Incredible HardStyle set. Top 40 is for pussies.
Incredible HardStyle set. Top 40 is for pussies.
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?
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.
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.
Greetings from the glorious time of life referred to as the third year of medical school/the breeding ground of antisocial personalities. Iâ€™m presently in the midst of my surgery rotation after having done IM, neurology, EM, family med, psych, and OB/GYN.
The following is exactly how I felt during an evening at the end of my day. Donâ€™t try to say you will never sound as angry, cynical, or crazy as this. I didnâ€™t think I would either, but trust me, it happens.
There was a time when I was a nice person. I vaguely remembered that time, but after the 14th hour of being at the hospital, Iâ€™m sitting in the ICU – waiting for the attending to finish his stupid story about the fish he caught that one time that was â€˜this bigâ€™ â€“ and a horrible thought crosses my mind. â€œWe still have 4 more patients to round on . . . â€œ
I drop my eyes to our patient census and skim the list. There is Mrs. Smith, 85 YO WF w/COPD, CAD, CHF, past MI, recent ileostomy. Look she has pneumonia and sheâ€™s on a vent. Even better, she hasnâ€™t been conscious for a week, lived in an ECF, and her family left her full code. Mrs. Smith is on three different antibiotics, which arenâ€™t doing anything to budge her raging sepsis and sheâ€™s on the dobutamine drip that seem to not be raising her BP the least bit. Our other three patients are in pretty similar sad shapes. They are all going to die.
Then the next horrible though crosses my mind, â€˜canâ€™t these fricking people just die so I can go home already?â€ Yes, I did just wish some innocent grandma to die because her terminal illness is ruining my day. All of our efforts are completely futile in her case, but when she starts coding tomorrow, Iâ€™ll have to go with the team to attempt to save her. Which will put us even further behind on our ever growing census. Thanks dumb grieving family for putting ME through this.
Now I glance at my resident who is still nodding at the stupid story. Iâ€™m so annoyed with you that if I had an uzi Iâ€™d be gunning for you. Why the hell havenâ€™t you let me go home? The med students donâ€™t even see the ICU patients because this is our surgery rotation. Iâ€™ve been here doing nothing for two hours. I canâ€™t write orders, I canâ€™t see patients by myself, and the patients we are seeing I donâ€™t even round on. You arenâ€™t teaching me â€“ no, pimping isnâ€™t teaching â€“ and since youâ€™ve ignored my existence except when I failed to give you that imaginary crucial bit of info the attending scooped you on, why am I still here?
Attending, if I shot the resident, youâ€™re next. Stop telling the fucking story and let me leave. You didnâ€™t bother to show up here until after 7pm to round on your patients, and I know your last surgery ended at 4pm because I was there. I was that med student who held the retractor for two hours that you periodically yelled at for not being able to identify random things in a body cavity that I was too far away to even see beyond my retractor. Donâ€™t you dare start whining about how much harder you worked in residency before the 80 hour work week. In case you havenâ€™t noticed, the 80 work week is a joke and I was here 100 hours last week. So fuck you and shut the hell up.
You know, the hospital doesnâ€™t have metal detectors to use on the staff. I look around at the members of my team and try to figure out which one of us are going to snap, go postal, and start mowing down the patients and the oh-so annoying nurses. Who has been abused the most? The other med student who is getting treated like shit for stating he wanted to go into peds? Or maybe the intern that was left in charge of 50 patients alone while the residents went to the OR and is about to getting it for not knowing Mr. Lâ€™s latest potassium. What the hell, itâ€™s totally going to be me, the sweet innocent seeming seething ball of rage that I am.
One hour later, we are sent home and reminded to be back before 5am tomorrow. Thanks, like Iâ€™m going to forget that since it means Iâ€™ll be heading to bed immediately upon getting home. I see people coming out from dinner at the local resturaunts and I hate them for having real lives. I debate briefly about whether I can hit some of them in the crosswalk and get away with it. Probably not, but prison seems like a good alternative to going back to the hospital tomorrow.
As I finally get ready for bed, I think back about how much I hate the hospital and how awesome it would be if it got hit by an asteroid or something between now and when Iâ€™m supposed to be there. Then I have the horrible thought â€“ in the event of a natural disaster, I would have to stay at the hospital even longer.
**MDAlien would like to point out that most of the anti-social feelings went away after she got off the service â€“ except those toward the attending. No patients were harmed or mishandled in the survival of that rotation. **
I had two chief residents during my surgery rotation. I posted the evaluation I wrote to chief resident number one awhile back. I spent an equal amount of time with each. They were both evil in their own way; it was clear that God never intended me to go into surgery given the experience that I had. Anyway, here’s the evaluation that I submitted to chief resident number two. Names have been changed to protect the guilty.
After being accustomed to wearing scrubs on rounds as I was taught to do from the previous chief resident, I was promptly scolded for doing what I had been doing on the service all along on Dr. XXX’s first day. As a matter of fact, it was the first words out of her mouth. Not “you shouldn’t wear scrubs on rounds” or “please don’t wear scrubs on rounds anymore. I realize it’s my first day on service and you didn’t know my preference.” In a harsh tone with head and hand motions to reinforce her point, it was “we wear real clothes to work.” Well, last time I checked scrubs were real clothes. Please, is it too much to ask for you to BE NICE?
Day after day, it was something with you. While being accused for not completing a task that I most certainly did, I was told to “do not argue while I am talking to you.” What the fuck? Am I your child?
“I feel the need to ask permission to go to the bathroom – like in third grade. I don’t like thanking people for granting me time for lunch. They like us both – student and patient – deferential and self-degrading. And I see it every day. –Dr. M Greggor”
It got to the point that I would not ask you anything. I didn’t care though, as it minimized my interaction time with you. I liked being ignored on this service. Ignorance was bliss.
Other students warned me about you. You are not liked. These are the same students that no doubt gave you shining evaluations because they are too afraid to speak their mind. Your fellow “colleagues” speak the truth of you, but they would never let that be known to your face. At first, I refused to listen but it only took a few days of being around you to realize that they were right.
What really sucks, though, is the fact that students are completely powerless to defend themselves while on service. You completely own us with your power to influence grades and you guys know it. In fact, I feel that attendings and residents exploit this fact in an attempt to exert even more control over us while on rotation. Intimidation, intimidation, intimidation. It’s all you know.
I breathe and remain silent
because my life is not my own
because I am not sure what is left of me
as I think this
I boil with hate
at the forces shackling me
and I’m just tired
and I feel deflated with pain.
Now that grades are posted I can speak my mind. You’ve just finished reading it.