how bad is it?

[Guest haloo]

I've heard that the hours of a general surgery resident are 'bad', but I'm wondering what that really means? I know that it's something like 80-100 hours a week which does sound pretty intense. How are those hours usually added up? What is the day of a surgery resident like?

[Guest UWOMED2005]

I was doing call 1 in 3 on my gen surg rotation, so the following was the most I worked (106 hours):

 

Monday: 24hrs, 6am until 6 am Tuesday (I was on call from 6pm to 6am)

Tuesday: 13hrs, 6am to 7pm

Wednesday: 11 hrs, 7am to 6pm (woohoo, got to start late and got off early!!)

Thursday: 24hrs, 6am to 6am (on call again)

Friday: 12hrs, 6am to 6pm

Saturday: OFF!!!

Sunday: 22hrs, 8am to 6am. (on call again. And thank god for being able to start late on weekends.) Of course, I then had to work the following monday until about 6pm

Total: 106 hours

 

Notes:

- As you can see, there is no "post-call" for gen surg at Western. Just because you're on call doesn't mean you can slack off the next day and sleep (unlike Peds, Medicine, and Obs/gyn)

- I guess technically, claiming 24, 24, and 22 hours for the nights on call is cheating. I probably got to sleep an average of 2-3 hours those nights on call - though there are many sleepless nights on gen surg call. But the bed at south street is not much more than a metal plank with sheets on it, and I had to stay in house, so I am going to be greedy and claim those few hours of sleep as being on the job.

- Fortunately, gen surg is fast paced so it keeps you awake when you're post call. Only once (5am on a Sunday towards the end of my worst day of call ever) did I almost fall asleep at the operating table.

- I was only a clerk on gen surg. Had I been a resident, I would have probably gone in on the Saturday to round on the patients for an hour or two. One of my senior residents was eager to point out the fact that she had not missed a day in the hospital in the 3.5 years of her program.

 

Yeah, you can probably guess that gen surg is not one of the specialties I'll be applying to in the fall. Not that I don't mind working hard (call me a masochist but I thoroughly enjoyed my surgery rotation) but doing the above for 30-40 years would probably kill me (and a lot sooner than 30-40 years!)

 

Lastly, I'll leave you with a joke I heard some of the old school general surgeons telling the med students:

 

"What's the problem with 1 in 2*call?"

 

Answer: "You miss half the cases!!"

 

*I only worked 1 in 3 call. 1 in 2 would have meant an additional night on call per week, or close to 120 hours in house.

[Guest Steve U of T]

How much of those 106 hours are spent in the OR? Also, what sort of responsibilities does a clerk have in the OR versus a resident or staff surgeon?

[Guest UWOMED2005]

I'd spend usually about two days in the OR (one for each surgeon on the team.) The rest of the time was spent admitting patients, rounding on patients, doing minor procedures like draining perianal abscesses in the ER, chasing down X-rays and Labs, etc.

 

The typical surgeon gets a day to a day and a half of scheduled time in the OR (plus nights on call.) That's it. Some premed and preclerkship med students get the impression that the bulk of a surgeon's time is spent in the OR, but that's not true.

 

As a clerk on gen surg, on most days all I did was retract (ie hold the wound site open.) I also was responsible for cutting sutures off and putting on steristrips (glorified band-aids). Occasionally, you'll get to close (I didn't on gen surg, but there were extenuating circumstances to that) and once I got to use the electrocautery, though only by touching the consultants pickups, which were in contact with the target tissue. My orthopedic rotation was actually much better for OR exposure - one half day per week the residents had teaching so it was just me and the orthopod operating. As a result, I got to do lots of stuff - close, put in screws, cut, etc.

[Guest Steve U of T]

Thanks for the info. I know my research supervisor, who is a vascular surgeon, only spends about 1 day per week in the OR. I was just wondering if it was any different for students. I guess not.

[Guest UWOMED2005]

For some of (s)elective rotations, ie orthopedics, they tried to give us more time in the OR by mixing and matching us with different surgeons. I think this was partly due to the short nature of the selectives (2 weeks) and resulted in about 1/2 OR and 1/2 clinic time.

