Residency Question

[DoctorB]

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I have heard that residents have to go through like 30 hour shifts at a time. I have this eye condition where I have to wear rigid gas permeable contacts otherwise I am blind. The problem is I only can wear them for 12 hours in a 24 horu time period due to oxygen diffusion to my cornea. Am I pretty much screwed or do residency programs make exceptions to the long work shifts?

 

[DrMom]

My residency program says that we have to be able to work a minimum of 24 hours straight without any accomodations. That said, I don't know of anyone who gets out of taking call for at least their own service, so that really means 30 hours.
Talk to your ophthalmologist about how you can best deal with this schedule.

 

[ORBITAL BEBOP]

I have heard that residents have to go through like 30 hour shifts at a time. I have this eye condition where I have to wear rigid gas permeable contacts otherwise I am blind. The problem is I only can wear them for 12 hours in a 24 horu time period due to oxygen diffusion to my cornea. Am I pretty much screwed or do residency programs make exceptions to the long work shifts?

You cant wear glasses??

 

[Blade28]

Hmmm...don't know what to say here. You've never had to be awake (and not blind) for more than 12 hours in a day, ever?

 

[humuhumu]

Do you have any other options? Eyeglasses? Surgical correction (e.g., Lasik)?

 

[AmoryBlaine]

I have heard that residents have to go through like 30 hour shifts at a time. I have this eye condition where I have to wear rigid gas permeable contacts otherwise I am blind. The problem is I only can wear them for 12 hours in a 24 horu time period due to oxygen diffusion to my cornea. Am I pretty much screwed or do residency programs make exceptions to the long work shifts?

Anything contacts can do glasses can do just as well. Plus they might keep the flying blood out of your eyes.

 

[chocomorsel]

Hmmm...don't know what to say here. You've never had to be awake (and not blind) for more than 12 hours in a day, ever?

Hilarious!!! But seriously dude, get some glasses.

 

[OMFSCardsFan]

I have heard that residents have to go through like 30 hour shifts at a time. I have this eye condition where I have to wear rigid gas permeable contacts otherwise I am blind. The problem is I only can wear them for 12 hours in a 24 horu time period due to oxygen diffusion to my cornea. Am I pretty much screwed or do residency programs make exceptions to the long work shifts?

I can only imagine what other kinds of cop-outs you're going to come up with during residency if you've already come up with this. Glad I have a co-resident already...

 

[DoctorB]

Look, if I could wear glasses do you think I would have been complaining about my problem. Look up the condition Kerataconous. My corea has thinned and peaked so much that I MUST wear RIGID GAS PERMEABLE CONTACTS. The contacts in a sense reshapes my cornea and tricks my eye into thinking that the contact is in fact my cornea. Glasses don't work as they do not physically reshape my cornea. My best vision with glasses is 20/4,000. And yes, after 12 hours i am blind. I could not recognize my father from my mother based on vision alone. Before you go attacking me please consider that there are aspects of medicine that you do not know. To those of you who attacked me I can see (because I have my contacts in right now) that you are goign to become great doctors!! I appreciate the comments that did not attack me. The only other alternative for me is to get a cornea transplant but since there is no direct blood flow to the cornea, the down time after a cornea transplant is like 4 months. Since I am a senior in college and have a busy life I can not sacrifice 8 months (4 months per eye) at this point. I imagine I will have to take a year of between med school and residency if they can not accomodate me.

 

[Shangal]

I'd recommend taking a year off between undergrad and med school to get that surgery out of the way.

I think in most schools, when you get accepted, you have to sign a form that you can visually distinguish diseases and have your other senses all intact. So the fact you can only use your eyes for 12 hours is something that might make you unqualified for many schools.

