Work life balance, is it possible?

[businessmajor]

In the early years, is there any time for a social life? I like helping people and I don't mind long hours, but I would like to have a life of my own also.

I believe that I would enjoy life as a doctor (and am considering GEM), but does your passion have to be deeper than that (I <3 science, couldn't see myself doing anything else etc.) in order to persevere through the hard times, or should logical thought suffice?

How many hours/week (on average) did medicine take in:
Medical school ___
Internship ___
Residency ___
Fellowship ___

Thanks in advance guys 🙂

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[Perrotfish]

In the early years, is there any time for a social life? I like helping people and I don't mind long hours, but I would like to have a life of my own also.

I believe that I would enjoy life as a doctor (and am considering GEM), but does your passion have to be deeper than that (I <3 science, couldn't see myself doing anything else etc.) in order to persevere through the hard times, or should logical thought suffice?

How many hours/week (on average) did medicine take in:
Medical school ___
Internship ___
Residency ___
Fellowship ___

Thanks in advance guys 🙂

The first two years of medical school are just school, you learn things from textbooks. The amount of time you put in has to do with the grade you want out of it and your natural ability to learn the material, just like in Undergrad. I think most people average 40-60 hours a week, though you will certainly meet people that put in 20 hours a week and people who put in over a hundred.

The third year of medical school sucks. You have tests every 4- 8 weeks you need to study for, as well as a clinic/hospital schedule that can be anywhere from 10-100 hours a week depending on the whims of your rotation. Some schools do med student call and literally don't let you sleep for up to 36 hours at a time, something that won't be legal again until fellowship. Its very school and rotation dependent. Between studying and work I think I was usually over 80 hours a week.

The fourth year of medical school is a joke. The first half is filled with electives without tests that you don't go to because you're traveling for interviews, the second half is electives without tests that you do go to for maybe a couple hours a day. Most people work less than 40 hours a week for most of them and less than 20 hours a week for at least one or two rotations.

Intern year is a maximum of 80 hours a week in the hospital, no more than 16 hours in a given day, and at least one day off a week. You would also be nuts not to put in another 10-20 hours of studying/ admin/ research outside of the hospital. How hard it is depends on the program, most people average over 60-80 hours a week in the hospital. My year long average was about 75 hours a week in the hospital, plus studying. You sleep but not much else.

The rest of residency is a maximum of 80 hours a week in the hospital (88 if you're a surgeon), no more than 28 hours at a time, a minimum of 1 day off a week, and enormous variation in how hard it actually is. Some specialties are easier than others and some programs are easier than others. I know surgeons that routinely break the work hour rules throughout all of residency to average 100 hours a week. I think I'm going to be closer to 50 hours a week on average, maybe even less. It is possible to do 'Q4' call within the rules, if you do that your schedule is: 12 hour shift, 12 hour shift, 28 hour shift. Rinse and repeat. Then you really don't sleep every fourth night.

Fellowship has no work hour rules and enormous variation in work hours. In some malignant/competitive medicine and surgery fellowships 110 hours a week is not unheard of, and that can go for all 3 years of the fellowship. In many pediatrics fellowships less than 40 hours a week is not at all strange, with over one of the three years devoted to research at your own pace. It depends on your chosen profession

Most attendings who aren't drowning in debt or alimony seem to work a very reasonable number of hours: 30-60 depending on preference.

Summary: There are only two years that definitely need to suck: Third year of medical school and Intern year, and even then you should sleep at least 7 hours a night most nights. The rest of residency and fellowship CAN suck depending on what kind of doctor you want to be, so choose wisely

 

[Law2Doc]

The first two years of medical school are just school, you learn things from textbooks. The amount of time you put in has to do with the grade you want out of it and your natural ability to learn the material, just like in Undergrad. I think most people average 40-60 hours a week, though you will certainly meet people that put in 20 hours a week and people who put in over a hundred.

