Can I terminate PGY-1 now

[Faebinder]

Honestly, I dont understand why there arent more Transitional Year internships out there because they are the type of PGY1 that will allow more good competition between residencies for the better of the resident and for the hospital.....

For the resident:
1) Perfect for picking up slack in all services...
2) Allows AMGs to practice after taking step 3 since most states will let AMGs practice in general medicine with 1 year of clinical experience
3) No constraints to stay with the program.

For the hospital:
1) Cheaper labor than midlevel.
2) Easier to recruit.

So where is the problem? Makes me wonder how come the number of spots in Transitional has been the same since 8 years ago.

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[Obedeli]

Look, it is pretty simple. I would never, nor did I even consider doing anything in surgery because I KNEW it was would suck and you would be worked like a dog (sorry Kim Cox). You can't tell me that you didn't know 2 days off per month was expected. I remember my chief resident during my surgery rotation in the 3rd year of medical school saying that he hasn't seen his girls in 2 weeks. They get up at 4:30 am to peek under the bathroom door just to see him. Forget that dude. So, I chose something that did work with me. Quitting sucks. Are there special circumstances where it is reasonable?? Well of course there are. But generally, just "not being happy" is a piss poor excuse, to cut short and run before the program can work to replace you. I have known several surgical residents who left because they too were not happy. Valid? ... of COURSE but they did it right and in the end, the PD and several attendings went to great length to HELP them find the spot in the field they wanted. They would actually call PDs from radiology programs and recommend the resident to them. The transition was smooth with very few if any bitter feelings. Why NOT do it this way if given the choice? It is so cliche but don't burn bridges if you don't have to. That is all I am saying. You can come up with any selfish rationalization for it but in the end, it is just that... all about you. I can't argue with that. It is a mindset, a frame of thought that cannot be reached.

 

[sunlioness]

Obviously things change when you change vantage points.

I suppose the white lie about leaving for a flight out of town would have raised some questions. The dead grandma comes to mind but that would require some acting.

Sick kid is what first came to my mind.

 

[sunlioness]

Amen! But have you ever heard of a PD stepping in to pull shifts when a resident is down? No, they pull people off of a pull list, which is fair. But after that they pull people from slow services, or research blocks that are supposed to be protected (depending on the program). Of course, if a faculty member is out for a day a Chief Resident can sometimes step in, which may or may not be fair. "Medical leadership" is almost an oxymoron.

My PD actually came in to the hospital at 3am to help me when I was on call and swamped in the emergency department.

The more I read stuff like this, the more I realize I need to quit complaining about the little things that piss me off because of how lucky I really am!

 

[Winged Scapula]

Look, it is pretty simple. I would never, nor did I even consider doing anything in surgery because I KNEW it was would suck and you would be worked like a dog (sorry Kim Cox).

Apologies not necessary...its not for everyone. Just as you knew surgery would suck, after I did FP I knew that would suck (for me). To each his own.

 

[Winged Scapula]

We're getting off topic here...the reason the OP wants to leave her residency early is not because she hates it so much but because she wants more time off to move, sell her house, etc.

Frankly, if her program gives it to her...fine, but it seems like asking for special favors when there are hundreds, if not thousands of residents and fellows who generally have a week or less to move, sell houses, get kids in schools, etc. Not really a good reason to quit your program, IMHO, since its entirely possible to do everything ahead of time without leaving your current program months early.

 

[sunlioness]

I left IM after my internship to pursue a psych residency. It never even occurred to me to ask to leave IM early even though aside from the neurology elective I managed to switch into last minute, I was doing nothing that my psych residency required. And I kept getting new patients in my outpatient clinic, which was really stupid. "Hi. I'm Dr. K. It's nice to meet you. You're never going to see me again." But I did it and it really wasn't that bad. The only really weird thing was the one attending who kept pulling me aside and asking how internal medicine had "failed" me. How many times can you say, "It hasn't, I just really want to do something else."

 

[8744]

Look, it is pretty simple. I would never, nor did I even consider doing anything in surgery because I KNEW it was would suck and you would be worked like a dog (sorry Kim Cox). You can't tell me that you didn't know 2 days off per month was expected. I remember my chief resident during my surgery rotation in the 3rd year of medical school saying that he hasn't seen his girls in 2 weeks. They get up at 4:30 am to peek under the bathroom door just to see him. Forget that dude. So, I chose something that did work with me. Quitting sucks. Are there special circumstances where it is reasonable?? Well of course there are. But generally, just "not being happy" is a piss poor excuse, to cut short and run before the program can work to replace you. I have known several surgical residents who left because they too were not happy. Valid? ... of COURSE but they did it right and in the end, the PD and several attendings went to great length to HELP them find the spot in the field they wanted. They would actually call PDs from radiology programs and recommend the resident to them. The transition was smooth with very few if any bitter feelings. Why NOT do it this way if given the choice? It is so cliche but don't burn bridges if you don't have to. That is all I am saying. You can come up with any selfish rationalization for it but in the end, it is just that... all about you. I can't argue with that. It is a mindset, a frame of thought that cannot be reached.

Whoa. I agree that a two week notice would be the courteous thing to do but not being happy is the best of reasons to quit a job. It ranks right up there with wanting more money, more independence, and fewer hours. That's the American way, for crying out loud and so important that the Pursuit of Happiness is in the Declaration of Independence as a right given by our creator.

The resident in question thought he'd like his job, decided he didn't, and took proactive measures to remedy the situation. That's how it works at every other job in the world.

As for giving your program time to replace you, why? It doesn't work like this in any other profession. Suppose I decide to quit my crappy minimum wage job at Taco Bell. Do I have to wait until my manager can hire a suitable replacement? Of course not. You give your notice as a courtesy and the clock is ticking for your employer, not you.

