Residency is the only fear of med school i have...is it justified?

[exFSIguy]

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I worked as an investment banker for 2 yrs. I worked 120 hr weeks, traveled a lot, etc... I got out recently at age 24. Some weeks were only like 80-90 hrs but even those were bad - and I was not making life or death decisions, just a lot of financial BS. At the end of these weeks (and sometimes they wouldn't end because we worked weekends) my brain would be so fried that I could barely give people directions to my apt who were driving me home (driving myself was out of the question, the banks know this, and that?s half the reason you see so many black towncars in lower Manhattan at night). I can?t imagine making healthcare decisions in this kind of mind state? let alone going through another 2-3 yr period with hours like this.

Going to med school was my original intent upon entering undergrad. I started off as a bio major but the dot com mania and mega$$ of i-banking changed my mind. Though I made a lot even amidst the bad economy (and layoffs), I was more miserable than I ever was in my life and vowed never to do it again.

I still want to become a doctor, but I do not want to repeat the same mistake with residency. I have no other fears of med school - cadavers, rectal exams, yeast infections, telling people they have 3 months to live... I can probably handle all of that.

It's just that I can't do the hours anymore - and by the time I go back and take the chem classes I need and apply... and get to residency - I'll be 31. I actually had a 4 week stretch of work where I was up every day from 5 am until about 12 or 1 (including weekends). At the end of it I had to go to the hospital bc I could barely move. Apparently I developed fibromyalgia! At 23! This went away, but they said if I continue the sleep deprivation (and drugs) then it would come back.

It really just appears that some people are more resilient to sleep deprivation. But every time I think this about someone, I find out that they are on coke, provigil, ritalin, caffeine pills etc?(most of which just make me pee a lot) So what is the deal with residency? Are certain people just wired to have more stamina? Am I not going to stand a chance? How bad is it really? Do you really work 14 hrs and then sleep for 2 in the hospital and work another 14? I know they put a cap on it but I don?t see how 80 hours is a cap. That?s at least 20 too many when you are dealing with people?s lives.

Anyway, thank you for reading this. I appreciate any insight. And yes I am off all the drugs? I do not intend to go back on them either.

 

[woundvac]

you sound like you need to get laid.

you need to figure out what you want from life. i never even thought about hours per week when i chose medicine cause its such a bad ass field. if your doing something you love 120 hours per week is too few. if your doing something you hate 40 hours is too many.

 

[Foxxy Cleopatra]

I am a surgery resident, so here is my 2 cents.

The cons of a career in medicine (to name a few):

1. Medicine is hard work, often much more than the proposed 80 hours. Long story short, working 14 hours, a 2 hour nap, then another 14 would be like a vacation during some of my months.

2. You will have an enormous amount of debt (>$100,000) when you graduate. I make less than $40,000 a year and if that is divided by the number of hours I work, it adds up to less than $7 an hour.

3. Respect/career "nobility"- hmmmm... well, that exists with some patients in some places, but get used to the "you owe me" mentality. People will come to you demanding what they want, and will become hostile if they do not get it.

4. Lawyers- some attendings I work with can hardly speak 3 sentences without bring up lawsuits. 1-800-LAWYER ads and the crooks that come with them are more rampant and annoying than diarrhea. You WILL get threatened and sued; it is just a matter of when and how often.

5. The "glory" of taking care; life-threatening situations, saving lives does happen, but that is a fraction of what being a doctor entails. Get ready for a sh#tload of paperwork, billing issues, social work, and then some.

The pros:

1. Well... the science of medicine is interesting, actual patient care is exciting, and it is always a challenge.

2. There are some patients who will make your hard work incredibly rewarding.

3. To me, when I actually have my hands in and operating, it is infinitely interesting and exciting.

4. Refer to the "What docs pull the most tail" thread. Problem is, I am at the hospital too much or am too tired to enjoy it!!

The surgery fields tend to be the most notorious for long hours. Other fields may never work 80 hours (psychiatry, pathology, sometimes internal medicine and peds are not that bad, though that is program-dependent.)

