What is your week like?

[MeghanMD]

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Hi so I'm one of those annoying pre-meds but I wanted to get some input from surgical residents.

I recently shadowed an orthopedic surgeon and got the chance to scrub in and observe three surgeries. It was incredible and I am really interested in Surgery. What is a typical week during residency like?

 

[VisionaryTics]

Hi so I'm one of those annoying pre-meds but I wanted to get some input from surgical residents.

I recently shadowed an orthopedic surgeon and got the chance to scrub in and observe three surgeries. It was incredible and I am really interested in Surgery. What is a typical week during residency like?

Intern. Up at 4am, arrive at hospital 5:00 or 5:30. Get signout from on call resident (what happened to patients, new consults, etc), pre-round on inpatients (check vital signs and labs, get wound/airway stuff together for rounds, check patients quick). Rounds at 6am or 6:30 (walk around as team with chief resident leading), usually writing notes on computer as we go. At this point, I usually either am assigned to 1. hold pager, see consults, do floor work, 2. Go to clinic or, 3. go to OR.

I take short call (stay at hospital until ~10-11pm) 2 days a week, otherwise day usually ends with evening rounds around 6-7pm if that's when the chief finishes up. Sign out to on-call resident.

Do that 6-7 days a week.

 

[SIGINT]

Intern. Up at 4am, arrive at hospital 5:00 or 5:30. Get signout from on call resident (what happened to patients, new consults, etc), pre-round on inpatients (check vital signs and labs, get wound/airway stuff together for rounds, check patients quick). Rounds at 6am or 6:30 (walk around as team with chief resident leading), usually writing notes on computer as we go. At this point, I usually either am assigned to 1. hold pager, see consults, do floor work, 2. Go to clinic or, 3. go to OR.

I take short call (stay at hospital until ~10-11pm) 2 days a week, otherwise day usually ends with evening rounds around 6-7pm if that's when the chief finishes up. Sign out to on-call resident.

Do that 6-7 days a week.

How long do you think you can keep this schedule up? Or are you pretty used to it by now?

 

[MeghanMD]

Intern. Up at 4am, arrive at hospital 5:00 or 5:30. Get signout from on call resident (what happened to patients, new consults, etc), pre-round on inpatients (check vital signs and labs, get wound/airway stuff together for rounds, check patients quick). Rounds at 6am or 6:30 (walk around as team with chief resident leading), usually writing notes on computer as we go. At this point, I usually either am assigned to 1. hold pager, see consults, do floor work, 2. Go to clinic or, 3. go to OR.

I take short call (stay at hospital until ~10-11pm) 2 days a week, otherwise day usually ends with evening rounds around 6-7pm if that's when the chief finishes up. Sign out to on-call resident.

Do that 6-7 days a week.

How often are you on call and how long are those shifts?

 

[Gastrapathy]

And then develop some real endurance as an attending. The PP staff surgeons I see like work.

 

[pathologyDO]

Man, and I thought ortho residency was supposed to be a little better than gen surg... I couldnt see the above intern schedule getting much worse. That is just depressing

 

[VisionaryTics]

How long do you think you can keep this schedule up? Or are you pretty used to it by now?

Used to it. I figure my resolve will crumble in the winter while shoveling my car out before 5am, recover during anesthesia or EM or something, and then be crushed again as a PGY2 (which is essentially oto intern year).

How often are you on call and how long are those shifts?

Interns can't take call with the new work hour rules. We are limited to 16 hour shifts (hence "short call" twice a week).

Our PGY2s take call q5. It's home call so technically it doesn't count against work hours (unless you come and report it). From what it seems, we're spread thin enough that chiefs can't afford to send home post-call residents unless they were literally up all night traching neonates, so you're expected to work a full day post-call.

Man, and I thought ortho residency was supposed to be a little better than gen surg... I couldnt see the above intern schedule getting much worse. That is just depressing

Oto intern. I have some easier off-service rotations where we don't get worked so hard. It's not so bad.

 

[anon9301]

Used to it. I figure my resolve will crumble in the winter while shoveling my car out before 5am, recover during anesthesia or EM or something, and then be crushed again as a PGY2 (which is essentially oto intern year).



Interns can't take call with the new work hour rules. We are limited to 16 hour shifts (hence "short call" twice a week).

Our PGY2s take call q5. It's home call so technically it doesn't count against work hours (unless you come and report it). From what it seems, we're spread thin enough that chiefs can't afford to send home post-call residents unless they were literally up all night traching neonates, so you're expected to work a full day post-call.



Oto intern. I have some easier off-service rotations where we don't get worked so hard. It's not so bad.

How do you feel, physically/mentally, on a daily basis? Is the work rewarding/stimulating enough to be constantly excited and reasonably happy, or do the long hours wear you down to the point where it's difficult to enjoy the work? I am sure there are highs and lows, but in general, what do you think?

 

[anon9301]

Additionally, when you are not working, do you have enough energy to do anything else, such as exercise, or are you so drained from work that you prefer to sleep and rejuvenate?

 

[VisionaryTics]

I've been doing this for 6 weeks; ask residents and attendings who are doing/did it for years.

 

[OtoHNS]

I couldnt see the above intern schedule getting much worse. That is just depressing

LOL, it could be a lot worse. Visionary Tics is working ~80 hours a week. Pre-work hours reform in 2003, it was not unusual that many residents would work 120-130 hours/week. My old chairman (in ENT) described a period during his surgical internship in the 1980s when the other intern on his service got sick and he spent 9 straight days never leaving the hospital.

 

[womp]

Man, and I thought ortho residency was supposed to be a little better than gen surg... I couldnt see the above intern schedule getting much worse. That is just depressing

VisionaryTics is ENT. The above schedule is typical for internal medicine too, maybe 1 hour later. Dude, residency is going to be hard. If you're really that concerned about working long hours, the only fields you should be looking at are EM, psych and anesthesia. Or you're going to be depressed for life.

Ortho has one of the hardest residencies outside of GS and NS, especially if you're at a busy Level 1 as your homebase. My typical schedule as ortho intern is 5am to 7pm for 6 days, plus one weekend short call every other week. And VisionaryTics really needs to live closer to the hospital. I get up at 4:30 to get to hospital at 5am. That 30 minutes is gold.

 

[womp]

How do you feel, physically/mentally, on a daily basis? Is the work rewarding/stimulating enough to be constantly excited and reasonably happy, or do the long hours wear you down to the point where it's difficult to enjoy the work? I am sure there are highs and lows, but in general, what do you think?

It's not the long hours that drags you down, I think it's the poor interpersonal relationships between some of the residents and attendings that really make your day turn to ****. I can handle most of my ortho colleagues 80 hrs a week, but I would die dealing with a few of the general surgeons I've had the misfortune of working with for 80 hrs a week beyond intern year.

 

[vhawk]

LOL, it could be a lot worse. Visionary Tics is working ~80 hours a week. Pre-work hours reform in 2003, it was not unusual that many residents would work 120-130 hours/week. My old chairman (in ENT) described a period during his surgical internship in the 1980s when the other intern on his service got sick and he spent 9 straight days never leaving the hospital.

So you think it was "not unusual" that residents worked ~22 hours/day on a consistent basis?

 

[filter07]

As an intern I started around 5:30am and ended around 8pm, 6 days a week. Some rotations I took call, the worst was when I was on all weekend. Totally illegal and got yelled at to "go home" and take home call so that I don't violate hours. So that was rad. Most rotations weren't that bad, that was just the worst. Avg 80-90 hrs a week during internship.

Second year was more of the same.

Third year was the easy year, probably did 70 hrs or so. Operate 4 days, clinic 1 day.

Fourth year was putting in 90-100 hours because I was service chief of all rotations and I was responsible for everything that happened on the service, including things that the juniors didn't do. Also not as efficient as a real chief. Operate 4 days, clinic 1 day.

Chief year I was home call a lot. At best it was q4. Sometimes q2. At worst it was every week day plus every other weekend. Probably 80 hrs a week not including all the home call and driving in for transfers (common) and cases (rare). Operate 4 days, clinic 1 day.

Overall unofficially I routinely violated work hours. Please don't be misled by the ACGME 80 hrs. My program director is not at all abusive and genuinely cares about the hours, yet I routinely violated them because I cared about my patients and my responsibilities did not end at some arbitrary time mandated. A lot of it is self inflicted, but at the same time, it's also built into the culture of surgery, and hence the unspoken expectations.

Surgery is difficult. But most people adapt. It's not very useful as a premed to imagine what it's like. It's a slow boil...

 

[Winged Scapula]

So you think it was "not unusual" that residents worked ~22 hours/day on a consistent basis?

120/7 = 17 hrs per day; 130/7 = 18 hrs a day not 22, and of course, this doesn't include call and not going home post call.

Remember "back in the day", there were no rules about "1 in 7" or "no q2 call" or "home post call" or "8 hrs between shifts".

Certainly its "unusual" in regards to today's work hours, but it wasn't "unusual" back then.

 

[mimelim]

I sleep 5.5 to 6 hours a night, but I have always slept that much and would be sleeping that much even if I wasn't a resident. I would say that it is hard to guarantee more than 7 hours of sleep, but for the most part, except when on call (most places, every other weekend or once a month), it isn't hard to get that 7 hours if you need it. My typical schedule is as follows:

4:00 Wake-up, brush teeth, eat a yogurt, play with the cats for 2-3 minutes
4:15 Start running to hospital (~2 miles)
4:30 Shower
4:45 Meet with night float team to find out who they admitted overnight or what issues there were
5:00 Chart check all the patients on service (25-40 patients), update the list, identify issues that need to be dealt with and prepare for rounds
6:00 Round with the fellow
7:00 Run through the team list with the nurse practitioner
7:30 - 5:00 Cover the floors, morning is mostly discharges and dealing with overnight things, afternoon is mostly consults and ER patients. If things are slow and the NP has everything under control, I'll slip into the OR. We typically have 5-6 ORs running, so it is always easy to find someone who can use extra hands.
5:00 sign out the service pager to the night team
7:00 leave the hospital (between 5 and 7 finish seeing consults, taking care of post op patients etc)
7-10 - me time, I rock climb twice a week, but for the most part those hours are reading for cases the next day, research, preparing presentations etc.

You have the hours to sleep. I burn ~30 minutes every day running to the hospital and needing to shower at the hospital. I choose to climb a couple times a week. I also make sure that I read at least a little bit every day. The question is what your priorities are outside of the hospital.

From here: http://forums.studentdoctor.net/thr...estions-tonight-part-ii.944769/#post-12989111