Why is residency hard?

[UnderdogMD]

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(stupid but honest question)

I understand why rotations are hard, you are trying to land the best residency possible and get all honors. So you work your butt off. But what is the incentive to go the extra mile during residency. Are you still graded during residency? Are you still kissing ass? What makes it so difficult?

 

[SomeDoc]

Because lives are in your hand.

 

[Law2Doc]

(stupid but honest question)

I understand why rotations are hard, you are trying to land the best residency possible and get all honors. So you work your butt off. But what is the incentive to go the extra mile during residency. Are you still graded during residency? Are you still kissing ass? What makes it so difficult?

It's hard because of the responsibility, the hours, and what you are expected to know at that point, and the never ending series of boards and specialty exams. But residency is also not going to be the end of the line for you. You are presumably going to want to go off into private practice or fellowship or be offered a position as attending. All that takes good evaluations from your bosses. So yes you are still kissing ass. And then you will be kissing ass at your next position. And so on. Until you are the boss. At which time you will retire or die. That's the cycle of life. Brown lips to the bitter end.

 

[UnderdogMD]

Because lives are in your hand.

What if I go into a Path residency?

 

[UnderdogMD]

It's hard because of the responsibility, the hours, and what you are expected to know at that point, and the never ending series of boards and specialty exams. But residency is also not going to be the end of the line for you. You are presumably going to want to go off into private practice or fellowship or be offered a position as attending. All that takes good evaluations from your bosses. So yes you are still kissing ass. And then you will be kissing ass at your next position. And so on. Until you are the boss. At which time you will retire or die. That's the cycle of life. Brown lips to the bitter end.

How many hours does the average resident work? Who decides how many?

 

[smq123]

What if I go into a Path residency?

Pathologists can help decide which treatments are best. If someone gets a biopsy, it's up to the pathologist to decide whether or not it is cancerous. If it's a malignant cancer, then the surgeon will often decide to take it out. If the pathologist mis-reads it as benign, and the surgeon therefore decides to leave it in.... That's problematic, to say the least.

Pathologists also often help diagnose lymphomas/blood related cancers.

So, yes, even as a pathologist - lives are in your hand.

How many hours does the average resident work? Who decides how many?

An AVERAGE of 80 hours per week - as decided by the ACGME.

 

[IHeartNerds]

stupid but honest question ... are you in medical school? please say no.

Let's see, after four years of post-undergrad school, you work 80+ hours a week (let's be honest, the 80 hour workweek is a minimum in plenty of fields) for almost no pay. Your gigantic loans accrue interest and your car falls apart while that jerk you knew in school who majored in finance buys his second house. Despite paying $120k+ for four years of med school, you still don't know crap and you're perhaps even lower on the ladder than med students -- after all, they're not expected to know everything. Then add on that you have the potential to kill your patients, or get kicked out of the program. And you're still wanting a good letter for fellowship or attending positions. Oh, and you need to publish some research while doing all this to end up in an academic attending setting.

Gee, that doesn't sound stressful at all.

 

[MrBurns10]

How many hours does the average resident work? Who decides how many?

It's supposed to be a max of 80 hours (not an avg or a minimum) worked per week, averaged over 2 weeks. Some programs don't follow these guidelines very strictly but others do. I was impressed to find during my surgery rotation that the chief resident of one of my services actually sent one of her interns home to make sure she stayed under 80 hours. Either way, you work a lot under stressful conditions and get paid minimum wage to do it.

 

[Blade28]

Pathologists can help decide which treatments are best. If someone gets a biopsy, it's up to the pathologist to decide whether or not it is cancerous. If it's a malignant cancer, then the surgeon will often decide to take it out. If the pathologist mis-reads it as benign, and the surgeon therefore decides to leave it in.... That's problematic, to say the least.

Pathologists will often see patients as well - usually to do a fine needle or core needle biopsy.

 

[Perrotfish]

And you're still wanting a good letter for fellowship or attending positions.

I think this answers the OP's question.

 

[Law2Doc]

An AVERAGE of 80 hours per week - as decided by the ACGME.

80 hours is a maximum (averaged over a period of time) actually. Surgery and obstetrics will push that line, most of the others won't usually approach it. Hours under that maximum will be set by whatever program you are matched into. Regardless, plan on long hours. The term "resident" was coined because those folks basically live in the hospital.

 

[smq123]

80 hours is a maximum (averaged over a period of time) actually.

This is what I was trying to say. 🙂 You just found a better way of putting it.

It doesn't mean that you can only work 80 hours a week, and that's it. You may be over 80 hours one week, but then will have to compensate by being under 80 hours the next week. This is a vast over-simplification, but you get the idea.