The best advice I think I could give anyone considering medicine is do you really want to be a doctor, even being slightly familiar with what it entails, or do you like the idea of being a doctor? If the latter is true, think your decision through long and hard.

good luck

 

[DrQuinn]

There are all types of people here in medicine, some like you who are resilient to lack of sleep, some who you can always tell that they are sleep deprived. You will find your niche and yoru specialty when you get through medical school. Give it a shot NOW. If you don't, in five years you may look back and wish you did. Just be realistic about why you wanted to go into medicine.

Q, DO

 

[exFSIguy]

Thanks for your replies

Really, I should've made a shorter post just asking about the sleep issue...That's my # 1 concern - how do you go into surgery if you can barely see from sleep deprivaiton? I am not resillient to sleep deprivation...and that's the problem. I'm scared that I'll feel like crap, screw stuff up, and wish I never went into it (like the last 2 yrs of my life).. I'm just trying to find people who run into this problem and somehow overcome it or actually DO drop out because they can't deal with it. I mean, there are people that need more sleep than others - right? and what happens then, they all become 9-5ers making <40k a yr bc they can't handle the hrs of high paying jobs (consulting, i-banking, medicine, some law firms)

I have considered the other variables for many years, and my dad has been a doctor for over 25 yrs... so I know/hear about all the lawsuit insanity, nonpaying patients, spending 10 hrs saving a public aid patient only to have them threaten to sue you..etc... i know. None of that "scares me" in the way that the hours of residency do...though they are all part of the overall equasion for med school. My dad said it was hellish too but he got through it and it wasn't a big deal... but he's the type that STILL sleeps over at the hospital sometimes.

 

[exFSIguy]

woundvac, if you

1. Never had a sleep problem / insomnia / hypersomnia / sleep deprivation related issues (i.e. fibromyalgia) and
2. Never worked in the real world before (for a long period of time excluding summer internships)

then i wouldn't expect you to have considered hours worked...i am just guessing these are traits of yours but i could be wrong. And yes you are right, if you like something, then it's much easier to deal with working on it for long periods of time - to a point though.

 

[woundvac]

yeah, yeah. you are much more worldly than me. congrats dude.
getting through med school (passing) ain't that tough, there are some serious physical wimps at my school. most med students are congenital nerds, you know. you can always choose a less physically demanding residency, like psych or path or neuro or derm.

 

[DR]

exFSIguy-
Hey man, I hear your concerns and it's understandable. I graduated med school at 30, so I know what it is like to consider age and time in the equation. I also worked before med school, so I understand that, too. Additionally, I am a sleeper, man...really. I mean, on weekends, I can sleep 15 hours a night...EASILY...and I was always like that, even as a child...so it's not a result of exhaustion or depression from residency. So, first I will reassure you that you can do it, even if you don't handle sleep deprivation well. I don't handle it well, either...and the hard, cold, scary fact is that most residents who are sleep deprived DO feel sleep deprived, and yes, their decision making skills will definitely be dulled (don't believe anyone who argues that they have a different physiology than all humans do!) It's a fact, and it's just a part of things. But the thing you have to remember is that when you are sleep deprived and making decisions regarding money and business, it's gonna be different than making decisions about a patient. You will find a drive and an energy that you can tap into that you would never think you could do before, because the stakes are different. You will not wind up seeing people "Drop out", either; I mean, sure, it can happen but it really doesn't (rarely). Why? Well, first off, it's temporary. Residency WILL end. Second, people want to be doctors, so they suck it up. Third, by the time residency rolls around, you are so far into the game you will most assuredly not walk away that easily. Fourth, the consequences of walking away are pretty dark...you will be black listed from ever going back, you will have to start paying major loans back, and the worst is that you might regret leaving some time in the future. So the basic message is, make sure you wanna be a doc before you jump in. People who tell you that when you love it, you'll not mind the hours are not really telling you the full story. That philosophy holds true for most things in life, but when you talk to people who absolutely love medicine, even they will tell you that internship and residency is NOT enjoyable...I mean, you aren't really doing the things you love about medicine during residency...so yeah, you won't love it. Trust me. But that's normal, because the real job of medicine is not residency. It's what you do when you're done. If being a doctor was like residency forever, no one would do it. So, it's temporary. Make sure you want to be a doctor, first of all. Second, decide whether you can handle stressors without resorting to drugs/alcohol, because that is just not an appropriate option in medicine (except caffeine, of which there are many junkies in residency!!). Anyway, that's my opinion. Good luck.

