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Is It Possible To Finish Med School Without Becoming Too Salty Or Cynical?

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The sad truth is it likely is true. Proficiency requires time. There is no way around it. If you cut the number of hours per week, you are gonna increase the number of weeks needed to become proficient.

 

Academic hospitals rely of residents to do work that non educational that chews up some number of hours per week. You could save some hours by dropping that work from a residents life. However, the only way to get rid of this and keep hospitals running is to hire a ton of new docs, NPs and/or PAs. No province can or will fund that.

 

Competence based education isn't going to decrease the amount of training hours needed.

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This is not true, especially considering a proficiency based model of training.

 

well for some fields I would say it is. I mean it is for me eyes on images. I need to see thousands of images, thousands and thousands of images. That just takes time.

 

for surgeons that is hands on patients. I guess there point is it isn't proficiency - they don't just want to be proficient, they want to master it. It isn't binary.

 

Don't get me wrong there are definitely ways to make this shorter, less stressful and easier. We need to do those things.  There are however still limits. 

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having PAs, NPs, and clinical associates helps a ton. The amount of scut work I have to do on call with and without these folks around is really a night and day difference. If my team has a PA, I can go to the OR while I'm on call and see less urgent consults in between cases. I find that when my day isn't being bombarded with ward calls my night becomes a hell of a lot more bearable. 

 

I wouldn't argue for reducing hours but for making the hours you are present in the hospital more relevant to your training. even then, feeling as if you have mastered something often doesn't come until you are a staff and forced to troubleshoot on your own. the more hours you get in during residency, the quicker you will feel competent once you're staff. 

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The problem is then you are looking at an extended residency because you still need the same amount of training. Even if you trim some of the scut work of residency it's still gonna be much longer. So instead of 5 years at 80 hours per week, maybe it's 8 years at 50 hours a week. Believe me, you don't want more years of residency.

 

There are diminishing returns from having long hours though. Sleep deprivation isn't a great state to be in for long-term knowledge retention and there's only so much information a brain can process in a short period of time, so the marginal value of 10 extra hours in a week after 70 have already been invested isn't going to be massive.

 

The research on work hour restrictions has been pretty mixed (and they're not always the highest quality studies), but they definitely aren't painting a clear picture that long work hours are necessary to have sufficiently knowledgeable physicians. Some articles say lower work hours reduce resident competency, some say the reduction increases competency, some say it doesn't make much difference.

 

We're never going to get residency or even practice down to a simple 9-5 job, nor should we be trying. It's true, there are limits on what we can do to reduce working hours in medicine. But 80 hours per week might not be necessary or even helpful and the profession needs to be open to that possibility. The assumption that long hours are essential is often made without independent justification.

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There are diminishing returns from having long hours though. Sleep deprivation isn't a great state to be in for long-term knowledge retention and there's only so much information a brain can process in a short period of time, so the marginal value of 10 extra hours in a week after 70 have already been invested isn't going to be massive.

 

The research on work hour restrictions has been pretty mixed (and they're not always the highest quality studies), but they definitely aren't painting a clear picture that long work hours are necessary to have sufficiently knowledgeable physicians. Some articles say lower work hours reduce resident competency, some say the reduction increases competency, some say it doesn't make much difference.

 

We're never going to get residency or even practice down to a simple 9-5 job, nor should we be trying. It's true, there are limits on what we can do to reduce working hours in medicine. But 80 hours per week might not be necessary or even helpful and the profession needs to be open to that possibility. The assumption that long hours are essential is often made without independent justification.

The other issue that never is really discussed but I think is relevant when it comes to training residents, is training different types of residents can be very different. Training a surgical resident is very different than training a medicine resident which is very different than training a pathology resident. It's likely that trying to apply blanket rules to residency training won't work.

 

I'll talk what I know (surgical training). A huge amount of stuff I do could never be learned from a book. It's a physical skill. Nothing replaces experience in the OR. Even simulation falls well short (tissue feels different and doesn't react correctly, the intricacies of anatomy aren't well detailed, the stress of operating isn't there). You can read it all you want in a book that if you accidentally open this up, you try step A, B then C to stop the bleeding. But knowing what to do and knowing how to do it are completely different things. Surgery is like training for a sport. For surgical training, hours matter.

