Stress/hours worked in family medicine residency?

[enantio1988]

Hey all, I've been interested in learning more about what the lifestyle/hours worked in family medicine residency are like. Weight of time spent in outpatient versus inpatient, hours per week, etc. Have your experiences in FM residency given you a good work/life balance and is it conducive to starting a family (one of my upcoming goals)?

How stressful all in all have your experiences been in family medicine residency?

Thanks!!

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[hallowmann]

Reported average at our categorical program is ~65 hrs/wk, but realistically that's divided between outpatient rotations that are 50-55 hrs/wk and inpatient rotations that are 70-80 hrs/wk. As stated above, the early years lean heavily towards the inpatient rotations and later in training there's more electives and outpatient.

I never interviewed at programs that quoted anywhere close to 40hrs/wk, closest were places that averaged 55-60hrs/wk.

 

[FrustratedFamDoc]

Residency is only 3 years. You should ideally look for the program that will best prepare you for life after residency. You've got time for "work/life balance" later. What places advertise as work hours and what they really are, are often 2 very different things. Go in to it expecting a butt kicking. Go in to it expecting to be uncomfortable but willing to learn and do anything it takes to get better. After residency, you can choose to work as little or as much (and make as little/much) as you would like. One of the primary unspoken purposes of residency is to expose you to stress from all angles and earn to manage it well.

My first year sucked badly, I wouldn't do it again for half a mil but am glad I went through it. Second year wasn't terrible as long as my first year didn't whine much and was ready to work. Third year was cake aside from being chief (Don't EVER accept the chief role).

 

[jacobus1919]

Wow 80hours/week and q 4 calls then after a 24 hour call your off for the day? That is pretty alright. How much patient load do residents usually get?

 

[Mad Jack]

Residency is only 3 years. You should ideally look for the program that will best prepare you for life after residency. You've got time for "work/life balance" later. What places advertise as work hours and what they really are, are often 2 very different things. Go in to it expecting a butt kicking. Go in to it expecting to be uncomfortable but willing to learn and do anything it takes to get better. After residency, you can choose to work as little or as much (and make as little/much) as you would like. One of the primary unspoken purposes of residency is to expose you to stress from all angles and earn to manage it well.

My first year sucked badly, I wouldn't do it again for half a mil but am glad I went through it. Second year wasn't terrible as long as my first year didn't whine much and was ready to work. Third year was cake aside from being chief (Don't EVER accept the chief role).

Three years is still three years. For those of us that are married or people with children, those years can be critical for any number of reasons

 

[FrustratedFamDoc]

Three years is still three years. For those of us that are married or people with children, those years can be critical for any number of reasons

We absolutely do and every day is a blessing but with that said, we all have choices that we must make. Often, trying to fit two things together that can be mutually exclusive will leave you with compromise. Everything in life has an opportunity cost. Medicine is a tough mistress and you'll never make everyone happy. Things have certainly improved from the 'old days' but residency is still a great big poo sandwich that requires getting it down in big bites. It's our basic training and lays the foundation on what is hopefully a great career.

 

[VA Hopeful Dr]

Three years is still three years. For those of us that are married or people with children, those years can be critical for any number of reasons

Medicine requires sacrifices. Less than in previous years (thank goodness) but good training is important. And you don't get that doing 40 hour weeks for 3 years.

 

[Mad Jack]

We absolutely do and every day is a blessing but with that said, we all have choices that we must make. Often, trying to fit two things together that can be mutually exclusive will leave you with compromise. Everything in life has an opportunity cost. Medicine is a tough mistress and you'll never make everyone happy. Things have certainly improved from the 'old days' but residency is still a great big poo sandwich that requires getting it down in big bites. It's our basic training and lays the foundation on what is hopefully a great career.

Beyond a certain point, more hours becomes more hours for the sake of there being more hours, not necessarily because they are beneficial to one's training. Plenty of European countries limit resident hours to 45/week, and their health outcomes aren't exactly suffering because of it. If the program's graduates have a decent board pass rate, they're probably being trained just fine.

 

[VA Hopeful Dr]

Beyond a certain point, more hours becomes more hours for the sake of there being more hours, not necessarily because they are beneficial to one's training. Plenty of European countries limit resident hours to 45/week, and their health outcomes aren't exactly suffering because of it. If the program's graduates have a decent board pass rate, they're probably being trained just fine.

They also train for more years. I'd rather do 3 years of 80 hours versus 45 hours for 5 years.

 

[Mad Jack]

They also train for more years. I'd rather do 3 years of 80 hours versus 45 hours for 5 years.

I'd be more inclined to do 60ish for 3 myself

 

[jacobus1919]

Is it true it was legal before to have 4th yr MS and residents to have roughly 120hr/ week??

 

[FrustratedFamDoc]

Beyond a certain point, more hours becomes more hours for the sake of there being more hours, not necessarily because they are beneficial to one's training. Plenty of European countries limit resident hours to 45/week, and their health outcomes aren't exactly suffering because of it. If the program's graduates have a decent board pass rate, they're probably being trained just fine.

More hours becomes more hours when you're cheap labor. Never underestimate the profit incentive, it always plays a role. Residents are a hell of a lot cheaper than hiring more hospitalists. You don't think your preceptors are actually gonna pick up the slack, do you? Is there actually THAT much more learning that goes on when a 60 hr/week turns in to an 80 hr/week? Possibly.

