But in that month you basically have to sleep during the daytime, because if a program is only having you work a 13 hour shift/day, they aren't going to expect you to be sleeping during it. It's the transfers from day work to night float and back at either end of the rotation that tend to be hardest on sleep patterns. It's very hard to go from sleeping days to sleeping nights, and you don't usually get a weekend off to regroup and get back to a normal pattern.

Finally you guys should realize that during 30 hour overnight shifts you may get some sleep a few hours, but not infrequently will be spending the entire call working and not sleep at all. I can count on one hand the number of nights I actually saw the call room, and even on those times you will inevitably be awoken every half hour with various foolish questions that didn't really need to be addressed at 3am.

So in short, no you won't get regular sleep as a resident. you will learn to sleep when you have the opportunity. Like whenever you sit behind the wheel.😱

 

[Law2Doc]

I have always thought this was incredibly strange. Of all people, you'd think a society of physicians would understand that peoples' performance (read: medical errors) decreases dramatically with sleep deprivation.

Sure, but there are other components of the system where errors will creep in when you adjust for this one. Meaning if you give everyone shorter hours they will be more alert, but then you have to have more handoffs, which happen to be the biggest source of medical errors. Patients do more poorly as a result of someone not knowing what's going on with them than they do with someone too tired to remember what's going on with them. As a result most studies have not shown errors to decrease as hours were decreased to the 80 hour limit.

Also, to get the training needed, residents need to log a significant number of hours in the hospital, because the goal is to see and do as much as you can in what ends up being a fairly short number of years of training, given the expectations. A practitioner is only well trained if he has seen and done a ton. And you can do neither when you are home asleep. The folks in years past and did q2 call were exhausted most of the time and logged 110+ hours/week regularly, but they came out of residency having seen literally half of all the cases that came through the hospital (as opposed to the quarter to third folks see now). The only way to address this loss of exposure would be to lengthen residencies, which few residents have an appetite for and there isn't money for.

So it's not really as simple as "don't doctors know sleep is important"? It's more an issue of (1) this doesn't actually decrease errors in the system, and (2) it leads to less case exposure. So it's a balancing act, and at this point 80 hours average is where the ACGME has deemed the balance between concerns reasonable.

 

[Law2Doc]

I doubt that those regulations are just a formality....

It's not, and thanks to whistle blowers, some of the programs that violate these hours have been seriously damaged. Getting caught violating the rules is a big deal for programs. But the residents have conflicting incentives -- they don't want to work crazy hours, but by the same token don't want to damage the program that they and their friends are hoping to "graduate" from.

 

[whoknows2012]

I find it eternally frustrating when pre-med's post misinformation on these boards. If you have anecdotal evidence about something DON'T state it as fact...I've literally encountered this 100 times in the past couple weeks in the pre-allo forum. When I post on a topic that I don't totally know for sure I make sure to say that it is my opinion or from MY OWN experience, and neither of those make a comment factual. Pre-meds and anyone in this thread reading...please heed this advice!

 

[drizzt3117]

Well as tn said, you can get a waiver to 88 hours/wk. That said, a lot of people in surgical specialties are working significantly more than 80 or even 88. I've talked to about 5-6 people in a few diff fields (urology, plastics, gen surg) that consistently put in 100 and a lot of it is voluntary. Residents want OR time and the ones that work harder often get it.

You can't opt out of the 80 hour work week, and no waiver is going to save a program. What you do see happening sometimes is that programs have residents fill out time cards and if the numbers come back too high, the less scrupulous programs browbeat the residents into resubmitting time cards that are within compliance, regardless of whether true. Honestly, at most programs the 80 hour duty hour restriction is abided to with most residents working closer to a 75 hour work week, thanks to inventions like night float.

