Are residents actually happy?

[Bookmark311]

A lot of residents I meet in my rotations barely have anytime time to do anything outside of medicine. Some are even unhappy with their choice.. which residency medicine allows for work life balance

[Bambi]

As a resident, I have no time to do anything of medicine. I do, however, love my residency and would not change a thing if I had to do it over again. There is no work life balance in residency, at least. Ot in my experience in my surgical specialty. This does not in any way speak to the future however. 

[offmychestplease]

-

[Intrepid86]

Residency is temporary. I suggest you focus on what area of medicine you ultimately want to practice in, rather than the quality of life during your training program. That being said, it would be hard to beat a Family Medicine residency for work life balance.

[rmorelan]

3 hours ago, Bookmark311 said:

A lot of residents I meet in my rotations barely have anytime time to do anything outside of medicine. Some are even unhappy with their choice.. which residency medicine allows for work life balance

Residency unfortunately I think - despite all the talk about it - is not about work life balance. It is about maximum training in minimal time coupled with required service etc. Making it more balanced would increase the training time (which is an option we could put it - they do that in Europe) 

FM is better - because for parts of it you work with family doctors that have a set schedule. Many places still have off service rotations that are more intense usually. It is also shorter - which I think is actually most important factor. It was for me at least about 2 full years into contact call shifts and sleep deprivation that I really crashed. No matter what you do people only have so much reserve. FM isn't the only lighter one either. 

Still as intrepid says above it is temporary. you have to be very careful taking to residents about what they like or if they are happy etc if you are making a long term decision based on it. Talk to staff as they are the ones past all that. Residents are often tired, overworked, overstressed, and pushing them to the limit - and accidentally going past that point quite often. 

Edited June 29, 2020 by rmorelan

[bearded frog]

YMMV depending on specialty/program. I love residency and have lots of free time, which will change this year with studying though. My neurosurgeon colleagues who work 6 days a week and don't take post call days on the other hand, may have a different perspective.

[ellorie]

Depends what you mean by happy.

I had a reasonable amount of time outside of residency to do the things I needed to do.  In my program we do about 1/7 call on service, which is miles better than the 1/2 to 1/4 that many specialties do.  We also don't do any off service after PGY1.

But it's exhausting and stressful and I don't think I know anybody who isn't burned out.  Like Rob, I hit the wall around mid PGY3 and didn't fully recover.

I still don't regret it - knowing what I know now, I'd have given much stronger consideration to social work or clinical psychology but ultimately I imagine I'd probably have still chosen psychiatry.

[blah1234]

I think fields that have less "emergencies" like FM, PMR, Path have more reasonable working hours. You will still have to study a lot and work longer than normal hours to compress all the learning into a a few years. I think it's in line with other demanding professions like law, prestige finance, etc.

Most likely you'll have to make some sort of sacrifice in your personal life until training is over. FM is generally considered the most reasonable because of the more normal training hours but also because it is only 2 years which is huge if you're looking to be independent as soon as possible.

[Hanmari]

56 minutes ago, ellorie said:

Depends what you mean by happy.

I had a reasonable amount of time outside of residency to do the things I needed to do.  In my program we do about 1/7 call on service, which is miles better than the 1/2 to 1/4 that many specialties do.  We also don't do any off service after PGY1.

But it's exhausting and stressful and I don't think I know anybody who isn't burned out.  Like Rob, I hit the wall around mid PGY3 and didn't fully recover.

I still don't regret it - knowing what I know now, I'd have given much stronger consideration to social work or clinical psychology but ultimately I imagine I'd probably have still chosen psychiatry.

How did you keep going when you hit the wall? Was there something you did in preparation ahead of time that facilitated the (partial) recovery? And how are you and your colleagues dealing with the unprecedented stress around the royal college fiasco? I am now heading into PGY4 and whereas I don't feel I've hit it yet, I am wary it's only uphill from here.

[unmatch]

No. In FM and feel totally brain dead. Would much rather be one of those over worked residency programs where I actually enjoyed what I was doing. There's a balance to be struck between interest and lifestyle especially beyond residency.

