Relationship with upper level residents

[Perrotfish]

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Out of curiosity, how do/did you guys act towards your upper level residents when you were Interns? Do you treat them more like bosses or more like coworkers? Do you hang out with them after work or is that inappropriate? Did you use first or last names?

 

[SeminoleFan3]

Co-workers/friends. I've hung out with some outside of work (and definitely whenever we have program get togethers), but I tend to hang out with other people in my year.

 

[Doctor Bagel]

Coworkers/friends who know more than you. I would be surprised if there's any program where you call upper levels Dr. so and so rather than use their first name, but here we actually call our attendings by their first names well (yay, west coast!), so maybe we're different.

 

[mlw03]

Coworkers/friends who know more than you. I would be surprised if there's any program where you call upper levels Dr. so and so rather than use their first name, but here we actually call our attendings by their first names well (yay, west coast!), so maybe we're different.

Agree with this. I cannot imagine a program where interns call more senior residents by title.

 

[QofQuimica]

Out of curiosity, how do/did you guys act towards your upper level residents when you were Interns? Do you treat them more like bosses or more like coworkers? Do you hang out with them after work or is that inappropriate? Did you use first or last names?

Seniors are not your bosses; they're more like your supervisors. Your boss is the PD. It is not inappropriate to hang out with seniors, fellows, or even faculty outside of work. Nearly everyone in my department (faculty as well as fellows and residents) goes by first name.

 

[Buzz Me]

There's been a definite change between how our residents interact now (more camaraderie and less distinct of a hierarchy) and when I was an intern (many years ago). When I was a PGY-1, there were some chiefs who barely knew my name, and I certainly would never be paging them. Now interns freely text or call me at all hours - I think the PGY levels are just more indistinct now.

 

[22031 Alum]

I interviewed at one program where interns called upper levels "Dr. Lastname," and ended up dropping said program completely off my rank list. Not only because of that, but I felt it was an indication of the environment not being as collegial as I was looking for.

 

[Law2Doc]

Out of curiosity, how do/did you guys act towards your upper level residents when you were Interns? Do you treat them more like bosses or more like coworkers? Do you hang out with them after work or is that inappropriate? Did you use first or last names?

Use first names ( or last, if they go by that) never "dr X", and you can certainly hang out with them at program events im promptu happy hours, etc. But in certain residencies where there is a real established hierarchy you don't want to totally forget who is the higher up. In some settings the chief resident pretty much IS your boss in that s/he can assign you to shifts, dictate what you are doing in those shifts, might be the first person you deal with if your actions are problematic and so on. Especially so if you are an intern and they have been there 4+ years, etc. So you don't want to blur the roles with too much familiarity.

 

[colbgw02]

I interviewed at one program where interns called upper levels "Dr. Lastname," and ended up dropping said program completely off my rank list. Not only because of that, but I felt it was an indication of the environment not being as collegial as I was looking for.

As a senior resident, I remember fielding a phone call from a general surgery intern during which he kept referring to what Dr. So-and-so wanted. Having spent a fair number of years in the hospital, I was momentarily confused about who Dr. So-and-so was, since I didn't recognize the name as one of the surgery attendings. The intern told me Dr. So-and-so was his chief, who was an intern with me, at which point I said something along the lines of "oh, you mean Firstname." So, yeah, those programs (and individuals) are definitely out there.

 

[45408]

Use first names ( or last, if they go by that) never "dr X", and you can certainly hang out with them at program events im promptu happy hours, etc. But in certain residencies where there is a real established hierarchy you don't want to totally forget who is the higher up. In some settings the chief resident pretty much IS your boss in that s/he can assign you to shifts, dictate what you are doing in those shifts, might be the first person you deal with if your actions are problematic and so on. Especially so if you are an intern and they have been there 4+ years, etc. So you don't want to blur the roles with too much familiarity.

Agreed on all of those levels. Also depends on their personality, as some people like to act more like that than others.

