Uncomfortable in program

[mwest]

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I am into 2 months of residency and during this time I found out couple of serious things about the program that they actually lied about or downplayed during interviews/recruitment. There are lots of issues concerning work hours , call coverage, inflexible clinic assignments, and crazy community clinics in 2nd year where we have to live in different places on our own & drive back and forth like crazy, etc. I also found out that 2 people left the program. Although I wouldn't say its a malignant program ( atleast not yet, except having certain attendings who like to treat residents like 3rd graders & love to humiliate interns on a daily basis), its serious enough for me to consider switching to a different program.

How can I start looking to transfer out in a diplomatic way? I am in family medicine so I am hoping I'll have better chances of finding a better program. But the very thought of this is daunting. Can I apply to programs before having a letter from this program? When should I let the PD know w/o having the risk of being treated unfairly because they know I'll be quitting? Sometimes I feel like quitting the whole 'inhumane' system of medicine that still treats us like 3rd graders at every stage, and the throws you into the "real world" where doctors are treated as criminals on parole. I just can't identify myself with this punitive system.

Thanks for your help.

 

[peerie]

These are my thoughts, for what they are worth. I am a new resident too and I have also had thoughts of: whoa! medicine is really weird sometimes. Plus, being a new trainee can be really hard. 🙁

Anyway, what I try and do is be patient - with myself and with the system. Sometimes, it's not that the system or the people are weird but maybe just that they are doing the best they can and it's not really very good - but, it's not really with malignant intent. That can go along way. Also, being new is really dizzying and I think that can really throw things off. I need to grow and change and accept alot of new things, and the people around me have to also grow and change and accept me. It's kind of a hard process all around.

Are you in a weird place? I don't know. Can you make it work? Probably. I keep asking myself - what can I change, and usually it's my perspective or something I am doing or not doing. Residency is a hard time and it asks us to really, really change and grow. Can you stick it out and say to yourself: I am going to learn as much as I can - and some of it is not going to be clinical but rather sociology and good people skills. Stuff like that. If you can go with the flow you might find some hidden gems in your program or, in yourself. I'm just saying. These are things I tell myself, tho.

 

[Groove]

This probably isn't what you want to hear, but I would encourage you to just "suck it up" and push through. I wouldn't take the risks associated with changing residency programs unless you felt that your program was completely malignant and that you just couldn't deal with it for 3 years. You're an intern, just like me, and internship is not supposed to be the easiest year.

I think your experience thus far as an intern is perhaps coloring your perspective of the program. 2 months is not very much time to get an accurate feel of what the rest of your training is going to be like. Don't make waves unless you have to. I could put up with damn near anything for 3-4 years of training.

 

[buckley]

Is it really so horrible to change residency programs? It's a job. Why shouldn't we have the freedom to look for better ones?

 

[Vader]

The truth is there are issues at every program. There are many things that go unadvertised, downplayed or are presented in a misleading way at most programs. I agree with the others that 2 months into internship is a bit early to have formulated a robust assessment. Unfortunately, intern year is usually the hardest and most life-changing of any year of residency. It is a year of tremendous growth, one that is all about learning to be comfortable being uncomfortable. The learning curve is huge and you are expected to perform within a new system at the bottom of the totem pole, often with little guidance or support.

After 2 months of internship (a month of ED and then a month of ICU), I have already had amazingly spectacular days and other days that I would consider among the worst of my life. This is the roller coaster that is residency and you just have to accept it and take it in stride. Unless there is something truly malignant about the program that you cannot tolerate for 3+ years, then I would recommend toughing it out, as the others here have recommended. It is also important to have a social support system, whether it be fellow interns, significant other, family or others who you can talk with and share experiences with.

 

[mokavious]

b

 

[mwest]

Thanks Peerie. You do make sense and it's probably the most mature thing to do but things are more complicated than that. I definitely plan to complete 1 year but have made up my mind to find a better program. I do not believe I can be happy in pgy-2 here, as it is internship sucks but the pgy-2 schedule is totally unacceptable to me.

As for others who have the 'suck it up' attitude, sorry but I am not going to reinforce the slave attitude, not for myself and also for any residents in the future. It's about time we discard this 'suck it up' attitude that's paralyzing us and taken us where we are now. Just switch on the TV or open NYT to get some love from public- it's all our doing.

 

[TopSecret]

I am into 2 months of residency and during this time I found out couple of serious things about the program that they actually lied about or downplayed during interviews/recruitment. There are lots of issues concerning work hours , call coverage, inflexible clinic assignments, and crazy community clinics in 2nd year where we have to live in different places on our own & drive back and forth like crazy, etc. I also found out that 2 people left the program. Although I wouldn't say its a malignant program ( atleast not yet, except having certain attendings who like to treat residents like 3rd graders & love to humiliate interns on a daily basis), its serious enough for me to consider switching to a different program.

