Sep 14, 2015
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I'm a very competitive applicant but am already starting to get burnt out with the long hours of medicine. Derm residents and tons of other careers learn their craft just fine training in-house 5 days per week and so I'm not buying the bs about forgoing outside life for 3 years to become a good doctor.

As I try to narrow my application list, can anyone share which IM programs you have heard are known for their work-life balance?
 
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Instatewaiter

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I'm a very competitive applicant but am already starting to get burnt out with the long hours of medicine. Derm residents and tons of other careers learn their craft just fine training in-house 5 days per week and so I'm not buying the bs about forgoing outside life for 3 years to become a good doctor.

As I try to narrow my application list, can anyone share which IM programs you have heard are known for their work-life balance?
Ha. As a medical student...

Why don't you just sell your soul already and go derm.
 
OP
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Sep 14, 2015
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I don't understand why you people think an interesting specialty and normal work hours are mutually exclusive... A ton of attendings I've worked with started working part time as soon as they became attendings/had kids so why don't you get on your high horse and yell at them. It seems to me it might be better to not get burnt out in residency and work full time as an attending.
 
Nov 24, 2013
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No one is actually answering the question.

The best answers come from interviewing at places and going to the event the night before the interview. Look at the turn out of residents, see how friendly and often they say they go out. They will many times tell you the honest answers like how overworked they are. Find the slightly jaded guy or gal and not the cheerleader for the program that seems to be at every one of these functions. Take their advice just like any other you receive like the once I am giving you. Use it as a piece of the puzzle when making up your mind where to go. You can believe what you want, or say well that person is mad about X but that isnt important to me so I'll just brush that off. So much of residency is location because you need to be happy where you sleep and eat outside of the hospital and the personality of the program.

For all the people acting like you need to work 100 hour weeks like its some badge of honor, dont worry about them. You will put in your time and feel confident when you're done if you work hard. Ask about duty hour violations when you interview. On paper the residents at my program have almost none documented as it is the culture to lie on the report. Sad since we are a part of the icompare study, however many of my friends and myself included frequently break duty hours. Just last week I did a 36 hour shift.

Once you interview you will get the feel for the program you are looking for.
 

obiwan

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I don't understand why you people think an interesting specialty and normal work hours are mutually exclusive... A ton of attendings I've worked with started working part time as soon as they became attendings/had kids so why don't you get on your high horse and yell at them. It seems to me it might be better to not get burnt out in residency and work full time as an attending.
just some advice for you, take the ROAD to happiness
 

IMPD

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Training and practice are pretty different. IM training is designed to give you the tools to practice inpatient or outpatient, to see well patients, acutely ill, critically ill, chronically ill. It is quite different than derm.

Most people narrow their practice after training, some do formal fellowship (hello, endo!), some work part-time their whole careers. As of now, though, there is no training that acknowledges this reality. We all get trained to do everything.

There are good arguments to be made for changing training paradigms and we're not there yet. So, you get to learn everything. In three years it's barely enough time. Places that pride themselves on an easy workload are almost certainly skimping on some part of the above. Which seems fine when you think "I'll never be an intensivist" or "I'll never take care of outpatients" or "I'll never take care of inpatients".

My experience is, however, that the defining feature of well-trained internists is that they *recognize* problems that appear in each of these settings because of the volume of people they saw in training. Even if you've forgotten exactly what to do, you remember seeing it before. Mid-levels generally have far fewer training hours and it shows in their much more limited differentials and clinical judgements. Spend as much effort as you can in training.
 

Mad Jack

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No one is actually answering the question.

The best answers come from interviewing at places and going to the event the night before the interview. Look at the turn out of residents, see how friendly and often they say they go out. They will many times tell you the honest answers like how overworked they are. Find the slightly jaded guy or gal and not the cheerleader for the program that seems to be at every one of these functions. Take their advice just like any other you receive like the once I am giving you. Use it as a piece of the puzzle when making up your mind where to go. You can believe what you want, or say well that person is mad about X but that isnt important to me so I'll just brush that off. So much of residency is location because you need to be happy where you sleep and eat outside of the hospital and the personality of the program.

For all the people acting like you need to work 100 hour weeks like its some badge of honor, dont worry about them. You will put in your time and feel confident when you're done if you work hard. Ask about duty hour violations when you interview. On paper the residents at my program have almost none documented as it is the culture to lie on the report. Sad since we are a part of the icompare study, however many of my friends and myself included frequently break duty hours. Just last week I did a 36 hour shift.

