Specialties ranked in order from most intense residency to least

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hollisterdoc

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As I wrap up my first year of med school and while feeling extremely exhausted, I wanted to give everyone a chance to rank specialties by how tiring and intense their residencies are. Obviously surgery ranks first. What's the rest of the ranking, for those of us who want to dream (at least for a couple days) of taking the slow lane.

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For the opposite end of the spectrum, psych by a mile. I have friends in programs who never even break 40 hours by PGY3 and 4.
 
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Neurosurgery
General surgery
Surgical subs
OB
Neurology
Internal medicine
Anesthesiology
Primary care/FM
Dermatology
Psychiatry
 
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Cool. Where would you say EM, urology, or ENT rank?
 
EM has low hours compared to most, but the environment strongly promotes burnout anyway. Ent and urology I don't have any experience with.
 
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For the surgical subs, highly program dependent. My residency was very chill and even more so now that they’ve gone to a night float system for call. My hours and qol was better than many of my friends in non surgical fields. Most all my weekends were golden, and call was q8-10 as a junior. Even better as senior/chief. I worked only 4 weekends my chief year - the other 48 were golden.

Compare with where I did fellowship, they were pulling q4 call and worked at least one day each weekend - just how they handled rounds and weekends. Their program would be considered much more intense, but I arguably logged far more good cases and came out with better training while also enjoying my life.

So it’s near impossible to compare fields when the individual programs vary so much.
 
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Neurosurgery
General surgery
Surgical subs
OB
Neurology
Internal medicine
Anesthesiology
Primary care/FM
Dermatology
Psychiatry
Where does peds fit on that list - is it comparable to IM or more along the lines of FM?
 
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Where does peds fit on that list - is it comparable to IM or more along the lines of FM?
Depends, but probably as busy/busier than IM.

Since there is a lot of variation between programs (e.g. the most intense programs I have seen were in OBGYN or GS, and I know a lot of neurosurgery residents) I think of it more based on tiers:

1) NSGY, gen surg, ortho, some OBGYN (maybe a little ENT, based on what I've heard?)
2) All other surgical subspecialties (except maybe urology, which may be closer to tier 3), remainder of OBGYN, neurology
3) IM, peds, anesthesiology, radiology, EM (as an average - low hours, but intense shifts), maybe some intense FM programs, ophthalmology
4) Most FM, PM&R, psych, derm, path
 
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Compare with where I did fellowship, they were pulling q4 call and worked at least one day each weekend - just how they handled rounds and weekends. Their program would be considered much more intense, but I arguably logged far more good cases and came out with better training while also enjoying my life.
Based on my limited experience, QoL and good training, even in surgical fields, are not mutually exclusive. Even more importantly, hours worked does NOT translate to good training. I worked long hours on my last sub-I (base hours 5a - 6:30p, 12 on, 2 off PLUS additional time for late consults, emergent cases, interns late for signout, etc...) despite being on a very low volume service (3-4 patients on service at most times including consults, 2-4 cases/week). I spent a lot of time sitting around the workroom reading, but it wasn't really efficient. I can read 3x more efficiently at home or in the library compared to the workroom, where you're being interrupted every 5 minutes or having to read while someone else is gossiping in the background. I tried to scrub for as many cases with other services as possible when there was down time, but even that didn't make up for it.

Overall, it was one of my worst learning experiences. Inefficient reading time. Long hours. Poor sleep. Low case volume. Poor prep for additional cases, which were scattered. It showed me that I want a residency program that is busy in terms of patient volumes and cases, but lighter on hours so I can actually sit down at my desk and re-organize, absorb, and supplement the conditions I managed that week. If I'm not studying my patients and their conditions, I am no different from a mid-level who practices based on experience alone rarely cracks a book.

As for the specialties, I agree it's definitely program dependent, but I love arbitrary lists so IMHO

1) Neurosurgery
2) Gen surg, ortho
3) ENT, urology, plastics, OB/Gyn
4) Neuro, IM, peds, rads, anesthesiology, ophtho
5) FM, EM, pathology, PM&R
6) Psych, derm
 
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Great info everyone, thanks for contributing! As a follow up, would any of you say that any of the specialties have a drastically different workload as an attending than what you would expect based on the intensity of their residencies, or would you say that residency intensity is a pretty good indicator of post-residency hours/workload? Thanks again all!
 
Great info everyone, thanks for contributing! As a follow up, would any of you say that any of the specialties have a drastically different workload as an attending than what you would expect based on the intensity of their residencies, or would you say that residency intensity is a pretty good indicator of post-residency hours/workload? Thanks again all!
Attending life varies even more than programs. I suppose there are some small correlations with residency intensity though.

Really it comes down to how much money you want to make and how much free time you’re willing to sacrifice to get it. Other logistical things like call, OR availability play a big role too.

For me, I work <40 hours a week most weeks, 8a-3p (as in walking out the door with all notes done). Out of 800+ docs at my institution, I am number 7 or 8 in terms of clinical volume and moving up as I get more efficient.

My life is pretty sweet, but I could work a lot more if I wanted to and get paid a lot more as a result. I could work later each day, add a weekend clinic, take more call, operate more, etc, and many docs do just that.

Couple of my buddies in Neurosurg are banking well over $2m a year but they work their tails off to do it and their lifestyle now is probably similar to residency. I know other neurosurgeons who chose better work life balance and are making do with lower seven figure salaries.
 
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Great info everyone, thanks for contributing! As a follow up, would any of you say that any of the specialties have a drastically different workload as an attending than what you would expect based on the intensity of their residencies, or would you say that residency intensity is a pretty good indicator of post-residency hours/workload? Thanks again all!

IM hospitalists. They work as hard as they did in residency for a week. Then they have a week off. Rinse and repeat.

All attendings have the potential to work far, far less than they did in residency. It all depends on your contract/how much you want to make.
 
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All attendings have the potential to work far, far less than they did in residency. It all depends on your contract/how much you want to make.

Radiology is the exception, unless you work at some low-volume VA facility. Radiologists generally read far more what they did during training.
 
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IM hospitalist

Attending life is sweet. You are making 5-6x of what you made as a PGY3 working 1/2 of the hours.
 
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Radiology is the exception, unless you work at some low-volume VA facility. Radiologists generally read far more what they did during training.
This is true for pathology also.
 
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My wife, who is a hospitalist administrator, thought Pathology M&M was the most detail oriented... that solved nothing.
“Pathologists know everything about everything…but too late.”
 
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It is definitely program-dependent. I'm a psychiatrist and have had to stretch the truth numerous times to avoid logging more than the 80-hour cap. I have also had a couple of months (off-service) where the weeks are closer to 35 hrs, but I don't ever plan on working less than 55 hrs while on service, and it is usually closer to 65 hrs.
 
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It is definitely program-dependent. I'm a psychiatrist and have had to stretch the truth numerous times to avoid logging more than the 80-hour cap. I have also had a couple of months (off-service) where the weeks are closer to 35 hrs, but I don't ever plan on working less than 55 hrs while on service, and it is usually closer to 65 hrs.
Psych at my hospital works 40-50 pretty much all of residency. Seems nice
 
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