The third year of medical school sucks. You have tests every 4- 8 weeks you need to study for, as well as a clinic/hospital schedule that can be anywhere from 10-100 hours a week depending on the whims of your rotation. Some schools do med student call and literally don't let you sleep for up to 36 hours at a time, something that won't be legal again until fellowship. Its very school and rotation dependent. Between studying and work I think I was usually over 80 hours a week.

The fourth year of medical school is a joke. The first half is filled with electives without tests that you don't go to because you're traveling for interviews, the second half is electives without tests that you do go to for maybe a couple hours a day. Most people work less than 40 hours a week for most of them and less than 20 hours a week for at least one or two rotations.

Intern year is a maximum of 80 hours a week in the hospital, no more than 16 hours in a given day, and at least one day off a week. You would also be nuts not to put in another 10-20 hours of studying/ admin/ research outside of the hospital. How hard it is depends on the program, most people average over 60-80 hours a week in the hospital. My year long average was about 75 hours a week in the hospital, plus studying. You sleep but not much else.

The rest of residency is a maximum of 80 hours a week in the hospital (88 if you're a surgeon), no more than 28 hours at a time, a minimum of 1 day off a week, and enormous variation in how hard it actually is. Some specialties are easier than others and some programs are easier than others. I know surgeons that routinely break the work hour rules throughout all of residency to average 100 hours a week. I think I'm going to be closer to 50 hours a week on average, maybe even less. It is possible to do 'Q4' call within the rules, if you do that your schedule is: 12 hour shift, 12 hour shift, 28 hour shift. Rinse and repeat. Then you really don't sleep every fourth night.

Fellowship has no work hour rules and enormous variation in work hours. In some malignant/competitive medicine and surgery fellowships 110 hours a week is not unheard of, and that can go for all 3 years of the fellowship. In many pediatrics fellowships less than 40 hours a week is not at all strange, with over one of the three years devoted to research at your own pace. It depends on your chosen profession

Most attendings who aren't drowning in debt or alimony seem to work a very reasonable number of hours: 30-60 depending on preference.

Summary: There are only two years that definitely need to suck: Third year of medical school and Intern year, and even then you should sleep at least 7 hours a night most nights. The rest of residency and fellowship CAN suck depending on what kind of doctor you want to be, so choose wisely

I basically agree with some of the above post but want to emphasize that with respect to duty hour rules, programs all put out schedules that on paper meet the 80 hour rules, but things routinely happen in a hospital at the end of your week that can push your numbers over duty hour limits, and the guy who stays past his 80th hour to work the code that happened as he was getting ready to sign out is going to be better regarded than the guy who says "sorry guys, my time here is up." programs will generally follow the rules if pushed, but a lot of your career is going to be based on subjective evaluation and sometimes it's just not worth it to be "that guy". Also just because you leave the hospital doesn't mean your job is done -- if you don't regularly read up on things, study for inservice and boards, etc, you will not be one of the better residents. So budget another 10 hours a week for that. I also think it's pretty rare to routinely get 7 hours a night of sleep during intern year if that's what you are saying. Most people I know averaged 5-6. On call (back when they were 30 hours) I was usually ecstatic to get 3, and that was rare -- now with night float you typically get zero at night because the theory is you have all day to sleep.

I'm not sure in what fields "most" attending work 30-60 hours a week. In MANY specialties your hours go up dramatically from residency to attending. That's when you start pulling those 100+ weeks in a lot of fields, particularly when you are the junior in the practice. I suspect the AVERAGE is close to 60, with 30 being an extreme outlier of very senior/semi retired/part time doctors, and more junior attendings frequently far on the other side of the average. When I was an intern the people with worse schedules than us were the junior attendings who still had to stay the whole next day even if we had to wake them up all night because of crashing patients -- ie they had similar call schedules without the post call days. That gets you above 100 hours pretty fast.

 

[Winged Scapula]

As the originator of this thread is a premed student, is being moved to pre-allo in accordance with SDN policy. Those who wish to respond can do so there.

