Residency Woes

[hul398]

Hey guys,
First time posting here, so please forgive any transgressions here, not wanting to offend or instigate anyone. I also don't know if this specifically has been discussed a lot here before, not as far as I can see.

Complaints about overworking, resident neglect, and a lack of a solid educational program have been louder than usual in my residency program and I'm writing to see if other residents in other programs feel the same way and therefore it just comes with the territory, or if we're being especially whiny.

Let me be specific. As residents, we're hired to learn, but also to work and we're getting paid for it, so this should be expected. But I think residents at our program feel that we are used more blatantly for work, and education is secondary. I wonder if this is a natural tendency in anesthesia, we're supervised for about 5 minutes at the beginning and (sometimes) the end of surgery, and then left alone. Sure, every case can be learned from, but seriously, after your 20th total knee, are you really learning much?! Relieving CRNAs at 3pm, being saddled with days of uneducational ortho cases, and being held until 6 or 7pm to give breaks in other rooms, etc. all incrementally feed this attitude. And when you're constantly dealing with bad attitudes from techs, circulators, and surgeons, I think it's easy to feel abused all around.

I think seeing anesthesiology attendings practice also fuels this concern. They're often seen in some back lounge joking with colleagues, watching TV, checking stocks, etc., so it's very easy to demonize them. Btw, I think this is also the view from other specialties, esp surgery, making it easy for them to see us as slackers, doing little, and collecting an unfair portion of the reimbursement for surgery. It's also fuel for the CRNA uproar, if the attending is "running" three rooms from the back office but the CRNAs are busting their asses to get the cases done, it's easy to conclude who is taking too much of the pie.

I'm perfectly willing to accept that this is all BS, should've been expected with residency, and we should all just sit down, shut up, and work hard. I see the gen surg residents and I know it could be worse. But because we only do one residency, it's hard to see what the "norm" is in anesthesia across the country and I'm wondering what you guys think. If the answer is, "it is what it is", maybe there are some ideas about how to change it instead of making residency into a feudal state and everyone's just trying to get out to be the next lord with your own serfs.

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[aneftp]

1. It's not the 30 knee ortho case you do. Remember it's the patient. The complexity of the patient is what makes the case challenging.

2. Attendings should give you pointers hear and there. 5 minutes if it involves teaching is usually enough

3. 70 hours is generally the working week in anesthesia residency

 

[Oggg]

Boring ortho case == study time for boards. Also, you want to cultivate the image of a team player for when you need rec letters, chief residency, favors, etc. of course you can still work for change within the system

 

[pgg]

Kind of sounds like you're being neglected a bit more than usual. An attending only being present 'sometimes' at emergence with a CA1 seems a bit bold to me, but I was at a program that had 1:1 attending:resident and was at the opposite end of the spectrum (attending required to be present at emergence until the last day of CA3 year).

6 months into your CA1 year there's still value in stool-sitting basic cases, so I don't think I'd zero in on that as a problem ... yet.

You can try telling your PD that you'd like more teaching, but there's a fine line between being viewed as a good resident who wants to learn more from his respected and loved attendings, and a whiny resident griping about attendings he has contempt for.

If your PD is unsympathetic, that's a rough position to be in. You really don't have much to gain by complaining; odds are they won't change anything about the program, and you'll just be marked as a problem. As a rule 'sit down, shut up, and work hard' is usually the right answer as a resident ... not necessarily because it's the right thing to do, but because squeaky wheels get hammered.

Take advantage of the opportunity you have (there are people who would love to have any slot in any anesthesia residency), learn what you can, and count the days. This too shall pass.

 

[hul398]

Take advantage of the opportunity you have (there are people who would love to have any slot in any anesthesia residency), learn what you can, and count the days. This too shall pass.

Thanks man, honestly appreciated and message taken to heart. I hear you: not much to do in terms of reworking a residency program from within (or from below), and better to make the most of it.

I don't actually think our lives as residents are all that bad per se, and it's great doing a bunch of cases that are relatively easy, getting paid, then going home to study. I don't have a problem with working 70 hours a week, or even 80. I guess I was also hoping to hear what other residents' experiences were in terms of work/education balance. And I'm also kind of interested in the broader issue of the overseer-attending role in anesthesia and its implications both in residency education and the profession as a whole. Anyway, thanks for the thoughtful replies.

 

[urge]

I felt like you do when I was in residency. It will come to an end. Books are your best teacher.

 

[BobBarker]

No, SDN is your best teacher.

 

[Jay K]

My residency was exactly as you describe and malignant as well, however I don't believe all anesthesia residencies are like that.

Be thankful you live in an era of smartphones and tablets.

 

[Consigliere]

If you think it's bad now, just wait until you're an attending.....