So if there is a surgery to correct your vision then do it. But I don't think most residency programs will accept a student who can only perform 12 hours a day. Its just not fair for the rest

 

[SoCuteMD]

Look, if I could wear glasses do you think I would have been complaining about my problem. Look up the condition Kerataconous. My corea has thinned and peaked so much that I MUST wear RIGID GAS PERMEABLE CONTACTS. The contacts in a sense reshapes my cornea and tricks my eye into thinking that the contact is in fact my cornea. Glasses don't work as they do not physically reshape my cornea. My best vision with glasses is 20/4,000. And yes, after 12 hours i am blind. I could not recognize my father from my mother based on vision alone. Before you go attacking me please consider that there are aspects of medicine that you do not know. To those of you who attacked me I can see (because I have my contacts in right now) that you are goign to become great doctors!! I appreciate the comments that did not attack me. The only other alternative for me is to get a cornea transplant but since there is no direct blood flow to the cornea, the down time after a cornea transplant is like 4 months. Since I am a senior in college and have a busy life I can not sacrifice 8 months (4 months per eye) at this point. I imagine I will have to take a year of between med school and residency if they can not accomodate me.

I applaud you for making it this far with only 12 useful hours in every 24 hour period. I wholly second Shangal's suggestion of a year off in between college and medical school. I could not make it through med school with only 12 useful hours each day. I'm not exaggerating when I say that there are times when just studying takes that many hours, not to mention self-care and domestic stuff. Not to mention that 3rd and 4th year also involve some 30 hour days (particularly 3rd year). I wish you lots of luck.

 

[skypilot]

The only other alternative for me is to get a cornea transplant but since there is no direct blood flow to the cornea, the down time after a cornea transplant is like 4 months. Since I am a senior in college and have a busy life I can not sacrifice 8 months (4 months per eye) at this point. I imagine I will have to take a year of between med school and residency if they can not accomodate me.

You certainly could get through the first two years of med school no problem but you may have a tough time with the second two depending on the school. You may have to take call even as a med student. Many students are taking a year off after passing the boards to do research. (or even more years to earn a PhD.)

You should discuss this with the school as they have made accomodations for students including blind students and paralyzed students based on their disability.

 

[DoctorB]

What do you guys think? Is it better to take a year off between undergrad and medical school or medical school and residency? I imagine it would be better to get it out of the way as i will probably be needing my eyes fully functional for those long nights of studying in med school.

I applaud you for making it this far with only 12 useful hours in every 24 hour period. I wholly second Shangal's suggestion of a year off in between college and medical school. I could not make it through med school with only 12 useful hours each day. I'm not exaggerating when I say that there are times when just studying takes that many hours, not to mention self-care and domestic stuff. Not to mention that 3rd and 4th year also involve some 30 hour days (particularly 3rd year). I wish you lots of luck.

 

[skypilot]

What do you guys think? Is it better to take a year off between undergrad and medical school or medical school and residency? I imagine it would be better to get it out of the way as i will probably be needing my eyes fully functional for those long nights of studying in med school.

If you are sure you want the transplant, getting it before you apply makes things much easier as you will no longer be disabled.

A year is nothing. You could have a great year and even do some research or another project.

 

[DoctorB]

What do you guys think? Is it better to take a year off between undergrad and medical school or medical school and residency? I imagine it would be better to get it out of the way as i will probably be needing my eyes fully functional for those long nights of studying in med school.

Oops, sorry guys made the above post while the other two were being written. I have been surviving finals week in undergrad by wearing only one contact at a time (thus I have function of one eye for 12 hours at a time thus i can see for 24 hours straight). Besides the headaches and lack of depth perception i have been doing ok with that strategy when push comes to shove. Anyone else deal with a similar situationt hat I am in?

 

[trudub]

Oops, sorry guys made the above post while the other two were being written. I have been surviving finals week in undergrad by wearing only one contact at a time (thus I have function of one eye for 12 hours at a time thus i can see for 24 hours straight). Besides the headaches and lack of depth perception i have been doing ok with that strategy when push comes to shove. Anyone else deal with a similar situationt hat I am in?