 

[DR]

P.S. When I said "you won't love it", I have to clarify; you can and will love it, but not all the time. That's what I meant. There are things you will be asked (and will have to) do that are just not enjoyable. Medicine is awesome, and if you love it, then you will love many things during residency, but...to cite an example...no one loves fighting with a family in the middle of the night, on 24 hrs without sleep, regarding some nutty issue that the day team never quite cleared up, and you have no idea because you're just covering on float. That's not pleasurable, even if you absolutely love medicine. Anyway, that's it.

 

[Kiwi MD]

I agree that the root of your problem lies in the lack of enjoyment you find in your current job. Residency can suck the life out of you, but it does depend on which residency you decide on in future - and obviously lifestyle factors will figure into the decision making in your fourth year of medical school.


I think most residents will moan and groan about the hours, but at the end of the day, would still be able to say that they love what they do. Long hours are not unique to medicine anymore - your own experience is testament to that and I know a guy who works as a dockmaster for a large shipping company - he works 100plus hour weeks, doing repetitive manual labour!

I agree with Quin - think carefully about where you see yourself ten years from now...and start working towards it.

Good luck

 

[RADRULES]

Do you need some vagisil? 😀

Red Bull works if you want to stay up all night. Be a man.

 

[exFSIguy]

Originally posted by RADRULES
Do you need some vagisil? 😀

Red Bull works if you want to stay up all night. Be a man.

Red bull? LOL. Ya ? telling that to someone who has done coke & meth is kinda cute actually. Or were you joking.

But really, this is exactly the kind of baseless machismo idiocy that was rampant in the i-banks. ?Can't stay up? Oh here's some powder for ya... be a man?? The irony is that they might as well have been telling me to bend over.

Vagisil was our joke name for modafinil/provigil (which people would snort ? is that bad to do?). How did you know? Bad branding on their part with that name...

Anyway, I really appreciated the comments DR, and others ? very useful to hear from people who have been through it ? as opposed to kids in college w/ their supposed perspective on the situation.

 

[Sessamoid]

I came from a similar background, having finished med school at age 30 after some years in actuarial consulting. I can understand your concern about residency hours and not wanting to go through that again. But if it's something interesting and something you really enjoy doing, the hours are much easier to do. Even 9 hours a day behind a desk working numbers was painful beyond belief. I was happier doing q3 calls on the trauma rotation. Even the rough weekend when I was the only trauma resident on a service of 40+ trauma patients and a full trauma ICU (the other residency had to go take his in-service exam that weekend) was better than going back to the desk job.

That said, the hours you'll have to spend in residency depend completely on what specialty you choose, and especially what program within that specialty. Have you any idea what field you'd be most interested in?

 

[Halcyon440]

Thanks for bringing this up. I am in the same position where I am pretty much decided to go for this but am deathly afraid of residency. Sleep deprivation is a big part of it for me as well. Right now I just can't imagine surviving it. But then again when I was doing music semi-professionally I used to stay up all night at gigs and was fine. I think that it's very true that as long as we really do love medicine we will be able to get through.

I'll be 34 by the time I start med school. *gulp*

I have another question, is the first year of residency worse than the rest (I saw lots of references to the suffering only being for a year)? Or is it bad for the entire time? Is it that after first year there is less scutwork and more actual learning (so the hours don't feel as long)?

I just read House of God and am not looking forward to the gomers!

