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Can anyone compare residency to something that an incoming student can understand? (e.g. How does it compare to a 40 hour/week job in in a factory? Or a 52 hour/week job as a clinical assistant?)

Any help would be much appreciated. I'm trying to develop realistic expectations so I dont end up frustrated with the field. 

No exaggerations please! I've already read a lot about medical students being cute fluffy animals and residents being the hyenas from lion king. 

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6 minutes ago, Potentiate said:

residents being the hyenas from lion king

That's an understatement not an exaggeration, those hyenas still laugh.

9 minutes ago, Potentiate said:

medical students being cute fluffy animals

This is indeed an exaggeration. You won't be cute or fluffy, you will just be expected to look and act cute and fluffy.

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26 minutes ago, Potentiate said:

Is that like a "ha ha I hate residency too!!" or more like a "this is causing me severe mental distress. I should have never signed up for this BS"

The latter. It's like working a 60 hour a week job on top of school.

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Highly specialty and program dependent.

In psychiatry, I think things are pretty decent.

I did not like clerkship - I hated rotating every 2-4 weeks, never really belonging anywhere or being able to become part of the team, constantly studying for endless frequent exams along with working long hours without really having any decision-making power or ever feeling really useful or capable, and trying to get set up for CaRMS.

Residency has been a lot better for the most part.  For us there is one big exam at the end (not counting the LMCC) so the need to study in any concerted way really only comes in PGY5.  Of course you should be reading and learning, but for me looking things up as I go and learning on the job without the constant exam pressure feels a lot better.

In psychiatry the way I went through we would spend 6 months in the same place (with CBD things are a bit different but not still many rotations are 4 months long) so you actually get integrated as a stable part of the team rather than an outsider passing through.  You have more ability to actually make decisions about your work to some degree (moreso than clerkship) and you feel more like you're actually responsible for people's care.

Also, the further up the totem pole you get, the more collegial your relationship with your staff become.  I call everyone by their first names, we text, I've been to some of their houses.  Nobody cares if I wear jeans to work, which I do basically every day.  It becomes much more like a mentorship relationship.

That being said, a lot of things about residency are still crappy.  Call sucks because you have very little control over your call schedule, and it can be very frequent and very exhausting.  As I've gotten older over the last five years, my body has become more and more affected to the point where I find I'm not totally normal for about a week afterwards, so if I'm doing call more often than once a week, I'm never really feeling clearheaded.  In my specialty it's less sprints (really brutal blocks) and more just a chronic marathon.  I feel lucky because our call is still relatively infrequent here, but it can be very busy.

Your life is also very supervisor dependent.  If you get a malignant supervisor (which I have on a couple of occasions) they can really make your life a living hell, and you often have very little recourse no matter how much noise the university makes about supporting residents and dealing with supervisors who are malignant.

In residency you are often stuck between hospital/supervisor demands and patient demands without really satisfying either.  Dealing with people who are ill and vulnerable exposes you to people acting in really unpleasant ways.  Psychiatry can be quite violent.  Nobody has ever managed to actually physically assault me, but people have given it a pretty good try on many occasions, and the verbal abuse from patients can really take a toll.

Residency can also be isolating because most people outside of medicine don't really get it, so it can get pretty lonely.

Also the Royal College exam is terrible but honestly don't get me started on that right now because I am BEYOND salty.  BEYOND.  The whole thing with the RC is really a great example of how the bureaucracy can absolutely mess up your life and you have very little power to do anything about it.

Overall though I do mostly feel lucky.  I think there are many people out there in the world doing absolutely brutal (physically and mentally) jobs where they have no power over their working conditions and also work horrific hours, but get paid far less, and get far less societal recognition than we do.  I can be pretty sure that I'll end up with a roof over my head and more than I need for survival for the rest of my life, and that's so much better than most of the world gets.

However I think other specialties can be far more awful than mine - residency for me has been exhausting and annoying, and I am at the end in a state of very high burnout and exhaustion.  But overall it's also just fine in a lot of ways.