Once you interview you will get the feel for the program you are looking for.
Another excellent tool is FREIDA. You can look at the self-reported hours worked by first-year residents (typically the worst year) and extrapolate from there. It's unlikely a program will say 55 hours and have their residents working 80+, though the ones that say 80 exactly are probably breaking duty hour limits on occasion, because it's hard not to when you're pushing your interns to the maximum hour limit.
 

Mad Jack

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I don't understand why you people think an interesting specialty and normal work hours are mutually exclusive... A ton of attendings I've worked with started working part time as soon as they became attendings/had kids so why don't you get on your high horse and yell at them. It seems to me it might be better to not get burnt out in residency and work full time as an attending.
You can be an attending for the rest of your life. You only get one chance to train. Once you're out there in the real world, you don't have people watching your back- you are where the buck stops. Just be aware that you are missing out on educational opportunities and you will likely start off as a poorer attending for it if you specifically choose the most chill program you can.
 
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jdh71

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I don't understand why you people think an interesting specialty and normal work hours are mutually exclusive... A ton of attendings I've worked with started working part time as soon as they became attendings/had kids so why don't you get on your high horse and yell at them. It seems to me it might be better to not get burnt out in residency and work full time as an attending.
Why? Because this specialty is IM and you can kill people if you are lazy it not paying ****ing attention!

In the same way surgeons need procedure after procedure after procedure to come out of training with a modicum of barely contained competence you need gomer after gomer after gomer to make sure you don't **** up someone's day. Those people you are taking care of are someone's mom, dad, brother, daughter. You are tasked with huge responsibility. And it's not the easy bread and butter nonsense you need to spend so much time preparing for its the the unusual cases and atypical presentations. I spend LOTS of time trying to save people that jokers like you weren't paying enough attention to.

If you want to spank around doing nine to five handing out cream then go into fickinh derm and leave the important specialties to the people who give enough of a **** to be properly trained not to kill people with lazy incompetence.

Understand now??
 

rokshana

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I'm a very competitive applicant but am already starting to get burnt out with the long hours of medicine. Derm residents and tons of other careers learn their craft just fine training in-house 5 days per week and so I'm not buying the bs about forgoing outside life for 3 years to become a good doctor.

As I try to narrow my application list, can anyone share which IM programs you have heard are known for their work-life balance?
so let me ask you why IM then? are you looking to sub specialize? or hospitalist work? or PCP (i know, i know, hard to say that with a straight face, very few in med school want to do PCP work)...yes you can adjust your work schedule to be part time or 8-5 or so forth (realize though there will be compromises to be made to balance that out...usually its money), but training is a different situation...are we saying you will always would 80/week? no you won't...but will you exceed 80/week at times..yep! there will be very few places that you could work 40h/week in IM a majority of the time...ward service and ICU months are necessary and patients don't get sick from 9-5...

if lifestyle in residency is that important to you, then you need to look at specialties where the breath of material is not as wide and you focus early...and doesn't really have much of an inpatient component to it...

and realize that almost anything in IM and its subspecialties is not going to be 40h/week unless its shift work (like hospitalist and intensivist work)...while you may not be seeing patients, there is all sorts of paperwork that needs to be done and its hard to get that done while seeing patients (you may get admin time, but the reality is that its not enough time)...and remember most of those specialties that you are looking at with "better" hours are longer in years of residency...(though I'm not sure what specialty is 5 days a week).
 

pulmoblast

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No pain no gain my friend...you want work life balance in residency? You will get it at the cost of your skills...the only question is...how much mediocrity are you prepared to admit...maybe for some being a mediocre but happy physician is better than a mad but sad genius...

Dismal P 0.1
 
OP
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Sep 14, 2015
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All I'm saying is that a residency in which you have time to actually think about interesting patients and do research on patients when you get home >>>>>> being a documentation jockey being forced to manage a 20 patient team, too jaded and overworked to ever do anything for learning but try to get notes in. I've seen the latter and it is in no way a form of increasing clinical skills.
 
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CatFactorial

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All I'm saying is that a residency in which you have time to actually think about interesting patients and do research on patients when you get home >>>>>> being a documentation jockey being forced to manage a 20 patient team, too jaded and overworked to ever do anything for learning but try to get notes in. I've seen the latter and it is in no way a form of increasing clinical skills.
You might have seen the latter but what those interns and residents may not have told you is that they're learning a **** ton. You are going to be running the show when you're an attending. It is much better to be too jaded/overworked when someone else's ass is on the line, not yours.

