Surgery vs IM residency hours and lifestyle

[Cuttlefish]

How do hours and lifestyle in Surgical residencies such as General Surgery and Urology compare to IM residency? I recently heard that call in IM was also pretty bad but I was hoping to clarify.

[jnuts]

No clear answer here.  Really depends on your training specialty, center, and site.  

There are definitely training years when IM looked worse than what I was doing as a surgical resident.  However, on average I think surgery is more consistently demanding on your time and more stressful/less supported than IM through all 5 years.

[NLengr]

In the community IM is the worst of the three for after hours work. The IMs at my center seem pretty busy on call but we are a rural secondary center so we don't have most subspecialties. So for MI's, AKI needing dialysis, ICU admits etc. general IM is handling those instead of cardiology, critical care, nephro etc. And the patients are not easy patients a lot of the time (grandma with mild dementia, pneumonia and CHF). Gen Surg seems tolerable at our center than IM but milage may vary.  Urology is almost as busy as gen surg when it comes to volume of on call cases (we recently reviewed all the after hours add on volume for the OR) but no urologist is doing a routine stone patient at 2 am (by far the most common add on case for them), where-as it's not unheard of for gen surg to have to take a bowel to the OR at 2 am. So the urologists here have better hours for add ons because they can put more off till the next day. 

Also, poop is gross. 

[1D7]

Hours/call: For IM residency 9 hour work days starting at 8am. During call you often work most or all of the night but will always take a post-call day. For general surgery residency 12 hour days starting between 6am-7am. Call shifts more variable in that some nights you'll get more rest. Post-call days are variable as well: there is a culture (worse at some places) of not taking post-call days if the night was light or if there's a significant lack of manpower/assists the day after.

Stress: Worse in general surgery. It stems from the culture, the fact that you work in close proximity to your attendings, and the fact that for ORs overnight, you will have to call them in.

Lifestyle flexibility: Variable across institutions but in general it is not very flexible in general surgery because it is a smaller program than IM. For IM there are usually more residents around and the culture is usually a bit more amenable to lifestyle flexibility/starting a family.

Overall it's worse in general surgery residencies. Hard to comment about the call and stress in surgical subspecialties, but the hours and lifestyle flexibility are worse across the board due to the nature of when ORs start/finish and how small the programs are.

[NLengr]

If you are debating between the specialties, I would strongly consider attending lifestyle and try not to sweat residency lifestyle. Residency will suck no matter what you do for 5 years. But you need to work your attending job for 30 years.

All residency sucks. Any surgical specialty will be horrible (maybe not optho?). I imagine IM residency also sucks the big one much of the time.

[ACHQ]

When it comes to residency (generally speaking), what I have seen from surgery residents (at my center) is that they definitely have longer hours (on non-call days) and less post call days than my IM colleagues.

If you are smart/efficient and aren't a tool your days on IM generally run from 8-5/6 at the worst. Occasional busy days you will finish later but those in my experience were far and few in between (and they are balanced out by the days you can take off early). I can't comment for sure but it seems all surgical residents are in the hospital on non-call days past 6pm (and they start usually before 7). IM will also ALWAYS get a post call day. I will say though IM residents (especially the SMR on call) are routinely busy AF. The volumes are much higher for IM (on avg) than surgery overnight. That being said we also have 3 JMRs on top of the SMR to do split the work, but the SMR has to review everything and see all the patients anyways... (and plus we go into a crap ton of detail when seeing patients)

This refers to the core 3 years of IM residency and not subspecialty. Because hands down surgery is busier than any subspecialty IM (with maybe the exception of cardio and ICU)

I also agree with all residency's suck big time, don't base your decision on residency lifestyle especially if they are the same length.

[1D7]

For small/moderate differences in residency lifestyle I agree it's not worth basing your decision of residency off of.

For absolutely massive differences like pathology/psychiatry vs general surgery, then it's worth thinking about. The difference is putting your life on hold x5 years vs being able to live some of it freely (e.g. being able to start a family vs putting it on hold).

[NLengr]

1 hour ago, 1D7 said:

For small/moderate differences in residency lifestyle I agree it's not worth basing your decision of residency off of.

For absolutely massive differences like pathology/psychiatry vs general surgery, then it's worth thinking about. The difference is putting your life on hold x5 years vs being able to live some of it freely (e.g. being able to start a family vs putting it on hold).

I started a family during a surgical residency. Added a second during fellowship. I'm a dude so the whole carrying the child/breastfeeding was a non issue. It's do-able. Your spouse has to shoulder a lot of work and be amazing though. 

[Edict]

On 2/29/2020 at 7:32 PM, Cuttlefish said:

How do hours and lifestyle in Surgical residencies such as General Surgery and Urology compare to IM residency? I recently heard that call in IM was also pretty bad but I was hoping to clarify.

