Residency hours

[Sonya]

Hi,

I'm just a pre-med student right now (Senior). Anyway, everyone says residency hours are very long, and it's tough and all. I was curious what long and tough meant. I've read it's like 60 to 130 hrs or 65 to 90 hours. How much work does residency require (working with patients, as well as the other stuff you have to write up/study). Is most of it seeing patients, or do you have to study stuff also? Does it vary a lot between specialties?

I'm just curious what it'll be like, i know, it's still many years from know. I heard 65 to 90 one place, and i'm thinking, really that's not too bad.

Thanks,
Sonya

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[tussy]

I'm a first year surgery resident, which is one of the busier residencies, but my schedule is quite busy. Most days I start at 6 and finish at 6 or 7. Every third or fourth night i have to do call, which means I work all evening and all night, then work the next day like usual. Sometimes I get a few hours of sleep on call but not usually. I spend most of my time during the day working with patients - either managing patients on the ward, in the OR, or in outpatient clinics.

After I get home each night I try and do about an hour or so of reading. We have monthly oral exams. I also end up having to present rounds of some sort about once a month or so(anywhere from an informal 15 minute presentation to a more formal hour long presentation). We are also supposed to publish at least 2 papers over the 5 year residency.

i hope this answers some of your question.

 

[GreatPumpkin]

It also depends a lot on the specialty. Surgery has the worst hours. Pathology for example has pretty decent hours. I work about 50-60 hours a week with almost all weekends off. And, I take call from home. Since July I have had to go in to work while on call one time. Though I am sure it will happen some more now that I am on autopsy call. We are expected to read and study at home.

Good luck.

 

[smuoracledba]

Tussy, where are you a surgery resident, if you don't mind my asking ? I want to go into surgery after Med School. I am a non-traditonal Pre-Med Student so I am trying to do research as I go.

 

[e2k]

Lifestyle is a huge issue for me also.

The most humane residencies are Psychiatry and Pathology, where you frequently get weekends and very little call. The worst are any surgical specialties, which can be 90-130 hours a week.
It also depends on the instituion itself: some are better than others.

Little known fact: EM actually is quite humane at 50-60 hours a week, although you have to work half of your shifts at night. EM residents frequently have three days off a week.

This being said, I know many residents who are enjoying themselves despite being hellaciously overworked. If you love what you do, it doesn't matter that much.

ERIC

 

[cardiosurg]

I have a question (I always get a different ans). After 4 years of med school
I would have 1 year internship and then a certain amt of residency and fellow. How many years would residency be for cardiothoracic surgery and vascular surgery? Is it always 2 years of fellowship? I have scrubbed in for vascular, thoracic, general, and ortho surgeries (for over a yr now). I have been told that it is too early to make a decision on what to specialize in. I hate peds and did my 1st gyn exam last month (hated it-dreading that rotation).I used to work with radiology and found it boring. anyhow, my fave surgeries (literally 4 hours flew by-FAST)were the vascular and cardiothoracic ones. Thank you for answering my question.

 

[Winged Scapula]

Originally posted by cardiosurg:
•I have a question (I always get a different ans). After 4 years of med school
I would have 1 year internship and then a certain amt of residency and fellow. How many years would residency be for cardiothoracic surgery and vascular surgery? Is it always 2 years of fellowship? I have scrubbed in for vascular, thoracic, general, and ortho surgeries (for over a yr now). I have been told that it is too early to make a decision on what to specialize in. I hate peds and did my 1st gyn exam last month (hated it-dreading that rotation).I used to work with radiology and found it boring. anyhow, my fave surgeries (literally 4 hours flew by-FAST)were the vascular and cardiothoracic ones. Thank you for answering my question.•••

Internship is your first year of residency. To become either a CT or Vascular Surgeon you must complete at least 5 years of general surgery and then a 2 year fellowship. CT also offers further subspecialties as does Vascular, but the basic fellowships are 2 years in length.

