Hours & Lifestyle Differences across Neurology Residency Programs

[DocMom1]

I am in love with neurology and I hope to apply to neurology residency in two cycles from now. As I have a growing family with three children and one on the way, one of the key features of a program will be to what extent it allows me to balance work and my obligations to my family.

Which particular residency programs have lighter/more family-friendly call schedules and work hours? (one neuro PGY2 at the hospital I recently rotated at in Florida felt strongly that there are big differences between programs)

It would be great if we could start a conversation among current/past residents at programs and applicants to get a real idea of the differences between programs in this regard.

Everyone stresses finding a program with a 'good fit' and yet this crucial dimension of programs are hard to come by. I understand this is a moving target due to the implementation of new work hour regulations which is why I to please not refer to posts from early 2000s.

Thank you in advance for your information and thoughts.

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[DocMom1]

Wow; 67 views and not 1 response! Hopefully you lurkers will chime in at some point...

 

[typhoonegator]

Peds neuro may on the whole be a bit lighter than adult, but is still highly program dependent. The residents at Boston Children's work their buns off.

There really isn't such a thing as a family friendly residency, in my opinion. Call is not family friendly. Getting to work at 6AM is not family friendly. The goals of residency are pretty much never aligned with the goals of being a great parent (other than preventing death where possible and humane).

You're going to have to decide whether you want to go to a big and busy program, where you cover a big service at multiple hospitals but have lots of co-residents with whom you can arrange trades, and pick up the slack if someone gets sick or goes out on maternity, vs. a small program where there may be a lighter clinical load but essentially no safety valve if you need someone to cover your call -- or if your residency needs you to take more call to cover for someone who's on bedrest.

I recall in my intern year there was another intern who went off the reservation and basically disappeared in October, and two more who had kids early in the year. I had picked that internship because it seemed fairly humane, but it didn't feel that way when I was doing my third MICU month in a row taking q3 call and having my elective months all turned into service rotations to cover the gap. That stuff happens even if you think you've planned it out perfectly.

I would spend more time planning out your safety nets and arranging the help and support structures you will need when things get rough. Those things are easier to plan. Look at places where you have family nearby. Obviously, don't go to Columbia or MGH or Baylor or UCSF if you don't want to work really hard, but picking a residency based on its present call frequency or number of inpatient rotations could leave you very disappointed down the road. It's only a couple of hard years anyway.

And certainly don't choose peds neuro over adult neuro because you think the residency might be easier. You'll have a long career afterwards and you won't be doing your kids any favors if your miserable in your job for the rest of your life.

 

[DocMom1]

Thanks for your response. I realize there is no truly 'family-friendly' residency, but there are true differences between programs and program directors that make the question worth asking, the conversation worth having, and the information worth knowing to make the most informed decisions possible. For instance, 4 months of on-call time vs 2 or 3 in a given year would make a real difference for me all other things being equal.

You state that "picking a residency based on its present call frequency or number of inpatient rotations could leave you very disappointed down the road;" I agree that on the whole this is true, in the sense that someone shouldn't go into dermatology or radiology simply on the basis of lifestyle to the neglect of ones inner true passions, but I would emphasize when deciding between programs that are by all other measures largely equivalent or marginally different, these features will for me, and perhaps should, be decisive, as I have obligations to my family that I take seriously. "It's only a couple of hard years anyway," you say, but within these 4 years there are many pivotal aspects of my family's development that I want to be as much of a part of as I can be. And yes, 4 versus 2 weeks of vacation can make a big difference in this respect. I grew up in a large Christian family in the south and perhaps this is my own idiosyncrasy, but I suspect many are curious about these issues but are simply afraid to ask.

When my colleagues in law school and business school are choosing between offers, these are considered fair and legitimate questions to ask, not to even mention questions about salary; it is know that some law firms are more flexible and pay more than others, and some business ventures and investment firms that are more amenable to family life. This information is generally readily made available, as opposed to in the medical sphere where one has to go hunting through the depths of internet forums and archives for a just a small glimpse of the truth, and I have no doubt that asking most program directors directly about such issues would cast some doubt on the competitiveness of one's candidacy. It puzzles me why simply broaching this issue in most medical circles is viewed with so much negativity and aversion, as though one will be a worse doctor because one cared about being around for her or his family and life outside of medicine (it exists!). I can only imagine the hell that would be raised if I included 'which neurology residency programs have the highest salaries' in my inquiry.

 

[typhoonegator]

The difference is that your colleagues in B-school and law school are getting real jobs, and there are no misrepresentations about them being out for anything other than their own interests. In contrast, you are only continuing your education, and people tend to expect a very high level of commitment over that short time period because medicine is an other-centered profession. When you finish residency you will have the chance to seek a career position that is most compatible with your life priorities, including salary support that is not largely provided by the American taxpayers.

You're more than welcome to seek your training location based on unstable criteria like numbers of service months or call frequency. Hopefully you can find what you seek here.

 

[kchan99]

Thanks for your response. I realize there is no truly 'family-friendly' residency, but there are true differences between programs and program directors that make the question worth asking, the conversation worth having, and the information worth knowing to make the most informed decisions possible. For instance, 4 months of on-call time vs 2 or 3 in a given year would make a real difference for me all other things being equal.

You state that "picking a residency based on its present call frequency or number of inpatient rotations could leave you very disappointed down the road;" I agree that on the whole this is true, in the sense that someone shouldn't go into dermatology or radiology simply on the basis of lifestyle to the neglect of ones inner true passions, but I would emphasize when deciding between programs that are by all other measures largely equivalent or marginally different, these features will for me, and perhaps should, be decisive, as I have obligations to my family that I take seriously. "It's only a couple of hard years anyway," you say, but within these 4 years there are many pivotal aspects of my family's development that I want to be as much of a part of as I can be. And yes, 4 versus 2 weeks of vacation can make a big difference in this respect. I grew up in a large Christian family in the south and perhaps this is my own idiosyncrasy, but I suspect many are curious about these issues but are simply afraid to ask.