 

Does a medicine or pathology fellow need to maximize hands on hours like I do? I'm not sure, but it's possible for them achieving competence is less dependent on maximizing hours of exposure.

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Agree with NLegr completely.

 

Also there are specialties where working extended call as staff is the norm so sleep deprivation and working while stressed are something the resident has to be acclimatized too. I know Obs/Gynes that work 72 hr straight calls and I know it s not uncommon for some ICU and intensivists too as well. 

 

One size does not fit all and I am against anything that extends residency by so much as a day, especially since more surgical programs are going the way of requiring fellowships and graduate degrees. 

Edited by Fresh fry

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The other issue that never is really discussed but I think is relevant when it comes to training residents, is training different types of residents can be very different. Training a surgical resident is very different than training a medicine resident which is very different than training a pathology resident. It's likely that trying to apply blanket rules to residency training won't work.

 

I'll talk what I know (surgical training). A huge amount of stuff I do could never be learned from a book. It's a physical skill. Nothing replaces experience in the OR. Even simulation falls well short (tissue feels different and doesn't react correctly, the intricacies of anatomy aren't well detailed, the stress of operating isn't there). You can read it all you want in a book that if you accidentally open this up, you try step A, B then C to stop the bleeding. But knowing what to do and knowing how to do it are completely different things. Surgery is like training for a sport. For surgical training, hours matter.

 

Does a medicine or pathology fellow need to maximize hands on hours like I do? I'm not sure, but it's possible for them achieving competence is less dependent on maximizing hours of exposure.

 

I completely agree, the training requirements for each specialty are not necessarily comparable. Procedure-based specialties almost certainly need more in-hospital training than knowledge-based specialties, though the experience of actual cases is still rather vital for them as well.

 

What I'd like to push against is the assumption that meeting those requirements should come from additional work hours per week. After all, surgical have the same requirements for a healthy lifestyle as other residents, despite the occasional assertion to the contrary. Surgeons still need to sleep, eat, exercise, socialize and spend time with their families, just like everyone else. If a typical internal resident experiences an unhealthy amount of stress, fatigue, and burnout from an 80+ hour workweek, I fail to see how a surgical resident doing arguably more stressful work could be presumed to be fine.

 

That might mean entertaining ideas that are currently considered non-starters, such as increasing years trained for some specialties.

 

Either way, the status quo isn't working. Poor mental health and grossly inadequate overall life satisfaction is reported by a shocking number of residents and practicing physicians, particularly for a well-paid profession primarily focused on human well-being.

 

Agree with NLegr completely.

 

Also there are specialties where working extended call as staff is the norm so sleep deprivation and working while stressed are something the resident has to be acclimatized too. I know Obs/Gynes that work 72 hr straight calls and I know it s not uncommon for some ICU and intensivists too as well. 

 

One size does not fit all and I am against anything that extends residency by so much as a day, especially since more surgical programs are going the way of requiring fellowships and graduate degrees. 

 

I guess my response to that would be that staff shouldn't be working those types of hours either. To me, that's a "two wrongs don't make a right" situation.

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I don't disagree that reducing hours could (although I believe the data is at best mixed about it) improve quality of life amoung residents. However, people just need to be realistic and accept that if you want to push for less hours per week, you better be ready to accept more weeks in residency (aka extend residency).

To be honest, last I read some studies about reducing work hours didn't have a huge impact on resident quality of life. I believe that. Work hours are only a small part of why residency sucks. Things like complete lack of control of your life and schedule, toxic personalities, lack of appreciation, low pay for the value of your work, lack of support, and occasional downright being taken advantage of, all combined to make residency suck. Work hours is a small part of it. I don't think anyone should think that reducing work hours will improve QOL immensely, especially if it means having to spend more time in residency.

I'd rather suffer slightly more for a shorter period of time. But that's just me. Others may feel differently.

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I don't disagree that reducing hours could (although I believe the data is at best mixed about it) improve quality of life amoung residents. However, people just need to be realistic and accept that if you want to push for less hours per week, you better be ready to accept more weeks in residency (aka extend residency).