 

[Writer1985]

The term "resident" was coined because those folks basically live in the hospital.

They used to literally live in the hospital, or in an attached house-staff dorm. I was reading a memoir of a guy who trained in the postwar period, and he was essentially on call every night, because his room was just down the hall from the patients he was covering. Of course, this was before hospitals became the high-power turnover machines they are now, so residents back then probably got more sleep than residents now.

 

[gujuDoc]

Judgeing from the thread in the residency forum, I'd say what's hardest about being a resident is being at the bottom again not really understanding what you are doing, being overworked even with the reduction in work hours, and some down right nasty attendings who will make you their bitch in no time
The mistreatment and constant under pressure situations is what makes it so difficult. Not to mention the lack of decent pay.

The bright side is that the max is no longer 120 hours a week but still.

This is why people gun for derm so they can get their 40/week schedules.

 

[Playmakur42]

So yes you are still kissing ass. And then you will be kissing ass at your next position. And so on. Until you are the boss. At which time you will retire or die. That's the cycle of life. Brown lips to the bitter end.

You forgot to mention that once you're the boss, you have to kiss the ass of your clients & potential clients. You probably can get by without ass kissing once you're retired, unless you live in a condo complex at which point you'll have to suck up to the "board" of the condo complex for some ridiculous infraction. It never ends!!!!!

 

[gujuDoc]

You forgot to mention that once you're the boss, you have to kiss the ass of your clients & potential clients. You probably can get by without ass kissing once you're retired, unless you live in a condo complex at which point you'll have to suck up to the "board" of the condo complex for some ridiculous infraction. It never ends!!!!!

Nah if you live in a house you also have peole to kiss ass to called the homeowners situation.

 

[UnderdogMD]

stupid but honest question ... are you in medical school? please say no.

Because my lack of understanding about a resident's life says so much about my ability to succeed in medical school right? I have yet to find a good resource that explains this whole process medschool->rotations->residency->fellowship in thorough detail. If you know of any let me know and I will gladly stop asking stupid but honest questions.

Gee, that doesn't sound stressful at all.

Gee, improve your reading comprehension skills. I never said it wasn't stressful. I asked why it is stressful/difficult.

The rest of the stuff you posted was more informative and less douchebaggish so thanks.👍

 

[IHeartNerds]

The rest of the stuff you posted was more informative and less douchebaggish so thanks.👍

That's ok, I want to go into neurosurgery. 👍

I hoped you weren't in medical school because it sounded from your post that once you don't have grades stringing you along, you won't achieve. That isn't the way medicine works. If that isn't you, apologies.

 

[mjl1717]

What if I go into a Path residency?

In case you didnt get it.. Lives are STILL in your hand.. [eg. you may have to CORRECTLY identify a certain tumor or tissue.. Being the basis of possible major life threatening surgery or toxic chemotherapy..

1) There is just NO easy way..

2)Another thing as said by Barbara Fadem: (for the 1000th time) You dont go into medicine for money, if you happen to make some along the way its ok!!

3)Oh, didnt read smq123s post .. Blade made an enlightening post..

 

[gujuDoc]

In case you didnt get it.. Lives are STILL in your hand.. [eg. you may have to CORRECTLY identify a certain tumor or tissue.. Being the basis of possible major life threatening surgery or toxic chemotherapy..

1) There is just NO easy way..

2)Another thing as said by Barbara Fadem: (for the 1000th time) You dont go into medicine for money, if you happen to make some along the way its ok!!

Not just that, even if you do medical examining for autopsies, you still have to correctly identify things that could be important in things like criminal cases and what not. So it can also indirectly affect lives too.

 

[UnderdogMD]

The path comment was tongue in cheek. I should have added this smilie 😛, but it looked gay so it didn't. I am not interested in path. In any case thanks for all info.

 

[Blade28]

They used to literally live in the hospital, or in an attached house-staff dorm. I was reading a memoir of a guy who trained in the postwar period, and he was essentially on call every night, because his room was just down the hall from the patients he was covering. Of course, this was before hospitals became the high-power turnover machines they are now, so residents back then probably got more sleep than residents now.

IIRC, this term (along with "housestaff") originated back in the days of Halsted at Johns Hopkins.

 

[Perrotfish]

I hoped you weren't in medical school because it sounded from your post that once you don't have grades stringing you along, you won't achieve. That isn't the way medicine works. If that isn't you, apologies.

It isn't? Medicine is one of the most hierarchical professions in the developed world. There's a gun to your head mentality until you at least finish your fellowship. You need the med school grades for the residency, to good residency reviews for the good fellowship, the good fellowship reviews for a good attending position, and the good attending position to pay off your 400K in debts. By then you're 36 and then, yes, some doctors stop working as hard, because they don't have to any more.