When my colleagues in law school and business school are choosing between offers, these are considered fair and legitimate questions to ask, not to even mention questions about salary; it is know that some law firms are more flexible and pay more than others, and some business ventures and investment firms that are more amenable to family life. This information is generally readily made available, as opposed to in the medical sphere where one has to go hunting through the depths of internet forums and archives for a just a small glimpse of the truth, and I have no doubt that asking most program directors directly about such issues would cast some doubt on the competitiveness of one's candidacy. It puzzles me why simply broaching this issue in most medical circles is viewed with so much negativity and aversion, as though one will be a worse doctor because one cared about being around for her or his family and life outside of medicine (it exists!). I can only imagine the hell that would be raised if I included 'which neurology residency programs have the highest salaries' in my inquiry.

Residency may seem to be a long time but in the grander scheme of things it really is not.

First, you should ask yourself if neurology is truly your passion. If your interest is in clinical neuroscience but not specifically neurology, you may want to consider psychiatry (better hours during residency?; access to behavioral neurology/neuropsychiatry and headache medicine fellowships; potentially access to pain fellowship but difficult to get into anesthesia-run programs), PM&R (more access to EMG training during residency; access to pain, neurorehab and neuromuscular fellowships), radiology --> neuroradiology fellowship, and pathology --> neuropathology fellowship. Of course, there's neurosurgery, but the hours are known to be much longer than neurology. Even with internal medicine, there are a few internists who go into headache, neurocritical care, and neuro-oncology fellowships.

If it is neurology, then do you want to work see adults only or children AND their parents?

The issue with choosing an "easier" residency with fewer hours would be insufficient exposure to diversity of patients, especially in terms of pathology. Residency work hours have already been significantly limited over the years further limited exposure to different diseases and their presentations. Usually, PGY1 and PGY2 are the rougher years in terms of call schedules. PGY3 and PGY4 are a lot "easier" in terms of call since many programs have home call for senior residents. You should ask if senior call is in house or home call at your interviews. In addition some ward work as a senior resident can be done from home, such as cleaning up info on sign out lists. Even some work as a junior resident, such as preparing discharge instructions and writing discharge summaries, can be done at home by remote access to the EMR.

Do keep in mind that call frequency may change from the time you interview and when you start your PGY2 year. There could also extenuating circumstances during residency that change call schedules, such as sudden illness of a co-resident or their family member. Keep in mind that neurology programs are nowhere as large as internal medicine programs so absence of one resident would have a noticeable impact on schedules.

 

[EVOLVED9]

It would help if somebody posted a typical neuro residency schedule.

 

[TUGM]

PGY-2 schedule at large, busy academic hospital system:

Inpatient Services: Usually arrive around 6-7am to pre round/morning report, maybe a bit earlier for ICU. Attending rounds and work rounds throughout the day. Can usually sign out and head home by 5ish, if things go well. There have been outliers where I have stayed in the hospital on non-call days up to 9PM or so, but this is rare, and only is extreme circumstances. Q4 24+"4" - hour calls. Usually break for noon conference each day, unless chaos is ensuing, or if I am in the unit. Coding patients > lunch break.

Outpatient Services: Usually arrive around 8am. Break for lunch, if possible, around noon. Then clinic again from 1PM-5PMish.

As said before, residency is a commitment, not only to your residency program but your patients. They will have to take priority... I mean you did take an oath, right? You're probably not going to make it to every soccer game your kids are playing in. But it's 4 years, then you can decide how busy you want to be, obviously, with your salary at the other end of the scale.

 

[EVOLVED9]

PGY-2 schedule at large, busy academic hospital system:

Inpatient Services: Usually arrive around 6-7am to pre round/morning report, maybe a bit earlier for ICU. Attending rounds and work rounds throughout the day. Can usually sign out and head home by 5ish, if things go well. There have been outliers where I have stayed in the hospital on non-call days up to 9PM or so, but this is rare, and only is extreme circumstances. Q4 24+"4" - hour calls. Usually break for noon conference each day, unless chaos is ensuing, or if I am in the unit. Coding patients > lunch break.

Outpatient Services: Usually arrive around 8am. Break for lunch, if possible, around noon. Then clinic again from 1PM-5PMish.

As said before, residency is a commitment, not only to your residency program but your patients. They will have to take priority... I mean you did take an oath, right? You're probably not going to make it to every soccer game your kids are playing in. But it's 4 years, then you can decide how busy you want to be, obviously, with your salary at the other end of the scale.

Thanx a plenty.7-5 doesn't sound bad at all.I'm in the same dilemma as the O.P.I'm passionate about both neurology and psychiatry(love the brain)and am considering settling for psychiatry after what i've heard about the hours and lack of appreciation(monetary wise).Offcourse passion and interest are the most improtant factors,but for some of us who have other obligations and responsibilites we gotta weigh our situation and choose what's best.Based on what i've gathered from friends,peers and aquaintances i've got to know that neurology and IM are equally demanding residencies.The neurology ICU is like the medical ICU,the paper work is the same.Further neurology is more of an academic oriented field with a lot of reading to do after residency hours(like IM again).Most neurology programs have few residents which means less division of work.A friend of mine switched to PM&R after his intern year because he just couldn't manage his schedule to spend time with his new-born kid,that really swayed my mind away from neurology.
In your opinion would neurology residency really be hectic compared to psychiatry?I know it sounds in-appropriate to put lifestyle above committment to pick a speciality,even if it is only temporary,but my situation demands for me to do so.

 

[TUGM]

Disclaimer: This is purely subjective, and anecdotal, based on my experience.

Neurology residency is hard. A LOT harder than I imagined as a medical student. I would say that is significantly more difficult than a medicine residency, and much more taxing than a psychiatry residency. Learning neurology is like akin to learning radiology. As a medical student, you probably have a very limited exposure to neurology. It is much, much, much more vast than just stroke, Parkinson's, MS, and transverse myelitis. Neurology in itself has almost as many subspecialty domains to learn about within it as internal medicine, and most things you never even get exposed to as a student. So, in my opinion, the learning curve is MUCH higher for neurology than internal medicine. Psychiatry is difficult in the sense that it is so subjective, but the hours are RARELY longer than 8-4 at most places. There are definitely some call requirements (emergency psychiatry, crisis, etc.), but I wouldn't really compare it to managing an acute medical emergency, a stroke alert, or a blown pupil.

No matter what residency you choose, just be aware that there will be some element of sacrifice when it comes to time. Time is arguably the most limited resource we have as humans.

Once again, purely my opinion, though I know some people who may share similar thoughts. Also, this is no way meant to disrespect any of our colleagues in medicine or psychiatry.