 

[SouthernSurgeon]

Use first names ( or last, if they go by that) never "dr X", and you can certainly hang out with them at program events im promptu happy hours, etc. But in certain residencies where there is a real established hierarchy you don't want to totally forget who is the higher up. In some settings the chief resident pretty much IS your boss in that s/he can assign you to shifts, dictate what you are doing in those shifts, might be the first person you deal with if your actions are problematic and so on. Especially so if you are an intern and they have been there 4+ years, etc. So you don't want to blur the roles with too much familiarity.

Yeah I would guess that this holds for many/most surgery programs.

I certainly consider my chiefs friends, call them by their first night, hang out after work. But in the hospital - what they say goes...

 

[mlw03]

Any speculation as to why such a different culture exists on this issue in surgical programs compared to everything else? Anyone trying to answer, please let's try to keep it civil. I ask this with genuine curiosity.

 

[Law2Doc]

Any speculation as to why such a different culture exists on this issue in surgical programs compared to everything else? Anyone trying to answer, please let's try to keep it civil. I ask this with genuine curiosity.

I assume because the attendings are in the OR, often unreachable for long stints of time, so the chief or senior is going to be the one running the show in their absence. Also there's a big difference when the chief is a fifth or sixth rer resident rather than a third or fourth year -- they are much closer in experience to the attending than the resident.

 

[Groove]

Personality dependent, program dependent, it's impossible to answer your question... Outside of work, they should be considered friends if you get along with them. Inside of work, it all depends on who the upper level is... I've noticed that younger (age) residents get more hung up on the totem pole hierarchy thing and are intensely sensitive to perceived insubordination making them more unpleasant to work around (for the juniors...at least "I think"). Others, like myself... see residency for what it is and could really care less about the hierarchy thing as there really is no relatively important hierarchy within residency. Who cares if you're a 3rd year or 4th year versus a 1st year, etc.. You're all residents and peons until you get out. That being said, I'm sure I've pulled the "upper level" card a few times and dumped stuff on junior residents and can sometimes also be moody, but some of that stuff is just part of residency. You're going to be the "low man" on the totem pole to some degree....as a junior, and also as a resident in general. Just don't analyze it so much and don't get your feelings hurt so much if someone barks at you or you feel that you're being unjustly treated in some way. Try to keep the big picture in mind. Residency is transient. The people you work with that are your "upper levels" are transient and will be gone shortly leaving you in their place. Your staff and attendings that you might not get along with are transient in that you will be graduated from residency in a short time. Life "begins" after residency in my opinion. Until then, suck it up and pick your battles. Try not to get upset about all the little things. Strive to embrace humility. Easier said than done that's for sure because you're going to get pissed off about a great many things during residency. Try to let most of it roll off your back.

 

[mlw03]

An interesting correlary to this discussion is what about junior attendings who were fellows or residents when you were a junior resident? I had a few of them in residency, and could not bring myself to call any of them by their last names. Was of course respectful, and did use titles in front of certain folks (am a pathologist, so very few patients), but I couldn't imagine going from calling someone "Justin" to "Dr. Smith" after you've known them a year or two.

 

[22031 Alum]

At my program (ob/gyn), we work at one hospital with more old-school attendings, and another with far more attendings who are recently out of residency. Last year the older attendings initially expected interns to refer to upper levels as Dr. Lastname. We quickly got rid of that tradition. The attendings themselves, of course, are always Dr. Lastname.

At our other hospital, the unspoken rule is that if you were a resident within the past 4 years (ie at the same time as any of the current residents), you are Firstname.

 

[45408]

Any speculation as to why such a different culture exists on this issue in surgical programs compared to everything else? Anyone trying to answer, please let's try to keep it civil. I ask this with genuine curiosity.

There's only one year in between a medicine intern and the medicine senior, and an "upper level" medicine resident might only be a PGY-2. That's pretty close. If you consider the surgery programs where someone can do research years as a resident, they might be a PGY-1 and a PGY-7, which is a much bigger difference.

Plus, the roles in surgery do actually change quite a bit. Now of course, the interns can't take overnight call at all, so that's one thing. The other big thing is that you don't operate much (or at least not on big cases - if you do a lot of cases, it will be hernias, anorectal cases, etc) as an intern, and it's a gradual ramping up.