 

To be honest, last I read some studies about reducing work hours didn't have a huge impact on resident quality of life. I believe that. Work hours are only a small part of why residency sucks. Things like complete lack of control of your life and schedule, toxic personalities, lack of appreciation, low pay for the value of your work, lack of support, and occasional downright being taken advantage of, all combined to make residency suck. Work hours is a small part of it. I don't think anyone should think that reducing work hours will improve QOL, especially if it means having to spend more time in residency.

 

I'd rather suffer slightly more for a shorter period of time. But that's just me. Others may feel differently.

NLengr, do you mind sharing your thoughts about which surgical specialties wouldn't make one's life a living hell during residency ?

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I don't disagree that reducing hours could (although I believe the data is at best mixed about it) improve quality of life amoung residents. However, people just need to be realistic and accept that if you want to push for less hours per week, you better be ready to accept more weeks in residency (aka extend residency).

 

To be honest, last I read some studies about reducing work hours didn't have a huge impact on resident quality of life. I believe that. Work hours are only a small part of why residency sucks. Things like complete lack of control of your life and schedule, toxic personalities, lack of appreciation, low pay for the value of your work, lack of support, and occasional downright being taken advantage of, all combined to make residency suck. Work hours is a small part of it. I don't think anyone should think that reducing work hours will improve QOL, especially if it means having to spend more time in residency.

 

I'd rather suffer slightly more for a shorter period of time. But that's just me. Others may feel differently.

 

Yeah, the data on resident well-beings is equally mixed, though the more recent reviews I've read indicate that the small effect was at least positive. It's also worth noting that specialties with lower working hours are fairly well correlated with increased satisfaction with home life. Hours are certainly not the only factor that matters, but they're not an insignificant factor either.

 

That said, work hours are a symptom of the main problem: the attitude in medicine that treats residents (and to a lesser extent staff physicians and medical students) like they somehow don't have the same human needs as everyone else. Long work hours, lack of schedule control, lack of appreciation, and all the other forms of disrespect you list. By all indications this attitude is getting better - the fact that work hour restrictions are so heavily discussed at all demonstrates as much - but it's still a surprisingly strong and prevalent attitude and my major concern is it's one that self-perpetuates. I've seen so many residents embrace the attitude in this weird form of quasi-Stockholm Syndrome, where they downplay, excuse, or even support the negative aspects of being a resident all while their quality of life suffers. I understand it as a coping mechanism, but it keeps that attitude alive for the next generation of residents.

 

This is the main reason I push back against residents on this forum defending current work hours, because I worry about the perpetuation of that attitude. Even if we accept that the work hours are an unfortunate necessity, or that there are greater priorities to address in resident well-being, there needs to be some acknowledgement that the current situation for residents is far from ideal. It's the only way some positive changes for resident well-being are going to be pushed forward.

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Yeah, the data on resident well-beings is equally mixed, though the more recent reviews I've read indicate that the small effect was at least positive. It's also worth noting that specialties with lower working hours are fairly well correlated with increased satisfaction with home life. Hours are certainly not the only factor that matters, but they're not an insignificant factor either.

 

That said, work hours are a symptom of the main problem: the attitude in medicine that treats residents (and to a lesser extent staff physicians and medical students) like they somehow don't have the same human needs as everyone else. Long work hours, lack of schedule control, lack of appreciation, and all the other forms of disrespect you list. By all indications this attitude is getting better - the fact that work hour restrictions are so heavily discussed at all demonstrates as much - but it's still a surprisingly strong and prevalent attitude and my major concern is it's one that self-perpetuates. I've seen so many residents embrace the attitude in this weird form of quasi-Stockholm Syndrome, where they downplay, excuse, or even support the negative aspects of being a resident all while their quality of life suffers. I understand it as a coping mechanism, but it keeps that attitude alive for the next generation of residents.

 

This is the main reason I push back against residents on this forum defending current work hours, because I worry about the perpetuation of that attitude. Even if we accept that the work hours are an unfortunate necessity, or that there are greater priorities to address in resident well-being, there needs to be some acknowledgement that the current situation for residents is far from ideal. It's the only way some positive changes for resident well-being are going to be pushed forward.

