Residency at Older Age (30-40 years old)

[remzremz]

I'm 28 and considering applying to med school. By the time I finish medical school I will be around 36-37 years old. I know that puts me on the older side for interns and residents. I wanted to hear from people who started their residencies in their early or mid-thirties or even forties. Did your age play a factor when interviewing? How has it affected your time as an intern/resident?

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[NotAProgDirector]

One of my PGY-2's is over 50. This is a second career for her. She is fantastic. Her age wasn't a factor for us at all.

 

[Trauma Surgeon]

One of my PGY-2's is over 50. This is a second career for her. She is fantastic. Her age wasn't a factor for us at all.

Surely it depends on the speciality? I know a cardiothoracic surgeon who decided at age 50 to start a residency in psyche! I'm sure the way around would have been impossible.

 

[QofQuimica]

I started residency at age 36, so I was ten years older than my fellow interns who were trads. For the most part, it didn't make much difference in terms of how people treated me or at interviews, other than getting some ribbing from the young'uns. (I was the oldest in my residency class at a high power academic program by seven or eight years.)

But I will tell you this: as you get older, you just don't bounce back from those nights on call or night shifts the way the younger folks do. In college, heck, even at your age, pulling an all-nighter was no big deal. At my age (40), well, being post-call feels a lot like being hung over without having had any fun the night before.

As a resident, you pretty much have to suck it up no matter what age you are. But it's still doable, even for someone in their 30s. And once you're an attending, you have some ability to control your schedule and prevent that constant feeling of jetlag based on what job you take. Some people work in the outpatient setting, in which case you can simply not schedule any night hours. But depending on specialty, you still might have to take night call.

I've compensated for it by becoming a nocturnist (work all nights) so that I never have to flip back and forth between nights and days. That solution works for me since I like sleeping in late and don't have kids. Most of my fellow middle aged colleagues who have families prefer to suck up the occasional night so that they can be on their family's schedule most of the time.

 

[serimeri]

I started residency at age 36, so I was ten years older than my fellow interns who were trads. For the most part, it didn't make much difference in terms of how people treated me or at interviews, other than getting some ribbing from the young'uns. (I was the oldest in my residency class at a high power academic program by seven or eight years.)

But I will tell you this: as you get older, you just don't bounce back from those nights on call or night shifts the way the younger folks do. In college, heck, even at your age, pulling an all-nighter was no big deal. At my age (40), well, being post-call feels a lot like being hung over without having had any fun the night before.

As a resident, you pretty much have to suck it up no matter what age you are. But it's still doable, even for someone in their 30s. And once you're an attending, you have some ability to control your schedule and prevent that constant feeling of jetlag based on what job you take. Some people work in the outpatient setting, in which case you can simply not schedule any night hours. But depending on specialty, you still might have to take night call.

I've compensated for it by becoming a nocturnist (work all nights) so that I never have to flip back and forth between nights and days. That solution works for me since I like sleeping in late and don't have kids. Most of my fellow middle aged colleagues who have families prefer to suck up the occasional night so that they can be on their family's schedule most of the time.

Trust me, even being young, bouncing back from those call days are difficult for those of us who love sleep, especially for those who love 9 hours a night like me haha

Luckily, my 4th year has been pretty chill as a med student, but I'm sure I'll be in for a rude awakening when I take call starting PGY1

 

[QofQuimica]

Trust me, even being young, bouncing back from those call days are difficult for those of us who love sleep, especially for those who love 9 hours a night like me haha

Luckily, my 4th year has been pretty chill as a med student, but I'm sure I'll be in for a rude awakening when I take call starting PGY1

You probably will. I know you think you're working as hard as your residents are, but trust me, you're not. 😛

These days, a lot of call for residents has been substituted with shift work anyway. On several residency rotations, I wound up doing a week or two of days, followed by a week or two of nights, rinse, and repeat. I'm a great believer in melatonin to help reset the clock. Might be mainly placebo effect, but if so, don't tell me. I still use it when I need to switch to days on occasion.

 

[serimeri]

You probably will. I know you think you're working as hard as your residents are, but trust me, you're not. 😛

These days, a lot of call for residents has been substituted with shift work anyway. On several residency rotations, I wound up doing a week or two of days, followed by a week or two of nights, rinse, and repeat. I'm a great believer in melatonin to help reset the clock. Might be mainly placebo effect, but if so, don't tell me. I still use it when I need to switch to days on occasion.

I so agree about melatonin...I think its placebo effect. I still take it everyday though, otherwise, I'll never get to bed at a reasonable time.

I was thinking about asking my PCP about Nuvigil for shift work, but I am concerned about the fact, that a person as hyper as me, may not get any rest that way, regardless of melatnonin.

