Surgery Residency with older children?

[DaveinDallas]

I would like to ask if any of the interns/residents in General Surgery have slightly older (ages 10-12) children and how the time commitments of a surgery residency impact their kids? I've talked with some of the residents
in the local programs and most are either single or newly married with no or infant age children.

I've read the handbook posted online but wondered if someone could provide their experiences on this topic (in terms of quality of life with the family, etc.).

I'm a second career type and put in my share of nights/weekends/holidays as they were younger. We worked around it by having them come to the office for dinner or I met them for lunch. I occasionally went in to work after the holiday celebration was over or came home for dinner and went back after they were in bed, etc.

I really enjoyed my general surgery experience, got a good letter and an invite back but family is an important consideration to me.

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[drtx]

I have 1 child in that range and another in elementary school. I would be lying to tell you that residency hasn't impacted their lives. But, my husband and I stagger our schedules as much as possible so that we only need a sitter for about 15 hours a week. I am getting them involved in more activities this spring but it is a lot of work. I really enjoy my job and my kids see that. I know they are happy kids and they know we love them. We tell them all the time. Sometimes, no matter how much you work, they still need to know that and the whole family will get through the bad as well as the good times.

 

[DaveinDallas]

Thanks for your reply. If we stay in the area we've got both sets of grandparents available. My wife works but the job is semi-flexible except during tax season.

The kids are used to Dad being gone and we make the best of it. Would you mind telling me how your schedule works in terms of call (I've seen from Q5 for the duration to Q3/4 for the first year and it gets progressively longer after that) and if the 80 hour rule is a pretty good round number average or is it a nice target that can be 'finagled'....

Please understand, I'm not trying to pimp you or be a jerk. I wound up doing a really great clerkship with a private practice general surgeon in Ft. Worth so I've seen that type of schedule. However, I've not seen a residency schedule but I've learned that sometimes things get blown out of proportion.

 

[DocMizzle]

Thanks for your reply. If we stay in the area we've got both sets of grandparents available. My wife works but the job is semi-flexible except during tax season.

The kids are used to Dad being gone and we make the best of it. Would you mind telling me how your schedule works in terms of call (I've seen from Q5 for the duration to Q3/4 for the first year and it gets progressively longer after that) and if the 80 hour rule is a pretty good round number average or is it a nice target that can be 'finagled'....

Please understand, I'm not trying to pimp you or be a jerk. I wound up doing a really great clerkship with a private practice general surgeon in Ft. Worth so I've seen that type of schedule. However, I've not seen a residency schedule but I've learned that sometimes things get blown out of proportion.

Call schedule can vary greatly from program to program. I'm on the interview trail now and have visited programs that are still the traditional Q3-Q4 call for 5 years with some home call chief years. I've also interviewed at places that are strictly nightfloat requiring only 2-3 overnight calls per month. Many programs fall somewhere in between with a mixture of nightfloat and traditional call depending on rotation. Although all places claim they are compliant with the 80 hr rule, as you can imagine, the lifestyle of the surgical resident can be vastly different depending on the call setup.

Without getting too far into the pros and cons of the different call systems, for me the nightfloat system is best. I am married, no kids yet, but the nightfloat system allows for me to have a 6am-6pm job so that I am home with my wife pretty much every night. I can imagine that this setup would also work out well for couples with children for the same reasons.

However, with the advent of the 80hr workweek, raising a family is possible under any call system. Time management is crucial and those who are best at it can maximize their free time for family activities.

 

[Winged Scapula]

I don't have any children so take this for what its worth, but it is true that bragging about how many hours you've worked is common in surgical specialties.

However, I honestly believe, at most programs, you should assume that 80 hours is not the average but rather the minimum worked on most rotations. In addition, the nature of a surgical resident is to typically not be a clock watcher, so someone who is frequently seen as trying to leave when his "shift" is over, even when something is happening, is not well respected. Your schedule will be unpredictable. Thus, you should expect, especially as a junior resident, to be in the hospital as much as you are at home and for your hours to be 80 or above on most rotations.