Bear in mind at the more competitive fellowships, conventional wisdom holds that applicants from academic programs are given more attention. Academic programs may require lab years - so your general surgery training may be 7-8 years in length rather than 5 before you start your fellowship (the 5 years includes the internship year.).

Hope this helps.

 

[cardiosurg]

Kimberli Cox,
Thank you for answering my question. I have another one, though. What do you mean by lab years? I think that I know what you are talking about, but I want to make sure that I fully understand what you are talking about. I know that I will be about 35 when I finish, but it would be worth it!

 

[AJM]

Originally posted by cardiosurg:
•Kimberli Cox,
Thank you for answering my question. I have another one, though. What do you mean by lab years? I think that I know what you are talking about, but I want to make sure that I fully understand what you are talking about. I know that I will be about 35 when I finish, but it would be worth it!•••

Many academic surgery programs require that their surgery residents take time off of their 5-year residency program and spend 1-3 years doing research, with little-to-no clinical responsibilities, typically in a surgery or surgical subspecialty lab. Hence the term "lab years". At my school's surgery program, the residents take off after their 2nd year of residency, typically do 2 years (or more) of research, and then go back to clinics after that as "3rd year" residents. During that lab time, residents are expected to publish a certain number of papers in the surgical area of their interest.

 

[cardiosurg]

thanks ajm! Is it better to do a combined PhD/MD program, then. For instance, right now I am doing research on VREs (pre-med, JR). In May 2004 I will have a double major in Chem and Med Tech (so I could qualify for PhD). Just wondering if I need to look at different school (right now I am looking at Tulane, Vandy, Meharry). I know that residency is so far off, but I would like to take the best route possible.I better get back to studying. Thanks!

 

[Winged Scapula]

AJM is correct about the meaning of the term "lab years". Here as well, residents typically take off after the 2nd year for their research years.

I'm not sure doing a MD/PhD would be of any help. It generally does NOT relieve you of the lab year requirement (or "strongly suggested") at some programs. If you are interested in academic medicine or research, it may help but do not pursue a PhD because you think it will score you a better residency or shorten your residency. By way of example, I have a nearly 10 year medical research background from before medical school - I will still do lab years, but likely not bench/starting from scratch kind of stuff because of my experience.

Hope this helps.

 

[GTMD2Bee]

I agree and disagree with the above post. One can get into almost any surgery speciality fellowship without going to a university programs. I'm a 4th year going into surgery, and I am interviewing at both university and community-based programs. Along the trail I have noticed both types of programs consistently matching people in fellowships (given that the community programs tend to be some of the better ones). With the exception of the most competitive residencies like peds, I have interviewed at community programs that consistently match people in CT, plastics.

That said, matching in a fellowship does require some research work and publication, but one does not have to take 2-3 years off to do it (I have seen programs with as little as 2 months of allocated research time). Given that,the fact that you are even interested in doing a MD/PhD, you may be interested in academic medicine in which case a university program is usually the best bet.

 

[cardiosurg]

To be totally honest with you , I am not interested in the MD/PhD program. Research is fun, but it is not something I can see mysel doing the next 60 years of my life. I thought that it might help me get into a CT residency. I know one of the cardio-thorac-vasc doc I worked for did research and the other did not. If I thought that it would really helped me, though I would have done it. It would be nice, however, to be practicing med by the time that I am 35. I am one of those, however,that would whatever it took to live my dream. When I was married, people (nurses and family) tried talking me into nursing school to shorten my time in school . Do not get me wrong, I have a great respect for nurses, but it did not feel right to me (now everyone is saying that it was good that my exhusband did not talk me into it).
I really apprectiate all of you taking out time and answering my question. It helped clear up a few things. Thanks.

 

[lilycat]

On the MD/PhD question...

Okay, it was in Peds, not Surgery, but I still think it's applicable. I worked in a Peds specialty at Stanford the last 2 years and we had this phenomenal applicant to our Fellowship program -- MD/PhD out of Hopkins, Peds resident at UCSF. Anyways, I was asking him about the "value" of going MD/PhD, and he said that in retrospect he regretted it as a waste of time because he felt like you basically redo that PhD work in your residency lab years and/or fellowship. I just thought it was an interesting perspective.