 

[Perrotfish]

I'm not sure in what fields "most" attending work 30-60 hours a week. In MANY specialties your hours go up dramatically from residency to attending. That's when you start pulling those 100+ weeks in a lot of fields, particularly when you are the junior in the practice. I suspect the AVERAGE is close to 60, with 30 being an extreme outlier of very senior/semi retired/part time doctors, and more junior attendings frequently far on the other side of the average. When I was an intern the people with worse schedules than us were the junior attendings who still had to stay the whole next day even if we had to wake them up all night because of crashing patients -- ie they had similar call schedules without the post call days. That gets you above 100 hours pretty fast.

You've said this on multiple threads and all I can say is that I have never met any attending, in any field, whose hours went up significantly after residency. I also can't imagine why anyone would put up with it. Physicians are a valuable, scarce commodity. Private groups and academic organizations that might want to value seniority (and overwork the new guys) are competing with MCOs/large corporate groups/large hospital systems that don't care about a physician's seniority and are willing to pay an extraordinarily lucrative flat rate regardless of a physician's experience. If someone told me, at the age of 35 and after 6 years of residency and fellowship, that I was expected to work 100 hours/week because I was the 'new guy' I would thank them for their time and walk down the street to Kaiser.

 

[csx]

I basically agree with some of the above post but want to emphasize that with respect to duty hour rules, programs all put out schedules that on paper meet the 80 hour rules, but things routinely happen in a hospital at the end of your week that can push your numbers over duty hour limits, and the guy who stays past his 80th hour to work the code that happened as he was getting ready to sign out is going to be better regarded than the guy who says "sorry guys, my time here is up." programs will generally follow the rules if pushed, but a lot of your career is going to be based on subjective evaluation and sometimes it's just not worth it to be "that guy". Also just because you leave the hospital doesn't mean your job is done -- if you don't regularly read up on things, study for inservice and boards, etc, you will not be one of the better residents. So budget another 10 hours a week for that. I also think it's pretty rare to routinely get 7 hours a night of sleep during intern year if that's what you are saying. Most people I know averaged 5-6. On call (back when they were 30 hours) I was usually ecstatic to get 3, and that was rare -- now with night float you typically get zero at night because the theory is you have all day to sleep.

I'm not sure in what fields "most" attending work 30-60 hours a week. In MANY specialties your hours go up dramatically from residency to attending. That's when you start pulling those 100+ weeks in a lot of fields, particularly when you are the junior in the practice. I suspect the AVERAGE is close to 60, with 30 being an extreme outlier of very senior/semi retired/part time doctors, and more junior attendings frequently far on the other side of the average. When I was an intern the people with worse schedules than us were the junior attendings who still had to stay the whole next day even if we had to wake them up all night because of crashing patients -- ie they had similar call schedules without the post call days. That gets you above 100 hours pretty fast.

Excuse my ignorance, what's the advantage of being one of the "best residents/being better regarded?"

 

[IJL]

Excuse my ignorance, what's the advantage of being one of the "best residents/being better regarded?"

The advantage comes when you are applying for fellowships and/or a future job.

 

[Law2Doc]

You've said this on multiple threads and all I can say is that I have never met any attending, in any field, whose hours went up significantly after residency. I also can't imagine why anyone would put up with it. Physicians are a valuable, scarce commodity. Private groups and academic organizations that might want to value seniority (and overwork the new guys) are competing with MCOs/large corporate groups/large hospital systems that don't care about a physician's seniority and are willing to pay an extraordinarily lucrative flat rate regardless of a physician's experience. If someone told me, at the age of 35 and after 6 years of residency and fellowship, that I was expected to work 100 hours/week because I was the 'new guy' I would thank them for their time and walk down the street to Kaiser.

You put up with it because moving up in such a practice leads to great wealth and eventually a much better lifestyle as you move higher up the pyramid.

The increase in hours also partly reflect the fact that your name will be on any lawsuit, so all of a sudden you'd better actually read the notes you are writing, actually examine the patient in detail, and other things that might be more cursory when your name isn't on the bottom line. So early on you stop moving fast.

But yeah it's very common in some specialties for hours to go up, not down as you emerge from training because the duty hours are actually keeping hours down pretty drastically for a number of specialties. That you have never met an attending whose hours went up may mean your location and circle of contacts isn't representative of the profession nationally.