Hours are much better than they used to be and you would be well advised to seek out a program in which the other residents are married with children, as this will likely be one that is more in tune with family needs.

 

[Pilot Doc]

As others have noted above, hours vary substantially between programs and between rotations within a program. I really enjoyed my general surgery experience, got a good letter and an invite back but family is an important consideration to me.

The thing you and your family will have to understand is that your schedule, as a whole, will be totally out of your control and very unpredictable. I think that's worse than the hours. Birthdays, school plays, prom night, etc - you might make them, you might not, or you might make them then have to leave. There's no way to tell in advance, and (generally) no way to arrange time off other than vacation which is frequently given out based on the needs of the program and not you.

I don't mean this to be discouraging - I've known a number of people that have had older kids as residents. The main thing it takes is a supportive and understanding spouse who is capable of happily being completely independent.

 

[DaveinDallas]

Thanks for the insight. I sincerely appreciate it.

It sounds like for the 5 years of residency you need to be mission focused
with everything else being secondary. That's doable and my spouse and kids are supportive. Doesn't mean they'll be jumping for joy if Daddy can't make certain important dates due to surgery but they understand that it's my training that's on the line and that directly impacts our future.....

Another question along this line -- in engineering you had to be strong enough to say,'No' or be abused. We had one VP that used to regularly pressure his people to work weekends just to be able to say a project was finished before Monday at 08:00. He'd come in Monday at 06:00 and update the schedule with all the finished projects. Why? Well, if it was updated before 08:00 the master schedule program called it done the prior week and he'd look good in front of the Prez. Happened on a regular basis, several of us were asked to cancel days off, etc. to 'make it happen'.

I'm assuming surgery residency isn't like that (pulling hours just to be pulling hours) but that usually there's a point - i.e. more training on various aspects (even if it's paperwork) of the job....another chance to round on patients, another chance to practice closing, another chance to observe seniors do a surgery you've seen a hundred times but can still learn from, etc.

 

[Pilot Doc]

you had to be strong enough to say,'No' or be abused.

For better or worse, that's not how surgery works. It's a hierarchical system. They say jump; you say how high. And I think it's best to learn helplessness early on and accept that you have no control.

That said, there is more than enough real work to go around that you rarely have to worry about working for works sake.

 

[Winged Scapula]

Agree with Pilot Doc...there is almost always enough work to do that little of the time are you working just to say you did.

However, I think there is pressure to do work that you might not necessarily benefit from; there is some limit to the benefit of some activities. Depending on the program, you may feel more or less pressured to do these things and as PD notes, in many programs there is no saying "no", no refusing to do tasks, etc.

The ol, "well its your education", if you balk at doing yet another dressing change, line placement, etc. at 11 pm post-call, 42 hours in the hospital, on your birthday when your sexy new BF is home waiting for you.

Not that that would happen to you, or anyone else here, during residency.

 

[DaveinDallas]

For better or worse, that's not how surgery works. It's a hierarchical system. They say jump; you say how high. And I think it's best to learn helplessness early on and accept that you have no control.

That said, there is more than enough real work to go around that you rarely have to worry about working for works sake.

Strangely enough, the fact that it's real work makes it more palatable. We used to get told to cancel Christmas vacation flights when our section of the job was done and tested just to sit around the lab since we were 'part of the team'. The other parts of 'the team' were working on their end of the projects and there was literally no way to help them. If we balked, we weren't 'team players' -- kiss of death at that company.

Of course, this was the same outfit that sent out a 'tiger team' of engineers to fix a project that they had initially screwed up when the customer threatened to pull it out of their site. Then, because they got it fixed and 'saved' the account, they got bonuses.....Peter Principle defined

Now I am beginning to understand what my general surgery attending meant when he introduced me as his 'slave'.....but i learned to do a surgery rounds physical in 3 minutes if I took my time.

