Lifestyle specialities

[sapphire17]

Aside from the roads specialties, which other ones are known for having decent hours both during residency and during practice. (An example of hours in these specialties during residency would also be appreciated). Thanks.

[Real Beef]

pathology, physiatry ....

[sapphire17]

Thank you. Are these specialties that would work a typical 9-5 day even during residency (with minimal call) or do they have more/less grueling schedules?

[BoyInTheBubble]

Pick a job you like.

 

If you don't want to work hard (or long hours), you won't. When you're a grown up, you get to pick your own hours!

 

Residency hours vary hugely, both between programs and schools. Further, you do lots of off service rotations that might be far more busy than your actual program.

[rmorelan]

Thank you. Are these specialties that would work a typical 9-5 day even during residency (with minimal call) or do they have more/less grueling schedules?

 

No residency is 9-5 even for these - you need emerg psych for instance. Plus everyone has a first year that is off service and has compounds of call and service etc. No one mentioned family medicine but it probably should fit into the somewhat lighter side of things - excluding the off service blocks etc.

 

I know you weren't asking for ROAD ones but they don't work 9-5 in residency either. Radiology for instance is 7:30 or 8 to about 5 or 6 depending on the rotation followed by extensive home reading required after. It has call about once a week, which is comparatively light although you could argue that call itself is pretty intense.

 

One way or the other it seems to be successful you are put in a lot of work

[rmorelan]

Pick a job you like.

 

If you don't want to work hard (or long hours), you won't. When you're a grown up, you get to pick your own hours!

 

Residency hours vary hugely, both between programs and schools. Further, you do lots of off service rotations that might be far more busy than your actual program.

 

always my take - spending most of your time doing something you don't like seems like such a wasted life to me.

[sapphire17]

Thanks for your input all! I'm finding it hard to find approximate hours for specialties like physiarty, psychiatry and such online so I was making a guess with the 9-5 since everyone says they have the best hours along with family med. And I am of course willing to work hard, but I do suffer from a condition which often causes chronic fatigue which is why I am interested in learning more about specialties with lighter hours and also learning about what that means during residency and as an attending after.

 

(I also do want to mention that as of right now I am interested in psyc, neuro, peds, pmr and perhaps internal or er and have no interest in any of the ROADs).

[ellorie]

Heh sometimes I feel like I say this a lot, but here I go. If you have a disability, make sure you are talking to your faculty's student affairs office (and to a lesser extent your school's disability office - though they often don't understand medical students very well) in terms of accommodations - they can also give you some counselling in terms of what careers will work for you and what you can expect during clerkship and residency. Sometimes they can also find physicians and residents with similar issues who would be willing to discuss it with you - mine has offered to do that, though they can't actually seem to find anyone for me.

 

You might also consider joining the Canadian Association of Physicians with Disabilities - it's free, and even though it's a small, quiet community, there are people there who are at all stages of training who are very friendly and willing to talk about things like hours and lifestyle and balancing medicine with a chronic medical condition.

 

You will also find that once you are a medical student doing clinical stuff, you will start to meet residents and staff who will talk to you about these things and give you the low down. I recommend the residents especially because some of the staff I think have blocked out their residency experience

[Satsuma]

If you have issues with chronic fatigue I cannot say I'd recommend emerg.

The shift work is hard, even though on paper it looks like a decent schedule.

Of course, you could work part time more easily. As a resident you will also have a fair number of call intensive rotations - ICU, trauma, CCU, medicine etc.

But if you already have an issue with fatigue, why pursue a career that involves shift work, which is known to cause a plethora of problems including sleep disturbance

[rmorelan]

Thanks for your input all! I'm finding it hard to find approximate hours for specialties like physiarty, psychiatry and such online so I was making a guess with the 9-5 since everyone says they have the best hours along with family med. And I am of course willing to work hard, but I do suffer from a condition which often causes chronic fatigue which is why I am interested in learning more about specialties with lighter hours and also learning about what that means during residency and as an attending after.

 

(I also do want to mention that as of right now I am interested in psyc, neuro, peds, pmr and perhaps internal or er and have no interest in any of the ROADs).