 

[Law2Doc]

Excuse my ignorance, what's the advantage of being one of the "best residents/being better regarded?"

This is a career based on networking and references -- your test scores stop being very important after you land a residency, and suddenly what people think of you and will say about you matter for career progression. Your fellowship and first job may heavily depend on people willing to write letters or pick up the phone on your behalf. It helps if you actually were a solid resident.

 

[csx]

This is a career based on networking and references -- your test scores stop being very important after you land a residency, and suddenly what people think of you and will say about you matter for career progression. Your fellowship and first job may heavily depend on people willing to write letters or pick up the phone on your behalf. It helps if you actually were a solid resident.

Interesting...they don't tell you that. They always say if your a dr, you can pretty much work anywhere.

 

[ghboyd25]

Interesting...they don't tell you that. They always say if your a dr, you can pretty much work anywhere.

who are they? It kind of serves to reason that not every doctor can work in their first choice fellowship or hospital.

 

[circulus vitios]

Choose a specialty/fellowship and look under "resident work hours." https://freida.ama-assn.org/Freida/user/specStatisticsSearch.do?method=viewSpecialty&pageNumber=2

 

[Law2Doc]

Choose a specialty/fellowship and look under "resident work hours." https://freida.ama-assn.org/Freida/user/specStatisticsSearch.do?method=viewSpecialty&pageNumber=2

Yes but (a) bear in mind that the hours people and programs ascribe to on paper and in surveys may not represent what they actually are (particularly if timecards are being submitted that fudge to meet the duty hour rules), and (b) you will be studying for boards, inservice exams, and reading up on patients on top of your work hours so add at least 10 hours a week to the total for this.

 

[Buzz Me]

In some malignant/competitive medicine and surgery fellowships 110 hours a week is not unheard of, and that can go for all 3 years of the fellowship.

110 hours is considered a light, easy week here.

 

[KnuxNole]

Yes but (a) bear in mind that the hours people and programs ascribe to on paper and in surveys may not represent what they actually are (particularly if timecards are being submitted that fudge to meet the duty hour rules), and (b) you will be studying for boards, inservice exams, and reading up on patients on top of your work hours so add at least 10 hours a week to the total for this.

I don't count studying/reading as "work hours". Especially if I'm at home, curled up in my couch with a hot cup of coffee, and reading 😛

I don't believe people usually talk about outside studying as part of extra work hours. And if they read during work hours, well, it's killing 2 birds with one stone. Of course, that's assuming you have time to read at work. I guess you can count the 5-10 mins of browsing UTD to figure out how to workup a complicated case 😛

 

[csx]

110 hours is considered a light, easy week here.

what the heck kind of fellowship are you doing???

 

[Buzz Me]

what the heck kind of fellowship are you doing???

Cardiothoracic surgery.

Most days start around 5 or 6. Usually I don't get home until around 10-11 pm. Then there's overnight call. And home call.

 

[IJL]

Cardiothoracic surgery.

Most days start around 5 or 6. Usually I don't get home until around 10-11 pm. Then there's overnight call. And home call.

No thanks.

 

[TheWeeIceMan]

Cardiothoracic surgery.

Most days start around 5 or 6. Usually I don't get home until around 10-11 pm. Then there's overnight call. And home call.

I would be a bumbling, incoherent mess by like the third week of this schedule.

 

[IJL]

I would be a bumbling, incoherent mess by like the third week of this schedule.

Same here. Much less coherent enough to perform thoracic surgery. But much respect to those who can... We need people like you.