As for the initial question about regular sleep patterns as a resident, you can forget it. There are LOTS of variations on the theme, but none give the typical intern a 7 hour/night regular sleep schedule. You either see q3-q5 type calls (see the q4 schedule that group_therapy posted above, which is pretty typical, with 30 hour long call), or you have night float. The way night float tends to work is that you come in at 6pm and leave at 7am for 6 nights in a row, with your day off usually falling on a weekend. The downside is that since you are leaving at 7am on your "day off" you are actually in the hospital for some time every single day. The up-side is that if everyone in the program does a month of night float, you don't have to have nearly as much overnight call the rest of the year. But in that month you basically have to sleep during the daytime, because if a program is only having you work a 13 hour shift/day, they aren't going to expect you to be sleeping during it. It's the transfers from day work to night float and back at either end of the rotation that tend to be hardest on sleep patterns. It's very hard to go from sleeping days to sleeping nights, and you don't usually get a weekend off to regroup and get back to a normal pattern.

Finally you guys should realize that during 30 hour overnight shifts you may get some sleep a few hours, but not infrequently will be spending the entire call working and not sleep at all. I can count on one hand the number of nights I actually saw the call room, and even on those times you will inevitably be awoken every half hour with various foolish questions that didn't really need to be addressed at 3am.

So in short, no you won't get regular sleep as a resident. you will learn to sleep when you have the opportunity. Like whenever you sit behind the wheel.😱

 

[Bacchus]

Just another reason to avoid surgical specialties. 🙂

 

[LRAccord624]

This is the scariest thing about medical training to me. At least I'm really not interested in any surgical specialties (not at this point anyway). But I definitely need 7+ hours of sleep in order to feel good and function well the next day. When I happen to get 0-6 hours of sleep, which rarely happens, I feel like crap the next day. Is this something you just get used to?

 

[drizzt3117]

This is the scariest thing about medical training to me. At least I'm really not interested in any surgical specialties (not at this point anyway). But I definitely need 7+ hours of sleep in order to feel good and function well the next day. When I happen to get 0-6 hours of sleep, which rarely happens, I feel like crap the next day. Is this something you just get used to?

Yeah pretty much! 4 hours of sleep is pretty much par for the course for me, you get used to it.

 

[Perrotfish]

Most of the docs that I've shadowed with laughed at the 80-hour cap when I brought it up. Apparently it's just a formality and residents just go along with whatever is happening with their schedule. It's kind of like being in the military, if you see something that there is something wrong that could get your superiors in trouble you keep quiet, brush it aside, and be a good little soldier boy. .

Please don't compare the military to these *****holes. Actually I've heard that one of the advantages of doing your residency with the military is that they actually adhere to the 80 hour work week. Ignoring the rules is definitely not a military trait.

I have always thought this was incredibly strange. Of all people, you'd think a society of physicians would understand that peoples' performance (read: medical errors) decreases dramatically with sleep deprivation.

This has nothing to do with either your or your patients' health. The reason the hours are so long is that the people who are working you to death charge for your service, and the more they work you the more they can pay themselves. It's really that simple. Also, because the government has effectively allowed medicine to operate as a trust, you can't walk away from the training and leave them in the lurch without getting blackballed from the entire profession.

 

[mvenus929]

So in short, no you won't get regular sleep as a resident. you will learn to sleep when you have the opportunity. Like whenever you sit behind the wheel.😱

Which is why I hope I get a residency in a city with a good public transportation system. I'd much rather fall asleep on a bus and annoy the bus driver than fall asleep at the wheel of a car and kill someone.

This is the scariest thing about medical training to me. At least I'm really not interested in any surgical specialties (not at this point anyway). But I definitely need 7+ hours of sleep in order to feel good and function well the next day. When I happen to get 0-6 hours of sleep, which rarely happens, I feel like crap the next day. Is this something you just get used to?

In the past 48 hours, I've had, at most, 9 hours of sleep. I woke up at 6 on Friday morning and stayed up until 1:30 Saturday morning, slept for 3 hours before work, and then slept Saturday afternoon for 5-6 hours before getting up at midnight to go to work. I could do another couple hours before I completely crash, though I wouldn't be the most pleasant person in the world doing it. And I'm not even a resident.

Your body will adjust for it, or your mind will to make up for it. It's a do or die situation, so you have to get used to it.