 

[Roentgen]

No offense cardiosurg, but I would just try to focus on doing well in medical school. MD/PhD, outside research, etc, etc, will be sure to disappoint if you invoke them only as a means to an end! Plus, just having research doesn't get you into a residency- still the #1 factor is your performance in med school... In these days where graduating med students shun fields like CT that force sacrifices- divorce, family, life- it would be very easy to get a general surgery residency if you do reasonably well in med school. Most folks want a life outside of the hospital!

 

[Winged Scapula]

Originally posted by GTMD2Bee:
•I agree and disagree with the above post. One can get into almost any surgery speciality fellowship without going to a university programs. I'm a 4th year going into surgery, and I am interviewing at both university and community-based programs. Along the trail I have noticed both types of programs consistently matching people in fellowships (given that the community programs tend to be some of the better ones). With the exception of the most competitive residencies like peds, I have interviewed at community programs that consistently match people in CT, plastics.

•••

While I appreciate that nearly all residency programs match people into fellowships, if you'll read my original post on the subject I said that the MORE competitive programs tend to favor university program grads. Certainly not all, and it certainly depends on the candidate, but one would be foolish to think they could match into a highly competitive program in any specialty from any program, especially lower level community programs.

With regard to lab years, sure some programs require very little in the way of research, generally community programs. But I was speaking about academic university-based programs which most often, when they require research, do so for at least a year.

I appreciate your input but wanted to clarify some misconceptions about my previous post.

Best of luck.

 

[cardiosurg]

M. D. Innmay, thank you for your response. Yes. I do realize that the overall picture is doing well in Med School. I was just wondering if doing the combined program would aid me in acceptance and cut down on my research years. I am not the type to just do 'reasonably well' in school. That happened the 1st 4 years of pre-med when I was married. You can read my previous notes and see why I chose Ct or even vasc (shorter surgeries in vasc). Most vasc and CT surgeons I know (and I know that they are the exception) do have time for a life, family, etc. I have learned a great deal from them about balance. I feel, though, as if God is calling me to be that type of surgeon. Faith is what has kept me in the past and is what lead me in the future.
KimberliCox, thank you for your input. everyone has given me lots to consider and ponder over the next few years. Back to studying....

 

[Hopkins2010]

Originally posted by lilycat:
•On the MD/PhD question...

Okay, it was in Peds, not Surgery, but I still think it's applicable. I worked in a Peds specialty at Stanford the last 2 years and we had this phenomenal applicant to our Fellowship program -- MD/PhD out of Hopkins, Peds resident at UCSF. Anyways, I was asking him about the "value" of going MD/PhD, and he said that in retrospect he regretted it as a waste of time because he felt like you basically redo that PhD work in your residency lab years and/or fellowship. I just thought it was an interesting perspective.•••


Isnt that his/her fault for choosing research that he already covered in his PhD? I dont understand why he would be forced to do repeat work. Do the residency programs FORCE you to choose research out of a very particular area within the specialty?

Otherwise I dont see why the person you speak of just wouldnt try to do research in a different peds area than what he did in school.

Is doing these "lab years" on the same level as earning a PhD? Pretty tough to do PhD quality research in 2 years I would think.

cardiosurg, I dont think doing an MD/PhD would let you cut down on your lab years requirements. It would help you perhaps get a jump start and maybe be more successful at it than others might be, but if you intend to do real research during the lab years and not just rehash something thats exactly like your PhD research, then any benefit would be minimal I would think.

Besides, MD/PhD programs average about 8 years. If you are just interested in cutting down the lab years requirement, it makes no sense to pursue a combined degree. You might as well go regular MD. You would graduate in 4 years, then maybe do a 5 year residency (2 of which are lab years). The alternative is to do 8 years MD/PhD, and THEN go to a 5 year residency. Even if the residency program was willing to let you bypass the lab years requirement, thus changing it to a 3 year residency, you would still be spending 11 years total in training if you go the MD/PhD route compared to just 9 years if you get the regular MD.