 

[somedumbDO]

Hey guys,
First time posting here, so please forgive any transgressions here, not wanting to offend or instigate anyone. I also don't know if this specifically has been discussed a lot here before, not as far as I can see.

Complaints about overworking, resident neglect, and a lack of a solid educational program have been louder than usual in my residency program and I'm writing to see if other residents in other programs feel the same way and therefore it just comes with the territory, or if we're being especially whiny.

Let me be specific. As residents, we're hired to learn, but also to work and we're getting paid for it, so this should be expected. But I think residents at our program feel that we are used more blatantly for work, and education is secondary. I wonder if this is a natural tendency in anesthesia, we're supervised for about 5 minutes at the beginning and (sometimes) the end of surgery, and then left alone. Sure, every case can be learned from, but seriously, after your 20th total knee, are you really learning much?! Relieving CRNAs at 3pm, being saddled with days of uneducational ortho cases, and being held until 6 or 7pm to give breaks in other rooms, etc. all incrementally feed this attitude. And when you're constantly dealing with bad attitudes from techs, circulators, and surgeons, I think it's easy to feel abused all around.

I think seeing anesthesiology attendings practice also fuels this concern. They're often seen in some back lounge joking with colleagues, watching TV, checking stocks, etc., so it's very easy to demonize them. Btw, I think this is also the view from other specialties, esp surgery, making it easy for them to see us as slackers, doing little, and collecting an unfair portion of the reimbursement for surgery. It's also fuel for the CRNA uproar, if the attending is "running" three rooms from the back office but the CRNAs are busting their asses to get the cases done, it's easy to conclude who is taking too much of the pie.

I'm perfectly willing to accept that this is all BS, should've been expected with residency, and we should all just sit down, shut up, and work hard. I see the gen surg residents and I know it could be worse. But because we only do one residency, it's hard to see what the "norm" is in anesthesia across the country and I'm wondering what you guys think. If the answer is, "it is what it is", maybe there are some ideas about how to change it instead of making residency into a feudal state and everyone's just trying to get out to be the next lord with your own serfs.

This is how my residency was as well... Bring a book and learn when u can. Also, private practice you will work more than what you are describing. There is some leeway in academics but the reimbursement is less.

 

[Sonny Crocket]

With regard to the lack of didactics/teaching; Isn't this something the resident review committee might crack down in at the next visit?

 

[hul398]

With regard to the lack of didactics/teaching; Isn't this something the resident review committee might crack down in at the next visit?

Yeah, actually this is kind of how the program-wide complaining awareness was brought up, via a review committee. I don't think the concerns are being taken with much gravity, but it's still early (they haven't in the past). But point well taken, you're right, we should be using that review as a springboard for an open and honest discussion. Of course as others have said, it could be detrimental to one's future to be singled out.

Thanks again for the responses guys, it is helpful to know it's kind of like this everywhere. We prob just need to suck it up. To reiterate, it's not that we're being worked hard, my colleagues and I don't have a problem with hard work, it's the feeling of being used as a cheaper CRNA.

 

[countingdays]

A) Talk to me when you are a fully trained general anesthesiologist, working for 1/10th your potential hourly income, to do 80% noneducational cases, while taking in house call while the faculty sleeps at home, and doing preops for cases that you have no role in because the faculty are too lazy to do their own damn jobs. Being used for labor as a resident is a dream compared to the shafting of fellowship when you are licensed and qualified to do most of the cases independently but are being blatantly exploited.

B) Being left alone in a room all day is much better than the alternative. Read- your books know more than your faculty.

 

[cognitus]

My residency was exactly as you describe and malignant as well, however I don't believe all anesthesia residencies are like that.

Be thankful you live in an era of smartphones and tablets.

Hopefully, this residency is NOT in the Northeast.

 

[cognitus]

BTW, what books are good for Anesthesia Residency? I currently have Baby Miller but I want to supplement that with one or two more. This does not include reading for specific specialties

 

[floridaboy18]

No, not all residencies are like this. There are days at my residency where the attending doesn't come in a lot to teach and check on me and I read chapters online or in a book I bring, but far and away the attendings are very intentional about teaching. Yes, there are some that don't...but they are the exception. I will say I am more pro-active in asking questions, which might lend to my experience in being taught regularly. Be intentional. Ask questions.

We average 65 hours per week. Our attendings are there for every single induction and emergence unless there other room (they only cover 2) is waking up at the same time and then they'll send someone else to help out in their place. I've woken a patient up and extubated without an attending this year as a CA-1 maybe twice.

CRNA's always relieve us, we do not relieve them unless we are on call and their shift ends and rooms are still running. We are out of the OR by 3pm every day (some days we are relieved late when a ton of rooms are going) for lecture and/or pre-ops. Week days are busy, but we get three weekends off each month with one weekend on call.
I think this was the biggest question I tried to answer when interviewing actually: What is the focus of the residency? Are you there for an intentional education or are you there to be a cog in the wheel of the work force?