I definitely agree that the time to do the surgery if you are going to have it done is between ugrad and medical school. Get it out of the way so you can thrive in medical school. A year is nothing. It is one less thing for you to worry about down the road and one less thing to keep you from excelling in medical school and beyond. As a previous poster said, you probably will be fine for the first two years but year three and four might be tough if you don't have the surgery before then. That's my two cents. Take a deferral for a year and have the surgery.

 

[DoctorB]

I definitely agree that the time to do the surgery if you are going to have it done is between ugrad and medical school. Get it out of the way so you can thrive in medical school. A year is nothing. It is one less thing for you to worry about down the road and one less thing to keep you from excelling in medical school and beyond. As a previous poster said, you probably will be fine for the first two years but year three and four might be tough if you don't have the surgery before then. That's my two cents. Take a deferral for a year and have the surgery.

If I get into medical school and then ask for a medical deferral to get my surgery and reinstate the following year can they legally reject me or do they have to let me take the year off?

Thanks again for all the help

 

[AmoryBlaine]

If I get into medical school and then ask for a medical deferral to get my surgery and reinstate the following year can they legally reject me or do they have to let me take the year off?

Thanks again for all the help

I don't think they would reject you, and BTW I learned something new from you (the condition).

You really should try to have this taken care of pre-med school. At my instituion, 12 hours/day is considered standard at least on surgery. People being how they are, no one is going to lbe nearly as understanding as they probably should of the student who MUST leave at a certain time everyday.

Plus, imagine if as a 4th year you decide you want to do surgery, ortho, or even EM (or really any field at all). On your audition rotations you're definitely not going to want to be the student who can't work 12+ hours.

Best of luck, sorry for the comment about glasses.

 

[DoctorB]

I don't think they would reject you, and BTW I learned something new from you (the condition).

You really should try to have this taken care of pre-med school. At my instituion, 12 hours/day is considered standard at least on surgery. People being how they are, no one is going to lbe nearly as understanding as they probably should of the student who MUST leave at a certain time everyday.

Plus, imagine if as a 4th year you decide you want to do surgery, ortho, or even EM (or really any field at all). On your audition rotations you're definitely not going to want to be the student who can't work 12+ hours.

Best of luck, sorry for the comment about glasses.

Don't worry about it. It's funny because everytime I try and explain to a friend that I only have functional vision for 12 hours they always argue with me that glasses will work. I think it is funny how ignorant and close minded some people can be. If anything, I would hope that medical schools could teach more rare diseases so doctors could be more open minded and less ignorant to claims made by some patients. Thank you all for your help.

 

[skypilot]

If I get into medical school and then ask for a medical deferral to get my surgery and reinstate the following year can they legally reject me or do they have to let me take the year off?

Thanks again for all the help

They probably will grant the deferral without a problem but I doubt if they will be required to since the problem did not develop while you were applying. But don't worry, med schools are not going anywhere.

You will have a good personal statement and a great motivation for attending med school.

 

[AmoryBlaine]

Don't worry about it. It's funny because everytime I try and explain to a friend that I only have functional vision for 12 hours they always argue with me that glasses will work. I think it is funny how ignorant and close minded some people can be. If anything, I would hope that medical schools could teach more rare diseases so doctors could be more open minded and less ignorant to claims made by some patients. Thank you all for your help.

I don't disagree with you on the issue of sensitivity, but wait until you're an M2 to see if you want to learn about "more rare diseases."

 

[skypilot]

I don't disagree with you on the issue of sensitivity, but wait until you're an M2 to see if you want to learn about "more rare diseases."

Typically the professor will say "I've only seen one case of this in my entire 30 year career" and then spend 10 pages discussing it, while only spending two pages on diabetes.

🙂

 

[DrMom]

Don't worry about it. It's funny because everytime I try and explain to a friend that I only have functional vision for 12 hours they always argue with me that glasses will work. I think it is funny how ignorant and close minded some people can be. If anything, I would hope that medical schools could teach more rare diseases so doctors could be more open minded and less ignorant to claims made by some patients. Thank you all for your help.