 

[Law2Doc]

I don't count studying/reading as "work hours". Especially if I'm at home, curled up in my couch with a hot cup of coffee, and reading 😛

I don't believe people usually talk about outside studying as part of extra work hours. And if they read during work hours, well, it's killing 2 birds with one stone. Of course, that's assuming you have time to read at work. I guess you can count the 5-10 mins of browsing UTD to figure out how to workup a complicated case 😛

While i agree that this doesnt usually get discussed when talking about work hours, Since the question was about balance and time for other things, I think it really needs to be included. Even in you are reading on the couch, that's still time you aren't out with friends or family or at the bars or watching a concert or on a date. Very rare residents get away with doing most of their reading at work -- I think a 10 hour estimate of outside reading a week is in the ballpark. (and even if you do this all of your evaluations from attendings will suggest you "read more"). And as you approach boards and other big tests that matter certainly the amount of studying outside of work can go up.

 

[Law2Doc]

I would be a bumbling, incoherent mess by like the third week of this schedule.

To a great extent these hours go by much faster than you think. A lot of premeds probably log this kind of time playing marathon sessions of video games each week without thinking too much about it, and you have more downtime in residency.

 

[mimelim]

You've said this on multiple threads and all I can say is that I have never met any attending, in any field, whose hours went up significantly after residency. I also can't imagine why anyone would put up with it. Physicians are a valuable, scarce commodity. Private groups and academic organizations that might want to value seniority (and overwork the new guys) are competing with MCOs/large corporate groups/large hospital systems that don't care about a physician's seniority and are willing to pay an extraordinarily lucrative flat rate regardless of a physician's experience. If someone told me, at the age of 35 and after 6 years of residency and fellowship, that I was expected to work 100 hours/week because I was the 'new guy' I would thank them for their time and walk down the street to Kaiser.

I don't think any of our faculty work less than 80 hours a week. Most of them work 100+.

 

[Perrotfish]

I don't think any of our faculty work less than 80 hours a week. Most of them work 100+.

100 hours a week means twice a week in house call, with 14 hour shifts on non-call days, full work days on post-call days, and only 1 day off a week. That works out to exactly 100 hours a week. You are saying most of your attendings work MORE than that (maybe only one day off every other week?). Perpetually, through their mid-30s and early 40s, after enduring 8 years of surgical residency and fellowship following 8 years of premed and medical school.

There is a chance you are getting fooled because you're not seeing the days off. I seen many intensivist/surgery services set up so that one person is there essentially around the clock (on every day and on home call every night), but everyone only works 12-15 days a month. You see your attendings are working the same hours you are and you forget they aren't working nearly as many days. You might just also be miscounting. A lot of people I know seem to think they work many more hours than they actually do. When you're working HARD (60+ hours a week without a lot of downtime) you can feel like you're always at work, and say you're working 100 hours a week. I remember being perpetually surprised during Intern year that I was within the work hour rules: 6 12.5 hour shifts a week feels like more than 80 hours, but its not.

However if you are right, and your attendings really are working 28 14 hour days a month and taking Q3 in house call for years on end, I would say that they have made a poor career decision. I don't care how much you like your job or how well it pays, if you've signed a contract to not see daylight more than 40 days out of the year that's a poor decision. Per hour, they'd be making less that most IM hospitalists, barely more than a general outpatient Pediatrician. That's the reward for your attendings are working for, for which they almost never see their children, never have a hobby, and never even having the time to play with all of the expensive toys they earned. They also would have, necessarily, passed up a mid-300K salary (or more) at a major hospital system both after residency and again after fellowship, where they could have worked a reasonable 40-50 hours a week pretty much for the rest of their careers. All for the privilege of hoping to possibly one day advance out of their academic purgatory.

Life is a journey, not a destination. If the first half of your career involves working hours that would violate the Geneva conventions you have made some poor decisions.

 

[mimelim]

I mispoke, I should have said, virtually all work 80hrs/week and some 100+. Certainly not most.

A little bit of context, we went from 9 faculty to 6 in the last 2 years. They take a lot of call and it is atypical for us to have a non-operative night or weekend day. (today we had 6 cases before the consults even started rolling in. It is also atypical for attendings not on call to leave the hospital before 7pm. When our night float shows up at 6pm, we usually have 4-5 ORs still going and the night team will have 10-12 post op checks from cases that started after 3pm.

And that is just the clinical stuff... Add in the research, education and administrative hours, people just don't leave the hospital. We are a private hospital trying to be "academic". Which basically means everyone operates like they are private and try to do everything else on top.