[BigM]

Residency isn't necessary a sentence to a life of misery.  While I only have experience in the field that I trained in, all residencies are going to have their grueling periods.  For some, predominately surgical specialties and some medical specialties, it will be a rough ride.  For some others e.g. family, PMR, psychiatry, rad-onc, lab medicine, neurology and periods of internal medicine, its tough, and going to make your normal 8-4 job look like child's play, but its not exceedingly miserable.  You are going to have some years of heavy call, for me this was PGY2 & PGY3.  You are also going to have a year where you bust your behind to get ready for exams.  But keep in mind at the end of this you are an independent specialist. In most fields you are not going to struggle to find employment and you are likely going to make $300,000+/year for the rest of your working career.  You also get to work in a field where you get to make meaningful differences in the lives of others.  That's a pretty sweet payoff for 5 years of sacrifice.  Also, there are very rewarding parts of residency.  Feeling incompetent sucks, but that gets better with time, and you do eventually feel like you're making meaningful contributions, able to lead teams and feel that you're somewhat prepared to do this on your own. You also get the bonding experiences of working in the trenches with your co-residents that are going through similar experiences.

[ellorie]

9 hours ago, Hanmari said:

How did you keep going when you hit the wall? Was there something you did in preparation ahead of time that facilitated the (partial) recovery? And how are you and your colleagues dealing with the unprecedented stress around the royal college fiasco? I am now heading into PGY4 and whereas I don't feel I've hit it yet, I am wary it's only uphill from here.

Not really, I just had to do it, because what other option is there?  You try to continue with as much of whatever hobbies or activities you find replenishing as you can, and catch up on sleep when the opportunity presents itself.  Take your vacation regularly - I'm not a fan of saving it all for huge vacations that come very rarely but some people find it better to do it that way.  I try to take a week about every 2 months to recuperate.

I wouldn't say we are coping great, but what can you do?  We are all absolutely powerless over the Royal College - they do what they want and we are just kind of scrambling to transition to practice while also preparing again for the exam.

One day at a time.

[dooogs]

6 minutes ago, ellorie said:

Not really, I just had to do it, because what other option is there?  You try to continue with as much of whatever hobbies or activities you find replenishing as you can, and catch up on sleep when the opportunity presents itself.  Take your vacation regularly - I'm not a fan of saving it all for huge vacations that come very rarely but some people find it better to do it that way.  I try to take a week about every 2 months to recuperate.

I wouldn't say we are coping great, but what can you do?  We are all absolutely powerless over the Royal College - they do what they want and we are just kind of scrambling to transition to practice while also preparing again for the exam.

One day at a time.

You are so inspiring! :-) 

how many weeks of vacations do residents get per year ? Can you get additional time for conferences? 

[ellorie]

I think it varies by province - in ON we get 4 weeks, 7 conference days, a floating holiday, and then 5 consecutive days for Christmas/New Year (you get one of the two off).

TBH I get through it by reminding myself that all over the world, people have jobs where they work horrifying hours for terrible pay basically indefinitely and get much less respect/appreciation than we do.  Like long haul truck drivers.  I would way rather be a resident than do that.

[gogogo]

8 hours ago, unmatch said:

No. In FM and feel totally brain dead. Would much rather be one of those over worked residency programs where I actually enjoyed what I was doing. There's a balance to be struck between interest and lifestyle especially beyond residency.

Damn, sorry to hear that. Why do you feel brain dead in FM? Are there things you think a med student aiming for FM should be aware of before deciding on it?

[dooogs]

8 hours ago, unmatch said:

No. In FM and feel totally brain dead. Would much rather be one of those over worked residency programs where I actually enjoyed what I was doing. There's a balance to be struck between interest and lifestyle especially beyond residency.

What's preventing you from reading up on things yourself if you find that the day to day is too easy?

[Hanmari]

1 hour ago, ellorie said:

Not really, I just had to do it, because what other option is there?  You try to continue with as much of whatever hobbies or activities you find replenishing as you can, and catch up on sleep when the opportunity presents itself.  Take your vacation regularly - I'm not a fan of saving it all for huge vacations that come very rarely but some people find it better to do it that way.  I try to take a week about every 2 months to recuperate.

