As my wife and i are dissecting this decision that we are making we were discussing the time commitment needed in a residency and her idea is it is weeks on end without seeing your family. My ideas were more like days on end. Can anyone give me some accurate representations of the time commitment?
It is highly dependent upon which residency you do. If you do Psych, FP, Path, Rads, Derm or those like these - the hours tend to be more forgiving, once you are past your internship. Of that list, the most demanding would be FP. On the other hand, if you enter Surg, NSG, Anesth, OB/Gyn, IM or other more intense programs, then you will constantly be bumping up against your hours limitations & frequently going over…
Currently, the ACGME & AOA limit your works hrs to 80/wk with 4x 24hr periods off (no clinical responsibility) per month all averaged over any random 28-day period. Also, you cannot be primarily responsible for pt care for greater than 24 consecutive hrs, but the programs are given a 6hr buffer to account for continuity of care. This is supposed to limit the number of hrs you are taking care of folks to 24, but the “creative” buffer concept essentially extends it to 30hrs since no one really has defined “primarily responsible” & “continuity of care”. Finally, you must have a minimum of 10hrs of responsibility-free time b/t all shifts.
It is a sad indictment that it took threat of federal legislation to force the medical training regulatory bodies to adopt these “restrictions” if you wish to call greater than DOUBLE any other normal job’s requirements a restriction on duty time. Virtually all other professions where sleep-deprivation can be a safety factor were many years ago heavily restricted: truck drivers, air traffic controllers, train engineers, pilots…just not physicians. Apparently, according to the Gov’t, we Docs truly are immune to the effects of sleep deprivation?
In summation, you will never go weeks on end w/o seeing family, but it may seem like it. There are only 168hrs in a week & when you spend 80 of them in-house working your ass off, deduct time to sleep, there is frequently not a lot left over. However, you become quite adept at maximizing the “quality” of your time in lieu of quantity. At times, it will just suck! Most of the time, it becomes routine…the whole time facing forward to when life will return to quasi-normal.
Physicians will never have a normal lifestyle, but the lifestyle you can have can be fantastic if you regulate it appropriately. The tick to the concept is that during your education & training, you do not have control over your schedule. However, once you get out in private practice, you re-gain substantial influence of your obligations. To some extent, again - highly specialty dependent, your pts will hold a trump-card on your hours. But, in an overarching sense, you can dictate your lifestyle by how much control you are willing to surrender to your profession.
- OldManDave Said:
It is highly dependent upon which residency you do. If you do Psych, FP, Path, Rads, Derm or those like these - the hours tend to be more forgiving, once you are past your internship. Of that list, the most demanding would be FP. On the other hand, if you enter Surg, NSG, Anesth, OB/Gyn, IM or other more intense programs, then you will constantly be bumping up against your hours limitations & frequently going over...
Currently, the ACGME & AOA limit your works hrs to 80/wk with 4x 24hr periods off (no clinical responsibility) per month all averaged over any random 28-day period. Also, you cannot be primarily responsible for pt care for greater than 24 consecutive hrs, but the programs are given a 6hr buffer to account for continuity of care. This is supposed to limit the number of hrs you are taking care of folks to 24, but the "creative" buffer concept essentially extends it to 30hrs since no one really has defined "primarily responsible" & "continuity of care". Finally, you must have a minimum of 10hrs of responsibility-free time b/t all shifts.
It is a sad indictment that it took threat of federal legislation to force the medical training regulatory bodies to adopt these "restrictions" if you wish to call greater than DOUBLE any other normal job's requirements a restriction on duty time. Virtually all other professions where sleep-deprivation can be a safety factor were many years ago heavily restricted: truck drivers, air traffic controllers, train engineers, pilots...just not physicians. Apparently, according to the Gov't, we Docs truly are immune to the effects of sleep deprivation?
In summation, you will never go weeks on end w/o seeing family, but it may seem like it. There are only 168hrs in a week & when you spend 80 of them in-house working your ass off, deduct time to sleep, there is frequently not a lot left over. However, you become quite adept at maximizing the "quality" of your time in lieu of quantity. At times, it will just suck! Most of the time, it becomes routine...the whole time facing forward to when life will return to quasi-normal.