 

But for your core rotation, it will be a lot closer to a typical surgeon's schedule - like one day per week. As there were two surgeons on our team, the students ended up with two days in the OR.

 

It's not uncommon for preclerks to be gungho surgery under the impression the OR is a surgeon's entire career. One day electives in first and second year have the unfortunate habit of reinforcing this idea, as it is usually OR days that preclerks attend. But there is a lot more to a surgeon's life than being in the OR. . .

[Guest moo]

It's not uncommon for preclerks to be gungho surgery under the impression the OR is a surgeon's entire career. One day electives in first and second year have the unfortunate habit of reinforcing this idea, as it is usually OR days that preclerks attend. But there is a lot more to a surgeon's life than being in the OR. . .

 

So true. One of my classmates is so gungho about surgery. She thinks the life of a surgeon is spent in the OR. But when my friend who just finished surgery told her that I (on ob/gyn) spent more time in the OR than he did, she refused to believe it and just went off on us.

[Guest UWOMED2005]

Haha. I know a few people like that - they have preconceived notions of rotations and the like, and when you point out the obvious their response is to blow up at you, perhaps thinking getting mad at a classmate might change things. It's rather funny, actually.

 

A wise medical graduate once pointed out to me the fact that interventional radiologists often spend their entire week in the cath lab. They don't admit and follow patients like the surgeons do, but get to do cool procedures. And there's an increasing demand for interventional radiologists - many procedures are being done this way now (ie PICC lines vs traditional sc/ij/fem central lines.) I can't believe how busy the interventional guys are in London. We could easily use 3-4 times as many interventional rad guys here.

[Guest Ian Wong]

IR usually spends more time in the cath lab than a surgeon will spend in the OR in any given week. As mentioned by UWOMEDS2005, the reason being that the surgeons also need to spend time rounding on patients, as well as seeing them in the clinic both pre-operatively (to determine if they need surgery or not), as well as post-operatively (to check for any potential complications or for satisfactory healing/resolution of symptoms).

 

In contrast, IR spends a lot of time in the cath lab, and the remainder of the time can be spent doing diagnostic radiology (if needed because of the high volume of diagnostic imaging going to the group, or if personal preferences dictate mixing up the IR with some diagnostics to keep things interesting). The actual amount of time spent with patients is pretty minimal, usually consisting of getting informed consent, and perhaps a quick visit in the recovery bay afterwards.

 

In the US, IR is becoming much more clinically-based in an attempt to retain clinical volume that is being slowly absorbed by other specialties that perform endovascular techniques (neurosurgery, vascular surgery, cardiology). Interventional radiologists are starting to see patients in clinic, admit them to the hospital, round on them, and discharge them home, much like the surgeons and other clinicians do. Still, there's a lot of concern in the US that the interventional radiologists are slowly losing their "turf", as other specialties learn these minimally-invasive techniques.

 

In Canada, there really hasn't been that much encroachment onto interventional radiology from those specialties, and the IR's find that the referral base is high enough that they don't need to go to those extra lengths to retain the clinical volume of referrals. If all you want to do each day is procedures, interventional radiology is a great choice at the present time. There's always another new innovation around the corner, and minimally-invasive techniques are the wave of the future because they often reduce patient morbidity and usually shorten inpatient length of stays compared with more extensive open procedures.

 

Ian

[Guest physiology]

One of my classmates is so gungho about surgery.

 

It seems that way at UBC too. But I think the people gunning for surgery will be pleasantly surprised that once they finish their residencies, OR time in urban areas such as Vancouver is at a premium.

 

For instance, which ophthalmologists get to do the cataract surgeries? Well, certainly not the guy who just finished residency. If it's any consolation, they can up to a rural area and get loads of OR time there, but in Vancouver, you're outta luck.

 

I never realized how politicky getting OR time was.

 

And what about all the doctors that will retire en masse in the next few years? Well, it seems like that's not the case for all specialties.

[Guest UWOMED2005]

Yep, I know at least a few subspecialists in Toronto who can't get any OR time and so end up doing week-long stints up North (Timmins, etc) to make ends meet, hoping OR time will free up in T.O in the future.