Work-hours among the different specialties...

[Cozenboy]

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Hi, after checking the forum I didn't find anything on this, so if there's already I thread on this which I know nothing about, please let me know ;-)

I'm a current medical student from Germany who would like to go to the US for residency training. I'm very well aware of the fact that work hours (and their regulation) are very different between Europe and the USA, and I already know all about the "big picture" (60 hours as an intern, 80 hours from second year on, no more than 24 hours, exception of 88 hours for neurosurgery, etc.).

What I was asking myself, though, (and where I couldn't find an answer to) is this:

1.) Are there REGIONAL differences in work hours during residency? (major city vs. city vs. non-city areas)

2.) Are there SPECIALTY differences? (I know there are, but what does it look like practically?)

3.) Are there PRESTIGE differences? (Ivy league vs. bigger hospitals vs. smaller no-name hospitals etc.)

4.) Does 80 hours mean you actually always have to work that much or is it more like a ceiling and often one stays below?

5.) Can anyone recommend me a book or webpage where they present all the different specialties with their respective pros and cons, their lifestyles and many more details? I already know quite a bit about how things work overhere in Germany, but I know that there are some differences between the way things work around here in Europe and in the US...

I hope you guys don't get me wrong. I do wanna make progress in life and my career (got a 258 in my USMLE step 1), but I'm also very interested in having a BALANCED life with FAMILY etc. and also with enough SLEEP!

I thank you already in advance for all the feedback that you'll (hopefully) provide me with here ;-)

 

[Ronin786]

Go into a residency you want, not something you think you'll be able to be happy outside of.

If you're doing something you love, then there's no difference if you're working 50 or 80 hours. But if you hate it, then those 50 hours will feel a lot more like 100. And if you like what you're doing enough, you'll make things work somehow with family and life.

 

[mass1]

As a psych resident, I can give you perspective on psychiatry if that's something you are considering.
2.) Are there SPECIALTY differences? (I know there are, but what does it look like practically?)
At my program, when I was doing internal medicine, i worked at most 65-70 hours a week. Now that I'm in my psych rotations, I work 40 hours a week and I have a full day of didcatics on Wednesdays, so it's pretty awesome. If you are passionate about psych, I think it's a great field in terms of lifestyle as you definitely have plenty of time to pursue other interests.

4.) Does 80 hours mean you actually always have to work that much or is it more like a ceiling and often one stays below?
-I've never worked more than 80 hours.

 

[xrevision]

Interns have a 60 hour work limit? Hmmm... that doesn't sound right.

 

[Cozenboy]

Interns have a 60 hour work limit? Hmmm... that doesn't sound right.

Ok, I just tried to look that up. I was obviously wrong on that. That number was just floating around somewhere in my brain, and I thought I had read it somewhere. It just says on the ACGME website that they have 16-hour shifts during PGY1 (instead of 24h as a maximum from PGY2 onward).

 

[Law2Doc]

Ok, I just tried to look that up. I was obviously wrong on that. That number was just floating around somewhere in my brain, and I thought I had read it somewhere. It just says on the ACGME website that they have 16-hour shifts during PGY1 (instead of 24h as a maximum from PGY2 onward).

It's an 80 hour limit, averaged over a 4 week period for every year including intern year. Meaning you could be there 96 hours a week for two weeks (16 x 6) and then 64 for the next two weeks every month and still technically be in compliance. The key difference is interns can't be in the hospital as many hours in a row, forcing them to instead endure night float.

 

[DrBowtie]

It would help if you let us know what specialties you are interested in. Some are more IMG friendly than others, so a few focused answers will probably be better than answering that it varies widely by specialty, hospital, etc.

 

[Cozenboy]

It would help if you let us know what specialties you are interested in. Some are more IMG friendly than others, so a few focused answers will probably be better than answering that it varies widely by specialty, hospital, etc.

Currently I'm interested in...

- internal medicine (especially gastroenterology and rheumatology)
- neurology (with possibly pain medicine fellowship afterwards)
- anaesthesiology (with possibly pain medicine fellowship afterwards)
- general surgery
(- emergency medicine, with possibly intensive care medicine fellowship)
(- dermatology; probably hard to get, I know...)

I know, a lot of fairly different specialties, but I've always been "multi-interested" during med school ;-)

 

[Law2Doc]

Currently I'm interested in...

- internal medicine (especially gastroenterology and rheumatology)
- neurology (with possibly pain medicine fellowship afterwards)
- anaesthesiology (with possibly pain medicine fellowship afterwards)
- general surgery
(- emergency medicine, with possibly intensive care medicine fellowship)
(- dermatology; probably hard to get, I know...)

