Transplant surgeon lifestyle question

Discussion in 'Surgery and Surgical Subspecialties' started by Jasonbuyer, Jul 30, 2015.

  1. Jasonbuyer

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    Hi all- I've been dating a great guy who is currently in his final year of a surgical residency. He's going to do his fellowship in transplant surgery and I have been wondering if there is a significant difference in the amount of time he'll be spending at the hospital during his fellowship compared to residency. Thanks in advance for your input.
     
    #1 Jasonbuyer, Jul 30, 2015
    Last edited: Jul 30, 2015
  2. doc05

    doc05 2K Member
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    transplant surgery is one of the worst in terms of hours for fellows. figure 100-120 hours per week. not to mention donor runs. good luck with that.

    p.s. please remove the names of the 2 hospitals in your original post. try to keep things anonymous.
     
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  3. ThoracicGuy

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    Transplant is not an ACGME sponsored fellowship. They are not held to the 80 hour work week like residencies. If its a kidney/pancreas only transplant program, his hours have the potential for being tolerable. If they do livers as well? Yeah, 120 hours a week wouldn't be completely unheard of.
     
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  4. thedrjojo

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    Many fellowships, while not technically acgme, do abide by the work hours at least on paper. I think it was something like a 50-50 split. But yeah, I don't necessarily believe it, nor would I necessarily want it when(if) I'm a fellow
     
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  5. ThoracicGuy

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    Ours certainly did not. They were also a top 5 in volume center for kidney and liver. They also did pancreas and started small bowel while I was there. They are freakin' busy.
     
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  6. thedrjojo

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    Yeah, I didn't believe the Stat when they presented it, but maybe they do exist. Clearly most programs know they work you like a dog (and flat out say as much on the interview) but you become one of the most revered and respected surgeons at the end, and if you can't operate at the end of the two years, you will never be able to
     
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  7. Buzz Me

    Moderator Emeritus Gold Donor Verified Account 10+ Year Member

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    I was at an ACGME-accredited program for cardiothoracic surgery and was never compliant with duty hours. Just because it's ACGME-accredited doesn't mean you won't be frequently breaking the rules as a fellow.
     
  8. Gastrapathy

    Gastrapathy no longer apathetic
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    Lol. Jason the future transplant fellow is gonna love this when he sees it. I once heard a transplant attending tell the transplant fellow who was falling asleep standing up on rounds that he could leave anytime. As the fellow started to collect his stuff, the attending said "after all, you're a board certified surgeon, its not like you need this"...and the fellow came back. As a fellow on the medical OLT side, it made me sad but since they guy was an incompetent douche, in a way, it made me happy. Then again, that program just about transplanted itself out of existence over the course of that year and all the surgeons were ultimately replaced.
     
  9. Jasonbuyer

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    You've all been a great help, thank you.
     
  10. sinombre

    sinombre carboloading
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    What do you think now that you're a fellow? You're obviously pretty busy... you haven't even had the time to change your "status" from "resident" to "fellow" ;)
     
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  11. thedrjojo

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    My week: Monday 6am til 7pm Tuesday 12am til 8pm, 11pm til Wednesday 6pm. Thursday 630am til 1130pm. Friday 7am til 7pm. Granted I was involved in 2 deceased donor and a living donor liver transplant, managed 7 icu pts, got an after hours Angio done, and had an attending rounding for the first time ever so he took up more of my time, and some of that in hospital time was sleeping in the call room (between noon and 4pm)...

    But weeks I'm not on service I've left at 2pm plenty.

    You definitely gotta love this to do it, no lie.
     
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  12. thedrjojo

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    That said, I've managed to step foot in my house every day since ive started fellowship, even if for two hours to have dinner with the wife, as stated above.

    And my fellowship wouldn't ever say something like above. I've been encouraged to go home get rest, call me and update me when you wake up, put pts in the unit if they are acting sick so someone else can manage them acutely, etc
     
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  13. DoctwoB

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    Similar experience rotating through transplant at my place. The hours are long and unpredictable, but there was also a culture of getting out of the hospital when possible. They had PAs to cover routine floor calls on weekdays. 10AM on Monday and done with rounds with no cases going on? Go home and sleep. Of course there were many weeks where cases stacked and this never happened, but it never felt like you were stuck at the hospital for stupid reasons like on other services waiting for the attending to round, staff a consult, etc.
     
  14. ThoracicGuy

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    Could. Not. Pay. Me. Enough.
     