 

[EVOLVED9]

Disclaimer: This is purely subjective, and anecdotal, based on my experience.

Neurology residency is hard. A LOT harder than I imagined as a medical student. I would say that is significantly more difficult than a medicine residency, and much more taxing than a psychiatry residency. Learning neurology is like akin to learning radiology. As a medical student, you probably have a very limited exposure to neurology. It is much, much, much more vast than just stroke, Parkinson's, MS, and transverse myelitis. Neurology in itself has almost as many subspecialty domains to learn about within it as internal medicine, and most things you never even get exposed to as a student. So, in my opinion, the learning curve is MUCH higher for neurology than internal medicine. Psychiatry is difficult in the sense that it is so subjective, but the hours are RARELY longer than 8-4 at most places. There are definitely some call requirements (emergency psychiatry, crisis, etc.), but I wouldn't really compare it to managing an acute medical emergency, a stroke alert, or a blown pupil.

No matter what residency you choose, just be aware that there will be some element of sacrifice when it comes to time. Time is arguably the most limited resource we have as humans.

Once again, purely my opinion, though I know some people who may share similar thoughts. Also, this is no way meant to disrespect any of our colleagues in medicine or psychiatry.

Much appreciated.

 

[Thama]

At my hospital neurology is generally considered the hardest non-surgical residency. We do the same intern year as the medicine residents but PGY-2 is twice as hard. If you are looking for a lifestyle residency then be a psychiatrist.

 

[deathmerchant]

Yup, agree with above posts, Neuro residency is much more hectic than all other non-surgical specialties, esp especially PG2. Although PG3 and PG4 are laid back and u can expect most of the weekends off; in my program. There is a lot of reading involved in addition to clinical work. Each neurological disorder is a subspecialty in itself.

 

[EVOLVED9]

Well,i've had 24 hours to decide before i apply for electives,and i'm not letting go of what i've always wanted to learn about.I'm sticking to persuing neurology.

 

[807crash]

I understand where the OP is going, but I want to say you are looking at Residency the wrong way. This is not a job/work, in the traditional sense. It is training. It is education. It is the hardest years of work and learning of your life. And it's the one time in your life where studying and learning is supposed to be part of the job and it is your responsibility.... not really the program's.... to make sure it happens. If this is not the hardest time of your life, you are doing it wrong and not learning enough. The work hours have decreased dramatically over the past decade. But there is also a big loss with that. I have found that new residents are less well trained. For years already they have talked at my program about adding another year onto residency. The residents need it. Several are not safe to be practicing on their own. Will you be? The only one who decides that is you.

Also, the simplicity of the Residency schedule you were given is misleading. You can definitely not come in as early in the morning, but then you will be short-changing your patients and contributing less to the team. It is felt by all. Clinic never ended for me at 5pm because I was still writing notes, reviewing records, and following up with patients who had called during the day. Honestly, I never had clinic lunch breaks, but that's a nice possibility. At least I could eat quickly while I was writing notes and going through records

There are also unexpected things that happen to residency programs. One resident dropped out before PGY2. Another resident dropped out of our program after PGY2. The repercussions were severe. A male resident's wife had a baby and was hospitalized for a period. Suddenly additional coverage was needed. It happens. You have to be ready.

Basically OP, you stay away from any of the top tier, big city programs that are known for being very competitive. You look for programs that emphasize intensive training in outpatient neurology > inpatient neurology with fewer hospitals to cover. You look for programs where the residents say they have a lot of time for learning and learning is a high priority. You look for programs big enough that if one resident of your class drops out, it wont be a disaster. Then chances are higher you will have a little more breathing room. It is very easy to ask the Neurology residents at your program what programs they considered and why.

But you know.... that means you are supposed to be spending more time studying! Because you will probably have less inpatient hospital exposure, less exposure to more rare neurologic conditions etc... and Neurology is vast and you have a lot to learn.

Of course, I am generalizing here.

Be very careful about even asking about "how to balance family and "work""..... that question immediately makes me question your dedication and priorities. You simply ask residents what their typical day is like, what their rotation schedule is like, and their call schedules. This is normal to ask, and many programs put it on websites these days. If I sense at the beginning that you are trying to figure out how to get home as early as possible, I will question whether you are the right person for our program. You know the work hours restrictions that are currently in place. Expect those will be your work hours, and add on more hours a week for study and finishing up paperwork.

That being said, it is amazing you have such a big family. But don't expect other residents and attendings to pick up slack for you. You only get to do Residency once, and it has to carry you for the rest of your career. I agree with others that with your priorities, you should carefully consider your residency choice. Find a mentor to talk with.... to really consider if Neurology is right for you.

 

[DocMom1]

I appreciate your responses. To those here suggesting that I go into another field, I do not want to and I have already decided that.

Yes, residency is training, yet it is also a job, and many hospitals profit significantly from the work of residents. To those who do not understand the economics of this reality, I suggest Sean Nicholson's book 'Money in Search of a Purpose' and "The economics of academic medical centers." NEJM 370.25 (2014): 2360-2362.

To those here casting doubt on my dedication to medicine simply by virtue of the fact that I am dedicated to my family, shame on you. Do you spend all 24 hours 7 days a week in the hospital? What do you do when you leave the hospital? Do you play any sport, instrument, or have any passion or interest outside of medicine? If so, why have you who argue along these lines not give up these things so you can spend more time in the hospital? Does the fact that you have not mean that you are less dedicated to medicine, your training or your field?

The point is residency ought to be training -- and often from what I understand residents do not have enough time to read or learn and instead are left doing tons of paper work, punching keys into computers like monkeys, among many other non-educational tasks. My simple aim in starting this conversation was to get a better idea of which programs put MORE of an emphasis on actual learning, which to me means providing more time to read and think. Ability to spend time with my family would also make me a less stressed and happier resident, which would make me a better doctor and a better learner. Reading for example can be done at home, which for me would allow me to be with my children at least for 15-30 minutes before they go to bed. I do not see the two as necessarily incompatible, as many of you seem to assume.