 

Why do you think it is a coping mechanism, that is completely baseless? Could it not possibly be more in line with what NLegr has said where people who have actually gone through the system realize that as much as it sucks there is something necessary to it? Soldiers who go through basic training don't have a "good time" but every one of them that has been to war would wish that their training had been even harder. It is completely naive of a person who has no real idea of what they are rallying against to condemn the people that support it and to insult them by saying that they have no real concept of why they are supporting it, that is way out of line.

 

I am applying to two surgical specialties that are probably #2 and #5 when it comes to hours worked (neurosurge is the worst hands down). I have a young family and the thought of being away from my kids and not being able to support my wife bothers me to no end. But I have actually walked the walk, I have done over 20 weeks of electives, spent nearly a year on 1 in 4 call during core rotations and I have a choice. I will probably chose one of the more "intense" programs specifically for the reason that in the specialties I am interested in, you need the hours to be competent. There is no stockholm syndrome, I have just seen the alternative and know that you need to do a 1000 assessments in the ER and you need to scrub in and retract on 1000 cases to see the anatomy to know what you are looking at and not chop up ureters, you need to sew with double gloves on a million times, etc. 

 

I want to get through that as fast as possible. As for resident "well-being", people have choices as to where they want to go; democracy is forcing programs to get better everyday to attract the best candidates. Schools have implemented night floats, afternoon naps, mandatory protected home time. There are many examples of toxic programs that are slow to catch on and I'm glad there are people who are pushing to correct this but the fact of the matter is residency sucks regardless; it is the same as a marathon or climbing a mountain. You can do things to make it suck less but it is hell while you are going through it; the trick with both is to get it over with as fast as possible. The bigger the mountain the greater the challenge and the greater the suck. 

 

Here is the thing: when you get on to the ward in a couple years, and you are on overnight call for the first time in your life, and you are tired because you have been up all night admitting some COPD'er for the 13th time this month you are going to think back on this and think "I was right, why don't we have night float" or "what is the point of this, this is scut I'm not learning anything". But then your next page will be a for a coding patient or someone who is really sick and having chest pains and you are going to wish you had seen this a hundred times before. You are going to feel scared and inadequate and when that person dies, even if it is through no fault of your own, you are going to feel worse than you have ever felt before. You are going to start staying late after you could go home to see more cases, you are going to study harder than you have ever before. That's not stockholm syndrome, that is the drive to be the best, the sense of commitment and professionalism that has brought us all this far. This is a serious game with the most serious of stakes; maybe your attitude will change once you have played it, I'm sure you won't be so quick to condemn those who have.

Edited by Fresh fry

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Why do you think it is a coping mechanism, that is completely baseless? Could it not possibly be more in line with what NLegr has said where people who have actually gone through the system realize that as much as it sucks there is something necessary to it? Soldiers who go through basic training don't have a "good time" but every one of them that has been to war would wish that their training had been even harder. It is completely naive of a person who has no real idea of what they are rallying against to condemn the people that support it and to insult them by saying that they have no real concept of why they are supporting it, that is way out of line.

 

I am applying to two surgical specialties that are probably #2 and #5 when it comes to hours worked (neurosurge is the worst hands down). I have a young family and the thought of being away from my kids and not being able to support my wife bothers me to no end. But I have actually walked the walk, I have done over 20 weeks of electives, spent nearly a year on 1 in 4 call during core rotations and I have a choice. I will probably chose one of the more "intense" programs specifically for the reason that in the specialties I am interested in, you need the hours to be competent. There is no stockholm syndrome, I have just seen the alternative and know that you need to do a 1000 assessments in the ER and you need to scrub in and retract on 1000 cases to see the anatomy to know what you are looking at and not chop up ureters, you need to sew with double gloves on a million times, etc.

 

I want to get through that as fast as possible. As for resident "well-being", people have choices as to where they want to go; democracy is forcing programs to get better everyday to attract the best candidates. Schools have implemented night floats, afternoon naps, mandatory protected home time. There are many examples of toxic programs that are slow to catch on and I'm glad there are people who are pushing to correct this but the fact of the matter is residency sucks regardless; it is the same as a marathon or climbing a mountain. You can do things to make it suck less but it is hell while you are going through it; the trick with both is to get it over with as fast as possible. The bigger the mountain the greater the challenge and the greater the suck.