  15. VincentAdultman

    VincentAdultman Senior Member
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    The month I intern'd on the transplant service was the worst month of my life. Not exaggerating, worst month ever.
     
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  16. thedrjojo

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    I'd say the same regarding thoracic...
     
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  17. ThoracicGuy

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    I wouldn't mind kidney's though. Those are nice. Not too many middle of the night kidney transplants going on.
     
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  18. thedrjojo

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    Did I mention kidneys get admitted to nephrology post op here and we manage the Foley, diet, pain meds, and drain?

    Livers get transferred to hepatology after 1-2 clinic visits when stable surgically...
     
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  19. Psai

    Psai Snitches get zero vicryl
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    Why not just push clinic back a bit...
     
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  20. Gastrapathy

    Gastrapathy no longer apathetic
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    Damn straight. 89 and 23 hours.
     
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  21. VincentAdultman

    VincentAdultman Senior Member
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    I remember having to put postop orders on cases I didn't scrub for....the PGY4 would just page me with the name and the orders he wanted....in addition to the million other things I had to do.

    I didn't really think much of it at the time because I was an intern and interns get dumped on but now that just seems incredibly lazy to me.
     
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  22. jonnythan

    jonnythan Some men play tennis, I erode the human soul
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    120 hours in a week is 7 AM to midnight every single day.
     
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  23. evilbooyaa

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    When I spent two months on transplant as an intern, we literally took every patient with a history of transplant, period, because the chairman of the transplant department had a few bad experiences with transplant patients being mismanaged without consultation of the transplant team.

    This meant we would routinely have 30 to 40 patients on service, 95% of which were just standard IM patients, for which we basically acted as hospitalist and pan-consulted for every medical problem, but had to deal with nursing pages on each and every single one of.
     
  24. sinombre

    sinombre carboloading
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    That's exactly how it is where I am too. Every single patient with a history of a transplant, regardless of the problem. I had no idea there were so many people walking around with donated organs prior to intern year.
     
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  25. Gastrapathy

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    Next team. Ah the memories
     
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  26. Winged Scapula

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    And?

    (But who comes in at 0700? It was more like 330-430 and you're forgetting in house call without home post call so like 400 am in on Monday and home 7 pm Tuesday).
     
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  27. SLUser11

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    Still, I do believe a lot of people who reported 120 hours back in the day tended to round up. I remember my co-students recalling 120 hour weeks on our surgery clerkship, and they were off by about 30 hours.

    Long weeks may have been 120, but I don't think most programs averaged 120 even before 2003. I would guess it was more likely 100. This is based on discussion with my senior residents and subsequent colleagues, as I admittedly trained post-2003 work hour restrictions.

    In a night float system, it's very difficult to get to 120, as it would require 17 hour days every day obviously. 4am to 9pm happens, but not daily outside of a program with extremely poor balance.

    In q2 call, the 120 hours can occur, so I guess in programs where q2 call was standard 120 happened every week.

    In q3 call, it's hard to do, and requires essentially no days off and full post-call days, once again a reality for some, but not the standard across training programs prior to 2003.

    I'm not defending the other person's skepticism, but I have been a firsthand witness to many self-proclaimed 120 hour weeks that were actually much less.
     
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  28. Winged Scapula

    Winged Scapula Cougariffic!
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    True...even before 2003 it was not 120 hrs EVERY week except when we were on CT when we were q2.

    However 100+ weeks were the usual (even without rounding up); we ran"thin" and definitely did not leave post call or had a 1/7 off.

    I assumed the person I was responding to thought it never happened back in the day; programs are better run these days.
     
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  29. jonnythan

    jonnythan Some men play tennis, I erode the human soul
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    I was just putting the "100-120" number into perspective for the OP.
     
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  30. SLUser11

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    I honestly believe training is better with work hour restrictions. I believe in flexibility, however, allowing residents to work longer when a true patient need exists or when there is outstanding educational opportunities...unfortunately we've demonstrated that we cannot self-regulate, and that in the absence of rules the residents will be abused, so it's impossible to balance perfectly.
     
  31. Winged Scapula

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    There is no doubt that the extreme exhaustion did not make for a better trained surgeon.

    As you note, the flexibility to be available for unusual cases (like the antrectomy and TV I did in residency; not many of those to go around) is important.

    Unfortunately, those rules were forced upon programs because of the egotism that did not allow them to see what was coming down the pike. Without penalties for breaking the rules, they would never be enforced. Training has to change and educators like yourself are key in finding ways to get residents educated with fewer hours.
     
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