If you'll stay until they find a replacement, why should they make the effort to replace you? What if it takes them a month? Two months? You're still there. They have time. Personally, if I decided that a job sucked so hard that I wanted to quit (which I would have done last year except I needed the money and my new program expected me to finish out the year) I would not put up with one more week of the abuse that is routine in residency much less two months. Like I said, your hospital has money. They could bloody well pay a moonlighting resident or attending to cover your call except that they have you folks so firmly mentally and physically by the gonads.

Loyalty is a good thing but your loyalty to a bureaucracy that will throw you to the wolves at the first sign of trouble is puzzling.

 

[8744]

Look, it is pretty simple. I would never, nor did I even consider doing anything in surgery because I KNEW it was would suck and you would be worked like a dog (sorry Kim Cox). You can't tell me that you didn't know 2 days off per month was expected. I remember my chief resident during my surgery rotation in the 3rd year of medical school saying that he hasn't seen his girls in 2 weeks. They get up at 4:30 am to peek under the bathroom door just to see him. Forget that dude. So, I chose something that did work with me. Quitting sucks. Are there special circumstances where it is reasonable?? Well of course there are. But generally, just "not being happy" is a piss poor excuse, to cut short and run before the program can work to replace you. I have known several surgical residents who left because they too were not happy. Valid? ... of COURSE but they did it right and in the end, the PD and several attendings went to great length to HELP them find the spot in the field they wanted. They would actually call PDs from radiology programs and recommend the resident to them. The transition was smooth with very few if any bitter feelings. Why NOT do it this way if given the choice? It is so cliche but don't burn bridges if you don't have to. That is all I am saying. You can come up with any selfish rationalization for it but in the end, it is just that... all about you. I can't argue with that. It is a mindset, a frame of thought that cannot be reached.

Do you think that your program, or any program, will not sell you up the river at the first sign of trouble? You owe your program work and they owe you your pay and benefits. After that it's all metaphysical crap.

 

[Obedeli]

Whoa. I agree that a two week notice would be the courteous thing to do but not being happy is the best of reasons to quit a job. It ranks right up there with wanting more money, more independence, and fewer hours. That's the American way, for crying out loud and so important that the Pursuit of Happiness is in the Declaration of Independence as a right given by our creator.

The resident in question thought he'd like his job, decided he didn't, and took proactive measures to remedy the situation. That's how it works at every other job in the world.

As for giving your program time to replace you, why? It doesn't work like this in any other profession. Suppose I decide to quit my crappy minimum wage job at Taco Bell. Do I have to wait until my manager can hire a suitable replacement? Of course not. You give your notice as a courtesy and the clock is ticking for your employer, not you.

If you'll stay until they find a replacement, why should they make the effort to replace you? What if it takes them a month? Two months? You're still there. They have time. Personally, if I decided that a job sucked so hard that I wanted to quit (which I would have done last year except I needed the money and my new program expected me to finish out the year) I would not put up with one more week of the abuse that is routine in residency much less two months. Like I said, your hospital has money. They could bloody well pay a moonlighting resident or attending to cover your call except that they have you folks so firmly mentally and physically by the gonads.

Loyalty is a good thing but your loyalty to a bureaucracy that will throw you to the wolves at the first sign of trouble is puzzling.

A patient load is not the same as a load of refried beans. They may smell the same . . . but.

I am not saying you stay FOREVER until they are ready. The OP does not have that long to go and as Kim pointed out, he/she is asking for some time. I know how tough house shopping is, if they aren't being reasonable, becoming homeless after the year is out is not an option.

 

[Adam_K]

A patient load is not the same as a load of refried beans. They may smell the same . . . but.

That's why they call them attending physicians.

Why is the patient load the resident(s)'s problem?

It certainly isn't the tech's (he's getting paid by the hour) or the nurses.

As Panda so eloquently points out on his blog, why is it that residents are the only ones being overworked without adequate compensation?

Everyone else wins.

Starting from the custodial staff, the techs, the nurses, and the attendings, never mind the administrative staff, no one pulls as many hours as the residents for less than the gordita jockey.

 

[Winged Scapula]

Would it be possible to divert this discussion (which is tiresome because its raised in nearly every thread here, and by the same people) back to the REAL reason the OP is asking to leave early?

I would be interested in seeing if people think differently when they consider why she wants to leave early. Its not because of hating her work, or the hours, or anything onerous (at least that she's admitted to). Its because she wants more time to move. Given that people do it all the time without too much trouble and there is a partner who can help, is it appropriate (we'll leave the term fair out of this) to leave residency early to do things everyone else does in a week or less?

 

[Obedeli]

I'm done. My point is clear and that is that.

 

[dry dre]

I would be interested in seeing if people think differently when they consider why she wants to leave early. Its not because of hating her work, or the hours, or anything onerous (at least that she's admitted to). Its because she wants more time to move. Given that people do it all the time without too much trouble and there is a partner who can help, is it appropriate (we'll leave the term fair out of this) to leave residency early to do things everyone else does in a week or less?

Really...the decision to leave is personal, whether it be because the OP hates his/her coworkers, or because s/he wants to stop at the Grand Canyon on the way across country. To debate the merits of either line of reasoning seems to be an exercise in cleaning someone else's castle in the sky.

Frankly, I find it malignant for an employer to 'expect' you to move across the country in 3 days. Seriously....would you every join a private practice group that expected you to do this?

At some point we have to call into question co-dependence with the medical education training system. This "thank you sir, may I have another" approach to life is wholly absurd and frankly indicative of some type of self-abusive personality disorder in those who support it.