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17 minutes ago, Potentiate said:

Is there anything you do to cope with the obscene stress?

Meditation, hobbies, physical activity, etc.?

It's important to take care of one's health as best as possible. But time and energy can be a limitation, especially for things like hobbies.

I found that having high intrinsic motivation, sense of meaning in one's work, and a supportive team environment made for a positive residency experience overall.

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1 hour ago, Total Gunner said:

How much harder, if at all, is getting matched into a "competitive speciality" than getting into medschool in Ontario? 

Statistically it’s easier (50% match rate into derm/plastics for example). The difference is that The pool of applicants to those specialties are all gunners for the most part. It’s a little like asking what are the chances of winning an Oscar - well 1/5, but you have to be one of the 5 first. 

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5 hours ago, ellorie said:

Highly specialty and program dependent.

In psychiatry, I think things are pretty decent.

I did not like clerkship - I hated rotating every 2-4 weeks, never really belonging anywhere or being able to become part of the team, constantly studying for endless frequent exams along with working long hours without really having any decision-making power or ever feeling really useful or capable, and trying to get set up for CaRMS.

Residency has been a lot better for the most part.  For us there is one big exam at the end (not counting the LMCC) so the need to study in any concerted way really only comes in PGY5.  Of course you should be reading and learning, but for me looking things up as I go and learning on the job without the constant exam pressure feels a lot better.

In psychiatry the way I went through we would spend 6 months in the same place (with CBD things are a bit different but not still many rotations are 4 months long) so you actually get integrated as a stable part of the team rather than an outsider passing through.  You have more ability to actually make decisions about your work to some degree (moreso than clerkship) and you feel more like you're actually responsible for people's care.

Also, the further up the totem pole you get, the more collegial your relationship with your staff become.  I call everyone by their first names, we text, I've been to some of their houses.  Nobody cares if I wear jeans to work, which I do basically every day.  It becomes much more like a mentorship relationship.

That being said, a lot of things about residency are still crappy.  Call sucks because you have very little control over your call schedule, and it can be very frequent and very exhausting.  As I've gotten older over the last five years, my body has become more and more affected to the point where I find I'm not totally normal for about a week afterwards, so if I'm doing call more often than once a week, I'm never really feeling clearheaded.  In my specialty it's less sprints (really brutal blocks) and more just a chronic marathon.  I feel lucky because our call is still relatively infrequent here, but it can be very busy.

Your life is also very supervisor dependent.  If you get a malignant supervisor (which I have on a couple of occasions) they can really make your life a living hell, and you often have very little recourse no matter how much noise the university makes about supporting residents and dealing with supervisors who are malignant.

In residency you are often stuck between hospital/supervisor demands and patient demands without really satisfying either.  Dealing with people who are ill and vulnerable exposes you to people acting in really unpleasant ways.  Psychiatry can be quite violent.  Nobody has ever managed to actually physically assault me, but people have given it a pretty good try on many occasions, and the verbal abuse from patients can really take a toll.

Residency can also be isolating because most people outside of medicine don't really get it, so it can get pretty lonely.

Also the Royal College exam is terrible but honestly don't get me started on that right now because I am BEYOND salty.  BEYOND.  The whole thing with the RC is really a great example of how the bureaucracy can absolutely mess up your life and you have very little power to do anything about it.

Overall though I do mostly feel lucky.  I think there are many people out there in the world doing absolutely brutal (physically and mentally) jobs where they have no power over their working conditions and also work horrific hours, but get paid far less, and get far less societal recognition than we do.  I can be pretty sure that I'll end up with a roof over my head and more than I need for survival for the rest of my life, and that's so much better than most of the world gets.

However I think other specialties can be far more awful than mine - residency for me has been exhausting and annoying, and I am at the end in a state of very high burnout and exhaustion.  But overall it's also just fine in a lot of ways.