As for supplements: We are asked to read Baby Miller and Morgan and Mikhail by the time the ITE rolls around at our program. We also have a question bank our program provides that we are supposed to finish by the end of the year.

Just my experience.

 

[floridaboy18]

Also, I'll add as someone on some of these committees (it's called the Residency Quality Improvement Council where I am), there has to be a way to address these problems semi-anonymously and to gain attention to the lack of education you are receiving. Reading is great, but an ACADEMIC attending is getting paid to be good at two of three things: research, teaching, and clinical abilities. Very few people are successful in academics without being good at at least two of those things....

You should have a way to draw attention to this. Use your chiefs. Use your GME council. Use your RQIC.

 

[sleepallday]

Hey guys,
First time posting here, so please forgive any transgressions here, not wanting to offend or instigate anyone. I also don't know if this specifically has been discussed a lot here before, not as far as I can see.

Complaints about overworking, resident neglect, and a lack of a solid educational program have been louder than usual in my residency program and I'm writing to see if other residents in other programs feel the same way and therefore it just comes with the territory, or if we're being especially whiny.

Let me be specific. As residents, we're hired to learn, but also to work and we're getting paid for it, so this should be expected. But I think residents at our program feel that we are used more blatantly for work, and education is secondary. I wonder if this is a natural tendency in anesthesia, we're supervised for about 5 minutes at the beginning and (sometimes) the end of surgery, and then left alone. Sure, every case can be learned from, but seriously, after your 20th total knee, are you really learning much?! Relieving CRNAs at 3pm, being saddled with days of uneducational ortho cases, and being held until 6 or 7pm to give breaks in other rooms, etc. all incrementally feed this attitude. And when you're constantly dealing with bad attitudes from techs, circulators, and surgeons, I think it's easy to feel abused all around.

I think seeing anesthesiology attendings practice also fuels this concern. They're often seen in some back lounge joking with colleagues, watching TV, checking stocks, etc., so it's very easy to demonize them. Btw, I think this is also the view from other specialties, esp surgery, making it easy for them to see us as slackers, doing little, and collecting an unfair portion of the reimbursement for surgery. It's also fuel for the CRNA uproar, if the attending is "running" three rooms from the back office but the CRNAs are busting their asses to get the cases done, it's easy to conclude who is taking too much of the pie.

I'm perfectly willing to accept that this is all BS, should've been expected with residency, and we should all just sit down, shut up, and work hard. I see the gen surg residents and I know it could be worse. But because we only do one residency, it's hard to see what the "norm" is in anesthesia across the country and I'm wondering what you guys think. If the answer is, "it is what it is", maybe there are some ideas about how to change it instead of making residency into a feudal state and everyone's just trying to get out to be the next lord with your own serfs.

Having been an academic attending not to long ago, I feel that most residents are unaware of some of the issues and logistics or running a residency program. For example, regarding the complaints of having to relieve CRNA's. This is usually not a decision that comes from within the program. But often a directive coming from the university or hospital administration because they do not want to pay the CRNA's for overtime. Which brings up another point, (and this more the fault of the training programs and not the residents) that we are training our residents to think its ok to routinely be relieved midway through cases. This is just poor form. If we want start distinguishing ourselves from CRNA's how about we start taking more ownership of our patients and stop looking at anesthesia as shift work. In my group, if you start the case, more often then not you finish it.

I do agree with you that formal didactics are lacking in many programs and this is usually because it is hard to fit in protected academic time with a busy OR schedule. When it comes to intraoperative teaching, and I try to spend time in the OR to teach, the evaluations I receive are usually along the lines of me not providing enough autonomy to residents.

The only suggestion I can provide is to take more ownership of your education. Have questions ready to ask your attending each day or better yet tell your attending the night before what topics you would like to discuss the next morning. If your doing 20 total knees, try as many different anesthetics as possible. Hang in there and try to enjoy and take advantage of this time because once your in the real world, you'll wish you were back in residency.

 

[urge]

A) Talk to me when you are a fully trained general anesthesiologist, working for 1/10th your potential hourly income, to do 80% noneducational cases, while taking in house call while the faculty sleeps at home, and doing preops for cases that you have no role in because the faculty are too lazy to do their own damn jobs. Being used for labor as a resident is a dream compared to the shafting of fellowship when you are licensed and qualified to do most of the cases independently but are being blatantly exploited.

I don't think anybody forced you into a fellowship. You can quit whenever.

 

[BobBarker]

As a CA3, my best days are when I only see my attending for a lunch break if at all. It's my patient and my anesthetic plan. I can intubate, art line, and 16g faster than them. The only thing they can do to help my education is not to be present for induction. What you are asking for, you won't want at all soon enough.