 

Here is the thing: when you get on to the ward in a couple years, and you are on overnight call for the first time in your life, and you are tired because you have been up all night admitting some COPD'er for the 13th time this month you are going to think back on this and think "I was right, why don't we have night float" or "what is the point of this, this is scut I'm not learning anything". But then your next page will be a for a coding patient or someone who is really sick and having chest pains and you are going to wish you had seen this a hundred times before. You are going to feel scared and inadequate and when that person dies, even if it is through no fault of your own, you are going to feel worse than you have ever felt before. You are going to start staying late after you could go home to see more cases, you are going to study harder than you have ever before. That's not stockholm syndrome, that is the drive to be the best, the sense of commitment and professionalism that has brought us all this far. This is a serious game with the most serious of stakes; maybe your attitude will change once you have played it, I'm sure you won't be so quick to condemn those who have.

My comment there wasn't directed at NLengr, but at other residents I've seen who are clearly suffering beyond what they seem to be able to handle in a healthy fashion, but still defend the situation causing that suffering. If that doesn't apply to NLengr, that's fine, it wasn't intended to.

 

Again, even if it is necessary, that doesn't mean it's positive or even benign, yet that's often the attitude that comes out. Simply saying those work hours are necessary is the reflexive response, but it puts the onus on individuals to deal with the fallout of that necessity, which more than a few can't for very understandable reasons. Even something as simple as saying it's necessary, but undesirable changes the conversation a bit, putting more responsibility on programs and systems, rather than dumping it largely on the individual residents.

 

We are moving in that direction, but it's slow, with a fair bit of resistance and much more apathy standing in the way. A culture in medicine that reflexively defends the sucky parts of medicine as necessary or desirable isn't a culture that's likely to promote change. Yeah, in the end, longer work hours might be necessary or better than the alternative, but it shouldn't be the assumption that they are. After all, the argument was that >80 hour work weeks were necessary when the original work hour restrictions went into place in the US and a decade later, the evidence that those pre-restriction hours were actually necessary is fairly inconclusive.

 

I guess my overarching point is that it's worth calling a spade a spade. It sucks to work 80 hours a week. If it's necessary, I'll do it - like you, I've pretty much already signed up to do it (and am doing it). But it shouldn't be a controversial or objectionable point to say that 80 hour work weeks suck - yet the frequent response, including in this thread, is to object to these statements.

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NLengr, do you mind sharing your thoughts about which surgical specialties wouldn't make one's life a living hell during residency ?

None. Unfortunately, surgery of any kind generally has lots of stuff that can't wait. If you want a balanced resident life stay far far away from the OR. Maybe look into family, psych, path etc.

 

Less terrible than average: ENT, Optho, Plastics

Average levels of terrible: Urology, Cardiac (maybe, I haven't spent much time with them)

Terrible: Gen Surg, Ortho, Vascular

Ultra terrible: Neurosurg

 

That's my own opinion based on my experience at my center. Don't take it for gospel.

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That said, work hours are a symptom of the main problem: the attitude in medicine that treats residents (and to a lesser extent staff physicians and medical students) like they somehow don't have the same human needs as everyone else.

I agree that medicine seems to have a problem with people acting badly toward each other as a default.

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Why do you think it is a coping mechanism, that is completely baseless? Could it not possibly be more in line with what NLegr has said where people who have actually gone through the system realize that as much as it sucks there is something necessary to it? Soldiers who go through basic training don't have a "good time" but every one of them that has been to war would wish that their training had been even harder. It is completely naive of a person who has no real idea of what they are rallying against to condemn the people that support it and to insult them by saying that they have no real concept of why they are supporting it, that is way out of line.

 

I am applying to two surgical specialties that are probably #2 and #5 when it comes to hours worked (neurosurge is the worst hands down). I have a young family and the thought of being away from my kids and not being able to support my wife bothers me to no end. But I have actually walked the walk, I have done over 20 weeks of electives, spent nearly a year on 1 in 4 call during core rotations and I have a choice. I will probably chose one of the more "intense" programs specifically for the reason that in the specialties I am interested in, you need the hours to be competent. There is no stockholm syndrome, I have just seen the alternative and know that you need to do a 1000 assessments in the ER and you need to scrub in and retract on 1000 cases to see the anatomy to know what you are looking at and not chop up ureters, you need to sew with double gloves on a million times, etc.