Thank you for your post. I'm also a psychiatry resident, and I'm nearing the end of my second year of residency with three more years to go. I just got off a series of brutal call shifts, working during the long weekend. Honestly, right now, if I could go back in time to speak to my former self holding that letter of acceptance to medical school, I would tell them to think long and hard about this. Residency kind of feels like prolonged micro-aggressions that day by day wear you down little by little. One brutal call shift alone may not make you feel this way, but the call, the lack of control over your sleep, really takes a toll on you after a while. Working 24 hours at a time (sometimes more) is not humane no matter how you cut it. I think I'm coming out of this as a less kind and caring individual, and I think that fact makes me sad. 

I'm curious to hear what your experience has been with the Royal College exam -- I heard the oral component got cancelled, so this must be a relief, no?

Would also be curious to hear about your malignant preceptors - how long did you have to work with them for? Did you have a choice in choosing your preceptors? 

At the end of the day, I try to remind myself that I am one of the lucky ones, with a stable income and roof over my head. There is a part of me that knew that when I was accepted into medical school, I had absolutely no idea it was going to be like this (especially call). To be honest there are times I kind of wish I went into a field with a stable 9-5 job instead of what I'm doing now.  

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7 minutes ago, jollibee said:

Thank you for your post. I'm also a psychiatry resident, and I'm nearing the end of my second year of residency with three more years to go. I just got off a series of brutal call shifts, working during the long weekend. Honestly, right now, if I could go back in time to speak to my former self holding that letter of acceptance to medical school, I would tell them to think long and hard about this. Residency kind of feels like prolonged micro-aggressions that day by day wear you down little by little. One brutal call shift alone may not make you feel this way, but the call, the lack of control over your sleep, really takes a toll on you after a while. Working 24 hours at a time (sometimes more) is not humane no matter how you cut it. I think I'm coming out of this as a less kind and caring individual, and I think that fact makes me sad. 

I'm curious to hear what your experience has been with the Royal College exam -- I heard the oral component got cancelled, so this must be a relief, no?

Would also be curious to hear about your malignant preceptors - how long did you have to work with them for? Did you have a choice in choosing your preceptors? 

At the end of the day, I try to remind myself that I am one of the lucky ones, with a stable income and roof over my head. There is a part of me that knew that when I was accepted into medical school, I had absolutely no idea it was going to be like this (especially call). To be honest there are times I kind of wish I went into a field with a stable 9-5 job instead of what I'm doing now.  

I think in psychiatry, PGY2 and PGY3 are extremely hard years.  Really PGY2 is the first "real" year of practicing psychiatry.  Almost everyone I know emerged from it burned out to some degree.  It does get better.  I found PGY4 and PGY5 miles better.  Having more seniority, more role power, more control over my life, and more comfort with the job.  Also finding mentors that I can genuinely trust with anything - I only really have 1-2 that I trust that way, but it's enough.  I also think that in psychiatry, in clerkship the residents shielded me from a lot of it - particularly the verbal and physical violence.  I had no idea how violent it was going to be and what I would see/participate in/have done to me.  It was really a shock to the system in the early years.

In our program you can get stuck with someone crappy for a full 6 months, which I did at one point.  I survived it in the end but it definitely contributed to the early-mid residency burnout.

The RC situation is a mess - they should have given the exam online with remote proctoring.  Now none of us can get independent licenses and we are all stuck in supervised practice until the fall because they insisted on postponing the exam to the fall.  Even the MCC has managed to get it together to give the MCQ portion of theirs online before the end of the academic year.  It's not the end of the world because the supervision is minimal and we can still bill, but it's pretty crummy having to study all over again right in the first few months of being staff.

Feel free to PM/message me if you ever want to get residency stuff off your chest - I remember those junior residency years and they are so hard.