How do you handle the physical demands of long call. The most contiguous I've done so far has been 30h but the residents were nice and let me catch about 4 hours of sleep from 02:00 to 06:00.....

 

[Blade28]

The ol, "well its your education", if you balk at doing yet another dressing change, line placement, etc. at 11 pm post-call, 42 hours in the hospital, on your birthday when your sexy new BF is home waiting for you.

 

[Dr. V]

There are surgical residency programs that are more family friendly and they actually do follow the 80 hours, including the 30 hour max shift limit for call.

If you end up at one of those places it will make it somewhat better for you, just expect to work your tail off when you are at work though cause the amount of work is the same even if the hours are restricted.

 

[Winged Scapula]

Which part shocked you - that I had a sexy new BF?

 

[Blade28]

Which part shocked you - that I had a sexy new BF?

No, the ol' "I-can't-wait-until-I-get-out-of-here-because-of-what's-waiting-for-me-at-home" bit during your residency!

 

[Winged Scapula]

No, the ol' "I-can't-wait-until-I-get-out-of-here-because-of-what's-waiting-for-me-at-home" bit during your residency!

You know what they say, "all work, no play..."

(and besides, after 42 hours, it wouldn't have mattered WHO was at home, if any one, I just wanted to go home and sleep).

 

[drtx]

I look at call nights as a double sided coin. On one side, you are away from your kids and don't get to see them go to bed....but the next day, you will be there (hopefully) when they come home from school. It becomes a sort of thing we look forward to. As far as scheduling goes, it is a constant discussion me and my husband have all week long. (ex. I am waiting for a case, it's 5 pm so I call my husband "looks like it will be late, I was going to make X for dinner, can you get it started? Make sure to fill out X form, and check their homework) Then when I get out I make it, or coach my husband through how to make it quickly before I run to my next task.

The reality:
I am not as good as I could be at both being a mom and being the "best, top resident" but I give both all the effort I can. And I accept it for what it is.

Surprisingly, I am present for everything that I can be and don't miss every single bday, anniversary, etc...and I really don't ever feel that I have to use the "mommy card" but I have heard of a lot of stories about various experiences people have had by other threads. I am really self conscious about NOT doing that....but what I can do is sign out when it is time to do so or call and check on stuff I need to follow up from home.

Oh, and I am at an academic program...Only 2 women with kids--I'm one of them. It can be done.

 

[DaveinDallas]

Would anyone mind posting the programs that are family friendly? I don't know if this next one matters but I'm at the D.O. school in Ft. Worth. I've been told by 4th years that 'the surgical programs in Dallas don't take D.O.'s so don't even bother'...to which I responded, 'There's always a first time'. I brought that up to ask if any of the programs are more difficult to get into as a D.O.?

It was alluded to earlier in the thread about people being looked at differently who wanted to leave at the end of their shift or were perceived as 'clock watchers'. Since I didn't do my clerkship at a residency program, I just left when the attending told me to and it was no problem. Came back when he called during emergency situations and pretty much did what I was told when I was told to do it. No biggie. Can someone give me a rule of thumb about when it's ok to sign out, etc.? Logic would say that you stay until your tasks are done and handoff has been accomplished. If the team needs more help, you stay until the person in charge dismisses you. Hopefully, they recognize how long you've been there and your level of seniority. If you're a newbie, hopefully they have mercy and balance your need for training with your need for sleep and downtime.....

Thanks for all the info.

drtx - would you mind PM'ing me with some of the programs you looked at when you have a moment?

 

[Winged Scapula]

It was alluded to earlier in the thread about people being looked at differently who wanted to leave at the end of their shift or were perceived as 'clock watchers'. Since I didn't do my clerkship at a residency program, I just left when the attending told me to and it was no problem. Came back when he called during emergency situations and pretty much did what I was told when I was told to do it. No biggie. Can someone give me a rule of thumb about when it's ok to sign out, etc.?