How can I start looking to transfer out in a diplomatic way? I am in family medicine so I am hoping I'll have better chances of finding a better program. But the very thought of this is daunting. Can I apply to programs before having a letter from this program? When should I let the PD know w/o having the risk of being treated unfairly because they know I'll be quitting? Sometimes I feel like quitting the whole 'inhumane' system of medicine that still treats us like 3rd graders at every stage, and the throws you into the "real world" where doctors are treated as criminals on parole. I just can't identify myself with this punitive system.

Thanks for your help.

Find a program with a vacant PGY-2 slot, get an interview, ask several sympathetic attendings for letters of recommendation and then get your program director's approval. Stay motivated and upbeat during this whole time and avoid burning your bridges. You will need verification letters from the program director when you apply for state licensure and for board certification.

 

[Groove]

mwest... Listen buddy, we're all here to offer our advice and to help. In the end, you're going to do what you want to do irrespective of what we think, but I'd like to call your attention to a post that YOU made on 7-24-09 which was barely 1 month ago...:

This is definitely not how a 'normal' program should be. I can't say I am super thrilled about any residency program (as long as overnight calls are there) but my FM program is pretty cool and supportive. I have to say our hours are also much better, even at the ICU. I had a few rotations with IM ( and will have with OBGYN too) and their culture seems a little more malignant to me. The IM residents were super intimidated of their 'intimidating' attendings, something you'll never find with our FM attendings. I don't know if its just my program or the whole FM culture but the personalities are starkingly different. It's just a different world out there in the same university/hospital. This will be one of medicine's great mysteries 😎
Between conformity and peer pressure, I think med students/doctors really lose track of what they really want to do and what they can really handle. Sometimes it's as simple as choosing a specialty that supports the kind of lifestyle you want to lead-sometimes its $ and sometimes it's time, or sometimes both. I am happy that with FM I get enough time to stay happy, even during pgy-1. 🙂

That was 1 month ago, 1 month into residency. To anyone reading that post, it sounds like you're a new intern pretty darn happy with your program. I don't know what has happened in the past month, but one month of bad experiences is not worth jumping the gun and being impulsive. I still would encourage you to finish out the year and re-evaluate at that point. Just my 2 cents of course.

 

[DrJosephKim]

It can be difficult to be diplomatic about such things. Can you think of other reasons why you may wish to transfer? (such as personal/family reasons?) Sometimes, it may be a better option to try to exit by focusing on those types of things.

 

[mwest]

mwest... Listen buddy, we're all here to offer our advice and to help. In the end, you're going to do what you want to do irrespective of what we think, but I'd like to call your attention to a post that YOU made on 7-24-09 which was barely 1 month ago...:
That was 1 month ago, 1 month into residency. To anyone reading that post, it sounds like you're a new intern pretty darn happy with your program. I don't know what has happened in the past month, but one month of bad experiences is not worth jumping the gun and being impulsive. I still would encourage you to finish out the year and re-evaluate at that point. Just my 2 cents of course.

Yes, that was a month ago and yes, you can find out a lot in 1 month. There has been some changes in out schedule, I can't post details here for the sake of privacy but it's not something I signed up for. I definitely plan to complete 1 year, but like I said, it's the PGY-2 schedule thats also a big problem as I found out. Thanks for taking the time to review my posts.

 

[Substance]

This pi55es me off.

A resident's funding should go directly to the resident so that if they do not like their program, and find a better one that will accept them, they can jump ship with no repercussions.

Sure, some people will say "but what about service requirements?" My answer is "So what?" If a residency program cannot retain residents, then it has to restructure itself to become competitive. Otherwise, it'll be the attendings from that program that will be taking care of patients on call, and those same attendings will lose the extra income brought in by resident labor. Such a system would ensure healthy competition between all residency programs.

 

[Doctor Bob]

and those same attendings will lose the extra income brought in by resident labor.

Hmm... it must be different in other fields, but in emergency medicine, residents just slow the whole process down. Attendings could see a lot more patients in the same amount of time if they didn't have residents taking twice as long to process a patient. Plus we're a lot worse at proper documentation on a chart so as to maximize billing. If it was truly all about getting the most income, then they'd just dump residents all together.

It would seem to me that the same would hold for other fields.
Surgeons operate faster when it is just them vs having to oversee residents, rounds as an IM doc would probably be half the length of time (plus there's no time out of their day for academic requirements), etc, etc.