Physicians will never have a normal lifestyle, but the lifestyle you can have can be fantastic if you regulate it appropriately. The tick to the concept is that during your education & training, you do not have control over your schedule. However, once you get out in private practice, you re-gain substantial influence of your obligations. To some extent, again - highly specialty dependent, your pts will hold a trump-card on your hours. But, in an overarching sense, you can dictate your lifestyle by how much control you are willing to surrender to your profession.
Currently, the ACGME & AOA limit your works hrs to 80/wk with 4x 24hr periods off (no clinical responsibility) per month all averaged over any random 28-day period. Also, you cannot be primarily responsible for pt care for greater than 24 consecutive hrs, but the programs are given a 6hr buffer to account for continuity of care. This is supposed to limit the number of hrs you are taking care of folks to 24, but the "creative" buffer concept essentially extends it to 30hrs since no one really has defined "primarily responsible" & "continuity of care". Finally, you must have a minimum of 10hrs of responsibility-free time b/t all shifts.
It is a sad indictment that it took threat of federal legislation to force the medical training regulatory bodies to adopt these "restrictions" if you wish to call greater than DOUBLE any other normal job's requirements a restriction on duty time. Virtually all other professions where sleep-deprivation can be a safety factor were many years ago heavily restricted: truck drivers, air traffic controllers, train engineers, pilots...just not physicians. Apparently, according to the Gov't, we Docs truly are immune to the effects of sleep deprivation?
In summation, you will never go weeks on end w/o seeing family, but it may seem like it. There are only 168hrs in a week & when you spend 80 of them in-house working your ass off, deduct time to sleep, there is frequently not a lot left over. However, you become quite adept at maximizing the "quality" of your time in lieu of quantity. At times, it will just suck! Most of the time, it becomes routine...the whole time facing forward to when life will return to quasi-normal.
Physicians will never have a normal lifestyle, but the lifestyle you can have can be fantastic if you regulate it appropriately. The tick to the concept is that during your education & training, you do not have control over your schedule. However, once you get out in private practice, you re-gain substantial influence of your obligations. To some extent, again - highly specialty dependent, your pts will hold a trump-card on your hours. But, in an overarching sense, you can dictate your lifestyle by how much control you are willing to surrender to your profession.
This is slightly off-topic, and I don't mean to hi-jack the thread, but out of curiosity how is the lifestyle for anesthesiology? If I don't go into EM, I'll probably be looking very closely at anesthesiology, hence the question.
Is there anyway to “see” how a particular program treats their charges BEFORE we sign in blood? Also, do you know of any family friendly" programs? Or at least more family friendly than most?
TIA
gwen
When you go on the residency interview trail, you’ll have the chance to find out how they run the program. You’ll want to be sure to get the opportunity to talk to residents in settings where they can speak freely – unscripted time such as lunches or dinners is usually part of an interview day and if it isn’t, that could be a warning sign that they don’t want candidates talking to unhappy residents.
There are specialties that are known for being more and less “family friendly” – surgery and OB/GYN have awful schedules and honestly, I don’t see how they could be family friendly but I’ve known people to have babies and families while doing those residencies… primary care specialties such as family medicine and peds and internal medicine will usually be more “family friendly.” The “shift-work” nature of emergency medicine can be appealing for those who like predictability of their schedules.
When you get to the point of looking at programs in a particular specialty, you’ll hear about toxic programs and ones that are more humane. Given the sheer number of programs, it’s not possible to answer your question now, but when you are at that point, you’ll be networking with people on the interview trail, at your school, etc. and you’ll get lots via the grapevine on programs you might be interested in.
Mary
I have heard that there are part-time residencies. Is this really true?
boy i hope so!
gwen
I recall reading about shared residency slots in Ken Iserson’s book Getting Into a Residency, which is a phenomenal reference. However, never having sought one, I cannot tell you how many, how competitive or in what specialties they exist…but, at least back when I was seeking a residency slot, these options did exist.
I would strongly suspect that these PT-slots are in one of the primary care specialties & not surg/anesth/OB and so on.
Anyone who has recently been thru this have any additional info?
I wasn’t looking for it, so don’t know if it’s out there. As Dave said, the only way it would work is if there were a “shared slot.” What you need to know about residency positions is that they are mostly funded by Medicare money and programs each year construct a budget that is based on a fixed number of funded positions. It is MUCH more rigid than in the “normal” world of work. [e.g. the program I graduated from budgets for eight positions yearly – if someone were interested in a “part-time” slot they would have to find another person who wanted to split one slot with them. The program’s interests are not served by having 7.5 residents when they need eight. In other words, you would have to find a stranger who wanted to make a SIX-YEAR commitment with you… and a program willing to take a chance on that.]