I'm just saying that its a moot point whether you go MD/PhD relative to reducing lab years, because even if you CAN reduce the lab year requirement (which you probably cant) by virtue of having both degrees, in the end it would STILL take you longer to get completely trained as MD/PhD compared to regular MD.

 

[AJM]

Originally posted by baylor21:
•
You might as well go regular MD. You would graduate in 4 years, then maybe do a 5 year residency (2 of which are lab years). The alternative is to do 8 years MD/PhD, and THEN go to a 5 year residency. Even if the residency program was willing to let you bypass the lab years requirement, thus changing it to a 3 year residency, you would still be spending 11 years total in training if you go the MD/PhD route compared to just 9 years if you get the regular MD.
•••

Not to split hairs or anything, but these 2-3 lab years are *in addition* to the 5 year residency program, making the residency 7-8 years long if you include research. (ie -- you get 5 years of clinical training no matter what. I've never heard of a 3 year general surgery program...).

So it pretty much makes your time scale even that much more dismal.

 

[Hopkins2010]

ajm,

You are correct but that doesnt detract from my argument. I wasnt sure if we were talking about peds or surgery because there were mentions of both residencies. Peds doesnt last 7 years does it?

The specific lengths of the residencies are trivial. I was just trying to make a point about the relative comparison time-wise between regular MD and MD/PhD and how the possible incentive of reducing lab years as the sole purpose of an MD/PhD combined degree makes no sense in my opinion.

 

[lilycat]

Originally posted by baylor21:
•
Isnt that his/her fault for choosing research that he already covered in his PhD? I dont understand why he would be forced to do repeat work. Do the residency programs FORCE you to choose research out of a very particular area within the specialty?

Otherwise I dont see why the person you speak of just wouldnt try to do research in a different peds area than what he did in school.

Is doing these "lab years" on the same level as earning a PhD? Pretty tough to do PhD quality research in 2 years I would think.
•••

The applicant in question was applying for a peds nephrology fellowship, and I'm almost 100% positive that his PhD work had nothing to do with nephrology or peds.

As far as the level of work, I really can't say since I'm not the person in question. However, for a 3-year peds fellowship, usually the bulk of the first year is spent in clinical work, with some attention being paid toward establishing the focus of your research project(s) that will then entirely occupy the remaining 2 years of fellowship. Assuming that average MD/PhD is 7 years, you're only talking about the difference of 6-12 months of research time, although now the research is being completed at the post-doc level.

Either way, this was just one person's opinion when I asked him if he would recommend the MD/PhD route.

 

[SocialistMD]

I guess it all depends on what you want- if you are doing the research solely for the sake of saying you did it then maybe doing the MD/PhD isn't the best path; however, if you are doing the research because it is something you like and something you will be doing for the rest of your life then (a) it shouldn't really matter if it takes you longer because you are still doing something you enjoy and (b) it isn't really a waste of anything because you can build on your PhD research in your fellowship and advance the science that much more.

On a side note, cardiosurg, I am just wondering how you have already done a gyn exam yet you will not even have your undergrad degrees until May of 2004. Did you shadow an ob/gyn and you observed or did you actually perform it?

 

[Hopkins2010]

I guess it depends on whats considered the "norm" for time length of a PhD. I've heard some people comment that the PhD in an MD/PhD program is "watered down." I think the average time length for a stand alone PhD program is well over 4 years, something around 6-8 years.

Maybe I am mistaken with this assumption, but I was thinking that MD/PhD is really mostly used for basic science research. Sure, you can use it for clinical research too, but the advantage of a combined degree is somewhat reduced in clinical research, since it requires knowledge that you would be able to pull out of a regular MD program and residency without having a PhD.

I think its hard to compare MD/PhD vs regular MD unless you are talking basic science vs clinical science research. The MD/PhD would help you much more for basic science than it would for clinical science, so if all you want to do is clinical science research in a residency or fellowship, it seems as if MD/PhD wouldnt be extremely helpful.