 

I want to get through that as fast as possible. As for resident "well-being", people have choices as to where they want to go; democracy is forcing programs to get better everyday to attract the best candidates. Schools have implemented night floats, afternoon naps, mandatory protected home time. There are many examples of toxic programs that are slow to catch on and I'm glad there are people who are pushing to correct this but the fact of the matter is residency sucks regardless; it is the same as a marathon or climbing a mountain. You can do things to make it suck less but it is hell while you are going through it; the trick with both is to get it over with as fast as possible. The bigger the mountain the greater the challenge and the greater the suck.

 

Here is the thing: when you get on to the ward in a couple years, and you are on overnight call for the first time in your life, and you are tired because you have been up all night admitting some COPD'er for the 13th time this month you are going to think back on this and think "I was right, why don't we have night float" or "what is the point of this, this is scut I'm not learning anything". But then your next page will be a for a coding patient or someone who is really sick and having chest pains and you are going to wish you had seen this a hundred times before. You are going to feel scared and inadequate and when that person dies, even if it is through no fault of your own, you are going to feel worse than you have ever felt before. You are going to start staying late after you could go home to see more cases, you are going to study harder than you have ever before. That's not stockholm syndrome, that is the drive to be the best, the sense of commitment and professionalism that has brought us all this far. This is a serious game with the most serious of stakes; maybe your attitude will change once you have played it, I'm sure you won't be so quick to condemn those who have.

I don't think Ralk was condemning anyone but rather questioning (appropriately I think) why we seem to be so eager in medicine to accept some really negative aspects of training. We all get that heavy hours are necessary in some form or another. That doesn't account for all the other reasons why residency sucks as described by a resident.

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I'm now an attending out 5 years since fellowship. 

 

It's tough not to have your cynical moments in medicine.  I think there's a major shift in cynicism throughout medical school.  I think there's a big one between med school orientation (when everyone and everything is immensely positive, and the world couldn't be better), and the end of preclerkship (where you are getting tired of hitting books and memorizing). 

 

Then, there's an even bigger increase in cynicism as you go through clerkship.  Hours are long, call is frequent, and you are always the low-person on the totem pole rotating into an unfamiliar specialty/ward.  You also start to really experience the widespread dysfunction in medicine, and finally get lots of 1 on 1 time with bitter interns/residents/staff.  You will probably get treated like crap by a higher-up at least once, if not frequently.  Unlike when you were premed, and you could brush off a cynical physician as "just being jaded, and I'm not going to be like that", you start to discover that there are lots of reasons to be unhappy.  Additionally, if your personal life wasn't super resilient prior to clerkship, the added stress of clerkship often spills into your personal life, and can affect your relationships with friends and family. 

 

Internship/residency/fellowship is additional climbing along the staircase of cynicism.  You are directly responsible for the care of most patients in the hospital, often work the longest hours, and are paid a fraction of what you'd be paid if doing that work as a staff physician.  Along with all the call and weekend work, you are expected to pump out research and prepare for board exams.  Given your stage of life, you may also be balancing raising young children at this point.  Between the 60-80 hours/week of clinical work, and all those additional duties, there's not a lot of personal time left.  You are also likely in 6-figure debt at this point.

 

Then there's attending-hood.  :)  I'm really happy with work and life in general here.  Still have a few cynical moments here and there, but nothing like during training.  In my specialty, the hours are much better as an attending, and work-life balance is easily achievable for most.  I realise there are many specialties where this may not be possible, as a young attending who is trying to build out a practice.  I think a lot of the happy physicians out there are ones who have managed to control their work-life balance.  If I were advising a young medical student, I would say that choosing a specialty where you can control your lifestyle is likely to make you happier on a day to day basis. 

 

I'm also very fortunate to work in hospitals where we have good relationships with the other physicians, and this makes the work-day infinitely more fun.  Inter-specialty squabbling and fighting is draining and exhausting for all.  I haven't worked at that many sites, but my overall impression is that staff at community hospitals tend to be more friendly, compared to most academic places.  Smaller sites tend to have less politics.  I think a lot of people who end up working in a smaller community site go in with the goal of having a drama-free day, and the focus is on getting in, getting the work done, and getting back home.  As well, you are likely to know all the other physicians personally within a short amount of time, and it's a lot harder to tell someone off if you see them on a daily basis.