 

[urge]

We prob just need to suck it up. ....it's the feeling of being used as a cheaper CRNA.

Yes on both. They would need to hire 2 CRNAs to replace each resident based on hours. Plus they get to pocket about 100k per resident from the ACGME/Medicare money.

 

[Planktonmd]

So... there are 2 main complaints here:
1- Residents are used as cheap labor: It's true... that's what you are... cheap labor, and all that other BS about education and teaching that some programs excel at is just a marketing tool to attract more cheap labor like you.
2- Anesthesiologists are not respected and seen as lazy bastard: It's also true and it will be the reality you deal with for the rest of your career.
So... now it's a good time for you to decide if you are willing to accept these realities or not!

 

[countingdays]

I don't think anybody forced you into a fellowship. You can quit whenever.

I'm not a fellow. I finished it a few years ago. Quitting would look VERY bad on a CV.

 

[WholeLottaGame7]

No, not all residencies are like this. There are days at my residency where the attending doesn't come in a lot to teach and check on me and I read chapters online or in a book I bring, but far and away the attendings are very intentional about teaching. Yes, there are some that don't...but they are the exception. I will say I am more pro-active in asking questions, which might lend to my experience in being taught regularly. Be intentional. Ask questions.

We average 65 hours per week. Our attendings are there for every single induction and emergence unless there other room (they only cover 2) is waking up at the same time and then they'll send someone else to help out in their place. I've woken a patient up and extubated without an attending this year as a CA-1 maybe twice.

CRNA's always relieve us, we do not relieve them unless we are on call and their shift ends and rooms are still running. We are out of the OR by 3pm every day (some days we are relieved late when a ton of rooms are going) for lecture and/or pre-ops. Week days are busy, but we get three weekends off each month with one weekend on call.
I think this was the biggest question I tried to answer when interviewing actually: What is the focus of the residency? Are you there for an intentional education or are you there to be a cog in the wheel of the work force?

As for supplements: We are asked to read Baby Miller and Morgan and Mikhail by the time the ITE rolls around at our program. We also have a question bank our program provides that we are supposed to finish by the end of the year.

Just my experience.

This is more like my program, except we get relieved at 430ish. And not for cardiac/thoracic cases, we finish those out or get relieved by other residents/fellows. We have a nice mix of attendings w/ regard to amount of supervision. Obviously as a CA-1 I appreciated the micro-managers more, now as a CA-3 I appreciate the hands-off ones more.

Not all programs are like the OPs.

 

[Dejavu]

In defense of attendings, I spend very little time sleeping in the lounge.

Like everybody, attending have job pressures as well. Mostly, after supervising the launch of three rooms, I spend my time seeing the next pt for each room, teeing up the nerve blocks and preop meds, etc, getting the pts to the block shop after talking to my colleague who will do the block, attending to problems in the ORs I am covering, as well as dealing with the PACU issues that always crop up, and signing all the pts out of PACU. Then going for a quick soda in my office while I sign the charts for billing and JACHO requirements.

Anyway, I am not complaining, nobody has a better job than I do around here, but I am just explaining where I am when I am not in the room teaching.

 

[hul398]

In defense of attendings, I spend very little time sleeping in the lounge.

Like everybody, attending have job pressures as well. Mostly, after supervising the launch of three rooms, I spend my time seeing the next pt for each room, teeing up the nerve blocks and preop meds, etc, getting the pts to the block shop after talking to my colleague who will do the block, attending to problems in the ORs I am covering, as well as dealing with the PACU issues that always crop up, and signing all the pts out of PACU. Then going for a quick soda in my office while I sign the charts for billing and JACHO requirements.

Anyway, I am not complaining, nobody has a better job than I do around here, but I am just explaining where I am when I am not in the room teaching.

You're 100% right, there are several attendings in my program like you, manage to teach and share the work, and I would do well to remember them. My initial post was unfair to them. I will say you sound like a stellar attending to your residents and other attendings reading this should be taking notes. I'd guess 25% of attendings I've come across are like you, 25% are playing candy crush in the lounge, and most are somewhere in between, which is probably true to some extent of all specialties. I will try to focus on the good ones and remember to be one after I graduate.

Also as a quick note, to all the teaching attendings out there, we residents are always listening and watching, even if it may not seem that way. I guarantee even the most checked out resident is listening. Your comments, criticism, and good and bad habits are shaping years of practice, for better or worse.

 

[hul398]

No, not all residencies are like this. . . . .

Having been an academic attending not to long ago, I feel that most residents are unaware of some of the issues and logistics or running a residency program. . . . .

Thanks very much for these replies guys, these thoughtful perspectives were exactly what I was looking for and are much appreciated.