Warning to those who think path residency is a breeze

[stormjen]

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Beginning Monday until midnight tonight, I will have worked (been in the hospital) 74 hours. However, call-from-home is also counted into the whole "work hours" limitation; counting the time I've been on call, I'll be at 116.5 hours for the week.

This is nuts.

Programs get around this problem by saying that the week is "Sunday to Sunday". That way, if you're on call over the weekend, they split that weekend into two different weeks, to spread out the damage.

But do I regret going into Path? Absolutely not! I actually love what I do. Going into the hospital at 5:30am on a Saturday morning, to gross specimens, is kind of exciting. Call me sick, call me a nerd, that's okay. 😀

Now back to my specimens!

 

[yaah]

I have not approached 116 hours - we are on call basically two-three nights per month, if it's a weekday it's 5pm-8am, weekend 8am-8am. Call nights are sometimes restful after about 10pm or so, but sometimes not. I was woken up twice during my last one - at 12:30 and at 4am.

But when I was on surg path my days usually went 6:15-9 or 10pm daily, if I stayed late would often come in a little later the next day. If I was to be a bit of a slacker I could be out by 6 or 7 but I would rather stay late, take my time, preview things and read a bit.

Path residency is definitely not a breeze - the schedule is much different from other fields but that doesn't mean it's easier. Weekends are usually more palatable than other fields though. It's intellectually tough more so than physically, which I much prefer anyway.

 

[stormjen]

This week has been busier than normal, so it's definitely not like this all the time. Plus, call weekends (we are on call all weekend here) are only once a month. If every week were like this, I might run screaming from the hospital and never come back.

Even though I enjoy surg path, I'm looking forward to my first (non-BB) CP rotation!

 

[yaah]

Perhaps the 5:30 am isn't the required time - for me, generally between friday 5pm and monday AM on a busy surg path rotation there are a few hours of grossing and previewing, and generally I prefer not to stay on friday until it's finished, but come back saturday or sunday AM. For some people, 5:30am is mid morning. 😉

 

[stormjen]

Oh, I didn't have to go in at 5:30am on a Saturday; I chose to. I was going to go in at 8 but woke up at 5 and started worrying that I hadn't put my lumpectomies into formalin, and I wanted to get there and put formalin in before anyone got there and saw it. When I got there, the lumpectomies were already in formalin, so call that a surg path anxiety attack. I was also having trouble sleeping because I was worried there would be a frozen section for a transplant, my pager would go off, and I wouldn't wake up. We are responsible for informing the attending when there is a frozen section after-hours, so all the responsibility is on us. Hence the not being able to sleep.

My program is actually quite good. Like I said, this week is busier than normal, so it's normally more manageable. Plus, I'm my own boss. As long as the work got done, I could come in anytime I wanted on the weekend.

 

[b&ierstiefel]

Pathology is nice in that you don't have to do overnight call for the most part (except for covering weekend frozen section call for instance). Other than that, pathology residency is certainly not a breeze.

I was hoping for a quiet Sunday for my autopsy call. I remember joking around about the worst case scenario (the first up on-call resident gets assigned the first two autopsies, the third one gets assigned to the backup on-call resident) this past Friday during the departmental drink-a-thon. I remember my colleagues comforting me by saying, "We haven't gotten posts on Sundays this year so far...you should be fine."

YEAH RIGHT! I got paged at 10 am today. When I got in, a second body had just arrived. On external exam, the middle finger on the left hand of the second body was extended.

Now I gotta write these cases up and present them at gross conference tomorrow morning. The good thing is that these two cases were good, educational cases. Furthermore, I'm at 12% status. Bring it!

 

[yaah]

Pathology is nice in that you don't have to do overnight call for the most part

Tell that to my beeper. 😉 Of course, you are AP only so that helps. I haven't gotten any AP calls today.

 

[b&ierstiefel]

Tell that to my beeper. 😉 Of course, you are AP only so that helps. I haven't gotten any AP calls today.

yeah but we all do straight AP rotations for the first two years. bite me!

one writeup done...one more to go...hopefully in bed by 1 am 🙂

 

[xanthines]

Path isn't a breeze? Darn! I was going into path soley based on this:

http://www.staff.ncl.ac.uk/fraser.charlton/daylife.html

🙂

-X

 

[LADoc00]

Beginning Monday until midnight tonight, I will have worked (been in the hospital) 74 hours. However, call-from-home is also counted into the whole "work hours" limitation; counting the time I've been on call, I'll be at 116.5 hours for the week.

This is nuts.

Programs get around this problem by saying that the week is "Sunday to Sunday". That way, if you're on call over the weekend, they split that weekend into two different weeks, to spread out the damage.

But do I regret going into Path? Absolutely not! I actually love what I do. Going into the hospital at 5:30am on a Saturday morning, to gross specimens, is kind of exciting. Call me sick, call me a nerd, that's okay. 😀

Now back to my specimens!