 

[IHeartNerds]

It isn't? Medicine is one of the most hierarchical professions in the developed world. ... By then you're 36 and then, yes, some doctors stop working as hard, because they don't have to any more.

Thank you for your amazing insights into the medical profession, I think I'll go into it now.

Medicine at its core is not about getting a report card or a test score. This makes for crappy, cookie-cutter, think-like-everyone-else-lest-you-be-wrong doctors. It's BS and not everyone, thank god, believes in that type of system. Then again, I go to a pretty academia-oriented school, so my exposure might be biased.

 

[Gut Shot]

Nitric oxide.

 

[PeepshowJohnny]

Residency is also hard for some people because it may be the first "real world" experience. Third year is supposed to introduce you into the wonderful world of getting what you want from a hospital, but that's minimal at best.

Depending on your institution, having great medical knowledge may not be enough. You may also have to worry about how you are perceived by unit secretaries, nursing staff, other interns, senior residents, a chief resident, attendings etc. Certainly your "superiors" like your attendings have a large say in your evaluations, but those who process and complete your orders have a big impact on how you perform. If the unit secretary likes you, he'll make sure that Ultrasound you order at the end of the day gets done before the tech goes home. If he doesn't like you, it won't be ready by rounds tomorrow and you look like a jackass.

 

[wanabdoc]

(stupid but honest question)

Be sure to base your life on these answers, since I only saw 2 residents among all the medical / pre-medical students responding😉. I shadowed in the ER, and the residents didn't seem to be working that hard. The work was non-stop, but didn't seem particularly stressful or soul-killing. Then again, I am used to working hard, and an eight hour day seems heavenly to me.

 

[smq123]

I shadowed in the ER, and the residents didn't seem to be working that hard. The work was non-stop, but didn't seem particularly stressful or soul-killing.

You are basing your opinion on the difficulty of residency based on your experiences shadowing in the emergency room?

I can't...but...uh...uhm...just...yeah.

Suffice it to say that some residencies are MUCH harder than others. In terms of difficult work hours, EM is way down on the list. It's almost qualifies as a lifestyle specialty.

An eight hour day sounded heavenly to me, too, on my OB/gyn and surgery rotations. Especially seeing as how, if I worked eight hours, I would have been done by 1 PM. However, it was sobering to realize that my residents were leaving AFTER I left, and were coming in on days that I didn't have to come in. Plus, their call schedules were much harder than mine.

 

[njbmd]

(stupid but honest question)

I understand why rotations are hard, you are trying to land the best residency possible and get all honors. So you work your butt off. But what is the incentive to go the extra mile during residency. Are you still graded during residency? Are you still kissing ass? What makes it so difficult?

You bet your life you are graded in residency. Not only are you taking your in-training exams but you are evaluated by attendings and more senior residents on every rotation. There is no guarantee that once you are in a residency, you will finish if you screw up. Keep reading the posts in the residency section and you will read a post or two from someone who is dismissed. This is not common but it does happen especially if you get a reputation as a slacker.

If you decide that you want to go into fellowship, you are even more bound to the grading process because you have to have great evaluations and exam grades for good fellowships.

Medicine is the only profession where you are evaluated for the rest of your life. You are graded and evaluated in residency and then you are evaluated once you are an attending (by peers, by patients). The good thing is that one hopes that you are in a specialty that you actually WANT to practice.

Residency is just another step along the process and actually wasn't that bad in my opinion. I enjoyed all of the things that I learned and I enjoy my job tremendously. I didn't notice that any of my colleagues in residency were "hating life" either. I did General Surgery internship under the pre-80 hour system and frankly, it was better in terms of pace of work. I might have been in the hospital more hours but I covered less patients and knew them better. I finished under the post-80-hr rule and did just fine. Medicine is all about making adjustments and doing what you need to get the optimal training. The biggest difference for me was instead of reading in the hospital, I read at home.

In terms of being hard, I can't say that my profession is hard. I can say that it's enjoyable and a challenge that I love to meet daily. I DO enjoy my vacation time but I enjoy my work even more.

If you go into residency believing it is going to be a chore, it will be.

 

[wanabdoc]

You are basing your opinion on the difficulty of residency based on your experiences shadowing in the emergency room?

I can't...but...uh...uhm...just...yeah.

Suffice it to say that some residencies are MUCH harder than others. In terms of difficult work hours, EM is way down on the list. It's almost qualifies as a lifestyle specialty.