Even outside of Vascular... I'm pretty close with one of our new CRS faculty. He was telling me just this week that he works more now than he did as a fellow or ever as a general surgery resident. Working multiple hospitals, building a practice, getting involved in the residencies etc. has him working ~80-90hrs/week.

 

[Perrotfish]

I mispoke, I should have said, virtually all work 80hrs/week and some 100+. Certainly not most.

A little bit of context, we went from 9 faculty to 6 in the last 2 years. They take a lot of call and it is atypical for us to have a non-operative night or weekend day. (today we had 6 cases before the consults even started rolling in. It is also atypical for attendings not on call to leave the hospital before 7pm. When our night float shows up at 6pm, we usually have 4-5 ORs still going and the night team will have 10-12 post op checks from cases that started after 3pm.

And that is just the clinical stuff... Add in the research, education and administrative hours, people just don't leave the hospital. We are a private hospital trying to be "academic". Which basically means everyone operates like they are private and try to do everything else on top.

Even outside of Vascular... I'm pretty close with one of our new CRS faculty. He was telling me just this week that he works more now than he did as a fellow or ever as a general surgery resident. Working multiple hospitals, building a practice, getting involved in the residencies etc. has him working ~80-90hrs/week.

Well I believe you, but that sounds like a truly horrible deal for all involved, and might explain why 3 faculty members aren't there any more (assuming there's not another story there). I can't imagine how your hospital expects the remaining 6 faculty to put up with that. It doesn't even sound like there's an end game in sight: its not like there are more senior surgeons who are working more reasonable hours, it sounds like every single faculty member is drowning in work.

I hope they're at least getting paid well.

 

[Law2Doc]

I mispoke, I should have said, virtually all work 80hrs/week and some 100+....

that sounds like what I've seen in some specialties, but with the higher numbers of hours being primarily the more junior attendings and the more senior attendings having less call (although still working longer than some residents). But yes, for junior attendings, working post call days is common, working some of every weekend is common, and the hours can add up pretty quickly. I know several that had already finished rounding at other hospitals when I first saw them at 5:30 am, and they went off to see patients at other hospitals again when I was leaving for the day 15 hours later. And that was their noncall days. As they move up in the practice in a few years they will have less call, more vacation and weekends, and have an opportunity to start spending their earnings.

 

[Buzz Me]

No thanks.

I would be a bumbling, incoherent mess by like the third week of this schedule.

Sounds worse than it really is (probably helps that I love what I do).

As a pre-med or med student, no way I'd ever imagine myself working those kinds of hours.

You just have to find something you're passionate about.

 

[poorracerkid]

Sounds worse than it really is (probably helps that I love what I do).

As a pre-med or med student, no way I'd ever imagine myself working those kinds of hours.

You just have to find something you're passionate about.

Take it from the man. He is wise and speaks the truth.

 

[Music MD]

Medical school ___ 50
Residency ___65

Yes you can have a life but you must be EFFICIENT. Don't BS when you're studying. Just set aside time to study and do it. People who study 12 hours per day aren't studying effectively or they aren't actually studying. Medical school should be a 50 hour per week job. Some weeks will be way more for whatever reason, but if you plan your time well, you still have time to do almost anything you'd like to do. Take spontaneous 4 day road trips, visit family, go out with friends, play intramural sports, etc.

Medical school is not a prison sentence like some on here make it out to be.

 

[IJL]

Medical school ___ 50
Residency ___65

Yes you can have a life but you must be EFFICIENT. Don't BS when you're studying. Just set aside time to study and do it. People who study 12 hours per day aren't studying effectively or they aren't actually studying. Medical school should be a 50 hour per week job. Some weeks will be way more for whatever reason, but if you plan your time well, you still have time to do almost anything you'd like to do. Take spontaneous 4 day road trips, visit family, go out with friends, play intramural sports, etc.

Medical school is not a prison sentence like some on here make it out to be.

Agree with all of this and I think 50 is even high.