 

[8744]

View attachment 7934

Really...the decision to leave is personal, whether it be because the OP hates his/her coworkers, or because s/he wants to stop at the Grand Canyon on the way across country. To debate the merits of either line of reasoning seems to be an exercise in cleaning someone else's castle in the sky.

Frankly, I find it malignant for an employer to 'expect' you to move across the country in 3 days. Seriously....would you every join a private practice group that expected you to do this?

At some point we have to call into question co-dependence with the medical education training system. This "thank you sir, may I have another" approach to life is wholly absurd and frankly indicative of some type of self-abusive personality disorder in those who support it.

Right. When I left my my categorical position last year, I was polite and gave a bland, non-commital answer as to why. I swear, haven't you people ever heard about good manners? It's like telling a girl you don't want to go out with her again. Even if the reason you don't is because she's fat and your friends are laughing at you, you can still say it's because you're not ready to settle down or something like that.

"Need to look for a house," equals, "I hate everything about this place and I'm sick of pulling call and working like a Tortugan Sugar Plantation Slave."

 

[8744]

Would it be possible to divert this discussion (which is tiresome because its raised in nearly every thread here, and by the same people) back to the REAL reason the OP is asking to leave early?

I would be interested in seeing if people think differently when they consider why she wants to leave early. Its not because of hating her work, or the hours, or anything onerous (at least that she's admitted to). Its because she wants more time to move. Given that people do it all the time without too much trouble and there is a partner who can help, is it appropriate (we'll leave the term fair out of this) to leave residency early to do things everyone else does in a week or less?

I guess if she had said, "Because if I have to do call here one more time I'm going to burn this mother down," everything would have been alright.

Seriously, your tolerance for call and the rest is a lot higher than mine.

 

[f_w]

Frankly, I find it malignant for an employer to 'expect' you to move across the country in 3 days. Seriously....would you every join a private practice group that expected you to do this?

Last day of my fellowship, I walked out of the hospital, got into a truck, drove through the night, took a shower in the OR locker room and showed up for my new staff physician orientation. It wasn't expected, but heck if I can enter the pension plan a year earlier (and shelter some income) it was worth it.

At some point we have to call into question co-dependence with the medical education training system. This "thank you sir, may I have another" approach to life is wholly absurd and frankly indicative of some type of self-abusive personality disorder in those who support it.

The evil 'guild' that makes us do these things also ensures an above average income and unsurpassed job security after you go through the hazing rituals.

 

[Winged Scapula]

I guess if she had said, "Because if I have to do call here one more time I'm going to burn this mother down," everything would have been alright.

Seriously, your tolerance for call and the rest is a lot higher than mine.

That may be true.

And it may very well be true that the OP's real reason is that she hates the program, the call, or whatever. MY point was that we never dealt with the reason she gave - did that make a difference in anyone's viewpoint about her leaving early?

In reference to dry dre's comment about moving across the country in "3 days", of course I don't think that's appropriate. I don't think I've ever said in these forums that I thought the current way of training residents, especially in some programs, was fair or necessary. Just because I'm less vocal about my opinions here than you or some others, doesn't mean I don't share the same views.

But I do disagree with the attitude of "me first" and I think that is what the OP is showing. If she wants to work to change the policies that don't allow people enough time to move to a new area, that would be great. But as it stands, IMHO, she simply wants benefits that no one else is getting and that doesn't seem fair to me. But then...who said life (or residency) is fair? Just another example of the downfall of our society when everyone thinks about themselves first and not the commitment they made.

I don't claim to have done anything to make training better either...but at least I'm not asking for special favors. Egocentrism is a bad thing in the workplace; there was something to be said for the long work hours - residents really got to rely on each other because of all the time spent together.

 

[8744]

That may be true.

And it may very well be true that the OP's real reason is that she hates the program, the call, or whatever. MY point was that we never dealt with the reason she gave - did that make a difference in anyone's viewpoint about her leaving early?

In reference to dry dre's comment about moving across the country in "3 days", of course I don't think that's appropriate. I don't think I've ever said in these forums that I thought the current way of training residents, especially in some programs, was fair or necessary. Just because I'm less vocal about my opinions here than you or some others, doesn't mean I don't share the same views.

But I do disagree with the attitude of "me first" and I think that is what the OP is showing. If she wants to work to change the policies that don't allow people enough time to move to a new area, that would be great. But as it stands, IMHO, she simply wants benefits that no one else is getting and that doesn't seem fair to me. But then...who said life (or residency) is fair? Just another example of the downfall of our society when everyone thinks about themselves first and not the commitment they made.

I don't claim to have done anything to make training better either...but at least I'm not asking for special favors. Egocentrism is a bad thing in the workplace; there was something to be said for the long work hours - residents really got to rely on each other because of all the time spent together.

I'm not busting down on you, Dr. Cox, but all she wanted to do was quit a job she no doubt hated for a better job. It's got nothing to do with fair. As far as commitments, well, it's not the military. She swore no oath and has no contractual obligations not set forth in her employment contract. Her program, for their part, would stick the contract to her at the first sign of trouble.

It's just the nature of residency training that we only really have the chance to switch jobs once a year. If she hated it, why shoud she suffer for the whole year if she doesn't have to?

If she doesn't think about herself, nobody else will and If her program really loved her they would pay her more and work her less. At most places, it you want to quit and they really want to keep you they'll offer you more pay or better benefits to keep you. these are not "special favors" but rather incentives to keep valuable employees. Did her program try that if not, why not?

Simple, because da' Oberseeyer does not bargain with the slaves.

Unfortunately, as far as the hospital goes loyalty is a one-way street.

 

[8744]

Last day of my fellowship, I walked out of the hospital, got into a truck, drove through the night, took a shower in the OR locker room and showed up for my new staff physician orientation. It wasn't expected, but heck if I can enter the pension plan a year earlier (and shelter some income) it was worth it.