Focus on the End of the tunnel: real life pathology is soooooo cush, I pity everyone not in private practice. All I need now is a med tech who gives me massages and delivers lattes.

"Im living the dream"
-Will Ferrell, Wedding Crashers

 

[caduces]

I have not approached 116 hours - we are on call basically two-three nights per month, if it's a weekday it's 5pm-8am, weekend 8am-8am. Call nights are sometimes restful after about 10pm or so, but sometimes not. I was woken up twice during my last one - at 12:30 and at 4am.

But when I was on surg path my days usually went 6:15-9 or 10pm daily, if I stayed late would often come in a little later the next day. If I was to be a bit of a slacker I could be out by 6 or 7 but I would rather stay late, take my time, preview things and read a bit.

Path residency is definitely not a breeze - the schedule is much different from other fields but that doesn't mean it's easier. Weekends are usually more palatable than other fields though. It's intellectually tough more so than physically, which I much prefer anyway.

I thought my program had alot of work!! WOW!! Do you guys have PAs (not just biopsy PAs, but certified PAs that gross surgicals)? What is the majority of your time spent doing? My program has the largest volume in the country and I'm never out later than 7:00pm on surg path. I'm at my desk reading by 4:00pm on other rotations, and I'm home by 7:00pm after I've done my daily reading.

 

[deschutes]

For some people, 5:30am is mid morning. 😉

And for others, it's getting close to time for bed. 😛

My first year is CP-heavy (3 months of each hemepath, clin chem and microbio) i.e. free evenings and weekends for 9 months! I presume I'll make up for this lack of call at some point.

 

[b&ierstiefel]

I like my heme week so far. Heme is treatin' me real nice 🙂

 

[deschutes]

I like my heme week so far. Heme is treatin' me real nice 🙂

Wait till you start seeing blasts on the last marrow of the day... okay I'll shut up for now 😛

 

[b&ierstiefel]

Wait till you start seeing blasts on the last marrow of the day... okay I'll shut up for now 😛

I've seen plenty of blasts already. I was just referring to the fact that I was done by 11 am today and the same will apply tomorrow too. And I wrapped up all my autopsy ****.

Might go get a haircut and buy an iPod tomorrow...hee hee hee.

Next week is gonna suck the big floppy donkey dick though.

 

[deschutes]

I've seen plenty of blasts already.
...Next week is gonna suck the big floppy donkey dick though.

Seeing blasts is fine... it's those darned blasts which are not where they're supposed to be that are the problem.

Out of curiosity, what's your hemepath day like?

And what are you doing next week? 🙂

 

[b&ierstiefel]

Seeing blasts is fine... it's those darned blasts which are not where they're supposed to be that are the problem.

Out of curiosity, what's your hemepath day like?

And what are you doing next week? 🙂

I sit in on signout. There are other activities which I can do as well but it's really up to you. I'm still wrapping up little itsy bitsy things from my autopsies last week...stuff that doesn't get in the way too much but still has to get done. Today, my responsibilities on hemepath ended at 1 pm. I just sat in on in house case signout as well as consult case signout. Tomorrow will be more busy with regards to getting more cases but I'm not exactly sure what I'll be doing. I get the impression that I'll just be doing a lot of shadowing. The hemepath week during first year is an elective week...you really don't get into it until second year.

Next week, I am back on Gyn. Except unlike my previous Gyn weeks (where I grossed in a few placentas or looked at small biopsy cases, which I don't gross, thank god), I will be processing all the big specimens that come from the Gyn OR cases. Hence, given my black cloud, I'm gonna get F'd in the A next week. But I'm sure I'll learn a lot and that's what is most important.

 

[deschutes]

Okay so I got my ass well and thoroughly kicked today.

2 trephines to read from yesterday, 1 marrow trephine and aspirate to procure and read, plus 1 blood smear.

(I spent like 4 hours in total on the new BMBx, ordered for "query Brucellosis". The marrow itself wasn't hard to get. The titchy part was turning up on a transplant unit and finding the order not signed, and phoning to the moon and back to find out what sort of tube a Brucella culture would get sent out in.)

While it's a definite improvement in efficiency from 1 week ago when I was reading maybe one marrow every two days, I look at my officemate who is turning around 2 marrows a day plus a handful of smears and I'm like 😱

On the plus side I now have nearly 100% concurrence with the hemepath fellow on hematogones, promyelocytes, basophilic normoblasts and "funny-looking cells" 😎

And the highlight of the day was to hear the clinician say, "Yeah, if you look on the computer charts in this God-forsaken place, the correct consultant's name is in place 24% of the time"

 

[b&ierstiefel]

While it's a definite improvement in efficiency from 1 week ago when I was reading maybe one marrow every two days, I look at my officemate who is turning around 2 marrows a day plus a handful of smears and I'm like 😱

Reading bone marrows is hard especially for a noobie like me. I think heme is quite difficult, personally.

What kind of cases are you getting to look at?