 

[DocMom1]

For instance, basic information for any given program such as:

• In PGYx at your program, how many hours a day do you work on average? (12 vs 13 might seem like a small difference to many but for me would be a huge difference)
• In PGYx on the inpatient service at your program, how many patients on average do you carry at a given time?
• In PGYx at your program, how many days per week are you on call?
• In PGYx at your program, what is the balance of outpatient vs. inpatient vs. elective time?
• In PGYx at your program, how many weeks of vacation do you get? Do you have to take it in blocks or can you split it into days here and there?

We should put together a summary table of all programs with answers to these questions. People have different learning styles and lifestyles that would make their fit in a given program hinge significantly on these factors, and yet there is no clear way yet to sort them out.

 

[kchan99]

In PGY-2, I was working close to 80 hours per week when I was on hospital service. This did not include time for reading. I was still able to do some reading from textbooks and journals even during PGY2. Even as a senior resident, I was at the hospital for about 12 hours per day, including time for sign out and doing some updating of the sign out that was necessary for that night's sign out. Then I would be go home, eat dinner, spend a little time with my husband, do more sign out list updating to be prepared for the next day, then do some reading of papers related to patient's on the service, and then prepare some notes for teaching. Of course, there is never enough studying; there is always more to learn at all times during a physician's career. I also had time to sleep, play a musical instrument, take dance classes once in a while, and cook once in a while.

 

[Sitagliptin]

To those here casting doubt on my dedication to medicine simply by virtue of the fact that I am dedicated to my family, shame on you.

From what I've heard from multiple medical school deans/associate deans and program directors, applicants asking excessive questions about lifestyle during interviews will be seen to be less committed to medicine, whether or not that's actually true. It's not just on this forum.

I definitely agree that didactics are important since I personally learn well from things like lectures and power points. So looking for the nature of didactics in a program and their outcome (how long, are they protected from pagers, is any board or RITE exam prep given, how do the residents do on those tests) is super important.

Either way, hope you find what you're looking for.

 

[EVOLVED9]

Nobody is foolish enough to make that an obvious primary concern before a program director/authority,hence we all seek that kind of awareness from sdn.If the lifestyle doesnt fit someone's priority then im sure they'll take advice and look for other avenues.Simple as that.

 

[DocMom1]

From what I've heard from multiple medical school deans/associate deans and program directors, applicants asking excessive questions about lifestyle during interviews will be seen to be less committed to medicine, whether or not that's actually true. It's not just on this forum.

Obviously, and unfortunately. Which is why this information would ideally be available online.

Residency training should not be easy, as learning to practice medicine takes hard work. Beyond a certain point, however, additional hours almost certainly bring diminishing educational returns and increase the physical and psychological burden. As healthcare professionals, should we be the first to realize this?!

Although the exact number is often disputed, it has been reported that approximately 400-500 physicians in the United States take their own lives annually, many of whom, unsurprisingly, are residents. Despite calls from key interest groups for prevention and treatment protocols of physician/resident suicide, little systematic change has taken place. All the while, research on risk factors among physicians and residents has expanded, and increasing data are surfacing that highlight suicidal ideation in residency training as being affected largely by work-related emotional exhaustion, inability to achieve work-life balance, and lack of meaningful educational tasks and activities in a residency program's structure. I am puzzled by the seemingly well-accepted attitude that residency at its best is a period when one should be aiming for such emotional and physical exhaustion. While the differences between programs might be, on their surface, small, in reality they can make a big difference for someone who might spend that extra hour or what would have otherwise been a call night with family, exercising, or playing piano or ping-pong.

Here in Florida, I heard there is a group working to bring greater transparency to residency programs, but program directors at the major hospitals are resistant to enroll.

 

[typhoonegator]

I was working 100+ hours per week in residency and ICU fellowship, and was never "emotionally exhausted", and given the goals I had set forth, I thought my life was balanced well enough. I'm really confused about this thread -- is the goal to identify the residencies with the lowest hours spent in the hospital, or to somehow align the pursuit of fewer hours with suicide prevention and overall better mental health? It seems a convenient conflation given your established position. You can have whatever goals you want, but to dismiss my satisfaction with my training experience as being somehow diluted by "diminishing returns" is disingenuous at best. Some of us aren't just begrudgingly willing to work harder than others for a perceived benefit, but actually enjoy it and define some of our self-worth based on it. If you think you have the inside line by working less to spend additional time with family, that's OK with me, but you really shouldn't go around telling me and those like me that we're somehow part of the problem because we think it is a reasonable outlay. Maybe some would argue that extra time with family is subject to diminishing returns as well?

 

[DocMom1]

I was working 100+ hours per week in residency and ICU fellowship, and was never "emotionally exhausted", and given the goals I had set forth, I thought my life was balanced well enough. I'm really confused about this thread -- is the goal to identify the residencies with the lowest hours spent in the hospital, or to somehow align the pursuit of fewer hours with suicide prevention and overall better mental health? It seems a convenient conflation given your established position. You can have whatever goals you want, but to dismiss my satisfaction with my training experience as being somehow diluted by "diminishing returns" is disingenuous at best. Some of us aren't just begrudgingly willing to work harder than others for a perceived benefit, but actually enjoy it and define some of our self-worth based on it. If you think you have the inside line by working less to spend additional time with family, that's OK with me, but you really shouldn't go around telling me and those like me that we're somehow part of the problem because we think it is a reasonable outlay. Maybe some would argue that extra time with family is subject to diminishing returns as well?

Not all of us define our worth solely by the hours we spend in the hospital, and what makes a balanced life for one person might make a radically unbalanced life for another person. To clarify your confusion, the goal is to identify the differences between training programs in terms of hours in the hospital and other metrics that might help someone determine whether the program is a good fit for their learning style and lifestyle. The points made about mental health were brought in once the argument was made that residency should be a time when one should spend as much time as possible in the hospital, or at least be working to the point that one has the absolute minimum time for anything else. While for those who define their worth solely on how much they are in the hospital this would be a good arrangement (and I am by no means criticizing those who do so), for the rest of us who have more varied sources of self worth, such arrangements are detrimental, both in terms of learning, mental health, and ultimately patient care. In this thread alone, it is clear that there are some significant differences between how people think about what would make a residency program the best fit -- this is the point! And this is exactly why information about these differences should be made transparent and clear to all who are applying.