Well, since virtually everyone is functionally correctable with glasses you really shouldn't get annoyed...especially when you didn't make any attempt to explain the situation in any detail earlier in this thread. People responding to your initial post weren't being close minded and they were only ignorant b/c you didn't give them any significant information as to your rare condition. I'm not getting on to you, but just explaining why people were responding the way they were.

That all said, if you absolutely have to take a year off I'd recommend doing it before starting. If there is any way you can function in school with one eye during post-surgical recovery, then have them done during MS1 & 2.

 

[SoCuteMD]

So, in mulling over my response earlier, I realized something. If you are no longer in school you also will no longer be covered by your parents' health plan, and it might be hard to work while recovering from surgery. This would leave you uninsured while you are supposed to have surgery.

Thus, perhaps the only way to have this taken care of by insurance is to be enrolled in school but take "medical leave" for a year (or, if you time everything right, maybe only a semester). This way you can stay on any insurance plan you might have (which is pretty crucial). Just a side note, but a pretty important one in this case.

 

[neutropenic]

Are not residency "jobs" covered by the Americans with Disabilities Act?

This question is not purely rhetorical. I am unsure of the law on this topic.

 

[SoCuteMD]

Are not residency "jobs" covered by the Americans with Disabilities Act?

This question is not purely rhetorical. I am unsure of the law on this topic.

Yes, they are covered, but the ADA still states that if you can't do the job with reasonable accomodations, you can be terminated/not hired...

For example: I am 5'1". If I wanted to be a surgeon, but the standard table height was too tall and that was the only thing prohibiting me from doing so was the table height, my job would have to provide me a stool. If, on the other hand, I want to be a surgeon, but can't operate for more than 3 hours at a time due to some medical condition, then it is a risk to patient safety (assuming I would "rest" while the patient was under anesthesia)/I can not actually DO my job (someone else would have to finish any surgery longer than 3 hours) and they don't have to hire me.

 

[angel80]

Yes, they are covered, but the ADA still states that if you can't do the job with reasonable accomodations, you can be terminated/not hired...

For example: I am 5'1". If I wanted to be a surgeon, but the standard table height was too tall and that was the only thing prohibiting me from doing so was the table height, my job would have to provide me a stool. If, on the other hand, I want to be a surgeon, but can't operate for more than 3 hours at a time due to some medical condition, then it is a risk to patient safety (assuming I would "rest" while the patient was under anesthesia)/I can not actually DO my job (someone else would have to finish any surgery longer than 3 hours) and they don't have to hire me.

Exactly, a PD from and IM program once told me about a candidate who applied for a an internal medicine residency spot. She was really bright and personable with good scores, but she was permanently wheel-chair bound. Because IM residents are typically the ones in charge of running CPR codes, her being wheel-chair bound was problematic since she would not be able to get to codes in a timely manner. Since she couldn't run and go up and down stairs, she wouldn't be able to get to a code on time, which would make her a danger to the patient. They did not rank the candidate because of that.

 

[skypilot]

Exactly, a PD from and IM program once told me about a candidate who applied for a an internal medicine residency spot. She was really bright and personable with good scores, but she was permanently wheel-chair bound. Because IM residents are typically the ones in charge of running CPR codes, her being wheel-chair bound was problematic since she would not be able to get to codes in a timely manner. Since she couldn't run and go up and down stairs, she wouldn't be able to get to a code on time, which would make her a danger to the patient. They did not rank the candidate because of that.

I bet she could move pretty fast in her wheelchair. And don't elevators have overrides for emergencies?

