Here I am not even in med school yet, and I’m freaking out over the first year of residency! I keep trying to tell myself people get through it, and that it gets easier after the first year, but I really don’t know for sure.
I see many of the interns dragging their lifeless bodies around the hospital all hours everyday. That scares the s#it out of me. It makes me question can I do this, do I have what it takes to get through that first year?
I don’t even know for sure what kind of physician I want to be really. How do I figure that out? I’m assuming in med school? I know that their are different lengths of residency for different services, but I don’t know the particulars. I would like to know where to find out this info.
What is the first year like? Do you have days off? How about hours off? I’ve heard alot about this 80 hr wk week thing, but don’t really know if programs are adhering? I’ve also heard the term night float, and moonlighting, what do these mean?
I’m sure I can think of a million questions, but for now if someone could help me with these and maybe give a brief story/description of first year residency, I would be soooo grateful. Fear of the unknown can be a terrible thing 
Thanks in advance ~Jen
First of all you need to relax…first get into medical school then start thinking about what you like. Residency is grueling and will be 80hrs/week so as long as you are aware then you will deal with it. I would not worry about that just yet though…
Your getting the cart in front of the horse…HOWEVER it is recommended that you weigh whether or not you are willing to do whatever to achieve your goal. If so, then go for it…if not then look elsewhere. Not just about medicine but everything. Nothing worth achieving comes easy. There are people who didn’t become Navy SEAL’s because of the hours required. The work was exciting, they passed HELLWEEK but couldn’t handle the long hours and prep time during the dive phase…
Same goes for doctors. There are many who are now becoming surgeons who before would not have because of the hours required. Do some soul searching and see what it is about medicine you really want.
Helping people? There are other occupations that help people.
Money? There are many better ways to earn a paycheck.
Status? This depends on how you think people view doctors. I see a doctor as the ultimate public servant but no real status. However opinions differ.
Dig deep and ask the tough questions and see where you’re heart really is. My wife and I did the same last night about her wish to enter law school. She and I both realized that her passion is not in law but the “glamor” which having a law degree would portray. Instead she’s going into interior design because she loves designing and building things for decoration and functionality…
Seek and you will find the answer…you might surprise yourself. I ran from medicine for 14 years…Now I’m running toward it 
Well, yeah, the first year of residency IS tough. I am having a love-hate relationship with it at the moment, and I guess that will probably continue for the rest of the year… but you know what, I still love it, and if I can say that after twelve straight days without a day off, I must be in the right line of work.
Yes, you will see the interns dragging their sorry a$$es looking like death warmed over… and trust me, they FEEL like death warmed over. Some of them are thinking, wow I have made a big mistake. Others like me are thinking, good lord, this really sucks, but there are some good points to it and so I guess I will get through it. NO ONE enjoys it. If you want a job where you will not only get satisfaction out of your work but ALSO enjoy it, the first year of residency is the wrong place to look.
But truly, how many people actually love their jobs?
I hear people say things like, “I can’t do this because I absolutely have to have my [random number] hours of sleep each night.” I just shrug and say, well, when you’re really needed, somehow you find a way to function on less.
I think most of us are thinking, “It’s just one year. It’s just one year.” In the grand scheme of things, one year just doesn’t seem like much.
Maybe my perspective is different because I’m a mom. When I was up all night with sick little kids, I didn’t know if it’d be a day, a week, a month or a year before I’d get more sleep - I’d just have to grab whatever sleep I could get, when I got it. Same thing as an intern. The other night I had my third call without a day off (that is, I went to work last Monday, was on call Tuesday night, Saturday night, and Wednesday night, with no days off in the interim) and wow, I was really hurting. So was the twenty-something intern working alongside me. Both of us just gave up and grabbed an hour of sleep during the night even though our work load was such that we really couldn’t afford to take that time off… but we were about to face-plant in the charts and so there wasn’t much point in staying awake.
After that day/night/day was done, I came home, napped from 3-5:30, got up to have dinner (yay for my wonderful devoted husband who cooked a yummy dinner!) and went back to bed at 7:30pm, so I could get up to go to work at 4:45 this morning. And I functioned today; in fact I was pretty pleased with my ability to keep my head above water today.