 

[SouthernSurgeon]

There's only one year in between a medicine intern and the medicine senior, and an "upper level" medicine resident might only be a PGY-2. That's pretty close. If you consider the surgery programs where someone can do research years as a resident, they might be a PGY-1 and a PGY-7, which is a much bigger difference.

Plus, the roles in surgery do actually change quite a bit. Now of course, the interns can't take overnight call at all, so that's one thing. The other big thing is that you don't operate much (or at least not on big cases - if you do a lot of cases, it will be hernias, anorectal cases, etc) as an intern, and it's a gradual ramping up.

I think this pretty much covers it. The attitude/hierarchy difference in surgery as compared to medicine is a combination of tradition, major differences in experience level/age, and major differences in the role of the chief and the intern on the team.

When I was an intern all of my chiefs were PGY7s, with one PGY8 (three years in lab). And they all seemed much much closer to "attendings" to me than they did residents. Didn't stop us from going out on the weekend together though, which is one of the things I love about my program (compared to some places on the interview trail where the chiefs didn't even seem to know their interns names..)

 

[Buzz Me]

You become a better surgeon with time and experience...the PGY-3 will always be better in the OR than the PGY-1; same goes for the PGY-5 compared to the PGY-3, etc. That's why the hierarchy is followed so closely, and that's why you respect your senior attendings.

As stated earlier, the difference between an intern and a chief resident can be as many as 5-7 years, so there's a much bigger gap than between a Medicine intern and PGY-3.

 

[Law2Doc]

You become a better surgeon with time and experience...the PGY-3 will always be better in the OR than the PGY-1; same goes for the PGY-5 compared to the PGY-3, etc...

well this aspect is true even in the non hierarchical fields -- that those with more years of experience are better at their craft -- so it can't be the whole explanation of the difference between surgery and, say medicine. The number of years difference between intern and chief might explain some of it, but every field has 1-2 year differentials and not all have hierarchy. I think you have to focus on the differential of PGY 1 to PGY 6, and leave out the smaller steps, if you want to explain why surgery is "different".

 

[22031 Alum]

well this aspect is true even in the non hierarchical fields -- that those with more years of experience are better at their craft -- so it can't be the whole explanation of the difference between surgery and, say medicine. The number of years difference between intern and chief might explain some of it, but every field has 1-2 year differentials and not all have hierarchy. I think you have to focus on the differential of PGY 1 to PGY 6, and leave out the smaller steps, if you want to explain why surgery is "different".

I think it's more the difference in number of years than in skill. Ob/Gyn kind of straddles this line, in that it's a surgical field based on technical skills, but a short residency. The skill jump between each years is obvious, but the hierarchy isn't super strict- at least in my experience. I think it's because same PGY2s who shared junior duties with me last year, are now PGY3s that I'm subordinate to on call (as in, everything I do goes through them). And a few weeks from now we'll be running teams together as co-seniors. It's hard to be strictly hierarchical when things change that quickly.

 

[smq123]

I think it's more the difference in number of years than in skill. Ob/Gyn kind of straddles this line, in that it's a surgical field based on technical skills, but a short residency. The skill jump between each years is obvious, but the hierarchy isn't super strict- at least in my experience. I think it's because same PGY2s who shared junior duties with me last year, are now PGY3s that I'm subordinate to on call (as in, everything I do goes through them). And a few weeks from now we'll be running teams together as co-seniors. It's hard to be strictly hierarchical when things change that quickly.

This is program dependent. Where I did my OB rotation as an MS3, PGY-3s were NOT ALLOWED to speak to attendings about new consults. The only person that the attendings would talk to about new consults/patient issues was the service chief (usually a PGY-4).

 

[22031 Alum]

This is program dependent. Where I did my OB rotation as an MS3, PGY-3s were NOT ALLOWED to speak to attendings about new consults. The only person that the attendings would talk to about new consults/patient issues was the service chief (usually a PGY-4).

I totally agree with you; my last point was mostly how residents relate to each other. As in, the hierarchy is not as strict because different PGY levels switch between (rough) equals to supervisor/supervisee back to equals relatively quickly. Should've been more specific.

(Side note: here, calling the attending to dispo consults is totally the junior's job! After talking to the senior of course.)