 

[Shikima]

I so agree about melatonin...I think its placebo effect. I still take it everyday though, otherwise, I'll never get to bed at a reasonable time.

I was thinking about asking my PCP about Nuvigil for shift work, but I am concerned about the fact, that a person as hyper as me, may not get any rest that way, regardless of melatnonin.

So, instead of using good sleep hygiene principles, you're not going to sleep during the day, you'll stay awake all night using stimulants - rinse and repeat.
Not a very good recipe.

 

[Shikima]

This is a good point in time that it's the responsibility of programs to ensure that those they are training are aware of shift-work disorder and other circadian disruptions and how to manage them because those going into training with the knowledge but have very limited understanding.

 

[Law2Doc]

I'm 28 and considering applying to med school. By the time I finish medical school I will be around 36-37 years old. I know that puts me on the older side for interns and residents. I wanted to hear from people who started their residencies in their early or mid-thirties or even forties. Did your age play a factor when interviewing? How has it affected your time as an intern/resident?

This post should probably be on the nontrad board --it's a nontrad premed question -- it's not really a topic of interest for people already in residency (the purpose of the Gen Res board).

That being said, IMHO age becomes less of a factor the further down the road you get. You'll be working with attendings in their 50s - 70s who still see 37 as young. Your coresidents will be getting married and having kids and purchasing houses and looking for jobs by late in training and will start to seem much less young than the guys straight out of college that you started med school with.

A lot of it is about you. If you are focused on being the oldest one in the class that's bad. If you try to cop the attitude that you are somehow more grown up or experienced than the guys you are training with, know more, etc, that won't work. If you see yourself as young and eager to learn and just have a roll up your sleeves attitude, you'll be fine. Just keep fit, don't be the last one to the Codes, don't gripe about "these kids today", or talk about how things were different "back in the day" etc -- in general don't act your age and you'll do fine. If a resident ten years your junior tells you to jump, just happilly say "you bet -- how high" and don't make him/her uncomfortable for the ask. It's really less of a big deal than you are making it. the hierarchy in medicine is based on what you've done since med school --you a newbie are worthless no matter the age.

I do agree with Q that bouncing back from long calls is probably harder once you aren't in your twenties (and honestly I found it easier not to even try to go to sleep on calls if I knew I'd get only an hour) but fortunately for you, the 30+ hour shifts some of us experienced don't exist during training anymore. Night float is awful ( IMHO worse for most) but at least you stay on a sleep schedule. And I do think as you get older you do better on less sleep anyhow-- i know plenty of 20 year olds who whine about not getting 8-9 hours while i kno plenty of older people who just sleep 4-5 even when they don't even really need to get up early. Putting less of a premium on sleep goes a long way in medicine, and that's probably the older nontrads ace in the hole.

 

[mmmcdowe]

Moving to nontrads

 

[Nasrudin]

Finishing up my year as a 40 year old intern. About as awesome as being a 40 year old virgin. As above...but then as to what you haven't been told explicitly yet except for a small inference by the trauma surgeon:

If you think the answer to your question is not program or field dependent, think again. In addition to what has been already said that it is person dependent, particularly as it pertains to attitude--that was some gold for older people training dropped by L2D, but also to reiterate, what kind of shape you're in.

You're going to be redlining your old engine as an intern pretty much anywhere. The question, if asking if you can take it, is for how long and how often and with what kind of intensity.

So you have IM program director probably at a more-education-than-service-grinding program, saying yay for one old excellent intern; you have a 40 year old very fit ED attending; Another university medicine trained guy, and the hint of doubt from a surgeon. And now me a psych intern who survived a grinding NYC medicine 6 months but who is now cruising peacefully at psych altitude.

The question of stamina tends to glossed over on this forum amidst the gleeful crowd of cult followers, vying to get back stage to blow the leader.

Many older clerks will figure out what they're cut out for and shift gears appropriately if they haven't already done so by settling for passing performances on the step and so forth.

But very few come back here to tell you about how they calibrated the job they singed up for based on the fuel left in their tanks. Or will not admit to themselves and therefore to you their own energetic calculus and how that drove their choices. Because that's not a flattering process. And will score you no free BJ's at this revival.

Such that I appear as a dark sith lord violating the care of dutiful padawans to convert you to the wrong side of exuberance and enthusiasm.

You should think about your stamina going forwards and look for options that can accommodate you. And feel no shame in this. Or in forgoing a decade of training to do this job in the first place.

 

[jl lin]

Such that I appear as a dark sith lord violating the care of dutiful padawans to convert you to the wrong side of exuberance and enthusiasm.

You should think about your stamina going forwards and look for options that can accommodate you. And feel no shame in this. Or in forgoing a decade of training to do this job in the first place.