 

[silverhorse84]

This is the scariest thing about medical training to me. At least I'm really not interested in any surgical specialties (not at this point anyway). But I definitely need 7+ hours of sleep in order to feel good and function well the next day. When I happen to get 0-6 hours of sleep, which rarely happens, I feel like crap the next day. Is this something you just get used to?

Yeah, you'll get used to it. Also, as L2D said, you'll get used to getting sleep whenever/wherever you can (hopefully not while you're driving though). I never used to be able to take naps, but after working as an EMT with 24 hour shifts, I've learned to sleep any time of the day, including while sitting up.

 

[Xinlitik]

Sure, but there are other components of the system where errors will creep in when you adjust for this one. Meaning if you give everyone shorter hours they will be more alert, but then you have to have more handoffs, which happen to be the biggest source of medical errors. Patients do more poorly as a result of someone not knowing what's going on with them than they do with someone too tired to remember what's going on with them. As a result most studies have not shown errors to decrease as hours were decreased to the 80 hour limit.

Also, to get the training needed, residents need to log a significant number of hours in the hospital, because the goal is to see and do as much as you can in what ends up being a fairly short number of years of training, given the expectations. A practitioner is only well trained if he has seen and done a ton. And you can do neither when you are home asleep. The folks in years past and did q2 call were exhausted most of the time and logged 110+ hours/week regularly, but they came out of residency having seen literally half of all the cases that came through the hospital (as opposed to the quarter to third folks see now). The only way to address this loss of exposure would be to lengthen residencies, which few residents have an appetite for and there isn't money for.

So it's not really as simple as "don't doctors know sleep is important"? It's more an issue of (1) this doesn't actually decrease errors in the system, and (2) it leads to less case exposure. So it's a balancing act, and at this point 80 hours average is where the ACGME has deemed the balance between concerns reasonable.

Well, I really can't argue against an actual study. Thanks for the info

 

[randombetch]

It's a shame, then. In high school and during my freshman year, I'd sleep pretty irregularly (4-5 hours a night during the week, 12-14 hours a night on the weekends), but I decided my sophomore year to stick to 8 hours a night no matter how much work I have. Of course, since I sleep 8 hours a night, I remember things more clearly and work much more efficiently, so my grades have actually gone up despite spending less time studying. I guess I won't be able to do this while an IM resident...

Maybe I'll match into Rad Onc so I'll only have to deal with the crazy 30-10-10-30 schedule for a year before working "only" 50-60 hours a week as a Rad Onc resident. 😀

 

[Winged Scapula]

RE: 88 hours per week

Residency programs *can* petition the ACGME for an exemption to the 80 hours per week when there is an "educational need" for the increase to 88. To date, few programs have qualified and I believe all of them have been Neurosurg programs.

So yeah, you can't just "opt out" of the 80 hours; you have to have permission.

 

[tremulousNeedle]

RE: 88 hours per week

Residency programs *can* petition the ACGME for an exemption to the 80 hours per week when there is an "educational need" for the increase to 88. To date, few programs have qualified and I believe all of them have been Neurosurg programs.

So yeah, you can't just "opt out" of the 80 hours; you have to have permission.

This is the same information I have too.

 

[drizzt3117]

RE: 88 hours per week

Residency programs *can* petition the ACGME for an exemption to the 80 hours per week when there is an "educational need" for the increase to 88. To date, few programs have qualified and I believe all of them have been Neurosurg programs.

So yeah, you can't just "opt out" of the 80 hours; you have to have permission.

Well at least one uro program has.

I think it has to do with the years of the program. My brother's program is only 5 years while many are 6-7.

 

[Winged Scapula]

Well at least one uro program has.

I think it has to do with the years of the program. My brother's program is only 5 years while many are 6-7.

It was my understanding that the vast majority are 4 years after a Prelim year; there are a few 6 year programs but according to my Uro friends (and other sources on line), most *are* 5 years (1+4 or 2+3).

 

[tremulousNeedle]

As one of the perks of my chosen specialty, during my EM months I average ~60 hour / week throughout residency. I only have to worry about work hour restrictions when I am office service. 😱

 

[drizzt3117]

It was my understanding that the vast majority are 4 years after a Prelim year; there are a few 6 year programs but according to my Uro friends (and other sources on line), most *are* 5 years (1+4 or 2+3).