 

[lilycat]

Originally posted by baylor21:
•

Maybe I am mistaken with this assumption, but I was thinking that MD/PhD is really mostly used for basic science research. Sure, you can use it for clinical research too, but the advantage of a combined degree is somewhat reduced in clinical research, since it requires knowledge that you would be able to pull out of a regular MD program and residency without having a PhD.

I think its hard to compare MD/PhD vs regular MD unless you are talking basic science vs clinical science research. The MD/PhD would help you much more for basic science than it would for clinical science, so if all you want to do is clinical science research in a residency or fellowship, it seems as if MD/PhD wouldnt be extremely helpful.•••

Maybe Stanford is the only medical center in the country that operates like this, but the fellows I knew WERE primarily involved in basic science research. They might assist on some clinical research projects in the division, but it was my impression that the goal of the fellowship was to immerse yourself into the basic science side of that specialty, regardless of the fellow being an MD, MD/PhD, whatever.

Actually, I take it back, Stanford was not the only med center that operated that way -- most of the CV's we received for Asst. Professor positions had publications related to bench research done during fellowship and/or residency.

 

[Hopkins2010]

OK, I guess you can tell I'm not familiar with the intricacies of residency/fellowship.

I always thought that the main distinction between doing a postdoc and a fellowship (other than the fact that a PhD is required for postdoc) is that a fellowship is more clinical stuff while a postdoc is more benchwork type stuff. If both are engaged in basic science benchwork, whats the distinction between postdoc and fellowship?

Again, it comes down to whether you want to be primarily a researcher or clinician. For clinician, MD/PhD doesnt help that much. MD/PhD used to be called the triple threat option, because you could do clinical practice, teach, and do research simultaneously. But now I think thats a thing of the past. Most mudphuds would be lucky to get 70% research/30% clinical I would say; research is just too time intensive these days it seems.

 

[AJM]

Postdocs and fellowships are very, very different. Fellowships are done when one wants to subspecialize in a clinical field, such as cardiology, cardiothoracic surgery, infectious disease, etc. The primary goal of a fellowship is not to do research, it's to train subspecialists who will be clinicians in those respective areas. During the time of the fellowship, the fellow is expected to do research, and has a certain number of dedicated months to do so. The nature of the research is variable, and depends on individual interests. I know many fellows who have done basic, clinical, as well as translational research. Fellows can be MDs, DO, or MD/PhDs. Pretty much, any physician (academic or otherwise) in a subspecialty (that is more specialized than their prior residency) has done a fellowship.

Postdocs, on the other hand, are generally not done by MD/PhDs. (That is, out of the ones that I know). The postdoc is a position I'm not too familiar with, but I believe it's usually for straight PhD's, or for MD/PhD's who do not want to do any clinical practice. The MD/PhD's I know who are doing postdoc's are doing them straight out of med school and they don't do residencies (and therefore cannot do clinical practice). Now, I know there are exceptions, and there are probably MD/PhDs who did postdocs after their residencies, but I have not yet met any.

So basically in my mind the distinction is: postdoc: only research, no clinical practice; fellowship: clinical subspecialty training, clinical practice, +/- ability to do research.

It's interesting that you allude to the image of MD/PhD's as the physicians that are the ones most often doing research or in academic medicine. Because in reality, the majority of academic physicians are MD's who do not have PhD's. I know many MD's who do primarily research, and I know many MD/PhD's who do primarily clinical practice. The MD/PhD's do have their niche, but the boundaries are pretty darn fuzzy.

Anyway, I know I'll get attacked by angry MSTP students about my understanding of this, but please correct me if I am wrong.

 

[lilycat]

Originally posted by ajm:
•Postdocs and fellowships are very, very different. Fellowships are done when one wants to subspecialize in a clinical field, such as cardiology, cardiothoracic surgery, infectious disease, etc. The primary goal of a fellowship is not to do research, it's to train subspecialists who will be clinicians in those respective areas. During the time of the fellowship, the fellow is expected to do research, and has a certain number of dedicated months to do so. The nature of the research is variable, and depends on individual interests. I know many fellows who have done basic, clinical, as well as translational research. Fellows can be MDs, DO, or MD/PhDs. Pretty much, any physician (academic or otherwise) in a subspecialty (that is more specialized than their prior residency) has done a fellowship.

