The most competitive residencies and why

[Guest drews97]

One word...for the most part the most competitive specialties are the ones that will afford the best lifestyle while paying well. Let's face it...we are lazier as a whole than people were 30 years ago, have much more of a life outside of medicine and are generally willing to put up with less sh_t. This is why ortho and neurosurg aren't the hardest things in the world to get into (assuming you've done some electives, gotten good references, etc). You work frickin insane hours during residency (and as an attending for the most part). One of the R1's in ortho said they figured their pay was about $7 an hour!!! On the other hand, emerg and derm pay well (emerg doesn't look great overall, but if you factor in only about 36 hours per week on average and no overheads it's pretty sweet) and you'll have lots of time off. Emerg docs, for example only work about 14-16 shifts a month. You get half your month off!!

[Guest physiology]

Hello,

 

On paper, emerg sounds good. But imagine doing two 8-hour night shifts a week. Those shifts really screw up the circadian, sleep-wake cycles and it takes you time to recover...

 

And it only gets harder as you age...I know one FRCPC emerg doc and he doesn't understand how anyone could call emergency medicine a "lifestyle" specialty. This is probably one isolated case, but when I asked him if he thought emerg was fun, he gave a flat-out "no." That gave me quite the shock as I thought being kept on your feet, the variety of cases, and non-stop action of emerg would be fun.

 

Anyway - food for thought.

[Guest drews97]

Well, it's not so bad. Compare it to surgery where you may be doing a 36 hour shift!!! (at least as a resident). I just did 6 weeks of emerg recently and honestly, the night shifts aren't so bad. Most of the hospitals will give you consecutive night shifts so that you can adjust. Sleep till 2 or 3 PM and you've got a lot of the day to do things. Plus, 8 hours is a lot less time than you'll be working per day compared to most others!

[Guest Kirsteen]

Hey there,

 

This past week (Monday through Monday) I had 3 call shifts while in Gen Surg and for two of them we were up pretty much all night. So that amounted to one 36 hour shift (I didn't return home until 6pm the following night), one 30 hour shift with no sleep and one 30 hour shift with a bit of sleep (two hours or so). In between, we still had to show up for the regular shifts which began at 6:45am each morning. Comparatively, those ER shifts sound luxurious.

 

Cheers,

Kirsteen

[Guest muchdutch]

Kirsteen, was that in Alberta? I thought there wer limits to the number of hours you could work.....

[Guest summervirus]

I too have worked similar hours before (30-36) on general surgery. The limits that you might be referring to are according to the PARA contract. But, PARA protects residents, not students. So, students can be kept after as long as possible. I can't speak on behalf of Kirsteen, but for myself, I know that the residents in general surgery (and other surgical subspecialties) would frequently break the PARA rules to work more. Many of them said that they needed the extra hours in their training. So, the staff attendings would sometimes ask them to go home post-call, but, in reality, nobody would go home. They would voluntarily stay behind.

[Guest alysha05]

I was wondering when you say "Radiology", are people referring to Diagnostic Radiation or Radiation Oncology, since they appear as two separate programs in CaRMs.

 

thanks.

[Guest Ian Wong]

Radiology and "Rads" refer to the specialty of diagnostic radiology. This field deals primarily with medical imaging and its interpretation (ie. interpretation of ultrasounds, x-rays, CT and MRI scans, etc). There is a subspecialty of diagnostic radiology called interventional radiology, where interventional radiologists do procedures through the arteries and veins of the body.

 

Radiation Oncology aka "Rad Onc" is an entirely separate specialty. Their specialty deals primarily with cancer, and its treatment using all sorts of radiation therapies, including externally-applied radiation as well as implanted radioactive seeds (which can be placed within or adjacent to tumour to deliver higher doses of radiation with less harm to the adjacent normal tissue).

 

In Canada, both diagnostic radiology and radiation oncology are fairly competitive specialties, though not as competitive as other specialties like Ophthalmology, Dermatology, or Plastic Surgery.

 

In the US, diagnostic radiology is a fairly competitive specialty, while radiation oncology is one of the hardest specialties to match.

 

Ian

[Guest Lurkergonepublic]

I know that the residents in general surgery (and other surgical subspecialties) would frequently break the PARA rules to work more. Many of them said that they needed the extra hours in their training. So, the staff attendings would sometimes ask them to go home post-call, but, in reality, nobody would go home. They would voluntarily stay behind.

 

Is this really done so they can get extra training, or is there an unofficial expectation to put in ridiculously long shift even when you don't have to, simply becasue it's been done for so long? I.E. in your experiences, if you try to keep those rules are you seen as less dedicated, or lazy, etc etc.

 

My understanding is that those rules are not just to protect residents, but to protect patients as well from the mistakes that someone who has been awake and working hard for 20 plus hours is only naturally more likely to make. It's considered irresponsible to drive when your too tired to stay awake, so why is it considered normal to be able to perform a surgery under the same conditions? This has gotten attention in the press (including changes to improve the problem), so I'm wondering what your impressions as students and/or residents are about how it really is?

[Guest summervirus]

I think for many (most?) surgical programs, the residents will tell you that it's essential for their training to go on call as much as possible. I know that some residents in general surgery and neurosurgery have written letters and want their programs to withdraw from PARA altogether because they don't think they can get the training they need without substantially lengthening their residencies.

[Guest drews97]

You're right, these rules are put in place to protect both the residents and the patients. Residents will often go home if there is a clinic the next afternoon, butt most surgical residents wouldn't dream of going home if there is an OR the next day. Most want to operate or be involved in operating as much as possible so that they are competent when they finish. Not only that, but you can't schedule when that burst appendix comes in so if you want to learn how to do it you have to stay. Most of the docs neither encourage you to either stay or go. Remember, most of them trained in a time where there was no rules in place at all to protect residents so there was no such thing at post call at noon!

[Guest Kirsteen]

Hi there,

 

I've now rotated through a few Gen Surg programs across the country and it seems that their philosophies differ re: post-call leave. There were two programs that absolutely insisted that the residents leave before noon and most residents did so. There was another with staff who expected residents to stay post-call. Overall though, it appears that the body of residents in each place have adjusted to their surroundings and can adequately cope under either style of post-call management.

 

Cheers,

Kirsteen