I would say surgical residencies are worse than IM in general. surgical residencies tend to be worse than medicine especially R3+, but in R1 and 2, surgical residencies tend to still have it busier but less so. 

Generally speaking for general surgery your 1st and 2nd years are mostly 70-100 hour weeks 1 in 4 call. You start at 6:30 on average and finish around 6pm on average. You stay post-call until 11-12pm on average. General surgery and similar rotations will average 75% of your year. Your days are incredibly busy and you typically are covering multiple things at once, OR, ward, consults etc.  You do some ICU (3 or so) and you do have a few rotations that are more relaxing like GI/Scope but these number around 3-4 in the 2 years. 

As a R3-5 your responsibility shifts to more operative and your hours typically stay the same but there is more operating and less scut. R4s and 5s often have chief responsibilities and often have to take one for the team in terms of hours as they have to cover when others are sick or forget and this can add to your hours and stress. Surgery especially as an R3+ does not respect post-call as this is considered your time to learn. Your call typically shifts to home call which is typically less busy but you will still have to do some in house call depending on site location and responsibility. Your hours are definitely going to be worse than in IM at this point. 

For IM, your 1st and 2nd years are typically the hardest. Your hardest rotation is probably CTU but that usually starts around 745 and ends around 5-6pm with 1 in 4 call and you do it 4-5 months out of the year. During your non CTU rotations, if you are doing clinical based subspecialties (8-12 blocks in 2 years or so), your hours will be around 40-50 hours a week with 1 in 7 fly in call or so. If you are doing cardiology you may have to take cardio call which is 1 in 4 but probably slightly less busy. CCU and ICU are around 7 to 4:30pm with 1 in 4-5 call. 2nd year in IM can be stressful because you are applying to subspecialties and doing electives. 

In 3rd year IM is more focused on writing your RC which is stressful, but your rotations typically are more relaxing, once CaRMS results come through you are on full study mode and you typically choose rotations that have minimal call and 40-50 hours a week. You still may need to cover and do a few busier rotations, but it tends to be easier. 

IM respects post-call which generally means leaving around 10am. 

As a subspecialist, unless you are in cardiology (which tends to have a busy R4 and slightly better R5 and 6 years), things tend to be more relaxing. Home call is the norm, call is less busy and you can make a lot more income by working as an internist moonlighting than as a surgical resident. 

 

 

[tacotacotaco]

On 3/14/2020 at 5:56 PM, Edict said:

As a R3-5 your responsibility shifts to more operative and your hours typically stay the same but there is more operating and less scut. R4s and 5s often have chief responsibilities and often have to take one for the team in terms of hours as they have to cover when others are sick or forget and this can add to your hours and stress. Surgery especially as an R3+ does not respect post-call as this is considered your time to learn. Your call typically shifts to home call which is typically less busy but you will still have to do some in house call depending on site location and responsibility. Your hours are definitely going to be worse than in IM at this point.

I've heard this from a few residents while shadowing as well - provides learning opportunities, but also it reflecting poorly on your dedication/desire to learn if you take post-call days. Not in that boat but, do people generally retain a lot of what they learn during this time? Is this about squeezing in as many cases as possible during residency? Sounds like residents would be pretty sleep deprived.

[JohnGrisham]

On 3/3/2020 at 1:33 PM, ACHQ said:

If you are smart/efficient and aren't a tool your days on IM generally run from 8-5/6 at the worst.

I chuckled at this, definitely seen the opposite in action (Seniors not willing to delegate, shouldering too much on, being too micro-managing and staying until 8pm).

[ACHQ]

19 hours ago, JohnGrisham said:

I chuckled at this, definitely seen the opposite in action (Seniors not willing to delegate, shouldering too much on, being too micro-managing and staying until 8pm).

Hence my comment bout those people being tools... they think it will make them better physicians, but in reality it just a waste of time and will lead to burn out

[Edict]

On 5/19/2020 at 3:15 PM, tacotacotaco said:

I've heard this from a few residents while shadowing as well - provides learning opportunities, but also it reflecting poorly on your dedication/desire to learn if you take post-call days. Not in that boat but, do people generally retain a lot of what they learn during this time? Is this about squeezing in as many cases as possible during residency? Sounds like residents would be pretty sleep deprived.

I think you do retain most of it, I think being sleep deprived though does make it harder for you to learn outside of work because you just want to sleep. As a surgical resident you want to have more operating time to get experience since you do a lot of your learning by doing. I think residents are sleep deprived but your body also gets more used to it overtime, but I don't think anyone truly loves staying post-call, but its a bit like a rolling stone and the more you demonstrate keenness to operate and learn, the more staff want to let you do and mentor you