The evil 'guild' that makes us do these things also ensures an above average income and unsurpassed job security after you go through the hazing rituals.

So it's a hazing ritual? Now I'm really mad. Can you show me where in my contract it stipulates that I am to be hazed? Every hosptital and university I have ever been a part of has explicit policies against hazing or harrassment of employees and the fact that these are ignored for residents is just another example of the duplicity of the medical training bureacracy.

That's kind of the point I'm nibbling at. There are no good reasons to treat residents like dirt. Every one I have heard comes down to some variation of "Because we have your gonads firmly grasped in our steely pincers."

 

[8744]

Last day of my fellowship, I walked out of the hospital, got into a truck, drove through the night, took a shower in the OR locker room and showed up for my new staff physician orientation. It wasn't expected, but heck if I can enter the pension plan a year earlier (and shelter some income) it was worth it.



The evil 'guild' that makes us do these things also ensures an above average income and unsurpassed job security after you go through the hazing rituals.

Sure, the key being that you had some incentive to do it. The only incentive the OP had to suffer for three more months of Q4 call was the siren call of $8.35 and hour.

 

[bigtimesmally]

The arguments here in favor of residency directors are so ridiculous. You guys need to step back and check yourselves. Are you for real? Countless number of times, PD have screwed over residents because they can. I can tell you from my own program that the PD is no one to **** with, because he has and will go after residents and try to ruin their reputation. If at any moment, I felt that it was time for me to check out, I would do it without a single shred of guilt. The other residents have to pick up the slack, to bad.

Professional behavior is clearly a myth in this profession. On the surface, everything is fine and polite. Beneath the surface, the ugly beasts roam free and they're ready to make residents lives miserable. I am being worked to death because the training requires it? No, because, instead of having some PA's to help out with some of the bull**** paper work, I can be used and abused because the system says it's okay. Just because it's has been this way in the past, doesn't justify the continuation of abuse in the system. I love my work. Surgery is awesome. But, because I'm ambitious and harworking, the system is set up to exploit that.

I say, stay and finish the year for the sake of getting credit and personal achievement. But, by no means do it because it's the PROFESSIONAL thing to do. You owe them nothing. In fact, they should constantly be thanking you for taking responsibility of lives of others for minimal pay and maximal sacrifice.

 

[DigableCat]

As for giving your program time to replace you, why? It doesn't work like this in any other profession. Suppose I decide to quit my crappy minimum wage job at Taco Bell. Do I have to wait until my manager can hire a suitable replacement? Of course not. You give your notice as a courtesy and the clock is ticking for your employer, not you.

Poor analogy.

 

[DigableCat]

In fact, they should constantly be thanking you for taking responsibility of lives of others for minimal pay and maximal sacrifice.

Sometimes, it's not all about you.

 

[bigtimesmally]

What???

You must be wise beyond my comprehension, to sum up a reply to my post with a genius of a comment as such. Actually, you know what, **** it, it is all about me. I make it my busines to be about me because I didn't go to residency for other people. It's purely for selfish reasons to gratify my thirst for achievement, money, prestige, and all the things that I deserve for my hard work. And, if I decide, that's it's not worth it, and my life is worth too much to deal with all the bull****, then, I'm out, quick without guilt.

for now, even post-call, i'm content.

 

[8744]

Poor analogy.

Why? Like I said, it is ludicrous to suppose that a hospital like Duke cannot find temporary help to cover some calls until its residency program that lost a resident can either find a suitable replacement or adjust its commitments to take into account the realities on the ground (for example, how some Family Medicine programs have dumped their inpatient service because of lack of residents).

Duke, as an example, has approximately 1000 residents for which the they profit around $50,000,000 from the Federal Government after subtracting salary and benefits. This money is fungible. I'm the biggest mercenary capitalist tool in the world but even I see the ridiculousness of a big hospital crying poverty as an excuse for mistreating the help. Hell, when Duke needs a phlebotomist or any other technician they either pay for the overtime or they bloody well hire one. Why is that, exactly?

To further make your blood boil, the last residency program I was at actually made a fairly nice profit for the Department, money which was of course sucked up by the gaping maw of the bureacracy to be regurgitated into a hundred different ravenous beaks, most of them having little to do with patient care.

 

[8744]

Sometimes, it's not all about you.

Man. That is lame beyond words. You can use this excuse to justify anything. Why not work 80 hours a week for $10.13 an hour for your entire medical career? I mean, seeing that altruism is to be the justification.

Drink. Drink deeply of the Koolaid.

 

[Apollyon]

Why? Like I said, it is ludicrous to suppose that a hospital like Duke cannot find temporary help to cover some calls until its residency program that lost a resident can either find a suitable replacement or adjust its commitments to take into account the realities on the ground (for example, how some Family Medicine programs have dumped their inpatient service because of lack of residents).

Cardiology at Duke came up with (a lot of) cash to pay fellows (and then attendings) to take admissions in the evening, so the interns could admit overnight (something like $500 or maybe now $1000/evening) - 4 years ago, I mathed it out, and a fellow (which it was at the time) could make $25K extra money at it. One fellow who was "locked on" would guilt/order the interns to do the admissions, so he got paid to do NOTHING. When the intern coordinator heard of that, though, he dropped the hammer on this fellow (and I always truly felt that the guy running the interns really was on the level, and not smiling to my face and stabbing me in the back, despite my evaluation that made me look like I was one step above the guy who PLAYS a doctor on TV).

 

[8744]

The arguments here in favor of residency directors are so ridiculous. You guys need to step back and check yourselves. Are you for real? Countless number of times, PD have screwed over residents because they can. I can tell you from my own program that the PD is no one to **** with, because he has and will go after residents and try to ruin their reputation. If at any moment, I felt that it was time for me to check out, I would do it without a single shred of guilt. The other residents have to pick up the slack, to bad.