 

You know I never fully looked into this but there is supposed to be a way to do residency part time if necessary. Obviously that takes a lot longer perhaps and you cannot escape the requirement to do call no matter how you swing things but perhaps that could be a possible option as well. Several training programs had a section of their information sites dedicated to it.

[ellorie]

You actually can manage to not take call - at least in some residency programs. They will give you short call until 11 pm or so with medical documentation - I have spoken to residents who have had this happen.

[rmorelan]

You actually can manage to not take call - at least in some residency programs. They will give you short call until 11 pm or so with medical documentation - I have spoken to people who have had this happen at multiple hospitals.

 

hey that is interesting - which ones have you looked at? Dal seemed to imply that you don't have a choice for instance.

[ellorie]

I imagine that it's not something that they throw around or let people know about, but if you have appropriate medical documentation and you push hard, at least some programs will do it. I haven't asked for it, but I know some residents who have had it, some since medical school.

[A-Stark]

I imagine that it's not something that they throw around or let people know about, but if you have appropriate medical documentation and you push hard, at least some programs will do it. I haven't asked for it, but I know some residents who have had it, some since medical school.

 

I can only recall one instance of relief from call among residents I've known, and in that case it was because of pregnancy.

 

In my specialty, an inability to take overnight call would be incompatible with the demands of the training and career. I would be pretty unhappy with any accommodations made that weren't strictly temporary. It's simply unfair to other residents.

[fugacity]

I can only recall one instance of relief from call among residents I've known, and in that case it was because of pregnancy.

 

In my specialty, an inability to take overnight call would be incompatible with the demands of the training and career. I would be pretty unhappy with any accommodations made that weren't strictly temporary. It's simply unfair to other residents.

 

Would you have given the same answer if it was a MMI/interview question? If someone has an actual disability, it would be unfair to give them unreasonable demands. If we can't even treat our peers with respect and consideration, what of the patients with the same afflictions?

[A-Stark]

Would you have given the same answer if it was a MMI/interview question? If someone has an actual disability, it would be unfair to give them unreasonable demands. If we can't even treat our peers with respect and consideration, what of the patients with the same afflictions?

 

I'm not sure there are many disabilities that actually require someone to be asleep at home when co-residents are doing 24 hour call or night float. In any case, this is not about respect or consideration, but about whether it's appropriate to allow someone to be exempt from normal housestaff responsibilities. Exempting a resident from call ensures that everyone else has to do more work, and that is not equitable. Like or not, medicine is a demanding profession, in training and afterwards, and if you can't handle some cardiology or ICU call you should not be in a specialty that requires such rotations. Even for the ROAD specialties, an anesthetist unwilling to take overnight call is not going to get hired anywhere (not that you get through a tough anesthesia residency either).

[rmorelan]

I'm not sure there are many disabilities that actually require someone to be asleep at home when co-residents are doing 24 hour call or night float. In any case, this is not about respect or consideration, but about whether it's appropriate to allow someone to be exempt from normal housestaff responsibilities. Exempting a resident from call ensures that everyone else has to do more work, and that is not equitable. Like or not, medicine is a demanding profession, in training and afterwards, and if you can't handle some cardiology or ICU call you should not be in a specialty that requires such rotations. Even for the ROAD specialties, an anesthetist unwilling to take overnight call is not going to get hired anywhere (not that you get through a tough anesthesia residency either).

 

There service aspect of it is off course a big concern but there are a ton of fields (well of course most actually) in medicine when post residency you would never have to put in more than a 10 hour day. To block someone from being a family doctor because they cannot do 4 weeks of gen surg with required call seems a bit harsh for instance. Similarly you can run your own internal medicine clinic and never have to step foot in the hospital again (even staff cardiology or ICU have what - 1-2 weeks every 2 months or so as pure CCU or ICU? and then 99% of the time they just call in and maybe have to manage the odd phone call throughout the night?). That is no where near actual call work loads, and there are a number of medical conditions that would stop someone from being EFFECTIVE for 24-30 hours straight but wouldn't stop them from being a good doctor otherwise.