This week, I've seen a ton of AMLs (different varieties ranging from M0 to M-gazillion), myelodysplastic, and multiple myeloma (I breathe a sigh of relief everytime I get one of these cases).

 

[LADoc00]

Reading bone marrows is hard especially for a noobie like me. I think heme is quite difficult, personally.

What kind of cases are you getting to look at?

This week, I've seen a ton of AMLs (different varieties ranging from M0 to M-gazillion), myelodysplastic, and multiple myeloma (I breathe a sigh of relief everytime I get one of these cases).

Reading bone marrows is a joke, but performing 5+ biopsies a day is a horse of a different color.

 

[b&ierstiefel]

Bite me.

 

[yaah]

I have no trouble looking at bone marrow biopsies when someone is telling me what the diagnosis is. But eh, I haven't done much heme yet.

We don't really do bone marrow biopsies ourselves here...

 

[beary]

We don't really do bone marrow biopsies ourselves here...

Sweet! Michigan sounds very appealing to me. Eighties music in the gross room, no bone marrow biopsies, nice small town - basically all the things I'm looking for!! 😀

Of course, you had to go and get yourself a girlfriend. 😛

 

[yaah]

Yeah it's a good place. 🙂 The new first year residents are all great too.

 

[quant]

Sweet! Michigan sounds very appealing to me. Eighties music in the gross room, no bone marrow biopsies, nice small town - basically all the things I'm looking for!! 😀

Of course, you had to go and get yourself a girlfriend. 😛

Hey Beary
Are you on AOL?

 

[beary]

Hey Beary
Are you on AOL?

Nope. I get free internet access through my school. (Well, actually, I steal wireless from one of my neighbors. 🙂 )

 

[quant]

Nope. I get free internet access through my school. (Well, actually, I steal wireless from one of my neighbors. 🙂 )

oopsie....i meant AOL IM....my bad.... 🙁

 

[beary]

oopsie....i meant AOL IM....my bad.... 🙁

No problem!! Technically, I have it, but I almost never use it. I actually have only used it one time. 😳

 

[b&ierstiefel]

oopsie....i meant AOL IM....my bad.... 🙁

whattaya want?

 

[quant]

whattaya want?

wack wack wack wack

 

[b&ierstiefel]

wack wack wack wack

you msged me earlier...was in a game.

 

[quant]

you msged me earlier...was in a game.

nothing much andy.....jus wanted to say hi.....

 

[b&ierstiefel]

nothing much andy.....jus wanted to say hi.....

hi 🙂

 

[sohsie]

Beginning Monday until midnight tonight, I will have worked (been in the hospital) 74 hours. However, call-from-home is also counted into the whole "work hours" limitation; counting the time I've been on call, I'll be at 116.5 hours for the week.

This is nuts.

Programs get around this problem by saying that the week is "Sunday to Sunday". That way, if you're on call over the weekend, they split that weekend into two different weeks, to spread out the damage.

But do I regret going into Path? Absolutely not! I actually love what I do. Going into the hospital at 5:30am on a Saturday morning, to gross specimens, is kind of exciting. Call me sick, call me a nerd, that's okay. 😀

Now back to my specimens!

The ACGME does not include at home call in the 80 hour work week rule. The official rule states (I cut and pasted the relevant sections together):

b. Duty hours must be limited to 80 hours per week, averaged over a
four-week period, inclusive of all IN-HOUSE CALL activities. (Capitalization added)
d. At-home call (pager call) is defined as call taken from outside the
assigned institution.
2.) When residents are called into the hospital from home, the
hours residents spend IN-HOUSE are counted toward the 80-
hour limit.(Capitalization added)

 

[stormjen]

The ACGME does not include at home call in the 80 hour work week rule. The official rule states (I cut and pasted the relevant sections together):

Thanks for posting that, and actually a senior resident at my program clarified that for me this week. Interestingly, the state we are in has work-hour limitations that are even more strict than the ACGME's. I haven't looked to see how the state classifies in-home call.

 

[deschutes]

Reading bone marrows is a joke, but performing 5+ biopsies a day is a horse of a different color.

Look at it this way - at least your dominant biceps ain't ever gonna get flabby 😛

I only did 3 BMBx last month. Unbelievable!!

What kind of cases are you getting to look at?

I have no trouble looking at bone marrow biopsies when someone is telling me what the diagnosis is.

Tell me about it.

I'm keeping a log, which I wish I had started sooner - people are always calling about Mrs. So-and-So from the day after signout. Am getting AML/ALL/CMLs work-ups and follow-ups the wazoo, myelomas, Fanconi's anemia, Langerhans cell histiocytosis, MDS, myelofibrosis... and a "query Brucellosis" for good measure.

All of which send me scurrying in search of the WHO or Kjeldsberg (sp).

The Brucellosis I had to Google. 😀

 

[yaah]

Yeah - keeping logs is a good thing - I do that here too, keeping track of all the cases I see. It definitely makes things easier when you get called about cases or are trying to track down results.