 

[kiddingme]

Look, if I could wear glasses do you think I would have been complaining about my problem. Look up the condition Kerataconous. My corea has thinned and peaked so much that I MUST wear RIGID GAS PERMEABLE CONTACTS. The contacts in a sense reshapes my cornea and tricks my eye into thinking that the contact is in fact my cornea. Glasses don't work as they do not physically reshape my cornea. My best vision with glasses is 20/4,000. And yes, after 12 hours i am blind. I could not recognize my father from my mother based on vision alone. Before you go attacking me please consider that there are aspects of medicine that you do not know. To those of you who attacked me I can see (because I have my contacts in right now) that you are goign to become great doctors!! I appreciate the comments that did not attack me. The only other alternative for me is to get a cornea transplant but since there is no direct blood flow to the cornea, the down time after a cornea transplant is like 4 months. Since I am a senior in college and have a busy life I can not sacrifice 8 months (4 months per eye) at this point. I imagine I will have to take a year of between med school and residency if they can not accomodate me.

oh wow, you are the first person i've heard of that has the same condition as my brother. he was in junior high when we found out that glasses won't do anything much for him since he needs the contact to literally 'hold' his cornea together. just like u he cant see without them so we usually have to remind him if he's wearing his 'eyes' 😉 wishing u luck 👍

 

[njbmd]

I have heard that residents have to go through like 30 hour shifts at a time. I have this eye condition where I have to wear rigid gas permeable contacts otherwise I am blind. The problem is I only can wear them for 12 hours in a 24 horu time period due to oxygen diffusion to my cornea. Am I pretty much screwed or do residency programs make exceptions to the long work shifts?

Hi there,
Even on your on-call days(yes they can be 30-hours long), you are not going full-tilt for a straight 30-hours. You are going to have some down-time so you can change into your glasses. If you are napping, you don't want to keep your contacts in anyway.

Back before the 30-hour work restrictions, I did 48-hour shifts every third day. I was able to take out my contacts and wear glasses in the call room as I dozed off and on.

You can easily change into glasses and keep you contacts for daylight hours. During the night, you can wear your glasses and nap during those admissions. As you will see during third-year, your contacts will become a non-issue.

njbmd 🙂

 

[omgwtfbbq?]

DoctorB, I wish you the b est of luck. I had a medical problem that wasn't "obvious", just like yours isn't obvious (no wheelchair, seeing eye dog, etc.)
and most people were closed minded about it and cruel. It made it so that for about three years I couldn't walk properly, but because i wasn't in a wheelchair and didn't have crutches (i couldn't due to the problem, long story) that i was "faking" or "complaining" or they'd say "come on i saw you doing x the other day." just like someone saying, you could see at 3pm, why not at 4am? People stink, compassion doesn't abound, but i do think you'll find people who are understanding and they're the ones that matter.
I'm well now, and have been for a while, but took an extra year in undergrad to see how my injuries healed while applying ot med school. I had options, just as you do, to "fix" myself, and i knew i'd be better off in med school if i didn't have the stress of physical problems. It gave me the chance to see that I'd be just fine to function in med school and not ask for any special treatment, which was something that worried me. I would suggest taking the year and fixing your sight now, if it is a safe and viable option for you. You can even go ahead and apply to the medical schools and then ask for a deferral if you're accepted, if you're just starting your senior year now. The worst they can say is no deferral and then you apply again. same situation as if you don't, really. Plus, you CAN see, 12 hours a day at least, and thus you're not too disabled to be an effective physician. I saw you just say stick it to all the awful people out there who try to throw ignorant "solutions" at you because they're irritated by things they don't understand and listen to the nice people in this thread all suggesting you look into making yourself better. If you can heal, do so! I worked in a lab with a woman who had a cornea transplant and she was very happy with it. Plus it'll help you out during med school. My ability to walk (and dance now! yay!) is going to be VERY helpful in med school when i have to run around patient to patient and get places quickly. I'm glad I waited. you'll probably be happy you waited when you don't have to worry about being limited by sight problems. GOOD LUCK

Don't worry about it. It's funny because everytime I try and explain to a friend that I only have functional vision for 12 hours they always argue with me that glasses will work. I think it is funny how ignorant and close minded some people can be. If anything, I would hope that medical schools could teach more rare diseases so doctors could be more open minded and less ignorant to claims made by some patients. Thank you all for your help.

 

[vtucci]

Hey Dr. B.

I wish you the best of luck. Definitely speak with the Student Affairs Dean at the Medical School you attend.