Professional behavior is clearly a myth in this profession. On the surface, everything is fine and polite. Beneath the surface, the ugly beasts roam free and they're ready to make residents lives miserable. I am being worked to death because the training requires it? No, because, instead of having some PA's to help out with some of the bull**** paper work, I can be used and abused because the system says it's okay. Just because it's has been this way in the past, doesn't justify the continuation of abuse in the system. I love my work. Surgery is awesome. But, because I'm ambitious and harworking, the system is set up to exploit that.

I say, stay and finish the year for the sake of getting credit and personal achievement. But, by no means do it because it's the PROFESSIONAL thing to do. You owe them nothing. In fact, they should constantly be thanking you for taking responsibility of lives of others for minimal pay and maximal sacrifice.

****ing-A. Your program will roll your contract into a nice tube and shove it up your ass if they feel it is necessary. I can understand loyalty to family, to friends, to the Platoon, and to God but I cannot understand, for the life of me, this inexplicable impulse to treat a large bureacratic entity like it was some quaint little mom and pop store.

 

[3dtp]

Poor analogy.

Suppose instead of looking for sanity in life, the OP had a serious condition requiring medical attention, say a perfed appy. Or died? You think you're indispensible and irreplacible to a program, check your patient list a week after you've died in a sleep deprived car crash.

This ain't about taco bell or the CEO of Boeing. It's about life and choices, and for someone to say that one class or socio-economic status is different and more free than another, well that sort of brings to mind why we have the Civil War Amendments.

Bigtimesmally is absolutely correct. Professionalism in this business is non-existent. It is a buzzword that is used by program directors who love to smear and destroy the careers and create a world of hurt for those they do not like, those who challenge the lies told to recruits prior to the indenturing process we call the Match, which are the iron schackles of the latter age.

I have looked and looked at what exactly "professionalism" means in this field and cannot find a satisfactory answer, even when it is written down. For example, one NY program considers it unprofessional to leave your ID badge at home. Others think it's having sex with a patient. When the definition is that vague and broad, then it means exactly what the program director says it means at the moment and to whom. A favored one's behavior is not at all unprofessional, while the disliked one's identical behavior is "unprofessional."

That being said, and that being the case, look to your contract, and use it. PB is right, they will use that contract (or any violation they think they can get away with) and stick you. Use the letter of the contract and let that be your guide. If I had a dollar for every time a PD broke a promise to me and later said, "Do you have it in writing?" well, I wouldn't have to work another day of my life. In fact, even when I did "have it in writing," the excuse was, well things have changed.

Do what you can to get out, don't irritate them badly, if you can help it, keep your head down and hope the brown smelly stuff doesn't land on you.

And PB, we gotta get together, man, we have many things to talk about.

 

[Faebinder]

Gosh i cant believe there are people defending the program (No strike that, of course I can believe it, it's the mentality of "I took it up the ass and so can you.)

Residency is a JOB.

FURTHER.. how hard is it to find someone else to fill the ranks of a PGY1 position? I am sure even IN JANUARY, you can get a poor SOB who is down on his luck from the previous match to come fill in the half year left.

 

[toofache32]

....I have looked and looked at what exactly "professionalism" means in this field and cannot find a satisfactory answer, even when it is written down. For example, one NY program considers it unprofessional to leave your ID badge at home. Others think it's having sex with a patient.....

Uh oh. Is that wrong?

 

[Lonestar]

well, at our program the residents are taking more call b/c we have lost residents that we cannot replace. It is much easier to get "rid" of "problem" residents than to actually try to understand what it is that is the problem. We had a program director that was deemed as "resident friendly", but he recently "stepped down" and now is a much happier attending. Based on what i have seen so far from my residency, residency is just a rite of passage and nothing more. In residency, life tends to go by quicker when you are a perfect slave. "All that is required for evil to flourish is for good men to do nothing."

 

[f_w]

"All that is required for evil to flourish is for good men to do nothing."

Apparently it is also sufficient for mediocre men to do nothing (borrowed).

 

[juleswinfield]

Panda,

I think you're overlooking one important fact. Most of the people in medicine have never had a job in the real world. They go right from high school to college to med school to residency. I start med school this fall and it will be my third career. Leaving my first job out of college was one of the hardest things I've had to convince myself to do. I was so afraid that I would be quitting because I was weak, that I would be letting others down. But in the end I was so miserable at work that it spilled over to my personal life and destroyed a relationship I was in at the time. All told, I stayed about a year too long.

Leaving that first job was the best thing I ever did. Now I'm leaving my current job of four years to go to med school. (And for the record, I gave this job about a year's notice of my plans because I know that the respect here is a two way street.) The best thing I'm taking with me to med school is the knowledge that if it's really not for me, I'll just go do something else. Life is too short to put up with someone else's bs.

To the OP, call your new program and ask if you they want you to finish out your current spot, advising them of the other things you have on your plate - like moving and such - and see what they say. If they give you the ok then get the heck out of your current spot. On the other hand, if they suggest that you stay, you should.

 

[beefballs]

all things being equal, with signed contract and adefinite landing place, whether I stayed and pulled what had been my share would be determined by how I felt about the place. If I felt they unneccesarily treated me like crap-they can blow it out their a$$. All of this talk about contracts "You signed a contract!!!" Yeah, because in reality where else am I supposed to go, it isn't like I can line up competing offers, then maybe I would feel more obligated to it.

FWIW I enjoy hearing people who have different life experiences compare and contrast the differences in the health care field to others. Some may find it tiresome, but there is educational value in seeing how different entities function. Standing by the old company line "but this is how we have always done it" as a reason to oppose change is just wrong, as is using fear of retribution as a way of keeping an employee, this aint the Mafia.