Idk, maybe this is changing, when he applied (he's a pgy-3) many programs were 6 years (or 7 with an extra research or built in fellowship year(s))and the only 5 year programs he applied to were bwh and sf. Anyways they're definitely on a 88 hour work week.

 

[auburnO5]

My sleeping pattern gets thrown off really easily, so I was wondering how hard it is for residents to get the normal 8 hours a day. Anyone with any insight?

 

[Winged Scapula]

Idk, maybe this is changing, when he applied (he's a pgy-3) many programs were 6 years (or 7 with an extra research or built in fellowship year(s))and the only 5 year programs he applied to were bwh and sf. Anyways they're definitely on a 88 hour work week.

I doubt its changing as I graduated several years ago and our local programs were all 1+4 and the Uro attendings I know only did 5 years as well. Those with a superspecialty, did additional fellowship years.

If you do a FREIDA search, the majority of programs are still 5 years although there are some with required research. If your brother was applying to high powered academic programs, his sample may have been biased, as those may very well be longer than the usual Urology residency which is 5 years total (including the Prelim year).

A program with a"built in fellowship year" is a different animal. That is not a Urology residency but a superspecialty.

At any rate...not very important and back to the OP's question...

 

[deuist]

Idk, apparently. Apparently harvard figures they can do whatever they want

Well, they're on probation now anyway.

 

[deuist]

As one of the perks of my chosen specialty, during my EM months I average ~60 hour / week throughout residency. I only have to worry about work hour restrictions when I am office service.

One thing you alluded to without mentioning it is that EM is capped at 60 hrs/wk. It is the only specialty that is below 80. The bad news is that you're constantly switching from days to nights, leading to more fatigue than if you had a set schedule.

If the OP is so worried about sleep he can always try for a transitional year and then go into derm, PMR, rads, or one of the many lifestyle specialties. And yes, you can learn to fall asleep while sitting in a chair at the nurse's station.

 

[nmbutah]

I definitely worry about this question. I simply cannot imagine being chronically sleep deprived and working 80 hours a week for years on end. Maybe that means I don't want it enough, but I need leisure time in my life to avoid going insane. that said, it does seem that there are some residencies out there that are only mildly rediculous...so study hard in med school so you can make sure you get those residencies. fingers crossed things get better too.

 

[Perrotfish]

I definitely worry about this question. I simply cannot imagine being chronically sleep deprived and working 80 hours a week for years on end. Maybe that means I don't want it enough, but I need leisure time in my life to avoid going insane. that said, it does seem that there are some residencies out there that are only mildly rediculous...so study hard in med school so you can make sure you get those residencies. fingers crossed things get better too.

Oddly enough those aren't usually not the residencies you study hard to get. PM&R, Rural family med with a low emphsis on Gyn, Psyche, and EM are all the more likely candidates for normal hours in residency, and of all of them only EM is even romotely competitive. A lot of the high end residencies have great lifestyles once you're trained but in residency the only one I would imagine might be good is Derm (no idea if they actually are, I just can't imagine them find 100 hours/week of work to do).

 

[Law2Doc]

RE: 88 hours per week

Residency programs *can* petition the ACGME for an exemption to the 80 hours per week when there is an "educational need" for the increase to 88. To date, few programs have qualified and I believe all of them have been Neurosurg programs.

So yeah, you can't just "opt out" of the 80 hours; you have to have permission.

Agree with this. The 80 hour limit is what pretty much everyone is living under. The 88 hours may exist in theory for exceptional educational reasons, but is a rarity. That being said, you can work a lot more than 80 hours in a given week under the 80 hour rules. For example, if you work 100 hours for two weeks and then in the next couple of weeks you have a few days off/shorter days so you work for 60 hour over the next two weeks, that still comes out to an 80 hour average.

As others have pointed out, compliance on the 80 hour rule is spotty. That being said, it is a very big deal for a program to get caught violating the hours rules, so nobody regards it as just a formality.