Well, i guess i am somewhat mocking students who answer authoritatively about residency. Maybe I should have said the residents liked what they were doing instead. 4 residents/attendings were really positive about their job, while only one did seem a little pissed off at he world. I did line up the rest of the specialties for shadowing after seeing the ED, but yeah even the MS4 said the ER was the easy rotation.

 

[Law2Doc]

The work was non-stop, but didn't seem particularly stressful or soul-killing. Then again, I am used to working hard, and an eight hour day seems heavenly to me.

There are no residents who work 8 hour days. There are many who have to work 4 times that every 4th day with 12 hour days in between.

 

[Blade28]

There are no residents who work 8 hour days. There are many who have to work 4 times that every 4th day with 12 hour days in between.

Sometimes every third day with 14-16 hour days in between. 🙁

 

[sprinkibrio]

That's ok, I want to go into neurosurgery. 👍

I hoped you weren't in medical school because it sounded from your post that once you don't have grades stringing you along, you won't achieve. That isn't the way medicine works. If that isn't you, apologies.

We're all in medical school and have been through such a stringent admissions process that I think it's smarter to assume others are mature in motivation instead of misinterpreting wording.

 

[MJB]

I've watched my neighbor in his first year of a Urology Residency (meaning he's on General Surg more often than not), and I'm starting to understand the hours it takes...good lord.

He averages probably 100 hrs/week....and I watched him come home from being on call today...he had been up for 42 hours straight.

 

[gujuDoc]

Be sure to base your life on these answers, since I only saw 2 residents among all the medical / pre-medical students responding😉. I shadowed in the ER, and the residents didn't seem to be working that hard. The work was non-stop, but didn't seem particularly stressful or soul-killing. Then again, I am used to working hard, and an eight hour day seems heavenly to me.

Hmm that's because he didn't post it in the general residency forum. He posted it in the allopathic medical student forum where mostly med students, sometimes grad students who take similar classes to med students, and many times undergrads post.

More likely to get a real answer from residents if you visit the general residency forums.

It was a general question and the answer I gave was basic summation of reading the would you do it over again thread over the last year or two and what I've heard from other residents in their blogs and elsewhere.

 

[TRAMD]

Increased responsibility - that will never subside but only get worse
Long hours
No mandated reading but you must read a lot daily to keep up and not look like an idiot

 

[da8s0859q]

If you go into residency believing it is going to be a chore, it will be.

Residency, medical school, whatever else for that matter.

(This is still a slightly scary thread...)

 

[OncHeme2B]

If you are unhappy in medical school like me...I am assuming I will be even unhappier and miserable in residency...right?

 

[Blade28]

If you are unhappy in medical school like me...I am assuming I will be even unhappier and miserable in residency...right?

Not necessarily.

At least you'll be in a field that you enjoy, right?

(IM --> Heme-Onc?)

 

[smq123]

If you are unhappy in medical school like me...I am assuming I will be even unhappier and miserable in residency...right?

What year of med school are you in? I hated first year. Absolutely hated it. Liked second year a bit better, despite the huge shadow of Step 1 looming over my head.

Third year, in some ways, is much worse than first year and second year, but I'm generally a lot happier than I was then. My family says they can hear it in my voice - I come home bursting with stuff to tell them. There's so much to think about, and stuff that I want to read up on (that isn't required), it feels like a totally different world. This is a huge difference from first year, when my usual comment about my day was always "Yeah, it was fine and school is interesting. Blech."

 

[Anka]

Residency is also hard for some people because it may be the first "real world" experience. Third year is supposed to introduce you into the wonderful world of getting what you want from a hospital, but that's minimal at best.

Depending on your institution, having great medical knowledge may not be enough. You may also have to worry about how you are perceived by unit secretaries, nursing staff, other interns, senior residents, a chief resident, attendings etc. Certainly your "superiors" like your attendings have a large say in your evaluations, but those who process and complete your orders have a big impact on how you perform. If the unit secretary likes you, he'll make sure that Ultrasound you order at the end of the day gets done before the tech goes home. If he doesn't like you, it won't be ready by rounds tomorrow and you look like a jackass.