There's a lot of politics as to why residents have the hours that they do. It is our version of basic training. There is hazing. There are egos. There's definitely a profit motive. Certainly an "I went through it and you do too" attitude. You are essentially powerless as the directors and preceptors can at any time and almost any reason end your medical career whenever they so choose (and they know this). There's more but these are just off the top of my head.

It's a double edged sword and we must walk a very fine line. The more we try to diminish the rigorous nature of our training and the fewer procedures we do, the more we'll be equated to mid level providers (if we're not already there in the eyes of the beancounters.) Beware of ANYTHING that makes you in any way appear similar to your fellow "practitioner" who can be had at less than half the cost.

Does it suck? Oh God yes, and there are some places that are worse than others but from what I've seen there are similar aspects seen at most programs. What's the reward? Well, lots.

Patients will often consider you a part of their family
Helping those who will listen to hopefully live the most fulfilling and longest life possible
Almost guaranteed to be a top 5% earner
GREAT work/life balance after dues are paid
Ability to leave and find an even better job pretty quickly if you so choose

 

[VA Hopeful Dr]

I'd be more inclined to do 60ish for 3 myself

And best I can recall that's probably what my FM hours averaged out to over 3 years. I hear psych is the same if not slightly less.

 

[Mad Jack]

And best I can recall that's probably what my FM hours averaged out to over 3 years. I hear psych is the same if not slightly less.

And I guess that's what I'm pushing- don't go to the 80 hour places because more hours=better, I guess. There's a negligible ROI beyond a certain point and your time would better be spent studying than seeing patients. So look at the board pass rates and the hours and find a program that you fit with that has the best of both worlds within reason

 

[VA Hopeful Dr]

And I guess that's what I'm pushing- don't go to the 80 hour places because more hours=better, I guess. There's a negligible ROI beyond a certain point and your time would better be spent studying than seeing patients. So look at the board pass rates and the hours and find a program that you fit with that has the best of both worlds within reason

Well most of that for FM at least is a reflection of increasing clinic in later years versus primarily hospital in intern year.

I'd also say that for more procedural based work hours are better. More changes for hands on.

 

[Mad Jack]

Well most of that for FM at least is a reflection of increasing clinic in later years versus primarily hospital in intern year.

I'd also say that for more procedural based work hours are better. More changes for hands on.

Procedural work hours undoubtedly matter so long as those extra hours involve more procedures

 

[Stagg737]

Is it true it was legal before to have 4th yr MS and residents to have roughly 120hr/ week??

It's still legal for MS4's to have to work 120 hr weeks, as ACGME standards do not apply to medical students, LCME does. LCME does not have specific restrictions, the just recommend that schools/hospitals abide by ACGME rules.

Yes, residents did used to be able to work 120 hr weeks. This was far more common in surgical fields and I had a few attendings that said they'd regularly work 120 hour weeks in residency. Had one attending who said they had a few 140+ hr weeks. Some of the current laws are a little too restrictive imo, but necessary given the insanity that used to be possible in association with residency training.

 

[KeikoTanaka]

I feel like 60 hours a week is better than the hours im putting in for my 1st year studies... 40 hours would be a vacation.. lol

 

[deleted87716]

I feel like 60 hours a week is better than the hours im putting in for my 1st year studies... 40 hours would be a vacation.. lol

60 hours isn't as bad as it sounds (since it includes overnight call and weekends), and you will probably only work that many hours on inpatient rotations, mostly when you're an intern. I was a resident in the late 1990's (before the work hours restrictions), and even then we didn't work more than 60 hours/week that often.

Not trying to make residency sound easy (it isn't), but you'll still have time for a life outside of work.

 

[plica]

I graduated from a unopposed FM program 2.5yrs ago. And hours and time put in are often resident dependent. There were residents that showed up on time, did what they were suppose to do and averaged 60hrs/week, with an occasional week where they might have come close to 80hrs. There were also a few residents who "skimmed along". Doing the bare basics. They would often not show up on elective rotations (because often no one is really monitoring where you are at all times) and whine if just one patient were added to their already "full" afternoon clinic schedule of 6 patients. These residents would often probably only work 35-40 hrs/week.

So the first resident will probably be a competent outpatient doc, but may get a bit nervous around a atypical or truly critical patient. The second resident, well, I would want him/her as my mother's doc. But there a another type of resident.

This resident shows up. Does what they are suppose to do, but then, looks for more. How? Sticking around for an interesting admission. Making themselves available to and known to the ICU docs that when ever there is a line to be out in, or an intubation, they want to do it. And they moonlight, a lot. You would be surprised how much moonlighting you can actually do within work hr limits (especially in the 3rd year). at our program you could moonlight in the ER at local critical access hospitals starting on 7pm Friday night and ending on Monday morning at 7am. That's 60 hrs on, where you might have to manage STEMI, trauma, pediatric seizures, amputations, code blues etc... The learning is incredible. And you critical thinking and confidence grows. This resident will come out of residency comfortable with managing outpts, but also comfortable in the ED or as a Hospitalist. Residency is where you have a chance to learn and become the best physician you can be. Worry about lifestyle after you have done your best to learn as much as you can. And I am believe that more hours equals more learning because you will be seeing more patients. That is what you need a physician in training, to see as many different types of patients as you can those 3 years.

I will now step off of my soap box