You're not wrong in wanting to avoid places with more scut than anything else (but many places have lots of scut). However you want to be a busy and harried resident. I'd suggest looking into programs with strong training directors and high-volume/underserved patient populations.
 

dyeguy21

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You'd be surprised how much you learn by doing. I'm not saying you need to constantly manage a 20 pt team, but as an intern you're gonna be in charge of getting notes in, taking admits, and writing orders. You will learn to become efficient at this process and eventually it will take you about 1/3rd of what it used to.

When you do you will begin to notice how to identify patients that are actually sick vs. those that are stable (you may think you know this now, you don't). Then you'll start to notice how a pyelonephritis with obstruction admission becomes almost routine. Then that patient will go septic on you and you will run to the RRT to see what you missed.

Each time something happens you have an opportunity to learn. Patients don't read the text books or care about your nightly research. Learn from your colleagues and consulting doctors. Read their notes, if something makes no sense, take 2 mins and look it up, then you'll know how and why to do it next time. You don't need multi-hour daily chunks to sit down and research about everything you do. Your attending will ask you questions you won't know the answer to, it is now okay to say "I don't know" because that's what they're expecting and they want to teach you.

When you become an upper level you will have more and more time to spend learning the cerebral portions of your work. You'll have more electives and you get to manage the interns that were doing what you did before. You will also prepare for the boards and become the most book smart person in the world.

Derm is potentially 9-5, but that is filled with 5-10min outpatient visits, all day every day. They see thousands of rashes, moles, weird things, etc. during their training. You should want to do the same, except your problems will consist of more than make it more wet/dry so they will inevitably take more time, thus you need to be carrying a larger team so that you can see what you want to see.

I will leave you with this: Picasso is sitting at a bar and a lady walks up to him with a napkin. She asks him to draw something for her. He spends 5 mins and draws something decent on the napkin and turns to the woman and says, "That will be $500." Outraged she says, "$500!? That only took you 5 mins!" To which he replied, "Madam, it took me 30 years to learn how to do it in 5 mins."
 

jdh71

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I see everyone is saying here but honestly, don't hate on derm without really knowing what derm is.
No one. Not a single person has hated on derm. The specialty makes plenty of very very important diagnoses all the time. The day to day work though doesn't have the direct import to possible life and death RIGHT NOW the way it does in IM. And in a similar fashion IM has less direct important than certain surgical specialties.

It's not hate. You just need to work IM residency hours to be confident and competent when you are done.

Who do you want taking care of YOUR mom? The guy who did UTSW Parkland hospital hours and training or the guy that did derm residency hours on the IN-patient side at a community box??

No hard feels.
 

ArkansasMed

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Yeah they are right. More hours =better later on. Actually.... Hours and actual responsibility. I am an intern at a program with a rep of giving a ton of responsibility early on and we all work a ton. I can say that at times it totally sucks to work these long hours but I have seen the end product. my fellows senior residents are exceptionally well trained and can perform better than most attendings in the country. This is 100% due to the responsibility placed on them and hours worked during these years. Look at it this way, if you don't work hard now during intern/residency training, you will eventually have to be the one to make these calls and will not have the experience to do it well. Trust me, it is better to put the work in for 3 years and maximize your ability to take care of people than take the easy route and feel uneasy most of your career taking care of super sick patients. Your patients will appreciate it.
 
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Acoustic

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I would put in a plug for bolus admissions vs trickle. At my program on days where you aren't admitting you can basically leave as soon as everyone is stable, which they may never be until the night team comes. But then you work your ass off on days that you need to, but there are other days where you work your ass off to get out a little earlier and have more time at home. Then you are motivated by efficiency for the sake of necessity, patient care, and self care. Minimization of BS waiting around time, because longer hours does not always mean longer education.

Everyone above is right that this is the time where you want to work hard. But there ARE ways you can work better, not harder. I feel that's what you are asking in a sense, and I feel this is one of those ways to do that.
 
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Beacopp665

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Programs with an X+Y schedule are nice too. You have a guaranteed golden weekend every K-th week which is nice to look forward to, and a proportion of your class is off that same weekend so there are always people to hang out with. My program has this and talking with other friends at traditional half day of clinic/week programs this is a big plus as you're not going months on end without a two day break at least
 
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afanrin

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As I try to narrow my application list, can anyone share which IM programs you have heard are known for their work-life balance?
Northwestern has pretty amazing work-life balance, probably the best out of any top place I saw. PM me if you want to hear more.
 