 

This falls into a lot of the current debate about whether 24-30 call should be continued - gosh that argument never seems to end at the hospital. Some centres have already moved away from it - in Calgary for instance as a family doctor you never do call I was told yesterday. You always at worst have to leave the night before by 11pm. UBC has the majority of its rads call now in 8pm to 8am one week long blocks, Quebec of course is now doing its own somewhat confusing things, and PARO the studying the hell out of this currently - and even won the right in the last negotiation to actually argue for changes to the call system (before that was one of the few things they could not actually negotiate for). The only reason they would stick that in last time is because they are strongly considering doing something with respect to it the follow up.

 

The systems are changing I guess is my point - and I would not be surprised if there was further changes within my residency. Pushing this a bit is the public reaction every time this stuff gets published in the news - people just cannot intuitively believe that it is safe to have a person up for 24+ straight hours working none stop often without enough time to even eat in 12 hours making important decisions about their loved one's (or themselves). Naturally a huge group of residencies look at it like it is silly as well - the argument is that the vast majority of doctors in actual practise do not have to work those sorts of strenuous hours so putting it in training it is not for education (to teach you how to work the way you ultimately will have to) but rather purely for service and the convenience of staff and the hospital - that doesn't sit very well with them of course

[NLengr]

There service aspect of it is off course a big concern but there are a ton of fields (well of course most actually) in medicine when post residency you would never have to put in more than a 10 hour day. To block someone from being a family doctor because they cannot do 4 weeks of gen surg with required call seems a bit harsh for instance. Similarly you can run your own internal medicine clinic and never have to step foot in the hospital again (even staff cardiology or ICU have what - 1-2 weeks every 2 months or so as pure CCU or ICU? and then 99% of the time they just call in and maybe have to manage the odd phone call throughout the night?). That is no where near actual call work loads, and there are a number of medical conditions that would stop someone from being EFFECTIVE for 24-30 hours straight but wouldn't stop them from being a good doctor otherwise.

 

This falls into a lot of the current debate about whether 24-30 call should be continued - gosh that argument never seems to end at the hospital. Some centres have already moved away from it - in Calgary for instance as a family doctor you never do call I was told yesterday. You always at worst have to leave the night before by 11pm. UBC has the majority of its rads call now in 8pm to 8am one week long blocks, Quebec of course is now doing its own somewhat confusing things, and PARO the studying the hell out of this currently - and even won the right in the last negotiation to actually argue for changes to the call system (before that was one of the few things they could not actually negotiate for). The only reason they would stick that in last time is because they are strongly considering doing something with respect to it the follow up.

 

The systems are changing I guess is my point - and I would not be surprised if there was further changes within my residency. Pushing this a bit is the public reaction every time this stuff gets published in the news - people just cannot intuitively believe that it is safe to have a person up for 24+ straight hours working none stop often without enough time to even eat in 12 hours making important decisions about their loved one's (or themselves). Naturally a huge group of residencies look at it like it is silly as well - the argument is that the vast majority of doctors in actual practise do not have to work those sorts of strenuous hours so putting it in training it is not for education (to teach you how to work the way you ultimately will have to) but rather purely for service and the convenience of staff and the hospital - that doesn't sit very well with them of course

 

Theone thing that drives me nuts about the work hours debate is that lots of people never seem to consider the risk of lengthened residencies. It's a trade off. A crappy one IMO.

 

Luckily, I'll be done before any response from the college lengthening my specialty residency to 6 or 7 years.

[rmorelan]

Theone thing that drives me nuts about the workouts debate is that lots of people never seem to consider the risk of lengthened residencies. It's a trade off. A crappy one IMO.

 

Luckily, I'll be done before any response from the college lengthening my specialty residency to 6 or 7 years.