 

Although it's impossible to generalize, I think it's fair to say that many trainees may have limited exposure to community work in medical school and residency.  Just don't forget that it is out there, and many/most physicians will end up working in a community setting after training.

 

Ian

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None. Unfortunately, surgery of any kind generally has lots of stuff that can't wait. If you want a balanced resident life stay far far away from the OR. Maybe look into family, psych, path etc.

 

Less terrible than average: ENT, Optho, Plastics

Average levels of terrible: Urology, Cardiac (maybe, I haven't spent much time with them)

Terrible: Gen Surg, Ortho, Vascular

Ultra terrible: Neurosurg +OBS/Gyne

 

That's my own opinion based on my experience at my center. Don't take it for gospel.

One addition. However some people count gyne as its own thing

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My comment there wasn't directed at NLengr, but at other residents I've seen who are clearly suffering beyond what they seem to be able to handle in a healthy fashion, but still defend the situation causing that suffering. If that doesn't apply to NLengr, that's fine, it wasn't intended to.

 

Again, even if it is necessary, that doesn't mean it's positive or even benign, yet that's often the attitude that comes out. Simply saying those work hours are necessary is the reflexive response, but it puts the onus on individuals to deal with the fallout of that necessity, which more than a few can't for very understandable reasons. Even something as simple as saying it's necessary, but undesirable changes the conversation a bit, putting more responsibility on programs and systems, rather than dumping it largely on the individual residents.

 

We are moving in that direction, but it's slow, with a fair bit of resistance and much more apathy standing in the way. A culture in medicine that reflexively defends the sucky parts of medicine as necessary or desirable isn't a culture that's likely to promote change. Yeah, in the end, longer work hours might be necessary or better than the alternative, but it shouldn't be the assumption that they are. After all, the argument was that >80 hour work weeks were necessary when the original work hour restrictions went into place in the US and a decade later, the evidence that those pre-restriction hours were actually necessary is fairly inconclusive.

 

I guess my overarching point is that it's worth calling a spade a spade. It sucks to work 80 hours a week. If it's necessary, I'll do it - like you, I've pretty much already signed up to do it (and am doing it). But it shouldn't be a controversial or objectionable point to say that 80 hour work weeks suck - yet the frequent response, including in this thread, is to object to these statements.

 

I don't think you were attacking NLegr, what I am saying is this is not a "reflex response". NLegr et al is saying that this is necessary, crappy residencies have to be to a certain extent crappy, it is innate and unavoidable.

 

Here is where we have common ground: I would rather things only be as difficult as absolutely necessary. I agree there is a backwards culture in medicine where people say "it sucked for me so it should suck for them". I don't think this is productive. I think we should always be striving towards perfection in how we educate/learn, we are nowhere near there yet. I wish people took the same attitudes that they do with their children. We all want our children to have a better world than the one we experienced. In medicine, the attitude seems to be the opposite. 

 

I think where we differ (and this is common with most people who are interested or doing surgical training) is that putting time restrictions and limiting work hours is detrimental to our training. I used to think there was no way someone needed to work 100hrs/week to be competent at what they do. I automatically assumed the system was broken and most of that had to be scut. From where I am standing now I totally understand why this is the case and I will actively fight to prevent work hour restrictions for the reasons others have warned about: 1) longer residency 2) lower competency 3) resentment from staff which really can mess with your life (I would rather stay an hour later and dictate for my preceptor than have them pissed at me and not willing to help me find a job when I'm done). 

 

I think we all want to make things better for ourselves and for those coming behind us, no one would say the status quo is ideal. Please don't assume that those of us who are against work hour restrictions are reflexively doing so. We have our own informed and experienced reasons.

Edited by Fresh fry

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If you are gonna stick obs/gyne in the list (I didn't just because I didn't think of it), I would stick it in with Gen Surg. Bad hours, but generally decent outcomes.