<shrug>, Maybe I'm wrong... I often am.

 

[MeowMix]

Hmm... it must be different in other fields, but in emergency medicine, residents just slow the whole process down.

Not in FM outpt work. I'm in 2nd year, have my own licence, see many of my pts independently, ask for advice when necessary; the only pts my attending has to see are Medicare. When I rotate at community clinics and do the notes, prescriptions etc., my attendings get to leave work earlier. Everyone is happy, especially attendings who do not have to see or precept another pt with vaginal itching. On inpt work, I can admit pts all night while my attending stays home.

As far as billing, in our clinic the top-earning doctor is a resident who carefully documents and bills way more justifiable level 4s than any of the attendings.

 

[chocomorsel]

Thanks Peerie. You do make sense and it's probably the most mature thing to do but things are more complicated than that. I definitely plan to complete 1 year but have made up my mind to find a better program. I do not believe I can be happy in pgy-2 here, as it is internship sucks but the pgy-2 schedule is totally unacceptable to me.

As for others who have the 'suck it up' attitude, sorry but I am not going to reinforce the slave attitude, not for myself and also for any residents in the future. It's about time we discard this 'suck it up' attitude that's paralyzing us and taken us where we are now. Just switch on the TV or open NYT to get some love from public- it's all our doing.

Amen brotha or sistah. Why do we as residents bend over and get abused over and over again and just have to suck it up and bear it? This ain't the damn military and our attendings are not drill sergeants. I am so sick of this attitude myself and just get pissed off every time I hear this. We need to learn to stand up for ourselves and maybe over time, the whole malignancy issue will disappear. I mean, do other professions have to put up with constant humiliation, verbal abuse, and getting treated like idiot children? Seriously? Somebody please enlighten me.

To the OP, if you are unhappy, don't be scared to switch. It's been done many many times before you and while difficult it ain't impossible. Good luck.

 

[SoCuteMD]

Hmm... it must be different in other fields, but in emergency medicine, residents just slow the whole process down. Attendings could see a lot more patients in the same amount of time if they didn't have residents taking twice as long to process a patient. Plus we're a lot worse at proper documentation on a chart so as to maximize billing. If it was truly all about getting the most income, then they'd just dump residents all together.

It would seem to me that the same would hold for other fields.
Surgeons operate faster when it is just them vs having to oversee residents, rounds as an IM doc would probably be half the length of time (plus there's no time out of their day for academic requirements), etc, etc.

<shrug>, Maybe I'm wrong... I often am.

You may be right with respect to your program, but you are definitely wrong with respect to mine.

Sure, we're slower than attendings, but I guarantee you that the attending coverage we have at my program could not even come close to handling the volume we see. One attending and one senior resident supervise 3-4 interns who are each seeing 1.5 patients an hour (which translates to 4.5 or 6 patients/hr for the attending). Even the most efficient private practice EM physician couldn't keep up that pace.

 

[Pir8DeacDoc]

I would caution you that the grass isn't necessarily greener somewhere else. If you had a difficult time seeing the true colors of your current program, what makes you think your judgement and intuition are going to be that much better the second time around? Further, if you limit yourself to second year spots then the pickins might be slim and potentially you are filling a void left by another disgruntled soul (much like yourself at your current program).


I wish you luck as this whole mess of residency can be painful but really think through this and make sure it's the right decision.

 

[bigDinLV]

I think im the only resident at my program that speaks english. lol.

I actually feel sorry for you..

 

[civic4982]

Yes, that was a month ago and yes, you can find out a lot in 1 month. There has been some changes in out schedule, I can't post details here for the sake of privacy but it's not something I signed up for. I definitely plan to complete 1 year, but like I said, it's the PGY-2 schedule thats also a big problem as I found out. Thanks for taking the time to review my posts.

Get some family excuse to move to some other location and use that as your reason to leave.

I just left my program recently but that was 2/2 wanting to do FP instead of Ob/Gyn. I talked to my PD and it was a really straight forward process.

 

[mig26x]

I think im the only resident at my program that speaks english. lol.

where the hell do you practice? in south america???

 

[civic4982]

1) Tell them early on if you plan on leaving this will help them start looking for people and so they can place you on a schedule that makes it easy to be off for interviews and not need lots of coverage in the key months of interview season (nov/dec/jan)

2) Bust your ass all year and be well liked by your peers as best as possible. My PD wrote me an exceptional LOR and continued to ask me to stay until the day I e-mailed her my resignation in February of 2010 right before I put in my rank order list.

3) Kiss the ass of your Chiefs. You'll need their support to schedule time off.

hope thei helps.