 

well that is the flip side of course How long should these be - and the follow up question of course is does the current funding model make sense in the light of it? I mean people would have less concern about a 7 year residency if by year 7 you were already well ramped up to the earnings of a true attending (more lovely debates that get thrown up). If by year 7 you are basically doing everything a staff does (which would be true)

 

and how much actual education are you getting on those overnight calls? Is it really an educationally tailored experience? Could it be replaced with two comparative shifts going to 11pm with a normal start to the following day (total time in that case would be roughly the same - as most of the time you do get some sleep on most calls). The quebec system (which is of course rough at this point to say the least) doesn't result in a loss of actual time spent training. If there are issues of public safety (which is the big debate) then shouldn't that trump all other concerns anyway?

 

I have any answers to all of this by the way - just interested in understanding the problem - right now I don't

 

Couple this with a shift to the upcoming models for residency evaluation and things get even more interesting. Everything is tailored to a competency rather than raw time.

 

Things are about to get interesting!

[A-Stark]

There service aspect of it is off course a big concern but there are a ton of fields (well of course most actually) in medicine when post residency you would never have to put in more than a 10 hour day. To block someone from being a family doctor because they cannot do 4 weeks of gen surg with required call seems a bit harsh for instance. Similarly you can run your own internal medicine clinic and never have to step foot in the hospital again (even staff cardiology or ICU have what - 1-2 weeks every 2 months or so as pure CCU or ICU? and then 99% of the time they just call in and maybe have to manage the odd phone call throughout the night?). That is no where near actual call work loads, and there are a number of medical conditions that would stop someone from being EFFECTIVE for 24-30 hours straight but wouldn't stop them from being a good doctor otherwise.

 

There's a world of difference between 24+2 hour call with post-call rules respected and 24+2 hour call where there's an expectation to "finish up" work from the night (one thing I didn't like about CTU in Ottawa, I should mention!). The good family doctors are often working 9-10 hour days because they are making themselves available for their patients and doing administrative and other work in between time with patients. Maybe in some academic centres specialist staff never have to come in, but you can't practice GIM/ICU in the community and expect not to be working very hard. Even so, yesterday on cardio day call the staff was around from about 8 to 3. ICU staff are on CTU or fitting in clinics when not in the unit, and those with other backgrounds are in the OR. If for some reason you can't do overnight call - presumably including any kind of night float system - you certainly can't do shift work either, which is far, far more taxing on sleep, so that rules out emerg, GIM (and GI, cardio, ICU), anesthesia, most surgery (especially gen surg, vascular, neuro, plastics, obs), etc.

 

and how much actual education are you getting on those overnight calls? Is it really an educationally tailored experience? Could it be replaced with two comparative shifts going to 11pm with a normal start to the following day (total time in that case would be roughly the same - as most of the time you do get some sleep on most calls). The quebec system (which is of course rough at this point to say the least) doesn't result in a loss of actual time spent training. If there are issues of public safety (which is the big debate) then shouldn't that trump all other concerns anyway?

 

I don't think I learn much at 3:30 am, but the only way ending shifts at 11 works is if you also have to cover nights as well. Someone has to be doing night float, and these systems are much more difficult to organize than traditional 24 hour call. It can be done, though I think it's debatable whether you'd feel any more rested after four 15-hour night shifts in a row. And, really, I'd sooner do the 24 hour call and get the next day off than lose two evenings in a row.

 

The major educational benefit of call is being able (and being forced) to make decisions independently. There is no better learning than that which comes with real responsibility.

[NLengr]

well that is the flip side of course How long should these be - and the follow up question of course is does the current funding model make sense in the light of it? I mean people would have less concern about a 7 year residency if by year 7 you were already well ramped up to the earnings of a true attending (more lovely debates that get thrown up). If by year 7 you are basically doing everything a staff does (which would be true)

 

and how much actual education are you getting on those overnight calls? Is it really an educationally tailored experience? Could it be replaced with two comparative shifts going to 11pm with a normal start to the following day (total time in that case would be roughly the same - as most of the time you do get some sleep on most calls). The quebec system (which is of course rough at this point to say the least) doesn't result in a loss of actual time spent training. If there are issues of public safety (which is the big debate) then shouldn't that trump all other concerns anyway?