What keeps me going? I tell you, I am so pleased that I am doing this that the sleep deprivation, while painful at the time, is just part of the accomplishment. As a significantly older PGY-1 (post-graduate-year-1, the PC term for “intern” but in fact in my program we use “intern” for doctors who are in their first year of residency), I have a sense of accomplishment that my younger colleagues can’t appreciate - I’m keeping up with them! I am no more miserable than anyone else! And it gives me a real rush to be doing it.
That’s not the most important thing, though. The key is that I am making decisions that help other people. Usually they’re small decisions, like giving tylenol to a kid with a fever overnight. Sometimes they’re bigger decisions - someone with soaring blood pressure needs meds to get it under control. I haven’t been called yet, but I may need to respond to a situation where someone’s life literally hangs in the balance and it’ll be up to me to determine the best way to resuscitate them. I LOVE IT. It is a privilege to be doing this.
There is no way to project how you are going to cope with these situations, and so I agree, it’s too soon to worry about it. You’ll get a taste of all this during your third year, and you may start forming some ideas about specialty choices based on lifestyle - lots of medical students are doing just that. (be aware that even if you choose the most lifestyle-friendly specialty, you’re still going to do an intern year that is very tough in terms of hours)
Iserson’s book, Getting Into a Residency, describes all the specialties and the training required. Frankly I wouldn’t recommend looking at it just yet. You don’t know enough about the world of medicine to know what sounds bad, good, or indifferent… you’ll gain that perspective when you’re in medical school.
If you’re looking at ways to talk yourself out of your interest in med school, then thinking about the grueling training schedule is certainly one way to do it. I guess if you read enough about people’s experiences with intern year, and you still want to do it, then you’ve passed one test to vouch for your interest in medicine.
You asked about the significance of the 30-hours thing. Here’s how it works: you report for work in the morning, let’s say 6am. If you are NOT on call, you do your patient care during the day and you finish sometime in the late afternoon, let’s say 5pm. You go home, you sleep, you come back to work the next day at 6am, just like a normal job with long hours. BUT if you are on call, you go to work at 6am, you do your day’s work, and then you stay there through the evening and overnight. During that time you do your patient care, you admit new patients to your service, and you take care of the patients that other interns sign out to you. In my current rotation I have my own panel of patients, usually 8-10, and then when I am on call I am also caring for the patients of two other interns for a total of THIRTY children overnight. And then I admit kids besides… it is a very busy service with lots to do and no time to sleep. In the morning, the other interns come back (if it’s a weekday) and then I have the remainder of the morning to complete work on my patients’ concerns. The 30-hour rule requires that I finish my work by noon if I got there at 6am the day before. (In fact, I have yet to get everything done within the 30-hour requirement, something that’s pretty common early in the intern year; I AM getting more efficient though.) The tough thing about this twelve-day stretch has been that you go home post-call after getting no sleep, you make up for it with ONE decent night’s sleep, and then go right back to work the next day. Ugh. It has been a looong stretch.
Not sure this is making sense, but I hope it helps. I celebrated the end of my twelve straight days with a trip to the local tavern… mmmmmmm (Homer Simpson voice) beeeeeer.
Mary
I don’t know, the whole idea of that first year seems exciting to me!! I have also seen those first year docs dragging around and sleeping in the chair at the nurse’s station (when I mom was in OSU last year) but I keep hoping all the years of 16 hour shifts, 12 hour shifts with less than 8 hour turn around and long shifts with nothing more than a 2 hour nap will help me in that aspect. I also keep remembering that episode of “ER” when Noah Wiley’s character was new and a bit snotty and the nurse’s spent the whole night waking him up on purpose for piddly crap. Do you suppose they really do that? 
Kathy
Kathy,
You bet, some of the nurse are out to make interns lives a living hell, (especially if they are upety)! I am a nurse, a new one, and I view drs as part of the team “I” am on. We work together for the good of the pt. Some nurses are pissed off at their standing on the food chain, for lack of a better phrase (“the us vs them phenomena”), that they do anything to “break” the intern and somehow make them “respect” the nurses role? I don’t know what is going through their heads, all I know is the very idea that my colleagues do this kind of thing makes me angrt; and I have seen it.