I have to say that if you are going into pre-med thinking about how you can find a shared residency slot or part-time position, you really need to think hard about whether this is what you want to do. I started this post thinking it’d be pretty short, but as I’ve been writing I have thought of all sorts of reasons why residency programs have ended up the way they are. I am not saying that you cannot or should not consider a “part-time” residency but boy, it would be fraught with pitfalls. It turned out that I could enumerate quite a few 
Residency has its own very weird “apprenticeship” culture and going in with the hope that you can do things differently is unrealistic. It’s a big clunky system that doesn’t adapt well to people who want to do things differently. Even conventional maternity leave causes all sorts of problems because one resident’s schedule is so integrated to the schedules of everyone else in her/his class. I can’t stress it enough, it is NOT a conventional working environment.
And from my perspective, having emerged from the other end, I understand better now why residency is structured as such an intensive experience. Just as you wouldn’t be a very good swimmer if you only took one class every two months, and didn’t practice in between, you can’t really internalize everything you need to know in your field of medicine without practice, practice, practice.
In fact, I’ve been musing recently on how MUCH MORE I’ve learned in this, my first year as an attending physician, simply because I am doing the same thing every day. My level of comfort in dealing with different situations has gone up exponentially because of the number of times I’ve seen each of those situations.
Another analogy might be those foreign-language immersion programs… having struggled through high school and college Spanish, where I did an hour of Spanish three times a week, I adapted a lot quicker when I was working in a clinic where the predominent language was Spanish.
Totally aside from the educational reasons for which residency is structured the way it is, it’s also annoying and often mickey mouse, with people arguing over call schedules, resident duties, and dumb stuff that feels very high school-ish. I am pretty sure that if I had stayed a resident for much longer that I would have gone postal.
Maybe if you’re only there half the time it wouldn’t be as annoying, but that brings up another thing: quite frankly I wouldn’t trust a residency director to actually stick to a part-time commitment on a bet. I can just hear it now: “Yes, I know that’s part-time A’s day off, but part-time B is on an elective and we really need someone to cover this call.” Honestly, I think you’d be having to constantly argue to maintain the boundaries you negotiated… for six years if you do FP, IM or peds. Gack!
Sorry for the somewhat downer message. I don’t want to discourage anyone, just want you to be aware that medical education is one hide-bound institution and folks who want to make it more flexible have a huge challenge on their hands. Better to know that going in…
Mary
I think Mary’s post is much more reflective of what I would assume to be the reality of the situation. I meant for my post to appear bland & w/o slant…as I do suspect these positions are out there or at least advertised as being available. But, medical training in INFAMOUS for its lack of tolerance of being different or desiring something other than the status quo. For example, when I requested time off for both the birth of my youngest & her subsequent neurosurgical procedure (born with a tethered spinal cord that had to be detethered at 4mos), you would have thought I had asked the PD to rip off his arm w/o analgesia. It was NOT warmly rec’d nor supported and I had to flatly state, “I am not asking for your permission, I am forewarning you of an impending reality to afford you the luxury of scheduling machinations [which I offered to help with] far enoug in advance as to not cause disruptions.” For the paternity leave, I had to formally request FML, essentially going over his head to GME.
So, as Mary cautions, I would be very cautious in how you proceeded & make damned certain that you have EVERYTHING in writing and know, in depth, the rules of engagement and have them in written form too.
Contrary to popular belief, while your education & training are a primary focus of the PDs & the training programs themselves, an overarching & more pressing (in their eyes & in the actuality of implementation) focus is getting all of the patient care needs covered. The presence of trainees allows the facility to cover the needs of a volume of patients far in excess of what they would be able to handle in the absence of interns & residents. This is how & why you get paid to learn AND how they can maximize revenues while simultaneously minimizing costs. No, they are not getting rich off of this arrangement - in fact, they are barely squeaking by. But, it would be a death knell to a teaching program to understaff & subsequently undermine their ability to cover the pt volumes they require.