I also will have some limitations (not as severe as the ones you described)-- I am having a gastric bypass procedure this summer and the dietary restrictions are significant following the procedure for several years-- there are specific times and amounts that I must eat (i.e., every 2-3 hours and I will not have the sugar stores that most people do because of the intake amount-- you can see why this might be a problem with certain long procedures). I also must take a certain amount of time to eat a meal (30-45 minutes). I realized that this could prove problematic with many specialties- at the forefront of course, are surgery and Ob/Gyn. I spoke briefly with the Dean at my school and he assured me that they would work with me to make sure it was not a problem. I did not want anyone thinking that I would be whining or being lazy/not pulling my weight.

BTW- I plan to go into emergency medicine.

 

[DoctorB]

I was wondering if someone could breakdown an average 30 hour shift for me in residency. I bet it is different depending on what residency program you are in and where you are doing it at but I would appreciate if you could list what type of residency program you are in and how the average day breaks down. Like, are you busy doing stuff for the first 4 hours, get a 4 hour break, etc??

 

[njbmd]

I was wondering if someone could breakdown an average 30 hour shift for me in residency. I bet it is different depending on what residency program you are in and where you are doing it at but I would appreciate if you could list what type of residency program you are in and how the average day breaks down. Like, are you busy doing stuff for the first 4 hours, get a 4 hour break, etc??

Hi there,
The days differ for each specialty. For surgery, you are generally operating for the first 8 to 10 hours of your day and then doing floor care or clinic after that. If emergency patients come in through the ED, you would work them up, admit them or operate on them if an emergency. This can go on over the first 24 hours or you can have downtime and be napping in the call room. After the first 24 hours, you may not take on any new patients but finish up work on the ones that you have already admitted.

In medicine, you would typically round, write orders and attend conferences during the first 8 hours of your day. After that, you admit and work up patients that are admitted to your service through the ED. Again, through the night you may have patient after patient but that is rare. Usually, you admit a patient, work up and then back to the call room. After 24 hours, you may not admit any new patients but follow-up the ones that you have already admitted.

Some places have a cap on the number of admissions that may come to the teaching service after hours. Some places have more than one team on call after hours so that admissions are alternated.

As a surgery resident, I have had days where I never sat down or even visited the restroom but they are rare. Most of the time, I get the work done and wait for emergencies. Rarely, I have had nights where I slept all night and did not get a single call or just one or two.

Residency is a step up from medical school but it is by no mean torture day after day. The 80-hour work week has been good for some places and very bad for others. As you interview for residency slots, you have to evaluate how they manage night call. Some places have a night float systems; others do not. There are pros and cons to every system.

I have seen very physically disabled residents (wheelchair) get through residency in things like Family Practice, Psychiatry, Internal Medicine and Pediatrics. The surgical specialties are a bit more physically demanding in terms of longer hours of standing at the operating table. Again, during third-year, you will get a good idea of the hours as most OB and surgery clerkships require overnight call of their medical students.

njbmd 🙂

 

[scotttennis]

I have heard that residents have to go through like 30 hour shifts at a time. I have this eye condition where I have to wear rigid gas permeable contacts otherwise I am blind. The problem is I only can wear them for 12 hours in a 24 horu time period due to oxygen diffusion to my cornea. Am I pretty much screwed or do residency programs make exceptions to the long work shifts?

Ask your eye doctor about Menicon Z RGP contacts. These were just recently approved by the FDA for 30-day continuous-wear largely because of high oxygen diffusion. My current pair of Boston RGP contacts has a Dk/t (oxygen transmissibility) of around 85, compared to the standard soft contacts Dk/t of around 20. The new Menicon Z RGP contacts have a Dk/t of around 175. "To prevent anoxia throughout the entire corneal thickness the Dk/t requirements are 35 for the open eye and 125 for the closed eye" (source ) Therefore, you can see that at least by these numbers the contacts are suitable for continuous wear without tissue death. These are more expensive than the typical RGP contacts, but the higher oxygen permeability may allow you to see for longer periods.