 

I have any answers to all of this by the way - just interested in understanding the problem - right now I don't

 

Couple this with a shift to the upcoming models for residency evaluation and things get even more interesting. Everything is tailored to a competency rather than raw time.

 

Things are about to get interesting!

 

You won't get paid like a staff as a PGY 7. You'll get paid as a PGY 5 does now.

 

In ON, as part of the new contract, there was a specific point made that pay increases as you move up the years is due to increased responsibility, not increased seniority (thus how they avoided the pay freeze). That means if you are a chief PGY7 doing what a chief PGY5 currently does expect to get paid the same as a current PGY5.

 

Those 2 missed years of real work are gonna cost you a half a million dollars.

[rmorelan]

You won't get paid like a staff as a PGY 7. You'll get paid as a PGY 5 does now.

 

In ON, as part of the new contract, there was a specific point made that pay increases as you move up the years is due to increased responsibility, not increased seniority (thus how they avoided the pay freeze). That means if you are a chief PGY7 doing what a chief PGY5 currently does expect to get paid the same as a current PGY5.

 

Those 2 missed years of real work are gonna cost you a half a million dollars.

 

Oh I know currently they don't - that is my point, some are arguing that IF (big if of course) the duration gets extended the current pay system would require adjustments.

 

This is naturally not how the current system works at all. Whether or not that would fly I would expect there to be significant arguments about pay etc if anyone tried to extend things. The current contracts underlying assumptions would no longer hold.

 

Plus I should say as with Quebec (not saying I like this system) there are ways of removing call without actually changing the total number of hours worked, nor the total number of hours you work unsupervised (you can extend this argument to the other fields where call in not being used or not being used the same way - no one extended UBC or Calgary's training for instance).

[Jochi1543]

No residency is 9-5 even for these - you need emerg psych for instance. Plus everyone has a first year that is off service and has compounds of call and service etc. No one mentioned family medicine but it probably should fit into the somewhat lighter side of things - excluding the off service blocks etc.

 

I wouldn't say FM is an easy residency, it's just short, and since you have quite a lot to learn, your off-service blocks end up comprising about half of your residency. For the remainder, you have your FM rotations, which of course can differ from one program to another, but generally, you are assigned to GPs whose practices are full-service rather than just office-based. That means doing obstetrics with them (and the call that comes with it), having inpatients to round on daily, etc.

 

I'm at a smaller site and a GP-run hospital. My current FM rotation involves 7:30 rounds, clinic 9-5:30 with an hour's lunch, home call with my preceptor 1:8 for obs, and weekend obs/hospital home call 1 full weekend every 1.5-2 months or so. At our program, we also have hospital service call regardless of what rotation we are on, it's roughly 1:7 as long as our rotation is here in town. So it's quite busy, actually, even though it's the FM rotation. I'm on my Fri-Sun home call with my preceptor now, and my Fri home call already got converted to in-house according to union rules since I had spent almost the entire night in hospital, and we have rounds every morning for 8 doctors' patients. Took us 5 hours this morning, but depending on how busy obstetrics gets, my preceptor said it could even take over 12 hours.

[Jochi1543]

Thanks for your input all! I'm finding it hard to find approximate hours for specialties like physiarty, psychiatry and such online so I was making a guess with the 9-5 since everyone says they have the best hours along with family med. And I am of course willing to work hard, but I do suffer from a condition which often causes chronic fatigue which is why I am interested in learning more about specialties with lighter hours and also learning about what that means during residency and as an attending after.

 

(I also do want to mention that as of right now I am interested in psyc, neuro, peds, pmr and perhaps internal or er and have no interest in any of the ROADs).

 

If you have medical issues, part-time residency is an option. It's not widely advertised, but generally every faculty's PGME has a process in place for applying for part-time residency. The hours have to be at least half of the normal hours, though. If you have a condition that just flares up occasionally and you need occasional breaks, it is certainly feasible to arrange medical leave/leave of absence.

[Jochi1543]

You actually can manage to not take call - at least in some residency programs. They will give you short call until 11 pm or so with medical documentation - I have spoken to residents who have had this happen.

 

BRB, mysterious medical issues