1) when your Chief resident says its ok and you have asked, "are you sure?" at least once;

2) when no one on your service is crashing;

3) when there are truly no real tasks to sign out (ie, its ok in most cases to sign out to check labs or a CT scan that won't be done for hours, it is NOT ok, IMHO, to sign out to have a chest tube or central line placed);

4) at such time as your team deems sign-out to be ok (ie, some services do not want their team signing out before 5 or 6 pm, so even if the work is done, you have to stay around until the "witching hour")

Logic would say that you stay until your tasks are done and handoff has been accomplished.

Of course. But you'd be suprised at what people think is ok to sign out. And the answer is not what the attending thinks is ok to sign out, but rather what your fellow residents think is ok.

As I noted above, IMHO, the following are NOT ok to sign out:

1) discharge summaries
2) admitting a patient (who arrived in the ED or on the floor before your day is done)
3) procedures ike chest tubes, central lines, etc.
4) care of a patient actively dying/crashing
5) "talks" with family
6) consults to be called in

If the team needs more help, you stay until the person in charge dismisses you. Hopefully, they recognize how long you've been there and your level of seniority.

And its important to assess who that person "in charge" is. Generally this is the Chief resident but you need to be aware whether or not the 3rd year or senior level resident on service has the ability to make those decisions in light of the Chief not being available. The attending is not necessarily the person who is in charge (good residents will make the attending think he/she is in charge, but most of the decisions are made at the resident level). The mid-level is *never* in charge, so they are not to tell you if it is ok to go home.

Obviously, all of the above takes some getting to know. If there are questions and your Chief has not clearly delineated who is responsible for what and what the expectations are, then they should be asked.

If you're a newbie, hopefully they have mercy and balance your need for training with your need for sleep and downtime.....

Maybe they will maybe they won't. There are a lot of sadistic people in medicine, surgery in particular. I am hopeful that there are fewer than there used to be but I hear and have seen stories of arrogant senior residents abusing interns and juniors, including demanding they cut their vacation short to "help out the team" (fortunately, as the fellow, I put a kibosh on that when I found out), etc. I wish you the best of luck in finding such a program.

 

[DaveinDallas]

1) when your Chief resident says its ok and you have asked, "are you sure?" at least once;

2) when no one on your service is crashing;

3) when there are truly no real tasks to sign out (ie, its ok in most cases to sign out to check labs or a CT scan that won't be done for hours, it is NOT ok, IMHO, to sign out to have a chest tube or central line placed);

4) at such time as your team deems sign-out to be ok (ie, some services do not want their team signing out before 5 or 6 pm, so even if the work is done, you have to stay around until the "witching hour")



Of course. But you'd be suprised at what people think is ok to sign out. And the answer is not what the attending thinks is ok to sign out, but rather what your fellow residents think is ok.

As I noted above, IMHO, the following are NOT ok to sign out:

1) discharge summaries
2) admitting a patient (who arrived in the ED or on the floor before your day is done)
3) procedures ike chest tubes, central lines, etc.
4) care of a patient actively dying/crashing
5) "talks" with family
6) consults to be called in




And its important to assess who that person "in charge" is. Generally this is the Chief resident but you need to be aware whether or not the 3rd year or senior level resident on service has the ability to make those decisions in light of the Chief not being available. The attending is not necessarily the person who is in charge (good residents will make the attending think he/she is in charge, but most of the decisions are made at the resident level). The mid-level is *never* in charge, so they are not to tell you if it is ok to go home.

Obviously, all of the above takes some getting to know. If there are questions and your Chief has not clearly delineated who is responsible for what and what the expectations are, then they should be asked.



Maybe they will maybe they won't. There are a lot of sadistic people in medicine, surgery in particular. I am hopeful that there are fewer than there used to be but I hear and have seen stories of arrogant senior residents abusing interns and juniors, including demanding they cut their vacation short to "help out the team" (fortunately, as the fellow, I put a kibosh on that when I found out), etc. I wish you the best of luck in finding such a program.