Must say, as usual Nas, you are true to form with your imagery. LOL
I do believe you are calling it as you have seen it.


From my end, this is why I have ruled out A LOT of specialties. I mean, I'm not lying. Nursing has beaten me up somewhat with the rotating shifts and just so much other stuff--doing this all at a younger age while raising kids and dealing with major life events and tragedies. I know I will survive; but I have to be wise about my choices in order to go as far as I can with this. Love ED, but I've done more than enough off shifts and crazy running around w/ exhilarating codes and quasi codes, and all that stress, and though I may do them during residency, I am projecting out 5 years or so beyond that.

I also believe you have to get a clean bill of health from your doctors and embrace optimal wellness practices. I have seen those that are in their 20's and such putter out b/c of not taking care of things from this end.

But really, surgery, OB/GYN, ED, etc are off the table for me. I will enjoy what I can out of the clerkships, but I am not an utter fool. I'm not saying that there are those my age that can't do it. I am just saying that I've been to a rodeo that, while not the same, has put me through many tough arm-jerkers, chute-fighters, doubler-kickers in the arena. I learned. I enjoyed a lot of it. I am really good at it. But now I want to use my mind and work with people in a calmer kind of world.

 

[Dr.Tao]

The biggest problem I see (pun intended) is that as people age, they tend not to take good care of themselves. In other words, they get fatter and fatter and exercise less and less. Honestly, I've never in my ENTIRE life seen so many morbidly obese health care professionals as I've seen living in the deep South.

But I digress, I think any specialty is possible at any age if and ONLY if, you maintain a normal BMI throughout your training/life and barring any major accident/disability.

People love to focus on age at matriculation, when they need to focus more on how healthy you are at matriculation.

 

[Nasrudin]

That's certainly true. But also, and I think Q has spoken along these lines herself, you tend to want different things as you age. I knew for myself inside of the first 2 months of med school that the time necessary to perform at the highest level wasn't going to work. I knew, at my age, that life doesn't go on forever and I wasn't going to spend any amount of time hunched over a book that I didn't have to. Instead I worked out a lot and maintained my self-mandate of plenty of goof off time. I became a very efficient passer. An underestimated skill. And yes because of this didn't put on the 30 lbs or so that many of my colleagues did.

Sitting and studying is devastatingly unhealthy. We do this for over a decade. Knowing your internal ecosystem as you age is key.

Sure anything is possible at any age. But to me this point is made all to frequently to the point of being deceptive.

 

[AM508]

Well I hope residency in one's late 30s is fine, otherwise I have a big problem in my future😛

 

[serimeri]

So, instead of using good sleep hygiene principles, you're not going to sleep during the day, you'll stay awake all night using stimulants - rinse and repeat.
Not a very good recipe.

I don't think that stimulants will be good for me, consdiering how hyper I am and I drink enough coffee as it is.

I also don't think my sleep hygiene is bad. I sleep as early as I can, only do sleep in bed. I think Im a night owl at heart

 

[QofQuimica]

That's certainly true. But also, and I think Q has spoken along these lines herself, you tend to want different things as you age. I knew for myself inside of the first 2 months of med school that the time necessary to perform at the highest level wasn't going to work. I knew, at my age, that life doesn't go on forever and I wasn't going to spend any amount of time hunched over a book that I didn't have to. Instead I worked out a lot and maintained my self-mandate of plenty of good off time. I became a very efficient passer. An underestimated skill. And yes because if this didn't put on the 30 lbs or so that many of my colleagues did.

Sitting and studying is devastatingly unhealthy. We do this for over a decade. Knowing your internal ecosystem as you age is key.

Sure anything is possible at any age. But to me this point is made all to frequently to the point of being deceptive.

Agree with all of this.

Even as an academic attending, I get constant pressure to work more clinical hours than I'm contracted for. Now don't get me wrong: I get paid extra for working more hours. I get paid extra for working all nights. But there quickly came a point where what I really wanted out of life was more free time, not more money.

At first, I sucked up those extra hours and tried to be a good team player. We were always "close" to being fully staffed. Next month would be better.

But the last few months, I have started pushing back about being asked to work a bunch of extra hours every single month. I have realized that we will *never* have as much help as we need, especially in season. And I don't want to have all of whatever remaining time and energy I have left to me getting sucked into the black hole of our dysfunctional medical system's infinite neediness. I realized that if I was willing to continue working 80 hours per week like a resident, they'd "let" me. And then they'd ask me to work 90 hours. For bonus pay.

But you know, I'm not willing to work like that just for more money. I want to have time to enjoy life, be with my family, read books, travel, volunteer, work out every day. And as it turns out, they can't pay me for my work by giving me what I really want, which is more healthy lifetime. That only comes from working less.