 

What sets neurosurg to an extra level of terrible imo is the outcomes, even when good, are still frequently not very satisfying. That's on top of a heavy workload.

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If you are gonna stick obs/gyne in the list (I didn't just because I didn't think of it), I would stick it in with Gen Surg. Bad hours, but generally decent outcomes.

 

What sets neurosurg to an extra level of terrible imo is the outcomes, even when good, are still frequently not very satisfying. That's on top of a heavy workload.

That being said, there is less poo. The neurosurgeons I know like that.

/nonsurgeon

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I don't think you were attacking NLegr, what I am saying is this is not a "reflex response". NLegr et al is saying that this is necessary, crappy residencies have to be to a certain extent crappy, it is innate and unavoidable.

 

Here is where we have common ground: I would rather things only be as difficult as absolutely necessary. I agree there is a backwards culture in medicine where people say "it sucked for me so it should suck for them". I don't think this is productive. I think we should always be striving towards perfection in how we educate/learn, we are nowhere near there yet. I wish people took the same attitudes that they do with their children. We all want our children to have a better world than the one we experienced. In medicine, the attitude seems to be the opposite. 

 

I think where we differ (and this is common with most people who are interested or doing surgical training) is that putting time restrictions and limiting work hours is detrimental to our training. I used to think there was no way someone needed to work 100hrs/week to be competent at what they do. I automatically assumed the system was broken and most of that had to be scut. From where I am standing now I totally understand why this is the case and I will actively fight to prevent work hour restrictions for the reasons others have warned about: 1) longer residency 2) lower competency 3) resentment from staff which really can mess with your life (I would rather stay an hour later and dictate for my preceptor than have them pissed at me and not willing to help me find a job when I'm done). 

 

I think we all want to make things better for ourselves and for those coming behind us, no one would say the status quo is ideal. Please don't assume that those of us who are against work hour restrictions are reflexively doing so. We have our own informed and experienced reasons.

 

I think the difference of opinion we have is largely semantics. I understand why there are often long hours in residency and why the immediately available alternatives may not be preferable. Given that these same reasons were proffered when the original work hour restrictions were put in place and the feared outcomes haven't been clearly demonstrated, I don't accept that position as demonstrably true, but I do accept the clear rationale behind it and that there are almost certainly higher priorities to address in the realm of resident well-being.

 

What I'd like to close with is that semantics matter, especially when the underlying problem is cultural. Your first post on work hours in this thread was to summarily dismiss the opinion of a person who is only a single year behind you in training for daring to disagree with a resident. Regardless of the individual merits of work hour restrictions, that's not an attitude that allows individuals to advocate for their own well-being or those of others in medicine. As we've had a productive discussion, more of the nuance behind your viewpoint has come out, and that's an extraordinarily positive thing. However, that nuance needs to be led with, not something that comes out after a lengthy discussion, because many people never have such a long back-and-forth.

 

The concluding opinion that work hour restrictions would be detrimental - which as you say, is rather prevalent - covers over the real downsides to the long hours that exists in medicine. For individuals who are coping well with these long hours, that conclusion is enough. Yet, for the significant minority of individuals who, at any given time, are not coping well with the long hours, focusing on the conclusion alone is inadequate. It's these individuals who I claim sometimes reflexively support long work hours. I've seen too many people in medicine push themselves far too hard or for too long, then blame themselves for being inadequate because they live in a world where long hours are presented as an absolute necessity or a desirable situation by peers or superiors. How we talk to each other about the challenges of medicine or medical training matters.

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One thing I haven't seen mentioned is that residents are juggled around like a used chewtoy. Often there is little continuity and you are being shuffled from clinic to clinic, service to service and are constantly working with different staff members. After a while it becomes exceedingly exhausting to have to cater to all those variable factors. Sleep deprivation tends to bother me the least; it's running into different people who are adament that their way is the right and only way to do things that totally gets to me. If you are doing what you enjoy, hours suddently don't matter as much but the working environment will always affect you. Some of the most pleasant experiences have been with staff that let you do what you want to do in light of the fact it's not how they would do things.

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Entering 3rd year now, I've seen/heard a lot of my friends becoming cynical and salty.

 

I think the most important thing is to be passionate with both the scientific knowledge and of course the human side of medicine.

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