•••

I misspoke when I said that the goal of the fellowship was for further research in a field; obviously you can't subspecialize without doing a fellowship. However, while the clinical subspecialty training is a major component of fellowship training, most of the fellowship programs that I'm familiar with tend to focus at least as much time on the research component, if not more time, than on the actual clinical training. Are there fellowship programs that don't require any research time?

Also, I get the feeling that at some programs the delineation between what is expected of you in the research portion of your fellowship and what is expected in a postdoc program are not that different. To an extent, I think we may just be going around semantics here.

 

[AJM]

That's definitely true, lilycat. Fellowships typically replace postdocs when you're getting into subspecialties. Therefore, if you do a fellowship in pulmonary and critical care, for example, you may begin a productive career in research/academic medicine in that field without having to do a postdoc afterwards, since you get so much research experience during the fellowship training.

My understanding is that you have to spend a certain amount of time doing research during a fellowship, although I don't know if that's true everywhere. At Stanford, at least, the general rule of thumb is that the fellows spend about half of their fellowship pursuing research (usually more towards the end of the fellowship).

 

[cardiosurg]

SocialistmD, I did not do the gyno exan myself; there was a doc with me. It was at the Good Samaritan ministries medical clinic, where one of the FPs was allowing me to gain experience. I volunteer up there, taking vitals, assisting the doc, reading and performing certain lab tests (basic hemo and urinalysis). At the hospital in town, a few of the docs 1st let me watch surgery, then started allowing me to scrub in. It is awesome how much anatomy, physiology, and disease that I have learned. I have worked with the guy setting up the room, the anesth., and the docs and nurses. Even the reps teach me. It is also a great motivator (especially last semester when I was in Organic, Physics, Micro, Latin, research and going through a divorce!). This is when I realized that what I really wanted to do was surgery (not radiology and mostly clinincal work). I also follow them in their clinics and work with their nurses and office managers. I get a 360 degree view of being a doc. I NEVER do anything (and do not get me wrong, what I do is limited) without a doc or nurse beside me. However, I do perform more tasks and feel as if I have more experience than most my age. The vasc surgeon I worked with said that he did not get to do most of this stuff until he was a 3rd year.
To everyone else: What I am reading is that doing a PhD/MD program is not going to ease up any time restaints in my residency and will not guarantee me a better residency for Ct or Vasc. thanks for all of the input.

 

[Hopkins2010]

ajm,

A big part of the reason why MDs are still the majority of medical researchers is sheer numbers. MSTP graduates are few and far between relative to MD grads. I think there are around 30 MSTP programs, each graduates on average I would say 10 per year, for a total of 300 new MSTP grads per year. Compare that to over 10,000 US medical graduates (MD only) per year. With that kind of numerical contrast, its only reasonable to expect the vast majority of medical researchers to hold MD only.

I think MD/PhD gives an advantage to basic science/transitional research. Getting an MD by itself is generally sufficient for clinical research, but to do transitional stuff and basic science work at the very highest level, MD/PhD can be a significant advantage. MD/PhD grads generally are more successful at getting NIH funding. I think in many ways its hard to compare successes between MD and MD/PhD because of the sheer number difference mentioned above.

Again, I dont think that bridging the gap between clinical and bench science comes very naturally unless you have sufficient training/experience in both areas, which the MD/PhD gives you. Of course, I'm sure there are exceptional people out there who can do amazing transitional stuff with no formal training. However, I think for this kind of research having an MD/PhD is a clear advantage.

I've spoken to several MSTP directors about MD/PhDs who do only clinical practice, and the consensus is that those people have essentially wasted 4 years of their life since they are doing nothing that really is aided by having the PhD. Many of the directors had a very negative reaction to their grads who chose that path. I'm not sure how I feel about that, but I can see their point.