I know, a lot of fairly different specialties, but I've always been "multi-interested" during med school ;-)

You'll have to narrow the field -- way too broad a stroke unless you are very early in your schooling. Surgery you will work the most hours, by far, followed by IM. Derm will be the fewest hours after intern year. EM won't have terrible hours in terms of number but will be lots of night shifts. The others will be in between, with the caveat that if you do a prelim IM year for neuro, derm or anesthesia, you will be working IM hours for that year. How bad the hours varies from place to place, sometimes reflecting the size and staffing of. Program, sometimes reflecting the malignancy/benignity of a program. You really need to scope each place out and see what you can find out from helpful residents. I don't know how realistic some of the more competitive things will be coming from outside the US though -- it will depend a lot on stellar scores etc.

 

[dally1025]

Currently I'm interested in...

- internal medicine (especially gastroenterology and rheumatology)
- neurology (with possibly pain medicine fellowship afterwards)
- anaesthesiology (with possibly pain medicine fellowship afterwards)
- general surgery
(- emergency medicine, with possibly intensive care medicine fellowship)
(- dermatology; probably hard to get, I know...)

I know, a lot of fairly different specialties, but I've always been "multi-interested" during med school ;-)

Derm is really tough for US graduates and near impossible for non-US graduates. EM is becoming less friendly to non-US graduates but not yet impossible if you do several rotations here at less competitve programs. Neuro and internal are still non-US graduate friendly, for now at least.

The top programs for each specialty are completely different from other specialties. Ivy leagues are top programs in some specialties while relatively unknown to the general public programs are top notch in other specialties. For example, Carolinas is one of the best EM programs while Yale is mid-tier.

 

[konRAD 1]

I'm in rads and I work about 45-50 hours a week counting conferences, etc. This is definitely program dependent, but there isn't that much variation.

 

[Law2Doc]

I'm in rads and I work about 45-50 hours a week counting conferences, etc. This is definitely program dependent, but there isn't that much variation.

That was not a specialty he indicated he had an interest in.

 

[Silent Cool]

That was not a specialty he indicated he had an interest in.

LOL.

Uh-oh....call the police!

 

[Hypomanics]

I just want to second Law2Doc's answer. From what you listed, surgery has the worst hours. EM has the best. I'm not familiar with derm hours so I can't comment. Internal medicine is the most widely varied of the list. There's no distinguishing factor such as "all big city IM programs have 80 hr work weeks." You just have to do the research in which programs you apply to. And also realize you may not have much of a choice being an IMG.

Another point to add is that you can get to critical care through IM, Surgery, & Anesthesia. And you can do pain management through PM&R, which I believe is a lot less competitive than Anesthesia. (I'm confident that someone will correct me if I'm wrong.)

 

[45408]

I just want to second Law2Doc's answer. From what you listed, surgery has the worst hours. EM has the best. I'm not familiar with derm hours so I can't comment.

Derm hours are better than EM hours. I'm good friends with one of the derm residents here, and you basically work business hours on weekdays at my program. There is always someone available, but it can almost always wait until morning. If someone has bad SJS or TEN, they'll probably get shipped to the burn unit. I once called a derm consult on a Saturday morning, and I think I woke her up when I called at 8am. You cover every 6th or 8th weekend, not that you're likely to get much, if anything.

EM has fixed hours, and I think they are capped by their own regulations at 60 hours/week when they are in the ED. That's not bad, but 60 hours in the ED is like 80 hours (or more) anywhere else. ED shifts can be intense.

 

[DreamingTheLive]

I just want to second Law2Doc's answer. From what you listed, surgery has the worst hours. EM has the best. I'm not familiar with derm hours so I can't comment. Internal medicine is the most widely varied of the list. There's no distinguishing factor such as "all big city IM programs have 80 hr work weeks." You just have to do the research in which programs you apply to. And also realize you may not have much of a choice being an IMG.

Another point to add is that you can get to critical care through IM, Surgery, & Anesthesia. And you can do pain management through PM&R, which I believe is a lot less competitive than Anesthesia. (I'm confident that someone will correct me if I'm wrong.)

However, in general, I think that actually getting the Pain fellowship is much more difficult coming from PM&R as most fellowships are run by Anesthesia depts. Maybe like 80 - 20 Anesthesia run Pain fellowships.

 

[Cozenboy]

However, in general, I think that actually getting the Pain fellowship is much more difficult coming from PM&R as most fellowships are run by Anesthesia depts. Maybe like 80 - 20 Anesthesia run Pain fellowships.

Yeah, I've read that, too. And honestly, PM&R is something that I'm not really interested in anyways... Thanks for all your input so far, it has been helpful.

Maybe anybody on the differences between "big" and "smaller" programs? Can you say smaller programs = always more "family-like" and therefore more friendly in the way people treat each other? Or is that nonsense?

 

[DrBowtie]

Yeah, I've read that, too. And honestly, PM&R is something that I'm not really interested in anyways... Thanks for all your input so far, it has been helpful.

Maybe anybody on the differences between "big" and "smaller" programs? Can you say smaller programs = always more "family-like" and therefore more friendly in the way people treat each other? Or is that nonsense?

Small programs also means one bad apple can spoil the bunch quickly. Smaller programs also mean more call in general.