 

[SheepNeurology]

For me, this thread highlights the importance of interviews, pre-interview dinners, second looks etc for the residency application process. "Work-life balance" means such different things to different people and one can only find out if a program provides the appropriate "balance" by talking to those in the department and visiting it to get a gut feel. Even if we came up with a beautiful excel table that characterized programs by hours, size, amount of inpatient vs outpatient etc, it wouldn't capture other relevant factors like the regional culture, individual personalities, department values, etc. For example I might prefer working 80 hours per week in a program that fits my personality more than working 60 hours per week in a program where the culture goes completely against my personality.

OP I suspect there is an underlying regional culture clash since you say you're from Florida. Having lived throughout the country, I've noticed that the degree to which job is tied to identity/self-worth varies quite a bit from for example the west coast to the northeast. That in no way means one region works harder, is lazier, or is crazier than the other; rather I've found it involves a lot of semantics and communication differences. I would factor that into how you read others' responses, and for me I generally try to factor that into how I phrase questions or posts here on SDN!

 

[DocMom1]

For me, this thread highlights the importance of interviews, pre-interview dinners, second looks etc for the residency application process. "Work-life balance" means such different things to different people and one can only find out if a program provides the appropriate "balance" by talking to those in the department and visiting it to get a gut feel. Even if we came up with a beautiful excel table that characterized programs by hours, size, amount of inpatient vs outpatient etc, it wouldn't capture other relevant factors like the regional culture, individual personalities, department values, etc. For example I might prefer working 80 hours per week in a program that fits my personality more than working 60 hours per week in a program where the culture goes completely against my personality.

OP I suspect there is an underlying regional culture clash since you say you're from Florida. Having lived throughout the country, I've noticed that the degree to which job is tied to identity/self-worth varies quite a bit from for example the west coast to the northeast. That in no way means one region works harder, is lazier, or is crazier than the other; rather I've found it involves a lot of semantics and communication differences. I would factor that into how you read others' responses, and for me I generally try to factor that into how I phrase questions or posts here on SDN!

Can you please explain what you mean by 'culture' of a program, and give examples?

 

[typhoonegator]

I would be very careful using the term "work-life balance" around those senior to you, particularly in the medical profession. While it wouldn't go over very well at Google, a VC firm, or a big corporate litigation office these days, it will rub a ton of people in the academic medical field the wrong way -- even if in principle it is a very defensible concept. Many of us have woven our work through much of the fabric of our lives, and see what we do as so much more than a "job" or even a "career" that the idea of drawing a line between that section of your identity and Everything Else seems like heresy. This isn't meant to glorify our work or some B.S. about medicine being a pseudo-religious calling, but it's objectively true. Even people who don't necessarily spend a ton of time at their physical place of work still have aspects of their profession that follow them around. Responding to patient calls in line at the DMV, calling back a colleague about a consult while on vacation, refereeing manuscripts while your kids nap -- people do this stuff all the time. We respond to pages at Home Depot on a Saturday morning with our 3 year-olds in tow. You will see this in highest concentration in academic teaching hospitals (i.e. the places you want to do residency), so you would do well to investigate such characteristics more mendaciously and euphemistically, perhaps. "Amount of scut", and "time for reading" are ways to get at these issues without raising red flags. Out in private practice, the attitudes towards this sort of seepage are much more highly varied.

I'm done forcing my opinions on this thread. I encourage the residents to share their information about their residency experiences. I'm happy to share it anonymously if people don't want to out themselves to their programs.

 

[SheepNeurology]

Can you please explain what you mean by 'culture' of a program, and give examples?

I'm a residency applicant and not a resident, so everything I say is based on observations from my interview trail. By individual program, for example, some programs may be more focused on learning by doing (a phrase you'll see thrown around a lot). That is, residents have the opportunity of high patient volume and can basically kill the boards because they have seen and managed so much; they may not have as much time to read outside. Other programs may not have AS high of a volume, residents may not be as experienced at managing things as those in previous program, but may have more time to read up and kill the boards because they had more time to study outside of the hospital. Some programs market themselves as such thru their residents and even some faculty during the interviews. It's up to applicants to decide how they learn best. That's one example I've seen recently.

Had to edit this a million times because my cat has outstanding keyboard invasion skills...

 

[DocMom1]

I'm a residency applicant and not a resident, so everything I say is based on observations from my interview trail. By individual program, for example, some programs may be more focused on learning by doing (a phrase you'll see thrown around a lot). That is, residents have the opportunity of high patient volume and can basically kill the boards because they have seen and managed so much; they may not have as much time to read outside. Other programs may not have AS high of a volume, residents may not be as experienced at managing things as those in previous program, but may have more time to read up and kill the boards because they had more time to study outside of the hospital. Some programs market themselves as such thru their residents and even some faculty during the interviews. It's up to applicants to decide how they learn best. That's one example I've seen recently.

Had to edit this a million times because my cat has outstanding keyboard invasion skills...

For someone who hasn't applied and is looking to apply in the future, though, how is one to know which programs adopt the volume approach and which programs adopt the reading approach to learning? Do you simply apply to ALL of the programs and see how things are when you show up to interview? Of course there are certain programs at huge hospitals where we can assume that the volume approach is taken, but for many hospitals it just isn't self-evident. Surely there must be a more cost-effective and efficient way to sort this out. Also I'd like to call attention to the huge readership this thread has gotten; clearly this is a topic many are interested in.

 

[SheepNeurology]

You can get a lot from this forum. Look at the stickied interview impression threads. You can also search for post about individual programs. Also, talk to your department faculty and advisors

 

[DocMom1]

You can get a lot from this forum. Look at the stickied interview impression threads. You can also search for post about individual programs. Also, talk to your department faculty and advisors

the last thing I would ever do is talk to department faculty/advisors as, evidenced by the responses here, this would run the big risk of being stigmatized and effectively disadvantaged as the one looking for better lifestyle and to care for my family.

 

[typhoonegator]

the last thing I would ever do is talk to department faculty/advisors as, evidenced by the responses here, this would run the big risk of being stigmatized and effectively disadvantaged as the one looking for better lifestyle and to care for my family.

Are you concerned that your faculty mentors are going to rat you out to other programs because you're looking for an outpatient-focused residency program with a philosophical focus on didactics over practicum? First of all, worded that way it doesn't sound bad at all. Secondly, no decent mentor would ever do that. Hell, no decent human being would ever do that. You should hear the conversations I have with my mentors behind closed doors! And the conversations my post-docs have with me! None of that would ever get out -- that's the nature of the relationship. Find someone you trust, and explicitly ask that the conversation be held in confidence.

I think the real challenge is that many of them won't really know. And the people who have interviewed at these programs and not gone through them won't really know. You might get some stats about inpatient volume, call frequency, service weeks, but to get deeper you'd need people who've been through the program. And there aren't that many of us here. I won't say where I trained, but it definitely wouldn't meet your criteria. So yeah, get some info on regional programs from your faculty, look at a bunch of program websites, and apply broadly. Given your specific requirements, you'll probably need to interview pretty broadly.

 

[oopsy]

When you do ask, just remember who you are talking to. At most big programs, PGY2s are taking the brunt of the call, etc, so they will be more likely to give you a gloomier picture. More senior residents have lighter inpatient call responsibilities and more favorable schedules, although more responsibility for clinical decisions and events. Just remember who you are talking to when you get advice about their schedule, perspective, etc.

 

[DocMom1]

When you do ask, just remember who you are talking to. At most big programs, PGY2s are taking the brunt of the call, etc, so they will be more likely to give you a gloomier picture. More senior residents have lighter inpatient call responsibilities and more favorable schedules, although more responsibility for clinical decisions and events. Just remember who you are talking to when you get advice about their schedule, perspective, etc.

I think in the ideal world we wouldn't have to worry about asking for information about programs and would just get it transparently. I do not know of any other field where trying to find out the details of one's future job from the future employer diminishes one's likelihood of getting the job. The 'opportunities to talk to current faculty/residents' when visiting programs, from what I gather from the responses here, are really just traps to see if applicants value work-life balance, the ultimate sin.

 

[DocMom1]

An older classmate applying in IM recently shared with me the horrifying story that after asking a resident about her ability to balance work and life at the dinner the night before, the PD the following day started probing the applicant about why she was so inquisitive about this and whether she was not fully committed to medicine.. after hearing such stories it is no mystery why mental health among physicians and trainees is in perpetual doldrums

 

[MemberX]

OP you shouldn't be surprised by the reaction you are getting. As a fellow appliciant, you are sounding like a complete space-case to me and likely everyone else. While I do agree with you that having time for outside interests is important, you are prioritizing it to such a degree that makes everyone question your dedication to the field. The fact that 12 v 13 hours of call is a major difference for you is borderline ludicrous. You can get a sense of workload from talking with residents and using deductive reasoning (4 residents to cover 3 hospitals = high call schedule).

Residency is not a right, it is a privilege (just ask any FMG how bad they want a spot). Although I also learn better from having time to read/ didactics, I would HATE to have to work with someone who tries to leave work ASAP and dumps everything on me because of their personal life (we all have them). I doubt any programs are going to have residents willing to take up the slack because you have a large family. If family time is a major priority for during training I suggest choosing an easier residency (psych, FM, PMR) that would allow you to balance these competing interests. Even the most "cush" neuro program is still going to be alot of work and if you maintain this same attitude, you will quickly become hated by your fellow co-residents.

 

[Acherona]

It's unclear if you are aware that your life goals of being a great parent to four kids and becoming a well-trained neurologist are somewhat in conflict. Obviously this is not a problem that is unique to you. All of us had to sacrifice something we enjoyed outside of work to get through residency and you are not different. That being said, residency is doable even with kids and if you have a good support system and back-ups in place for when the inevitable crisis hits you should be able to get through it without killing yourself. Nobody wants to be at a malignant program and you should be able to get an idea of this by asking around and speaking with residents who have kids and how they coped.

Also I think you are somewhat misguided in how you view residency. It is basically an on-the-job apprenticeship, it is not school. You cannot become a good neurologist by sitting at home reading a textbook or even by listening to lectures. The most learning occurs in the hospital watching your attendings taking care of patients, doing it yourself and reading around cases. Learning how to do paperwork quickly and effectively is also part of the training process as these do not go away when you become an attending. When I was a senior resident I had a pgy2 who was somewhat detail oriented and could never finish her work or see more than a few patients because she got so bogged down in tasks and paperwork. After a few tough calls she had no choice but to get very efficient and became a super resident. If you never see the volume you will never learn this skill and your transition to attending may be tough.

 

[Sitagliptin]

As a current applicant myself, I honestly think that the scenario that WiredEntropy mentioned was totally fair. Residency is supposed to be the hardest time of your life. Also, keep in mind that nowadays they have work hour restrictions and many programs have replaced Q4 call with night float and protect their didactics from pagers. If I was a program director who worked 110-120+ hours per week in residency and had an applicant's main questions be about work-life balance, I would have doubts about their commitment. Why? Because residency is where you truly learn how to be a doctor.

I don't mean to be harsh, but maybe psych would be a better choice for your lifestyle goals. I hear a lot of those programs are like 50 hours a week for th most part, and you don't essentially do two years of internship like neuro does. Either way, hope you find what you're looking for.

 

[bustbones26]

I was working 100+ hours per week in residency and ICU fellowship, and was never "emotionally exhausted", and given the goals I had set forth, I thought my life was balanced well enough. I'm really confused about this thread -- is the goal to identify the residencies with the lowest hours spent in the hospital, or to somehow align the pursuit of fewer hours with suicide prevention and overall better mental health? It seems a convenient conflation given your established position. You can have whatever goals you want, but to dismiss my satisfaction with my training experience as being somehow diluted by "diminishing returns" is disingenuous at best. Some of us aren't just begrudgingly willing to work harder than others for a perceived benefit, but actually enjoy it and define some of our self-worth based on it. If you think you have the inside line by working less to spend additional time with family, that's OK with me, but you really shouldn't go around telling me and those like me that we're somehow part of the problem because we think it is a reasonable outlay. Maybe some would argue that extra time with family is subject to diminishing returns as well?

I think the opening line is where the money is? It is far better, in my opinion, to work 100 hours per week with a great program than 60 hours per week with a malignant program.

In short, your PGY1 year is internship.
PGY 2 year, all programs across the board heavily focus on inpatient neurology, hence why it is intense. Also, this will be your time to learn.
PGY3 and PGY4, much better as far as time off and more time to study/read on your own.

What I would suggest is that you get a feel for a program whenever you are rotating through. Ask current residents at programs you are interested in if you cannot get a chance to rotate there. You will sense if individuals are frustrated, burned out, or just plain hate their program and it likely will have nothing to do with hours work.

Perhaps consider this a check list whenever you are out there looking:
1) Indecisive staff: Seriously, I had a staff that sometimes was too scarred to give aspirin! Hours spent asking other attendings their opinions on the matter to form a consensus. Then blame you at the end of the day for not having the same consensus at the beginning of the day, even though you did (if that statement made any senses)

2) Long hours due to menial tasks. That is, not staying late because you are busy with patients, but because your attending red inked your note and made you re-write it three times because you misplaced a comma. Truthfully, if you are working late because you are busy seeing patients and learning something, you will not mind it.

3) Getting blamed for poor outcomes by your attending for things that are out of your control. (BTW, will happen on occasion, even at the best programs)

4) Unfair distribution of opportunities. Its natural for staff to give the "smartest kid in the class" all opportunities to essentially publish their paper for them, but if they do not throw a bone or spent time to help the other guys, that can be aggravating.

5) As for family time. Okay, you are a resident and you are expected to work hard. Nobody wants you to leave early so that you can take your wife fishing. But, if nobody cares or helps you if you have a "real family emergency", that can be aggravating as well.

Good things to look for:

1) Do the residents get along? Staff can and will always abuse residents. Hey, its the Socratic method, but if the residents do not seem collegial, stay away!

2) Does staff mentor you? Okay, again, maybe you will be subjected to abuses, but if during your PGY-3 year while learning EMGs, if your staff notices that you are sort of good at it, will then hone in on that ,help you refine your skills, and maybe even encourage you to apply for fellowship? Will anybody in the program at any point sit down with you and care about your career goals and offer advice (whether its good or bad advice)?

3) Does the staff even care about your progress? Like I said above, everybody loves the "smartest kid in the class" but if you do have a resident struggling, does the staff give up or do they make an effort to help that person out. Is there a "no man left behind" attitude from the staff and residents? I'm not being extreme here, every program has that resident that cannot pull his/her weight and should be dropped but there are a few that just need a swift kid in the behind to get their engine started too.

4) Are the didactics any good? All programs have what they call didactics but is what they offer actually meaningful and worth your time. They cannot teach you everything, but for times that they do try, is it worth it?

At the end of the day, its about the overall environment. Are the residents and attending relatively happy? Not all about the hours or time off. BTW, I think I have less time now then I did as a resident, for what that is worth. Its a hard job but you have to learn resiliency over time and that is it.

 

[MemberX]

Thank you TN, Bustbones, and other attendings for your reflections from other side. If nothing else, this thread has become a good source for aspiring neurologists (ie me) on potential red flags to look for and the right questions to ask during second looks. Most programs put their best "presentation" during interview day and residents spread the company line so it is difficult to gauge these issues then. As for me, I will be on the lookout for the things mentioned above as I revisit programs, especially in regards to scut, culture, etc. Please keep posting for potential things to look out for that would DEF affect QoL during residency. Any red flags or good questions to ask would be highly appreciated. Keep it up!!!

 

[DocMom1]

Thanks y'all for contributing to this discussion.

Those here regarding my loyalty to my growing family to be irreconcilable odds with a justifiable career in neurology cannot be more misguided -- are you who are urging me to go into psych ever planning to have a family of your own? If so, how do you justify this in light of the logic you invoke to discredit and malign my suitability for neurology? How do you justify your involvement in anything outside of medicine given your logic?

Residency training should not be easy, as learning to practice medicine takes hard work. Beyond a certain point, however, additional hours almost certainly bring diminishing educational returns and increase the physical and psychological burden. As healthcare professionals, should we be the first to realize this?! It is not unfair or wrong to ask about the level of non-educational or non-clinically-relevant activity residents are required to engaged in .. in fact, it is a travesty that programs keep this information under such close wraps.

When residents have such a high burden of depressive symptomatology, this is no surprise given the representative salient attitudes that have been expressed here. The prevalence is unacceptably high, with both personal and professional consequences. The deleterious effects of the culture and attitudes expressed here have been found to include lying about clinical data, medical errors, and clinical lapses, as well as less altruistic and compassionate care.

The literature would suggest that the profession has not yet found the minimal threshold of exposure below which both resident health and performance improve.

Unfortunately there has been little willingness or energy to change the system, which leaves us as prospective trainees to fend for ourselves. The profession appears to not fully appreciate how little the system for training physicians has changed in response to changes in the practice of medicine. The high burden of depressive symptoms experienced by physicians in training suggests that this mismatch has reached a crisis level.

The basic features of the current system of graduate medical education would be recognized by any trainee in the 1950s or 1960s, except perhaps for the limits on work hours. However, the actual delivery of medical care in 2015 would be unrecognizable to those same physicians. The reasons are numerous: life-prolonging and life-creating technologies that lead to unsolvable dilemmas, risk-based reimbursement strategies that limit the opportunities for patient engagement, electronic medical records and documentation requirements that lead to inaccurate and sometimes dangerous copy-and-paste shortcuts, malpractice exposure in which a high proportion of residents in some specialties are named in lawsuits before finishing their training, short hospital lengths of stay that require protocol-driven procedural care with little opportunity for thinking and learning, advertising that causes patients to demand medications for conditions they sometimes do not even have, and online ratings of physician performance. Clinical productivity pressures on faculty members detract from the formation of strong mentorship relationships and the ability of physicians in training to seek support and wide guidance for the many acute and often highly traumatic experiences they face.

The profession purportedly recognizes the importance of health and wellness, but the value system of the current training environment makes clear to residents the unacceptability of staying home when ill, having a family, of asking for coverage when a child or parent is in need, and in expressing vulnerability in the face of overwhelming emotional and physical demands.

I will reiterate that although the exact number is often disputed, it has been reported that approximately 400-500 physicians in the United States take their own lives annually, many of whom, unsurprisingly, are residents. Despite calls from key interest groups for prevention and treatment protocols of physician/resident suicide, little systematic change has taken place. All the while, research on risk factors among physicians and residents has expanded, and increasing data are surfacing that highlight suicidal ideation in residency training as being affected largely by work-related emotional exhaustion, inability to achieve work-life balance, and lack of meaningful educational tasks and activities in a residency program's structure. I am puzzled by the seemingly well-accepted attitude that residency at its best is a period when one should be aiming for such emotional and physical exhaustion. While the differences between programs might be, on their surface, small, in reality they can make a big difference for someone who might spend that extra hour or what would have otherwise been a call night with family, exercising, or playing piano or ping-pong.