 

[exFSIguy]

Sessamoid - either Neurology or hematology/oncology. I think the latter requires a fellowship after residency? I really don't pretend to understand the residency processes/timelines for the different subspecialties... I have come up with these specialty choices based on some undergrad biology classes, psych/neuro classes and the fact my father is one of the above & so I am at least aware of the field and have very similar interests to him.

How do the timelines go? Internship for how many yrs? then residency for how many? and then fellowship for how many? (in neuro or oncology / not radiation oncology). Are either of these particularly bad?

 

[Sessamoid]

Originally posted by exFSIguy
Sessamoid - either Neurology or hematology/oncology. I think the latter requires a fellowship after residency? I really don't pretend to understand the residency processes/timelines for the different subspecialties... I have come up with these specialty choices based on some undergrad biology classes, psych/neuro classes and the fact my father is one of the above & so I am at least aware of the field and have very similar interests to him.

How do the timelines go? Internship for how many yrs? then residency for how many? and then fellowship for how many? (in neuro or oncology / not radiation oncology). Are either of these particularly bad?

Neurology is 4 years IIRC--3 years of residency after a general internship of one year. Heme/onc is a fellowship after a 3 year residency in internal medicine. The heme/onc fellowship is at least two years, and often/sometimes 3 years long. So you're talking about post-graduate training time of 4 years for neurology or 5+ years for heme/onc.

Neurology is generally a pretty benign residency as far as I know. I know little about the heme/onc fellowships. Internal medicine residency hours depends a lot on the particular program, but generally involves a fair number of hours, much of which is downtime (rounding, rounding, and rounding some more, waiting for labs, attendings, interns, consultants, whatever). So the hours generally won't all be high intensity.

Re: # of hours worked in residency. In neurology and internal medicine and its subspecialties, there is more variation within residency programs in a subspecialty than between subspecialties. IOW, there are probably heme/onc fellowships that work you to the bone, and some that are relatively light on hours. Same for the other subspecialties.

 

[grouptherapy]

i worked my ass off during my surgery rotation and the morning after call, i would always look and feel like crap. the three chief residents however, were always bright eyed and bushy tailed. i never could understand why. last week, i was told that they were always juiced. is it common to take amphetamines during surgical residency?

 

[DR]

Grouptherapy...
You get used to it. After you do those shifts a number of times, you get used to it.

 

[RADRULES]

I did one year of I-banking in NYC after college. My GF at the time moved there and thus so did I and took a job with Lehman. Worst decision of my life. I ended up in medicine and radiology, which is by far the best decision of my life.

I have never taken meth or coke to stay up. I do pound red bull when on-call and to be honest it is about all you need for a call night. It is busy but it really is not as bad as you might think. If you pick the righ field it will be much better than you imagine currently.

 

[Mirror Form]

Originally posted by Halcyon440
I have another question, is the first year of residency worse than the rest (I saw lots of references to the suffering only being for a year)? Or is it bad for the entire time? Is it that after first year there is less scutwork and more actual learning (so the hours don't feel as long)?

I just read House of God and am not looking forward to the gomers!

The first year is internship which has traditionally been the worst. However, with the 80 hour rule, it's not as bad as it used to be. Although 80 hours is only on paper at many institutions. And don't take The House of God too seriously. Time have changed since then. For example, it's not as easy to have group orgies with the staff anymore.

 

[exFSIguy]

Group orgies?

 

[Teufelhunden]

Originally posted by Dr. Cuts
Internship sucks bigtime. My advice -- unless you're cat IM or surg, get the absolute cushiest internship you possibly can.

What are the "cushy" internships?

Maybe a better question: who are the least exhausted-looking residents in your hospitals? Who seem to be the happiest? Least-miserable?

 

[keith77]

If you want success [be it defined as money, prestige, position, whatever] it takes work, big time, as everyone here has attested to... Major sacrifice and major pain. Even actors and musicians, they have their own crap as well. When they are on, they are on...