This almost gets to a point I was going to make, so I'll quote it and then amplify a particular part of it. It matters what people think of you in the hospital because that is what gets your plan of care implemented effectively. While you can "give an order" as a resident, all of the people involved in getting that order implemented can help make it happen or come up with a series of excuses for why it didn't happen. If you make excuses for why something didn't happen, you lose respect which makes it difficult for you to get things done in the future -- it also makes it increasinly likely that you will be marginalized. It is your leadership ability (which generally rests on both tangibles such as you know what you are doing, as well as intangibles such as what the nurses think of you) which allows the former to occur more than the latter. With regard to your attendings, there is a big difference between an attending who thinks well of you and one who doesn't, and it doesn't just come accross in your evaluation -- it also affects (1) when you come up with a plan that is different than "what is usually done"... because of a paper you read, because the last three patients where you did the usual thing didn't work out very well, because this situation is different in your mind, whatever -- is the attending going to let you run with your plan, or override it and do something else? Are you going to have to call a BS consult or are you just going to get to do the right thing? AND closely related (2) when something goes wrong with your plan, is it because you are a f*ck up, or is it because it was a difficult situation? If you generally walk on water in that attendings eyes, it's probably going to be seen as the latter. If you are a clock watcher, it'll be the former.

In the end, only part of this is about evaluations -- mostly it is about knowing what should be done and getting it done (which requires others to accept your leadership) so that you can provide the best possible care to your patients.

Best,
Anka

 

[colbgw02]

Apart from being graded in residency, if you are ever put onto probation for any reason whatsoever then you have to report that to state licensing boards for the rest of your life.

You could be 75 years old, retiring to south Florida, trying to get a Florida license so that you can volunteer once a week at the local free clinic and you'll have to explain why you got put on academic probation 50 years ago because attending XYZ failed you on rotation ABC.

 

[cfdavid]

It's hard because of the responsibility, the hours, and what you are expected to know at that point, and the never ending series of boards and specialty exams. But residency is also not going to be the end of the line for you. You are presumably going to want to go off into private practice or fellowship or be offered a position as attending. All that takes good evaluations from your bosses. So yes you are still kissing ass. And then you will be kissing ass at your next position. And so on. Until you are the boss. At which time you will retire or die. That's the cycle of life. Brown lips to the bitter end.

As much as I don't want to admit this to myself, I'm afraid it's true.....

 

[Blade28]

Third year, in some ways, is much worse than first year and second year, but I'm generally a lot happier than I was then. My family says they can hear it in my voice - I come home bursting with stuff to tell them.

My family had the exact same observations. 👍

 

[Misterioso]

I don't think residency is as hard as so many people make it out to be. As has been said before, people in this profession like to complain...a lot. Last week I overheard a couple derm residents complaining, gimme a break...even bankers envy their hours but it doesn't keep them from whining. In other words, no matter how good they have it you'll find people in this profession who will still complain. If you enjoy what you're doing then the best thing to do is tune those type of people out and go about what you're doing. But if you're like the many phonies who stay in this profession because they don't have the initiative to do something else, have fun showing up to the hospital every day complaining and wasting your career.

 

[gx255]

Practicing Medicine isnt meant to be easy... If you really thinking along those lines, you can't be a good doctor "period".
And let's not forget, going into medicine is all about learning along the way and how they reflect the outcome of where you stand as a doctor.

 

[Blade28]

I don't think residency is as hard as so many people make it out to be. As has been said before, people in this profession like to complain...a lot. Last week I overheard a couple derm residents complaining, gimme a break...even bankers envy their hours but it doesn't keep them from whining. In other words, no matter how good they have it you'll find people in this profession who will still complain. If you enjoy what you're doing then the best thing to do is tune those type of people out and go about what you're doing. But if you're like the many phonies who stay in this profession because they don't have the initiative to do something else, have fun showing up to the hospital every day complaining and wasting your career.

I don't usually see derm residents here! All I know is they have clinic here and there, are hardly ever in the hospital...and barely have call.

 

[dilated]

Be sure to base your life on these answers, since I only saw 2 residents among all the medical / pre-medical students responding😉. I shadowed in the ER, and the residents didn't seem to be working that hard. The work was non-stop, but didn't seem particularly stressful or soul-killing. Then again, I am used to working hard, and an eight hour day seems heavenly to me.

Yeah? Well, I shadowed a derm therefore I can confidently say all doctors are hot chicks who only work 30 hours a week.

 

[TRAMD]

I don't think residency is as hard as so many people make it out to be. As has been said before, people in this profession like to complain...a lot. Last week I overheard a couple derm residents complaining, gimme a break...even bankers envy their hours but it doesn't keep them from whining. In other words, no matter how good they have it you'll find people in this profession who will still complain. If you enjoy what you're doing then the best thing to do is tune those type of people out and go about what you're doing. But if you're like the many phonies who stay in this profession because they don't have the initiative to do something else, have fun showing up to the hospital every day complaining and wasting your career.

The man! Good to see you posting Misterioso!

 

[OncHeme2B]

I know!!! I HATED first year too! Every day was miserable. Second year's SO MUCH better!!! Well ok...minus the Step 1 part.