 

[beefballs]

The evil 'guild' that makes us do these things also ensures an above average income and unsurpassed job security after you go through the hazing rituals.

I thought it was our education, training and demand that ensures us above average salaries and job securities?

 

[beefballs]

But I do disagree with the attitude of "me first" and I think that is what the OP is showing. If she wants to work to change the policies that don't allow people enough time to move to a new area, that would be great. But as it stands, IMHO, she simply wants benefits that no one else is getting and that doesn't seem fair to me. But then...who said life (or residency) is fair? Just another example of the downfall of our society when everyone thinks about themselves first and not the commitment they made.

May I ask why you disagree with a "me first" attitude? Would you put up with your residency hours if you weren't recieving what you deemed appropriate return on your investment?

 

[Winged Scapula]

May I ask why you disagree with a "me first" attitude?

Because without regard for others, a polite society ceases to exist. I believe that consideration for fellow man is a value that is being increasingly forgotten in an effort to do what is best for oneself.

Would you put up with your residency hours if you weren't recieving what you deemed appropriate return on your investment?

I did as thousands of others have before me. How do you determine how many hours are needed for "appropriate return"?

 

[f_w]

I thought it was our education, training and demand that ensures us above average salaries and job securities?

Tell that to some biology PhD

 

[Adam_K]

I hate to beat a dead horse, but since this thread is still around...

Just another example of the downfall of our society when everyone thinks about themselves first and not the commitment they made.

Actually, I would argue that you have it completely backwards.

Truth is, people are inherently selfish and greedy. The paradox is that political and economic systems (i.e. free market democracies) that take into account this fact and "exploit it" have been wildly successful for both society and individuals. Those that have not, have been complete and utter failures at the societal AND individual level (c.f. Stalin, Hitler and Mao among many others).

I don't claim to have done anything to make training better either...but at least I'm not asking for special favors. Egocentrism is a bad thing in the workplace;

Here's what I don't get. On other threads, you admit that you were humiliated during your residency training and your sleep patterns have changed permanently since then. Is this some sort of cognitive dissonance on your part?

You may think that egocentricism is bad in the workplace, because you didn't stand up to those that abused you.

Honestly, why should the rest of us follow your path?

The only explanation you appear to offer is

I did as thousands of others have before me.

So, do you resent those of us who want something better?

 

[Winged Scapula]

Here's what I don't get. On other threads, you admit that you were humiliated during your residency training and your sleep patterns have changed permanently since then. Is this some sort of cognitive dissonance on your part?

You may think that egocentricism is bad in the workplace, because you didn't stand up to those that abused you.

Honestly, why should the rest of us follow your path?

The only explanation you appear to offer is



So, do you resent those of us who want something better?

I appreciate your attempts to use your future clinical skills to make an assessment about me, but its not necessary.

You make assumptions about me and my experience when I never said anyone should follow my path, nor do I resent people who want something better. As a matter of fact, I WAS seen as a bit of a malcontent during my residency because I AGREED with the work hour restrictions and the fair treatment of residents. Perhaps I did not "stand up" to my abusers in the traditional way - ie, loudly complaining or outrightly refusing to do work, but I still registered my beliefs and when I did have more power, as a Chief, made sure that, at least for others, I did as much as I could to prevent the abuse where I saw it. As a fellow, I have been an active member of the Committee of Interns and Residents and fully support their efforts toward better working conditions for housestaff.

That said, I DO resent those who go into training, knowing what it entails, then act suprised when they work long hours or leave the hospital when there is work to be done. Because guess who does it? Those who have stayed behind to honor their commitment, and get the work done, while also working to make changes in the system. I think that the egocentric, clock watching attitude of many residents can be dangerous and serves only to benefit themselves rather than the patient. But I guess I'm naive to think that anyone wants whats better for their patients. And the belief may also stem from my field of choice: you cannot just walk out when you're in the middle of taking care of a critically ill patient or in the OR: I wonder how the current crop of residents will react when they see their cases as attendings being bumped later and later so that, God forbid, they actually have to stay in the hospital after 5:00 pm!

You'll get no argument from me regarding the issue of socialism, however I think you're taking my argument that a society needs to think of others first too far. Without that, there would be no social programs and other benefits for the less fortunate in our society.

 

[Adam_K]

I appreciate your attempts to use your future clinical skills to make an assessment about me, but its not necessary.

Sorry, I only meant to point out an apparent inconsistency in your responses.

You make assumptions about me and my experience when I never said anyone should follow my path, nor do I resent people who want something better. As a matter of fact, I WAS seen as a bit of a malcontent during my residency because I AGREED with the work hour restrictions and the fair treatment of residents. Perhaps I did not "stand up" to my abusers in the traditional way - ie, loudly complaining or outrightly refusing to do work, but I still registered my beliefs and when I did have more power, as a Chief, made sure that, at least for others, I did as much as I could to prevent the abuse where I saw it. As a fellow, I have been an active member of the Committee of Interns and Residents and fully support their efforts toward better working conditions for housestaff.

I'm happy to hear that, but I still have difficulty squaring this with some of what you wrote below.

That said, I DO resent those who go into training, knowing what it entails, then act suprised when they work long hours or leave the hospital when there is work to be done.

This is an excellent point. Kids, don't go into surgery unless you are ready for the hours.

Because guess who does it? Those who have stayed behind to honor their commitment, and get the work done, while also working to make changes in the system. I think that the egocentric, clock watching attitude of many residents can be dangerous and serves only to benefit themselves rather than the patient. But I guess I'm naive to think that anyone wants whats better for their patients.