Trogghunter

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Any program with a 4 +2 or 2+2 schedule. I am at one and we are in the experimental arm of Icompare... it's still not bad. Up to pgy2 and I've broken duty hours 4 times since I started, all in ICU and for good reason. Otherwise I worked 60-65 a week average as an intern on wards, 40 on consults.
 
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IMreshopeful

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I'm going to go against the grain of everyone having squee fests over the X+y schedule. I have a weekly continuity clinic and I think it's awesome. We have tons of elective time that isn't eaten up by the mess of ambulatory time that ends up happening with the block system.

My residency requires you to work very hard and take care of many sick patients. I have had to work late with numerous nights where I had less sleep than I'd like. I've only broken duty hours a few times on very specific rotations (which is something we are actively trying to fix) and we have an incredibly supportive house staff and faculty. If someone is on the verge of burnout, we intervene quickly to stave it off instead of the mentality of "shut up and put up with it", which some residency programs do unfortunately have. However, because of all the work that we do we come out as good clinicians. You can't expect to coast by in residency.

I guess what I'm saying is, you will have to learn a lot, as some of our older more curmudgeonly moderators are saying, and that requires putting in a lot of work and hours. However, the key is having a supportive atmosphere without malignant colleagues or attendings. This will help maintain a good work and life balance better than anything else.
 
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IMreshopeful

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All I'm saying is that a residency in which you have time to actually think about interesting patients and do research on patients when you get home >>>>>> being a documentation jockey being forced to manage a 20 patient team, too jaded and overworked to ever do anything for learning but try to get notes in. I've seen the latter and it is in no way a form of increasing clinical skills.
I agree that the amount of paperwork that we have to do nowadays in residency is pretty absurd. However, this is why you spend a lot of doing it in your intern year. This allows you to become efficient and quick. This is why in the beginning of my intern year it took much longer to write up an H&P and put in orders and do follow up etc and yes that could lead to me spending 6 to 8-9 pm daily doing lots of work. However by the end of the year I had become so efficient that I got most of the paperwork done quickly and would rarely leave later than I had to.

Also writing notes is not a bad thing. It also teaches you early on how to organize your thoughts and develop analytical skills.
 
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Gastrapathy

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We need to change the name of post-graduate medical training. The work-life balance residency and jumbo shrimp.

Why in the world do you want to do medicine?
 
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jdh71

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We need to change the name of post-graduate medical training. The work-life balance residency and jumbo shrimp.

Why in the world do you want to do medicine?
I might humbly suggest that name is too generous.

Perhaps just: "Free Sippy Cup!"
 

premedk

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I too am an IM hopeful who doesn't want to put their life completely on hold during residency. I'm looking for places with an average of 60-65hr on wards and less on outpt.

So far, programs with 3+1 or 4+2, with plenty of elective/outpt/research/consult months and not more than the acgme required ward and icu months seem to be the best. These programs do exist, and many are mid tier academic programs in less desirable cities. Mayo Jax seems to fit the bill.

Trogghunter talks of this magical 2+2, but after researching 100s of programs the last few weeks, if such a program does exist, I'm guessing its some small, obscure community program.

Also, lots of people are talking about these type of residencies, but very few specific programs were named. These would be very helpful for those of us in the process of applying now.
 
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ArkansasMed

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As William Osler once said:

"He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all."

Just something to keep in mind in deciding on what makes for a good residency.
I like the quote. Though to be fair, William Osler was argued to leave Hopkins for Oxford because his health was failing partially from the stress of increased patient demands and volumes (aka not getting hours with them but the short visits we are all accustomed to). Ironic isn't it?
 

HelpPleaseMD

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i'd say that you should look for programs with closed ICUs or you will be the scut monkey of private ICU attendings
 
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No one. Not a single person has hated on derm. The specialty makes plenty of very very important diagnoses all the time. The day to day work though doesn't have the direct import to possible life and death RIGHT NOW the way it does in IM. And in a similar fashion IM has less direct important than certain surgical specialties.

It's not hate. You just need to work IM residency hours to be confident and competent when you are done.

Who do you want taking care of YOUR mom? The guy who did UTSW Parkland hospital hours and training or the guy that did derm residency hours on the IN-patient side at a community box??

No hard feels.
I'll take care of his mom... :soexcited: