What to do

[surgonco]

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I am a senior resident in a southeast program. I am close to graduation but instead of being happy about this achievement, I am constantly thinking about all the calls, work, er that is ahead of me. No surprise to anybody, I am exhausted. Every day I walk into the hospital I can only think at what time I would be able to leave. It sounds crazy but I have even thought about switching specialties, may be do anesthesia or something with less workload. Somebody suggested doing a fellowship in a field that could provide me an alternative to general surgery, but can't think of any. All those practicing, any suggestions? How can I control my career so that at the age of 60 I am not taking er call or doing an emergency case in the middle of the night. Well... Got to go, just got another er consult

 

[dpmd]

There are many different options out there even without a fellowship that won't leave you hating each day. Some of those options mean less income, but you may be ok with that in order to have an outside life (I know I am). Right now I am on call about 6 days a month, including the one weekend a month I work. On my non call days I am only responsible for any patients I have in house, plus clinic (not a daily thing) and any elective cases (plus conferences and meetings, but not a daily thing either. There are plenty of days that I come in around 9 and am out by 3. Of course, sometimes I operate a bunch overnight on call or have a long clinic, but overall I am working about half as much as I did chief year. Maybe my situation is unique, but I don't think every job out of residency has to be as busy or painful as chief year.

 

[Winged Scapula]

The nice thing about General Surgery is that there are a multitude of fellowship and practice options. As dpmd notes, you can even practice GS without having loads of overnight call, although you might sacrifice in terms of reimbursement. More lifestyle friendly options might be Breast, CRS, MIS...essentially anything without GS call and lots of elective cases. Even SCC can be done as shift work.

IMHO however, anesthesia is not the way out of taking call. Every anesthesiologist I know takes call, and back up and even 3rd call and if the surgeon is operating, they're there. "Out of the fire..."

Have you considered that the problem might not be surgery but rather within yourself? The rate of depression in resident physicians is very high and with all the pressures facing you, it wouldn't be surprising if you found reasons to want to avoid work and feel exhausted. Emotional stress can certainly affect you physically.

 

[kindasorta]

Change specialties. You're speaking to a biased audience. Evidenced in the above notion that perhaps your inhumane hours aren't the cause of your distress, but more likely a weakness in your constitution, or some emotional baggage brought in for the ride, or something chemical, or just the ambiguous non-causational catch-all called depression. But from an outsider's perspective (I'm not a surgeon), the reality of your field is as clear as day. I have no doubt why you're depressed. As you should be. And it's why many of your med student colleagues who enjoyed surgery still didn't choose it.

 

[Winged Scapula]

Change specialties. You're speaking to a biased audience. Evidenced in the above notion that perhaps your inhumane hours aren't the cause of your distress, but more likely a weakness in your constitution, or some emotional baggage brought in for the ride, or something chemical, or just the ambiguous non-causational catch-all called depression. But from an outsider's perspective (I'm not a surgeon), the reality of your field is as clear as day. I have no doubt why you're depressed. As you should be. And it's why many of your med student colleagues who enjoyed surgery still didn't choose it.

🙄

Nothing could be further from the truth in my comment. I never said or implied that the OP had a "constitutional weakness" and have never, ever (not even once in my life) believed that residents who suffer during residency are somehow not strong enough. I also speak from experience as I took time off during residency for depression, after suffering through the exact same symptoms as the OP. The time off was the right choice for me; it may not be for the OP, but to assume that I am claiming that he is "weak" is completely false.

Before claiming bias, you may also wish to consider that you and your medical colleagues who didn't choose a surgical career, are perhaps also just as biased (but in the opposite direction) against the field and its practitioners.

The OP is a SENIOR surgical resident not an intern who is realizing he chose the wrong field. Attrition in surgery generally takes place during PGY1 or 2. And while it is true that perhaps he/she simply is a mismatch for surgery and always has been, depression (a very real clinical entity) is common amongst physicians, especially resident physicians. It is not more common in surgical residents but it can be difficult during a long residency to remember why you chose the field and to envision the practice you'll have some day.

Therefore, there is nothing wrong with suggesting that the OP seek some outside counsel or even take some time away from training and assess whether its residency, surgery or simply something unrelated.

 

[ajimd]

Agreed. If Gen surgery is not your ball of wax, I agree there are fellowships within the surgical field that can afford you a better lifestyle. I am sorry that it took 5 years of your life to realize that you're miserable in the career you chose, but be glad you realized it now before you take a job in GS somewhere and hate it. I think depression or "burn out" is common in GS residency - I know it happened to me. But honestly, I found no interest in any of the other surgical fields. So, I sought some serious advice from my closest attendings, friends, relatives...etc and pressed on. I look at it a lot differently now that I am an attending, but it helps to remember how trying those times were to be able to relate to a lot of the residents I work with - even if they are working a lot less.
Things DO GET BETTER if GS is really your passion. The responsibilities are greater as an attending, but you get to call your shots, when, where, how you want to do stuff and you move forward. Those consults you hate as a resident, you'll be begging for as an attending .... believe me. If its not for you, its not for you - I can only suggest you to seek some honest and solid advice from those closest to you.

 

[Buzz Me]

To defend the OP (and WS), it's also a little unfair for someone currently going through the Match process to imply they understand what life as a senior surgery resident is like.

 

[naus]

Wow a lot of defensive and ad hominem comments against the above med student. If circumstantial depression really is that common in a surgical residency, it is a problem, no? Acknowledging the pervasive existence of depression without creating institutional changes to address or remediate that really isn't very helpful. In fact, it's even worse than ignorance. We're supposed to be physicians and trained to recognize depression. And yet, browse through the threads in the surgery forum, and all you see is criticism of the 80 hour work week and insinuations that the current batch of residents are too soft and inadequately trained even as we approach year 10 of the work hours cap.

 

[LucidSplash]

Wow a lot of defensive and ad hominem comments against the above med student. If circumstantial depression really is that common in a surgical residency, it is a problem, no? Acknowledging the pervasive existence of depression without creating institutional changes to address or remediate that really isn't very helpful. In fact, it's even worse than ignorance. We're supposed to be physicians and trained to recognize depression. And yet, browse through the threads in the surgery forum, and all you see is criticism of the 80 hour work week and insinuations that the current batch of residents are too soft and inadequately trained even as we approach year 10 of the work hours cap.

I don't see any ad hominem attacks. I see disagreements over intent and clarifications of their advice to the OP. Ad hominem suggests name-calling or suggestions of personal character flaws rather than disagreeing with what someone says.

 

[Winged Scapula]

Wow a lot of defensive and ad hominem comments against the above med student. If circumstantial depression really is that common in a surgical residency, it is a problem, no? Acknowledging the pervasive existence of depression without creating institutional changes to address or remediate that really isn't very helpful. In fact, it's even worse than ignorance. We're supposed to be physicians and trained to recognize depression. And yet, browse through the threads in the surgery forum, and all you see is criticism of the 80 hour work week and insinuations that the current batch of residents are too soft and inadequately trained even as we approach year 10 of the work hours cap.

You're missing the point.

Depression is common amongst ALL resident physicians, and no more with surgery residents. In fact, if the data is to be believed, psychiatry residents and psychiatrists have the highest rates.

What needs to be changed is our institutional attitude toward our colleagues with mental illness. Programs, and not just surgical ones, seem to have difficulty in handling it and without built in accomodations, residents often feel trapped into working when they really should be taking time off to take care of themselves.

Finally the "above medical student" has a history of posting inaccurate or unkind things in other forums. This is not some innocent medical student who wandered into this forum by mistake and is defending the OP.

 

[BlondeDocteur]

OP, I wonder if you've adequately accounted for the sheer exhaustion. It's enough to send anyone, no matter how well-adapted, reaching for the barbituates if you're hauling yourself through a grueling residency, only to picture the finish line as involving 30+ years of the same thing. The proverbial pie-eating contest where the reward is more pie?

I don't pretend to be a chief resident, but I know for me when I finished R2 year and went into the lab it took 1-2 months before I caught up on enough sleep, and had enough sense of normal structure and autonomy, to feel like myself again. [This was compounded by having a baby in March of that same R2 year]. It's amazing how you awaken from a slumber you didn't even know you were in. By the end of my second year I had moderate short term memory deficits (if I didn't write it down, it was gone); I noticed my verbal and written fluency had diminshed; I couldn't crack jokes or be clever or do anything else that required much executive functioning. I didn't know if it was aging or a brain tumor or what. 🙂 But with some sleep and structure, it's amazing how normal you feel. From talking with my friends who were graduating chiefs, now in private practice, they swear the same thing happened to them.

I'd say listen to the advice of the attendings on this thread who assure you it does get much, much better. Most people take a couple of months off to ostensibly study for boards, travel, sleep, visit family, etc before starting their first attending job. If you are a chief I'd say give yourself the same R&R before making any big decisions.

 

[balaguru]

I imagine there's a wide variety of practice environments for GS--or subspecialties for that matter. There might be some in which the lack of control and demands for time and energy are as bad as or worse than what you are currently experiencing and there might be some as suggested above that are better in these respects.

This is counter to the problems with call and the ER that you cited above but you may want to look at acute care surgery. The schedule is predictable, potentially part-time and there's usually no back office to worry about. Furthermore, you can do it for a few years until you find a practice more to your liking.

 

[56789]

Hello
i am a medical graduate(MBBS) from india.
i have interest in orthopaedics/surgery or intervention cardiology.

i always wanted to work and settled in usa.but lately i heard a buzz that no of AMG are going to outnumber total residency seats in usmle and hence from 2015 usmle is gonna be very difficult for FMGs.
I hv not appeared for any usmle steps till now niether hv done any externship or observership.

DOUBTS

1.Is the above buzz is true?and if yes then whether is it still a wise idea to start for usmle nw.?
2.Should i continue my postgrads in india and come to usa for fellowship?
3.which all diciplines allow direct fellowship without residency.?(so that i will try to opt one of those dicipline in my postgrad)
4.what is the procedure to work as licence medical practioner after fellowship?
5.what is the best possible option for me in current situation if i want to settle in usa as a surgeon/orthopaedician or intervention cardiologist?

 

[cpants]

Well, one thing is for sure. If it's your chief year you should graduate and pass the boards. You've come this far, and It's a lot easier to make a big life change with a great fallback plan in your back pocket. If you walk away now, you have nothing -- you won't be able to practice medicine/make money at all. It may be difficult to get into another residency as you have used up most of your training allotment from uncle sam. This way at least you can make a good living while you figure things out.

You might rediscover that you love general surgery after you escape from the hell of residency. Call, ER coverage, clinic, work hours are a much different thing as an attending. Doing a few consults or overnight cases might not seem like the worst thing in the world when you are taking Q6 call from home, possibly with in-house resident/pa coverage, and your daily schedule is much lighter.

There are definitely more lifestyle oriented specialties within GS. Plastics, breast, SICU, bariatrics all come to mind. You don't even necessarily have to do a fellowship. Find a practice with a lot of subspecialty guys, and they might be thrilled to hand you all of their inguinal hernias, lumpectomies, and port placements. Can make a nice living that way without a lot of overnight stuff. Another option might be working per diem. Choose your own schedule, take days off whenever you want, and make some pretty good coin. I've heard of per diem trauma (not fellowship trained,ATLS certified) guys getting paid >2k just to take in house call and be present for traumas. I know of one older surgeon who does minor cases mostly and gets paid by the hospital to be the medical director of their busy RN-run wound care service. The point is there are options, and almost all of them don't involve you working the schedule of a chief resident. More time off, more vacation, less call, and way more money are on the horizon.

 

[Pir8DeacDoc]

Well, one thing is for sure. If it's your chief year you should graduate and pass the boards. You've come this far, and It's a lot easier to make a big life change with a great fallback plan in your back pocket. If you walk away now, you have nothing -- you won't be able to practice medicine/make money at all. It may be difficult to get into another residency as you have used up most of your training allotment from uncle sam. This way at least you can make a good living while you figure things out.

You might rediscover that you love general surgery after you escape from the hell of residency. Call, ER coverage, clinic, work hours are a much different thing as an attending. Doing a few consults or overnight cases might not seem like the worst thing in the world when you are taking Q6 call from home, possibly with in-house resident/pa coverage, and your daily schedule is much lighter.

There are definitely more lifestyle oriented specialties within GS. Plastics, breast, SICU, bariatrics all come to mind. You don't even necessarily have to do a fellowship. Find a practice with a lot of subspecialty guys, and they might be thrilled to hand you all of their inguinal hernias, lumpectomies, and port placements. Can make a nice living that way without a lot of overnight stuff. Another option might be working per diem. Choose your own schedule, take days off whenever you want, and make some pretty good coin. I've heard of per diem trauma (not fellowship trained,ATLS certified) guys getting paid >2k just to take in house call and be present for traumas. I know of one older surgeon who does minor cases mostly and gets paid by the hospital to be the medical director of their busy RN-run wound care service. The point is there are options, and almost all of them don't involve you working the schedule of a chief resident. More time off, more vacation, less call, and way more money are on the horizon.

Well said

 

[Poiu86]

Hello
i am a medical graduate(MBBS) from india.
i have interest in orthopaedics/surgery or intervention cardiology.

i always wanted to work and settled in usa.but lately i heard a buzz that no of AMG are going to outnumber total residency seats in usmle and hence from 2015 usmle is gonna be very difficult for FMGs.
I hv not appeared for any usmle steps till now niether hv done any externship or observership.

DOUBTS

1.Is the above buzz is true?and if yes then whether is it still a wise idea to start for usmle nw.?
2.Should i continue my postgrads in india and come to usa for fellowship?
3.which all diciplines allow direct fellowship without residency.?(so that i will try to opt one of those dicipline in my postgrad)
4.what is the procedure to work as licence medical practioner after fellowship?
5.what is the best possible option for me in current situation if i want to settle in usa as a surgeon/orthopaedician or intervention cardiologist?

I suggest starting a new thread to ask your own questions.

 

[filter07]

I can relate to the OP's sentiment. My perspective changed a lot once I decided to get enough sleep. Exhaustion makes everything seem painful, miserable, and hopeless. Get some rest and decide a few weeks/months later what you want to do with life. There will probably be a fellowship available outside the match somewhere. The CRS surgeons at academic and private practice seemed to not take ED call. General surgeons of course worked harder because of the ED consults but seemed to have decent hours when not on call.

 

[45408]

I know of one older surgeon who does minor cases mostly and gets paid by the hospital to be the medical director of their busy RN-run wound care service. The point is there are options, and almost all of them don't involve you working the schedule of a chief resident. More time off, more vacation, less call, and way more money are on the horizon.

This. My senior residents going out into practice have found tons of jobs like this. Wound clinics are a big industry, and a number of job offers say things like "no call, no weekends." Chronic wounds aren't going anywhere.