While I like to think that I work diligently for my patients when I am on, I think that the burden of the entire system SHOULD NOT rest on my soon to be underpaid shoulders. Why am I singlehandedly responsible for all the additional hours at no additional compensation?

Again, everyone else in the hospital from the janitor, the kitchen workers, clerks, techs, nurses, attendings and administrators benefit directly or indirectly from the present arrangement at MY EXPENSE. I (like Panda) just want a more reasonable share of the pie.

And the belief may also stem from my field of choice: you cannot just walk out when you're in the middle of taking care of a critically ill patient or in the OR: I wonder how the current crop of residents will react when they see their cases as attendings being bumped later and later so that, God forbid, they actually have to stay in the hospital after 5:00 pm!

I have no problem with putting in extra time in a critical, emergent or difficult case, well past quitting time. The problem is that residents are being assigned too much work everyday. Worse, as Panda points out, a good portion of that work is only tangentially patient related and a highly inefficient use of my time.

You'll get no argument from me regarding the issue of socialism, however I think you're taking my argument that a society needs to think of others first too far. Without that, there would be no social programs and other benefits for the less fortunate in our society.

I would argue that our experience over the last forty years with social programs has helped to foster a large dependency class and weakened the most basic societal structure, the family. I think that many of the "less fortunate" are victims of government social programs.

 

[beefballs]

Tell that to some biology PhD

you're ignoring the third part of my statement

 

[f_w]

you're ignoring the third part of my statement

Demand is controlled by the goverment, the biggest buyer of healthcare services (through the number of funded GME positions).

 

[bigtimesmally]

I appreciate your attempts to use your future clinical skills to make an assessment about me, but its not necessary.

You make assumptions about me and my experience when I never said anyone should follow my path, nor do I resent people who want something better. As a matter of fact, I WAS seen as a bit of a malcontent during my residency because I AGREED with the work hour restrictions and the fair treatment of residents. Perhaps I did not "stand up" to my abusers in the traditional way - ie, loudly complaining or outrightly refusing to do work, but I still registered my beliefs and when I did have more power, as a Chief, made sure that, at least for others, I did as much as I could to prevent the abuse where I saw it. As a fellow, I have been an active member of the Committee of Interns and Residents and fully support their efforts toward better working conditions for housestaff.

That said, I DO resent those who go into training, knowing what it entails, then act suprised when they work long hours or leave the hospital when there is work to be done. Because guess who does it? Those who have stayed behind to honor their commitment, and get the work done, while also working to make changes in the system. I think that the egocentric, clock watching attitude of many residents can be dangerous and serves only to benefit themselves rather than the patient. But I guess I'm naive to think that anyone wants whats better for their patients. And the belief may also stem from my field of choice: you cannot just walk out when you're in the middle of taking care of a critically ill patient or in the OR: I wonder how the current crop of residents will react when they see their cases as attendings being bumped later and later so that, God forbid, they actually have to stay in the hospital after 5:00 pm!

You'll get no argument from me regarding the issue of socialism, however I think you're taking my argument that a society needs to think of others first too far. Without that, there would be no social programs and other benefits for the less fortunate in our society.

The work is never done. You know that. So, who determines when I'm to leave the hospital post-call. Tradition? Patient's level of health? In one hospital, residents stay till 12 post call, in another hospital, residents leave immediately after morning rounds. So, who is right? When does my responsibility end post call if I was the one who admitted him/her during the night? If I leave at 9am and the patient still needs a serial abdominal exam, or a follow up CT or x-ray, should I have to stay? Am I being lazy for leaving when the resident that day can easily follow the patient?

I went into surgery well aware of the hours. Hell, I once did a 38 hour call as a 4th year student because I was trying to impress the program to land a spot. But, now I know that the staying post-call past morning rounds is sufficient. If you tell me otherwise, you are WRONG!!!! Anything more than that and it's abuse. That's it. I don't want to hear about how people have done it in the past. Yes, I can too, but, I would be miserable, just like all those poor souls who were also miserable but had to do it because of status quo. And, society doesn't come first before self. If you are that altruistic, please stop accepting your pay checks now and instead give it to the drunk dude with hemorraghic pancreatitis who just woke you up at night because he's too freaking poor and dumb to know any better.

 

[3dtp]

My, my. This has turned into an interesting thread.

The simple fact is that I think most, if not all of us are willing to get the job done. There are very few who are not consciencious enough work when it is necessary. I had a very successful career prior to med school and was appalled at the lies, abuse and flagrant disregard truth and honesty perpetrated on senior medical candidates by some residency programs.

With a strong professional background, and having been employed in a real world environment with a salary similar to attendings not to mention perq's and stock options, the deceit that a very few (or perhaps many) program directors use to attract residents to a bad program stagger the mind. In any industry without a captive labor force, this nonsense would be published far and wide. And those employers would soon be left with the dregs.

Why is GME different? Because we are a captive labor force and must do whatever we are told to do, irrespective of violations of ACGME rules, the truth or the laws. If we do not, then the consequences are severe. The NRMP, the COTH, the LCME and AAMC all say that they expect one to "match" into a residency position, remain in that one position for the duration of their training and that group has done a fabulous job of making it extremely difficult to change positions midstream or leave a program for the usual reasons one leaves a job in every other sector. And, if you try, and fail, you are screwed. Every one at one of these programs has seen this abuse, or been a victim of it.

As for myself, I'd rather be hit in the head with a baseball bat than go through that again and I totally empathize with the OP. I have zero (none) sympathy for an abusive program and agree with the OP that any work environment that is so miserable as to be unendurable should be dispatched, as quickly and as expediently as possible.