My brother, 23 years old, had a full ride to a private university double majoring in accounting and finance. Kid decides to drop out his junior year and join the i-dot movement. Today, he has his own business, bought a corvette, bought a house, and began opening offices abroad as he hires more and more engineers to work for him. And his life, IMO, sucks. He asked me to join him, and I could never do what that kid does, or put in the hours he does. It's just not worth it to me. I hate, absolutely hate, what he does for a living.

Decide what u really love. Forget about the hours and the details, just think of what u would really love to do if u had all the money in the world. and as long as it is somewhat practical for your personality, u'll get thru it.

no one sleeps more than me. i bitch everyday about what this field has done to my life. the way it has raped me and everything dear to me. but, that said, there is nothing else i'd rather be doing. nothing.

 

[alina_s]

exFSIguy-
I can definitely relate to your concerns about the hours. I am a lowly MSIII and maybe life does improve a little bit as we move up the hierarchy slightly, but it still really stinks. I don't understand all the, "if you're doing what you love, the time doesn't matter." It's true that ridiculous hours aren't quite as bad as they sound to the outsider but even if you get a thrill from every conversation you have with each and every one of your patients, you love learning so many new things every day, it is miserable to have no control over when/how often you get to eat, sleep, take a shower...never mind think about non-work things, hang around with friends and family. The hierarchy is very rigid and if one of your elders and betters "asks" you to do anything, you don't really have a choice, no matter what any official rules and regulations might say. Arguing or pointing out the rules isn't an option because all evaluations are highly subjective and the good and bad parts of the narrative evaluations can go into the Dean's letter, which goes to every residency program you apply to.
The 80 hour rule is a joke. I am about to finish the second inpatient month of my internal medicine rotation. My hours and responsibilities are a lot less than the interns', of course, and I am around this theoretical limit most weeks. I would sooner drop out of medicine altogether and work off my loans as a research assistant than commit to three years of an internal medicine residency. I can't believe that any of the people who do endure this are at all mentally or physically healthy. I'm not saying that you absolutely shouldn't go into medicine but if you're anything like me and need to have a little sanity time to yourself, look very carefully at the schools. I wish that I had talked to some third years when I was applying; I didn't even know that third years ever took night call (they don't at some schools). I suspect that different schools may have different cultures, and some may have more residents who believe that more is always better. On the bright side, there are some saner fields, like psychiatry, and the 80 week may become a reality some day.

 

[bustinbooty]

I think this thread subject is like asking, "Should my fear of jumping out of an airplane prevent me from taking up skydiving?"

I also remember another thread a while back where a girl asked if she would ever have to see or touch blood in medicine because she didn't think she could handle that.....not really the same type of query as this thread, but novel just the same.

Just like any other career, you have to take the good with the bad and go through the rites of passage. Careers are a package deal. If you are going to be successful at any line of work , you have to be prepared to at least tolerate the worst aspects of it. If you don't think you can do that, then it is a good sign that you should continue your career search elsewhere.

Best of luck finding what makes you happy.

 

[njbmd]

Hi there,

Foxy Cleopatra actually summed up most of my feeling about the hours of residency. I started medical school much older than most everyone posting on this board and I am doing General Surgery. Most weeks now, I have tally my hours each day to keep from going over the 80-hour work week. It is the law and I don't violate it. It is very easy to be in the hospital 120 or more hours if you are not careful.

Some residencies, like surgery, can chew up the hours. Others like peds, path and family medicine are less intensive. Internship in any discipline is going to be intense but after internship is over, the residency hours get better. When you become an attending, things can become intense once again so don't let the 80-hour rule lull you into thinking that everything is cushy once training is over with. I have attending Family Practice colleagues who are working my hours.

If you can't deal with being able to function with lack of sleep, medical school is going to be tough. You can go into something like Derm or Optho where you don't get too many early or late calls but you have to do well in medical school to get there. Keep in mind that very little of medicine is 9 - 5 but it doesn't have to be extreme.

njbmd