I wouldn't say we are coping great, but what can you do?  We are all absolutely powerless over the Royal College - they do what they want and we are just kind of scrambling to transition to practice while also preparing again for the exam.

One day at a time.

Thanks, that makes sense. I guess it is reassuring in a way that there is nothing special to be done. Takes too much to do things on top to prevent burnout. It is an inevitable leak but it is comforting to know that when it bottoms out one can still run on empty and let the days pass.

[ellorie]

I think it's like - even in weeks or rotations that are really demoralizing, there are bright spots that remind you why you're doing it.  Times where you really helped someone, or made a cool diagnosis, or learned something that really made you feel intellectually stimulated, or had a bonding moment with a colleague.  And I think you sort of hang on to that stuff rather than focusing on the shitty supervisors or sleep deprivation or the patients who treat you horribly.  And then you just take it one moment or day or block or year at a time, and go on living your life around it as best as you can.

I think I've also sort of learned to ration how much I give a shit about things, and what things are worth giving a shit about.  You can't take everything to heart or you'll lose it.  When I used to care about what every supervisor thought about me, it felt kind of impossible.  I also still care very much about my patients individually but I've learned to divorce my morale/self worth from the outcome, a bit, and instead focus on the care I provide rather than feeling like I've failed if patient or environment factors still result in things going wrong.  When I'm feeling burned out and have limited resources I try to be very conscious about maximizing them and focusing them where they do the most good.

[insomnias]

14 hours ago, rmorelan said:

Residency unfortunately I think - despite all the talk about it - is not about work life balance. It is about maximum training in minimal time coupled with required service etc. Making it more balanced would increase the training time (which is an option we could put it - they do that in Europe)

 

Every time somebody says that, I like to point to the example of Switzerland which has residencies of comparable length to ours in most specialties while abiding by EU work hour restrictions (48h/week max with no more than 13h of continuous work), and the RCPSC recognizes their training as equivalent for the purposes of exam eligibility. The reason we have long hours during residency isn't because it's a trade-off between hours worked vs competency but because resident labour is significantly cheaper to the government/hospital than that of attending physicians.

[dooogs]

9 minutes ago, insomnias said:

Every time somebody says that, I like to point to the example of Switzerland which has residencies of comparable length to ours in most specialties while abiding by EU work hour restrictions, and the RCPSC recognizes their training as equivalent for the purposes of exam eligibility. The reason we have long hours during residency isn't because it's a trade-off between hours worked vs competency but because resident labour is significantly cheaper to the government/hospital than that of attending physicians.

I have friends that say this too. Like what is the point of teaching on your post call day? 

Anecdotally my best friend is a resident and he did 5 26h call shifts in CTU in the last 10 days. Also things assigned on post call day. 

Oh and no sleep during the call nights. 

I'm only just getting into the game as a med student but this is really strange to me. I dont see the purpose of it or learning involved? He seems on autopilot with all the sleep deprivation 

I guess I will learn how to deal with it? Everybody does right ?

[MDinCanada]

11 hours ago, unmatch said:

No. In FM and feel totally brain dead. Would much rather be one of those over worked residency programs where I actually enjoyed what I was doing. There's a balance to be struck between interest and lifestyle especially beyond residency.

what were you interested in originally?

[gogogo]

Just came across the CMA National Physician Health Survey. It was done in 2018 and surveyed 400 residents and ~2500 attendings regarding wellbeing, burnout, depression, etc. The results are pretty damning. For instance, on page 10, they show data on residents vs. attendings. 48% of residents report having felt depressed on a screener and nearly 40% report high levels of burnout. 27% report suicidal ideation at least once, and 15% in the past year. On another page they show how these stats stratify according to years in practice. Lots of interesting data in there.

 

[BigM]

5 hours ago, insomnias said:

Every time somebody says that, I like to point to the example of Switzerland which has residencies of comparable length to ours in most specialties while abiding by EU work hour restrictions (48h/week max with no more than 13h of continuous work), and the RCPSC recognizes their training as equivalent for the purposes of exam eligibility. The reason we have long hours during residency isn't because it's a trade-off between hours worked vs competency but because resident labour is significantly cheaper to the government/hospital than that of attending physicians.