 

[drizzt3117]

Oddly enough those aren't usually not the residencies you study hard to get. PM&R, Rural family med with a low emphsis on Gyn, Psyche, and EM are all the more likely candidates for normal hours in residency, and of all of them only EM is even romotely competitive. A lot of the high end residencies have great lifestyles once you're trained but in residency the only one I would imagine might be good is Derm (no idea if they actually are, I just can't imagine them find 100 hours/week of work to do).

Rads/anesthesia aren't so bad. Rads call is intense though.

 

[Law2Doc]

Rads/anesthesia aren't so bad. ..

Both those have a prelim year requirement, where you will either be doing a year of medicine, surgery or transitional first. You will likely hit 80 hour marks in the prelim year.

 

[smq123]

Everyone keeps forgetting about pathology - the ultimate in <60 hours per week, minimal call, minimal nights, no emergencies. And no prelim year either.

 

[TooMuchResearch]

Which is why I hope I get a residency in a city with a good public transportation system. I'd much rather fall asleep on a bus and annoy the bus driver than fall asleep at the wheel of a car and kill someone.

Some programs offer free cab rides home for their residents after call nights. Not so sure how the residents get back to work, though

 

[drizzt3117]

Both those have a prelim year requirement, where you will either be doing a year of medicine, surgery or transitional first. You will likely hit 80 hour marks in the prelim year.

cushy transitional years aren't anywhere near 80 hours per week on average though, maybe on trauma or icu or some surgery rotations though, my cousin is finishing up her transitional year now though at a fairly average place in terms of workload and they were not working her hard at all, esp on rotations like anesthesia.

I hear the Torrance transitional program is the epitome of cushiness though 🙂 la ftw.

 

[Parts Unknown]

Everyone keeps forgetting about pathology - the ultimate in <60 hours per week, minimal call, minimal nights, no emergencies. And no prelim year either.

Mostly true. Surgical pathology months at certain institutions can exceed 80 hours per week. Many programs take home call in 1 week blocks. If you're covering a hospital with a big transplant service you can actually spend a lot of your call nights in house mucking around with renal biopsies and whatnot. Emergencies do exist, although usually in the form of after hours frozen sections or massive transfusions.

But yeah, overall not too bad compared to most other specialties.

 

[smq123]

cushy transitional years aren't anywhere near 80 hours per week on average though, maybe on trauma or icu or some surgery rotations though, my cousin is finishing up her transitional year now though at a fairly average place in terms of workload and they were not working her hard at all, esp on rotations like anesthesia.

I hear the Torrance transitional program is the epitome of cushiness though 🙂 la ftw.

Cush transitional years are often extremely competitive, by the way. And many include at least some OB time, in addition to ICU and trauma.

 

[drizzt3117]

Cush transitional years are often extremely competitive, by the way. And many include at least some OB time, in addition to ICU and trauma.

Yeah, so are the residencies they lead into though. Not worried about it. I feel like it's actually sort of useful to do for rads, though, while I would guess for anesthesia surgery or med might be more useful.

 

[smq123]

Yeah, so are the residencies they lead into though.

True, although the word on the street from this year's applicants is that the cush transitionals are more competitive than even the categorical residencies they lead into. I can believe it. There were a couple of scary stories on SDN these past few years of people who matched into a categorical advanced position, but couldn't find a prelim or a transitional year.

 

[Law2Doc]

True, although the word on the street from this year's applicants is that the cush transitionals are more competitive than even the categorical residencies they lead into. I can believe it. There were a couple of scary stories on SDN these past few years of people who matched into a categorical advanced position, but couldn't find a prelim or a transitional year.

The cush ones are much more competitive than the residencies they lead into because there aren't that many of them, and every top derm, rads, rad-onc, optho etc type wants one (not to mention the best of gas, neuro, PM&R etc). So although you may have had good enough stats to get into your desired ROAD field, you would now have to beat out the tops of all these paths to get the cushiest of transitionals. Which is why actually the majority of advanced path residents end up in prelim years rather than transitional -- there simply aren't the spots to go around and not everybody who gets into a competitive field is better than the average person going into a competitive field. And yes, it happens that folks don't match into prelim years, although there tend to be ample surgical prelims in the scramble.