A similar situation, although more common & less ‘frightening’ to the programs is couples matching. The difference is the program/programs involved get 2 FT-residents, but the risk is committing to a weaker resident for the sake of the other one. In a shared-slot match, success would be dependent upon another individual (either randomly or facilitated through your own networking) & you both appearing sufficiently attractive for the program to risk both of you honoring your extended, PT-commitment.
Not impossible, but most definitely the exception & not the rule.
MomMD.com had a post with a similar topic a few months ago. Several women chimed in about their part-time/shared residencies, but I don’t remember the particulars. As a parent, and especially as a single mom, I’m looking for ways to lessen the negative impact that a medical education could have on my daughter—3rd year and residency both concern me a bit.
Something that I didn’t really appreciate until I got into rotations was the “team” aspect. On a typical rotation at a typical allopathic school, you’ll be one of a few students who are assigned to a team of residents and attendings. The senior resident has a list of patients for which the team is responsible - and divvies up the list among the junior residents, who then delegate those patients to students. [note: this model is often different at D.O. rotations; read Linda Wilson’s diary to see what sorts of experiences she has had.]
In other words, as a third-year student, you ARE the first person of the medical team to see a patient in the morning, and your work of finding out lab values, vital signs, radiology reports, patient’s response to medications, etc. etc. is actually important to the team and actually does help the resident to take care of a bunch of people. You really do matter.
When you graduate and start your intern year, your role is kind of similar but of course with considerably more responsibility. Now YOU may be the one with students under you, and you have to scrutinize what they’re doing, sign off on their orders, and verify that they are getting the information right – in addition to doing some teaching.
In any case, each person on the team has a lot of work. And you end up developing a tremendous sense of responsibility to the other people on your team. You hear people outside medicine talk disapprovingly of doctors who go to work sick – I suspect that most of 'em would happily stay home in bed but they don’t want their colleagues (either in the hospital or in an office setting) to get stuck holding the bag for all their work.
You work closely with your team every day. You see them at their best and worst - all spiffed up to do a presentation for the attending who supervises the team, and unshaven / messy hair / rumpled scrubs on the morning after call night. Because you are with one another for much of every day, you get to know your team members well. You share meals together. Hell, on one rotation I did, guys and gals shared a call room!!! And of course you are dealing with intense situations. It is an intimate work situation.
I am describing all this in some degree of detail to demonstrate how difficult the balance will be when you have to also figure out how to keep your family in the balance. You will feel obligated to your team - you will not want to let them down - you will want to do your best not only because you want to excel, but because you want to help the whole team.
And so as you think about how to also make sure things are taken care of on the home front, you’ll need to pay special attention to “Who will take your place at home?” When schools open late because of snow, when a child is too sick to go to daycare, when your s.o. must be away on business… all these things screw up anyone’s schedule, but they will be especially hard for a medical student or resident.
And you’ll be torn - in a different kind of work world, maybe you’d work from home or call in sick yourself. But you won’t be able to do that – and furthermore, you probably won’t want to.
As Dave pointed out above, the attitude of med schools and residency programs is that you are there for them, and your life outside of medicine is not only not their concern, but something they would prefer did not exist. There aren’t allotted “sick days” during third year – it just goes without saying that you had better be deathly ill if you aren’t there.
Anyway, I don’t mean to scare anyone, just to point out that it’s not at all a typical work world, and your plans for family and child care are going to need to be pretty detailed and complex to support what you are doing.
And I should also say that there are sometimes rotations during third year where you have a nice predictable schedule, evenings at home, etc. It’s not boot camp the ENTIRE year. Similarly, as a resident you’ve got inpatient months and then elective months where you aren’t as busy and may not even be on call. It’s not ALWAYS bad. But when it is bad, you may be away from home for 12 hours or more, and may have work to do when you ARE home.
Of course as an attending, I am working from 8 to 5:30 then bringing home a couple hours of work each night 
huh, how much have I improved my life? (answer: well, at least I’m getting paid more!!!)
Mary
Thanks for the perspective, Mary. The day-to-day is still a ways away for many of us, but it’s always good to better appreciate it.
Hi Mary! That last post was a GREAT!!!
Mary, you could write a book. This site is like an interactive, beautiful reference, and I really appreciate your stories and advice. I’m taking it to heart and don’t know how I’ll make it work yet. I realize that–if and when I get to med school-- I’ll need more daily support than I have now.