While there's definitely some areas where training is overkill in Canada, just because the royal college accepts the training as equivalent doesn't mean that when the training program is said and done, the clinical skill of the physician is equivalent.  Not to knock on Switzerland, I don't know much about their system and assume they have competent doctors.  But at some point, when you are the MRP and the buck stops at you, you might not regret being pushed to get more hours under your belt.  That said, resident work without quality teaching is just cheap labour.

[unmatch]

10 hours ago, gogogo said:

Damn, sorry to hear that. Why do you feel brain dead in FM? Are there things you think a med student aiming for FM should be aware of before deciding on it?

Because I don't feel there's a lot of learning to be had after M4. The focus of the FM residency is instilling independence and practice management skills, you've learned 90%+ of the content by the time you're done med school. I think  you need to think about whether you enjoy the academic drive of the Royal College specialties and the need to learn a topic very in-depth. Family medicine is not about the medicine, it's about following preventative guidelines, reassuring the worried-well, and triaging to other services. You need to decide if you feel happy enough being a doctor regardless of what patients you're seeing or if you really want to be an expert on a topic. There's also a cost-benefit analysis that I think most FM-prospectives go through where you'll make nearly as much as most of the Royal College specialists (excluding surgeons, cardiologists, and GI) while doing an easy and short residency. 

9 hours ago, dooogs said:

What's preventing you from reading up on things yourself if you find that the day to day is too easy?

Because in the end, if you are not seeing patients on whatever you read there's no satisfaction from having that knowledge, and you won't retain it either. Family doctors don't have the time or training to be seeing complex patients. You could spend 30-60 minutes counselling a liver cirrhosis patient and treating all their comorbidities, but you could also just refer to GI or GIM who will be far more experienced in treating something like that. You also bill the same amount for seeing a patient for a rash for 3 minutes so there's no incentive to see complex patients.

[rmorelan]

9 hours ago, insomnias said:

Every time somebody says that, I like to point to the example of Switzerland which has residencies of comparable length to ours in most specialties while abiding by EU work hour restrictions (48h/week max with no more than 13h of continuous work), and the RCPSC recognizes their training as equivalent for the purposes of exam eligibility. The reason we have long hours during residency isn't because it's a trade-off between hours worked vs competency but because resident labour is significantly cheaper to the government/hospital than that of attending physicians.

Ha I mean you are right - the "required service" I mentioned wasn't to imply that service was required to learn the skills etc. It was "required" by the system to operate the way it currently operates. I was stating the philosophy we seem to operate under, not whether it is great system. 

We can in fact change that - it will have consequences of course- something some where would give (I mean even Switzerland for Radiology just as an example is not 5 years - it is 6. So 20% longer. In Europe a lot of the rad programs are 6 years. I am not as familiar with all the other fields - maybe they align with ours. I hope I am remembering this correctly but I think the salary in Switzerland is actually pretty good although some one would argue their tax rate is higher ha. also again I am stuck on rads - that isn't one of the fields we do consider equivalent for the exam although absolutely there are a solid bunch that are ). There are a lot of ways to change medical residency to be more educational - our current system is seems to be based on if you do enough things eventually you will learn enough stuff and see all the strange things so you will be able to practise independently. If you think about that from an educational point of view that is kind of stupid for many fields. Not to focus just on mine but there is nothing stopping you from creating a list of imaging studies all residents have to dictate that actually IS all the pathology you need to know, instead of hoping you eventually might see something (because you won't see somethings that way). I think in many fields there are ways if we wanted to either speed it up reduce the number of hours required in total. 

and someone mentioned this - the idea of academic days post call is nuts. 

There is a lot of back pressure against changing it still - yes it will cost the system more (but not actually the hospital more - I always found that strange actually but I suppose it is just directly the government). There is alway a ton of staff pushing against it - perhaps because they would have to deal with things the residents do now if they weren't there, but many also because it just delays reaching staff level longer which is expensive in many ways.