Some say you can still have a life while training as a resident. I tend to disagree, and here’s why:

1. Pager Matrimony
As a resident you’ll be married to your pager. The only time you’ll be allowed to turn it off is when you’re post-call. Even rarely after you finish your “shift” (on non-shift dependent rotations) will you be able to completely detach yourself from that dreaded beep machine.

Have you ever been in a conference and watch as how everybody in the room will reach down for their pager when one goes off? That’s really all the proof you need. Answering pages is typically a first priority for residents, as higher up attendings do not like to wait by the phone for more than 30 seconds for the call back.

2. Call and More Call
Taking call? Forget about leaving the hospital. Most training programs have strict rules that will not allow you to leave the hospital for food or running errands, especially when on call. This is one reason medical students are all too often used as food runners for residents.

If you have a must-do appointment somewhere, you’ll probably have to get into contact with your chief resident and request the time off. The difficulty that residents have in doing normal day-to-day things really boggles my mind. It’s not their fault, either. They’re at the hospital before normal working hours and stay until after normal working hours. When else are they to do the typical daily tasks that need taking care of?

3. Salaries
Residents are underpaid. The typical starting salary for an intern is somewhere in the high $30,000 range to the low $40,000 range. The maximum allowable work hours is 80. This equates to roughly $9.14 per hour using an average salary of $38,000 per year and 80 hour work weeks. We all know that most residents work more than 80 hours, so this number is just an estimate.

I’m willing to bet that some high-school dropout with a GED is making more than that working at McDonald’s somewhere. Does the promise of high salaries after residency training mean that residents can be underpaid in a monopolistic training environment without competition to naturally increase salaries? Hell no. But, as long as the NRMP is allowed to dominate the post-graduate training market, I don’t see salaries moving upwards anytime soon.

4. Time Off
Time off as a resident is nearly non-existent. Post-call days don’t count, either. Training programs have brainwashed residents into thinking that going home at noon post-call day is a day off. That’s crap. You go home and do what? Sleep?

If you’re single and live for the hospital, this might not be such a problem for you. But, if you’re like most people and have a life and family, this cuts into your personal time like a hot knife through butter. More time off needs to be given to residents.

5. 80 Hour Weeks
80 hour weeks are bullshit. If you absolutely love what you’re doing, 80 hours per week is nothing. Ask yourself this though: How many residents do you know that absolutely love what they’re doing? A small handful, at most.

Sure, limiting the residency work week to 80 hours was a huge plus for residents. Some of those poor people were working 120+ hours per week. The new rule essentially bagged them an additional 40 hours of free sleep time.

You’ll still run across those old-school attendings that think the 80 hour week is too lenient. Coming from a more hostile training environment, they think that just because they did it you have to as well. It’s the “I suffered, you’ll suffer” mentality

6. The Hierarchy
I discussed the medical training heirarchy a long time ago. It’s similar to that found in other manager-employee relationships, but medical training has found a way to take it a step further. Not only will you have to deal with your day-to-day routines and long work hours, but you’ll also have to put up workplace politics on steroids as well.

7. Inefficiency
Medical training is as efficient as the manual assembly of computers. Large scale manufacturing and corporate big business is efficient. Government jobs and medical training is not.

More time is wasted than is actually spent doing work. All of that time residents spend doing crap that’s better left for someone lower down on the food chain could better be spent at home or in the form of free time.

8. Inbred Social Life
Without time to leave the hospital and carry on meaningful relationships with people outside of medicine, you’ll be forced to treat residency as your primary social outlet. This is a dead end. While others are out strengthening more meaningful relationships, residents are forced to interact with whom they work with.

I don’t know about you, but most residents are not what I’d call a close friend. But, there’s not much you can do about it.

9. Contractual Employment
Residents operate on contracts. A new contract is signed at the beginning of your intern year (actually, when you are offered a spot during the match), and then each year thereafter.

If program directors do not feel you are living up to their expectations, they can terminate your contract. A resident who’s had a contract terminated for whatever reason might be hard pressed to find another program that will quickly pick him or her up.

That’s a pretty big gamble by anybody’s standards. It’s the system.

10. Becoming Them
The medical training process produces more of the same. All too often I’ve heard from physicians that used to love patients and their work who are now completely unhappy and wouldn’t do it over if you paid them.

This is probably the most serious consequence of residency training, as it has possible permanent effects. Personalities are changed for the worse, and all of a sudden you become them. You become what you hated so much during your third and fourth year of medical school and throughout residency.

It’s part of the process, and is the reason why the trend continues.

Maximum Security Prison
If you’re a nice, conditioned medical student that has been beaten into submission by the system, you’ll most likely be defensive about this post. However, if what I said above didn’t have a speck of truth to it, you wouldn’t have a reaction to it at all.

It’s really tough to throw away four years of your life and hundreds of thousands of dollars in debt when you suddenly realize that this isn’t for you, which could be considered another example of imprisonment via educational debt.

No matter what you decide to do, just be nice to the warden so he’ll let you go outside.

Whether you want to believe it or not, many training programs are in violation of the ACGME duty-hour standards. I’ve known this all along, primarily from talking with many people in residency that I keep in touch with on a regular basis.

The AMA has released a study that basically proves that the work hour standards are one big piece of political bullshit.

The study was a monthly web-based survey, and polled residents preimplementation and postimplementation of the work hour standards. The residents taking part in the survey completed 29,477 reports of their work and sleep hours.

Violations were reported during 3765 (44.0%; 95% CI, 43.0%-45.1%) of the 8553 intern-months assessed postimplementation (including vacation and ambulatory rotations), and during 2660 (61.5%; 95% CI, 60.0%-62.9%) of 4327 intern-months during which interns worked exclusively in inpatient settings.

There you have it, folks. Nearly half of all months had violations during ambulatory settings and nearly 62% of months had violations where interns were working on inpatient services.

The ACGME needs to start cracking some balls if they want programs to take these duty restrictions seriously. If nothing is done, or programs are simply slapped on the wrist, the system will continue to be abused and work hour restrictions will be nothing more than fudged numbers on some slip of paper in the program director’s office.

via: [JAMA]