WS- Thank you for all of your insight (and I'm being serious, not sarcastic). It's helping me make informed decisions. I find your comment about sadistic people in medicine interesting. On my family clerkship I was actually pimped about the size of the spleen. It was all the more interesting in that it came from a PGY-2 that had graduated from my school. Personally, I thought it was a 'gentlemen's agreement' that you don't pimp or make people from your school look bad, but try to help them.

It was even more interesting when I admitted I didn't know the size (I was thinking exact measurements in centimeters) and asked,'How big should it be, doctor?'.....I was honestly seeking information to increase my knowledge.....No answer was given and we quickly headed into the exam room.....

Forgot to mention that on the same rotation, I had a 4th year from my school pimp me on sliding scale insulin, pre/intra/post-renal creatinine values, etc....

 

[Pilot Doc]

Would anyone mind posting the programs that are family friendly?

No surgery residency if family friendly. I don't mean that as a knock on surgery - it's just true. There are only degrees of un-friendliness.

That said, the Scott & White program in Temple, Tx seemed like a great choice if you had a family.

Based on my (now quite dated) interview experience and supposition, the things that will tend to make a program less unfriendly are

- Larger ratio of residents to covered hospitals (less amount of in house call)
- Larger residency in general (more flexibility when people take vacation, get sick, etc)
- Rural location - single people typically go to big cities. Ergo, to attract families to your rural program you should be family friendly
- well funded hospital (less scut)

The degree of in-house vs. home call can be a big issue as well. Almost all intern call is in-house, almost all chief call is home - there's a lot of variability program to program in between. Home call will give you a lot more flexibility in terms of being around for bedtime, etc.

And a great resource for learning general surgical culture for an intern is
http://www.womensurgeons.org/aws_library/pocketmentor.pdf

 

[Winged Scapula]

WS- Thank you for all of your insight (and I'm being serious, not sarcastic).

You're welcome.

On my family clerkship I was actually pimped about the size of the spleen. It was all the more interesting in that it came from a PGY-2 that had graduated from my school. Personally, I thought it was a 'gentlemen's agreement' that you don't pimp or make people from your school look bad, but try to help them.

You will be in for quite a suprise then during surgical residency where pimping rises to a new art form. Socratic method they call it but Socrates never meant for the technique to include humiliation of the pimpee if they cannot answer the question(s).

Expect to be pimped. It may be a great learning experience, depending on how the pimper handles it.

Forgot to mention that on the same rotation, I had a 4th year from my school pimp me on sliding scale insulin, pre/intra/post-renal creatinine values, etc....

Its probably more of a faux pas (or breaking of the "gentleman's agreement") to have a fellow student pimp you rather than a resident, even if they were from the same school.

No surgery residency if family friendly. I don't mean that as a knock on surgery - it's just true. There are only degrees of un-friendliness.

True. I think it unlikely that there is any program which expects you to put your family first over service. Of course, there are programs that are worse about it than others. Let's just say surgical programs have moved from assuming the best resident is a single white male to tolerating women and married residents.

And a great resource for learning general surgical culture for an intern is
http://www.womensurgeons.org/aws_library/pocketmentor.pdf

Good resource even for males (although the OP can presumably skip the chapter on Locker contents - where keeping a supply of tampons on hand is on the checklist! )

 

[Bruingirl6]

People are advocating home call for families.....However, it's not always a great arrangement. Our chiefs do both. When I'm on in-house call, I know I will get to go home the next day. On "home call" I may spend all night at the hospital, but then not go home post because I was on "home call."

 

[Winged Scapula]

People are advocating home call for families.....However, it's not always a great arrangement. Our chiefs do both. When I'm on in-house call, I know I will get to go home the next day. On "home call" I may spend all night at the hospital, but then not go home post because I was on "home call."

Yes...the farce of home call when faculty look the other way and forget about those hours you were in house.

 

[teddybear]

on your birthday when your sexy new BF is home waiting for you.

A woman after my own heart.