Kimberli, I also empathize with your position. You have successfully negotiated the treacherous ropes of a surgical residency without becoming absorbed in the fragile ego system and vindictiveness of GME and done so unscathed. I am in an excellent program and one that is generally extremely committed to resident needs and education. But there are still frizzies around the edges that leave me scratching my head.

The problem is, what do we do, what can we do about evil programs if we can't speak up without feeling the baseball bat in the head, if we cannot leave without being called "unprofessional," if we are tied to a bad situation without recourse? This simply will encourage and foster bad behavior.

You said you did what you could within your limits as chief. That's great, but I suspect that if your program had the slightest hint of malignancy, you would not have been able to do anything at all except to tell residents who were enticed to keep their mouths shut and take whatever is dished out. This is how this cycle of abuse is perpetuated. Junior residents live in fear, senior residents have seen how whistleblowers can be sanctioned and the hospitals go on about their business with their cheap labor.

 

[8744]

My, my. This has turned into an interesting thread.

The simple fact is that I think most, if not all of us are willing to get the job done.

In a way, residency is like a hotage situation where the patients are the hostages and the program threatens them with death and all manners of dire consequences if the residents don't meet certain demands.

What else does it mean when your program pulls the Patient Care card whenever you complain about your hours?

"Work thirty hours in a row or the patient get it."

I think a lot residents have the Stockholm Syndrome.

 

[Winged Scapula]

My, my this has turned interesting.

I'm sure my statements, both current and in the past, have been relatively inconsistent, and I can appreciate that it can be difficult to reconcile that.

But if I may:

I do not believe in tradition for tradition's sake. That is, I spent a whole lot of hours in the hospital as a junior resident, before the work hour restrictions, and a whole lot after in a program which didn't adhere to the restrictions, and I strongly believe that much of the time in the hospital is wasted and not educational.

Therefore, I see no need to keep someone in house just because the "rules" say I can, and frankly, for that belief, I caught a lot of flak from attendings for telling interns to go home post-call after rounds. There are a lot of attendings who believe the "30 hrs" is how much you HAVE to stay, rather than how much you CAN'T stay over.

Obviously its hard to know when and where to draw the line. You can't stay 24 hours a day; I know that and would never encourage that. You have to sign out your patients at some point in time and go home. I have no problem with that.

And I envy those who say they don't know anyone who would leave when there was work to be done, because I do and I did. Most of my junior residents were hard-working, empathic and intelligent. But there were some who consistently "forgot" to do things and left them for the sign out coverage resident, or took it upon themselves to just leave and go home without notifying anyone, figuring the day was over. There were others who would ignore pages from certain extensions or refuse to see consults in a timely fashion.

Despite what it may seem like, I agree with Panda and others that say our GME system is deeply flawed. Its not only the issue with hours, but lack of formal education in many programs, lack of preparation for the "real world" and lack of professionalism -which isn't necessarily a GME problem but rather the field itself.

But I have not the time or the energy to argue those flaws here and have "escaped" as 3dtp notes, with a relative modicum of bitterness despite some serious concerns about residency. I was caught between "old school" and the "vacation classes" so heard arguments from both sides...and while I may be a traditionalist in many senses, I suspect that users here think I am more old school than not. Perhaps I am. For most of us, experience colors our opinions. Having seen the seachange in attitude among residents from my Chiefs when I was a junior to the classes now, I have to say it is enormous.

Its pretty obvious to me that I am not good at explaining my beliefs on this issue, but I hope this helps...somewhat.

 

[fang]

That said, I DO resent those who go into training, knowing what it entails, then act suprised when they work long hours or leave the hospital when there is work to be done. Because guess who does it? Those who have stayed behind to honor their commitment, and get the work done, while also working to make changes in the system.

I agree. To the OP, I do think you're crossing the line by leaving early for the express purpose of extra time to move. Be honest and negotiate with the PD, but if you leave early just for housing reasons I think you're satisfying only yourself at the expense of the free time of people in your program. Also, it's just good manners (pr professionalism, or whatever) to at least attempt to leave on a good note, no matter how much you hated the program.

PB has argued his views on the subject of resident "indentured servitude" many times here and makes some good points. However, I think the argument falls down for 2 reasons: 1. medicine is not "just a job", and 2. we all knew the situation when we applied for medical school.

Medicine is not a typical job because the system we work within is set up not just to make money, but to make money and provide medical care to sick people. The system has probably developed the way it has in part because residents are "guilted" into long hours by the promise of approval/money/prestige and by a sense of altrusim. The system is flawed in many ways, but you can't throw out the idea that we perform a needed service to society. (PB, I know it's a tool the administration uses to its advantage, but it's also real.) Because of this difference, we need to find a path to reform that ensures that the needs of patients aren't lost in the process. If medicine's only goal were to make tacos, it wouldn't mater how crappy the tacos are while the overhaul is taking place. I want reform, but I want it to happen by opening more medical schools and creating more slots for residents or decreasing time-consuming paperwork, not by demanding fewer hours when there is no one there to take up the slack.

Second, we all signed up for this. I knew medicine would be challenging, and I knew I was signing up for 4 years of med school followed by a couple of years of "intentured servitude". In my last job, there was always the fear of the dreaded lay-off; I was never one of the ones let go, but it sucked to think that it could happen at any time. I traded great hours and uncertainty for long hours and excellent job security, which for me feels better. I don't have kids, and I don't have a big house... the hours are not ideal but my life is at a point right now where I can deal with it and no one else is affected by my choice. If you are not OK with the hours, there are other options available: be a drug rep, work for the research division of a drug company, go abroad where the hours are better, find a post-doc, or re-enter the match in a more supportive field. My point is that we all have some responsibility in making the choice to go into medicine in it's current state of operation, so you can't call this stockholm syndrome-- it's more like joining the circius because you liked the show and then realizing its not as much fun as you thought.