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What's frustrating with residency is that your time is very precious, therefore everything you do, from seeing cases to studying after work must be high yield because you can't afford to waste time. Your attending and co-residents can make or break it. For example, as PGY2 attending tell you to read 1500+ page textbook and know the stuff in there. That is a completely useless advice, perhaps done with somewhat of a good intention. If you have a good senior resident they'll tell you what resources are most high yield, what's most commonly asked by attending vs on exam, etc. 99% of attendings does not know how to teach, or have any idea what good resources are out there for junior vs senior residents, not someone who's been practicing for 20+ years. Telling someone to just "read this textbook" is the most useless advice I've heard but it is given day in and day out. You can watch Youtube videos and get more out of them for your Royal College exam studying.

Also if your co-residents slack off then good luck because as PGY2 and 3 you'll be the ones doing the cleaning up. If you're in a small program and someone switch out or they reduce your residency spot then you're screwed because the work and responsibility will always be there and most likely junior residents will bear the brunt of the new workload. Never match to a program with a high drop out rate. Also pay attention to what happens with the senior residents in that program, because if they're desperate with job search or whatever then you can sense the PD/admin people don't care about what happens to their residents and in a few years it'll be your turn. Ask if the senior residents are happy with what they are doing  after residency, there are lots of fellows who are in fellowship because they can't find jobs or their training was poor and they're afraid of going into a job. Also never ask any admin or PD how their residents are doing because that's like asking a wolf if they eat tofu, always ask the residents in an informal setting outside the hospital. Also pay attention don't just ask the most keen star resident because most likely you won't be the star resident and sometimes they have moral hazards like they were promised to be hired back to the program or have some academic aspirations so now they can't speak poorly of the program or chair or PD etc, so also ask the mediocre and even poor residents what they think. 

Don't dwell on bad people around you, know your goal is to complete residency and find a job. Don't dwell on bad patients, bad admin, bad attending, etc. Let them putrefact and always write down your long term, 5, 10 or even 20 year goals so you don't get distracted by short term. Academic physicians are often stuck in academic because they are too specialized. I've seen those that want to transition to community practice but have forgotten what they learned in residency and don't have the skill anymore so they are basically hostage to the department. So I ask why don't they just retire or do something outside the medicine? Like they've been in practice for 15 years you think they'd save and invest enough money they're financially independent now? Or maybe they're the HENRY makes lots of money but never rich because spent it all on trillion dollar HGTV house and have to pay alimony or something.

I always tell people explore the world outside your center, do lots of electives at other hospitals and see how others do their work. Academic hospital runs very differently from community hospital or outpatient clinic etc. Academic center the cases are always harder, more complex, more layers of bureaucracy etc, and your mind get stuck thinking this is how the earth rotates. Sometimes people get sucked into being academic and look up to people with encyclopedic knowledge etc because that's all academic centers teach you. But once you go in community you see people with vibrant lives outside of medical practice who is doing fine even though they don't have some title of endowed chair in useless research studies. They might even teach you a thing or two about incorporation, work less and make more money, or something else you never get taught in academic centers. Also academic center cares too much who's assistant prof, associate prof, full prof and all that, it's all useless titles like the medieval era when you have to be Marquise or Baron of some plot of land or something. If I donate $5Mil to a department I guarantee you I create my own endowed chair then name myself the endowed professor and maybe even have a hospital wing named after me.

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Just to add, for example if a program matches 5 residents per year but there are only 3 PGY2 or PGY3 then find out what happened to the other residents that year that are MIA. Maybe they're off on maternity leave which is legitimate but maybe they switched out because most switches happen around PGY2/3 year. If in a small program you see people switching out frequently that's big red flag, imagine you lose 2 of 5 residents then you lose 40% of workforce and whoever remains will have to take call and pick up the paperwork etc. If you see PGY5s doing heavy clinical work that's also big red flag because you need 6+ months to study for Royal College, so too much clinical work can be detrimental for PGY5s. Even better find out if any PGY5 has failed Royal College recently because that's big red flag. For example if a fellow they have is not Royal College certified find out why, sometimes people who fail exam can do a "fellowship" for 1 year, which is just a euphemism for the program bailing them out while they study so at least they have money to survive. A lot of times the program offer no support so PGY5s are on their own which is big red flag, remember the royal college is the big forest so don't lose sight of the forest for the trees.

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