Cheers~Jen
Jen,
I wondered about that. I’m hoping all of my years working as a nurse will make things smooth when I get to that point. I’m not an “uppity” type person anyway, pretty mellow. The episode where I saw that happen was pretty funny though.
Kathy
Hi there,
Here was how PGY-1 worked for me under the old system: I got up at 3:30 AM showered and got to the hospital about 4:15 AM. I got sign-out from the guy who was post-call, pre-rounded on my patients checking wounds, and lab work from the previous day. At 0600h, my chief and senior residents would gather (I would have a list of patients for each of them). We would go from room to room while they examined wounds and I presented my findings. The cheif would give the plan for the day for each patient. I took notes. At 7:15AM, they would go off to the OR and I would sit and order tests, check labs, do treatments and carry out the plans. Around 9:00AM, my first post-ops would start to arrive. I would get them tucked in and get post-op orders written. I would grab breakfast in-between. On some days, there would be lectures for me or I would be responsible for speaking on a topic. I would discharge patients and dictate their charts. I would then do another set of afternoon rounds (checking wounds, checking labs and checking patients vitals and radiographs). I would then write all of the post-op checks from the days’s surgeries. I would start to prepare a sign-out sheet with things for the night man to watch for or for me if I was on call. If I were lucky, I might get to scrub on an afternoon case. I would then be ready for evening rounds with the chiefs where I would review the day’s events. If there were any problems during the day, I was responsible for notifying the chief and getting/carrying out a plan. If I were in overnight, I would then get signout from the person whose patients I would be cross covering (cardiac and thoracic). I would then round on their sickest patients and mine. I would squeeze in dinner if I got time around 8pm. I would admit patients who were coming in for surgery the next day. Cardiac patients usually had to be worked up on the medicine floor so the night person had to do that. Again, if I were lucky, I could scrub on a night case if the floor wasn’t busy. If there was a problem, I had to address it. If the problem was complicated, I had to notify the chief on call for instructions on how to handle it or I would simply handle the problem like a-fib. or a leaky chest tube etc.
Usually by 1am, I could grab a couple of hours of sleep but this was highly unusual. I would get up at 3am and check the sicker patients and put out fires (I didn’t wait for nurses to call me). I would then get up at 4am to pre-round on my patients. I would start the cycle all over again, with about 2 hours of sleep. At about 6pm, I would be allowed to leave after I signed out my patients to the on-call guy.
When the 80-hour work week came into play, I was one of the first to take on the Night Float position. Here I came in at 6pm and received signout from each of the services. I would cover 65 to 75 floor patients. There was another first-year resident who did all of the admissions and then turned then over to me. I would go from floor to floor putting out fires all night. I would have to call each of the chiefs if there was a problem on their service. I was responsible for transplants and gastric bypass patients. I had to make sure that everything was going well. It took organization but at 6am, the regular crews came in and I reported my overnight findings and adventures. At 7am, I participated in morning report and then left. My hours were better in that I worked about 75 per week but I worked harder and there was no sleeping time. I covered more patients and I had to learn to move quicker and make decisions faster. I also did not get the advantage of being able to scrub on the night cases. For the month that I was Night Float, I didn’t operate.
Yes, the hours are long, especially in General Surgery. Even today, I am hovering just at 80-hours and it’s a all out run for that whole time. I go into the hospital for morning report at 0545h and I usually leave around 1900h on most days. Sometimes I can have a late case and like last night, I was on ICU overnight call.
I got used to the hours very quickly and I don’t tolerate folks who waste my time. I leared to multi-task and I have a good base of being able to handle cases and procedures under my belt. It takes five to seven years to train a surgeon because of all of the procedures. There are hundreds to study and know thoroughly. We have to have nearly 1,500 operations to be qualified to do oral and written boards. It’s grueling but it is the most fun that you can have with your clothes on. The rest is experience. Every time I do a hernia, it is a learning experience and every thing counts. It’s all out “haul a–” at all times and I love every second of what I do.
Natalie 