Here in Florida, I heard there is a group working to bring greater transparency to residency programs, but program directors at the major hospitals are resistant to enroll.

 

[typhoonegator]

There's a story about Miller Fisher where one of his residents was presenting patients post-call and said that the patient had a "standard internal capsule lacunar syndrome". Fisher, having defined the lacunar syndromes, got excited and said, "I've never seen one of those before, let's go examine him together." He spent the next hours obsessively examining and describing the examination of the patient, as well as their early CT scan, quantifying all of the ways in which this patient was unique and fascinating in their presentation. His point was very well-made.

How does one quantify the educational content of an hour spent on activity A vs. activity B? Is that educational content portable across individuals? Across different time periods in the same individual's career development?

Also, it is not fair to conflate prioritizing your family with mental health. It discredits people with depression, who could still be depressed even with all the time in the world to engage in activities of their choice, as well as individuals who are able to maintain good mental hygiene even when they can't go home and kiss their children goodnight.

 

[TUGM]

It is possible to have work-life balance, and still obtain a great education during residency... but a lot of that depends on your individual effort as a person. If you learn to function on less sleep, then by gosh, you will have a lot more free time, especially if 1 or 2 hours makes a huge difference in your lifestyle. That was just one example.

Agree with the above sentiment that less family time does not always result in more depression.

Bottom line is residency will inevitably cause you to sacrifice and compromise your free time, despite the specialty. People keep saying do an easier specialty, but I'd say if you can't or won't be willing to give up your time to the profession, then consider a different profession... Even psych residents and family medicine residents have call.

 

[DocMom1]

There's a story about Miller Fisher where one of his residents was presenting patients post-call and said that the patient had a "standard internal capsule lacunar syndrome". Fisher, having defined the lacunar syndromes, got excited and said, "I've never seen one of those before, let's go examine him together." He spent the next hours obsessively examining and describing the examination of the patient, as well as their early CT scan, quantifying all of the ways in which this patient was unique and fascinating in their presentation. His point was very well-made.

How does one quantify the educational content of an hour spent on activity A vs. activity B? Is that educational content portable across individuals? Across different time periods in the same individual's career development?

Also, it is not fair to conflate prioritizing your family with mental health. It discredits people with depression, who could still be depressed even with all the time in the world to engage in activities of their choice, as well as individuals who are able to maintain good mental hygiene even when they can't go home and kiss their children goodnight.

What you describe is obviously an educational experience... filling out prior auth forms, booking appointments, chasing down consultants, etc, are not. I am not conflating family time with mental health, but inability to do what one cares about outside of medicine likely is a contributor to the dismal mental health seen in residents. Not everyone can or should spend 24/7 in a hospital like you seem to be advocating. I understand some sacrifice will need to be made and I completely accept and embrace that, however I want to make sure that I am in a program where whatever I receiving in return for this sacrifice is as high value as possible, hence my introducing this thread.

I am further curious to hear from your perspective what it is that ever justifies a physician not being in the hospital

 

[typhoonegator]

You can go home when your work is done and your patients are tucked and your signout is tight. Not a minute before.

Filling out prior auth forms, chasing down consultants -- part of the process. It's either you or another clinician doing that work. And no one should ever care as much as you do about getting it right.

 

[DocMom1]

Obviously I or anyone in their right mind is not advocating that residents go home before patients are safely in the hands of others. However, I am learning that some programs hire resident assistants, PAs, NPs and other staff to reduce the burden of non-educational activities on residents. This is the kind of program I am looking for ... it is this kind of program where I believe residents can focus on things that matter and learn to be the best neurologists possible..

 

[DocMom1]

The following reading is recommended for all who are less informed about this matter:

Anagnostopoulos, Fotios, et al. "Factors Associated with Mental Health Status of Medical Residents: A Model-Guided Study." Journal of clinical psychology in medical settings 22.1 (2015): 90-109.
Pereira-Lima, K., and S. R. Loureiro. "Burnout, anxiety, depression, and social skills in medical residents." Psychology, health & medicine 20.3 (2015): 353-362.
Khan, Rida, Jamie S. Lin, and Douglas A. Mata. "Addressing depression and suicide among physician trainees." JAMA psychiatry (2015).
Dyrbye, Liselotte N., et al. "Burnout among US medical students, residents, and early career physicians relative to the general US population." Academic Medicine 89.3 (2014): 443-451.
West, Colin P., et al. "Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial." JAMA internal medicine 174.4 (2014): 527-533.

and the current issue of JAMA: http://jama.jamanetwork.com/article.aspx?articleid=2474424

 

[807crash]

Ahhhhhhhh....... so finally we are getting to the crux of it.

You are looking for something that does not exist in the field of Neurology.

Scut work often has learning. Even gathering vital signs quickly teaches you so much about your patient. You need to learn to present well to colleagues and consultants over the phone. You need to spend time pouring over outside records to pull out the relevant info, and find what your attendings will miss. You need to learn about all of the different permutations of MRI/CT/other scans so that you are sure the correct scan is done for the correct question. You need to walk that CSF sample down to the cytology lab because you cannot trust the nurse will get to it in time and it must be processed before the sensitivity of the test drops precipitously. And.... you have to make some appointments. You cultivate relationships with people and learn the quickest way to do this... you are efficient and polite so people like you and try to help you... you multi-task... you have two phones going at once and are writing your notes at the same time. Not a big deal.

And if you think you know all of these things already and that these things are below you - you are wrong.

And why the heck do you think every part of your job should be educational? This is still a job, my friend. And things need to get done.

And don't you know part of your job is delegate? As is teaching your students, and then your intern, and then your junior residents how to do these things? And to teach them so many, many, many more things about Neurology?

You are coming across as more entitled, and arrogant, with each post. This is going to hurt you during the interview process.

 

[TUGM]

I think we all realize we are being fairly harsh on the OP, but it comes from a good place. I think at the core of what we are saying to you, WiredEntropy, is that we do not want to paint you a false portrait of green meadows, butterflies, and teddy bear hugs and call it residency. Residency is hard on everyone, and that's it. There is absolutely no neurology residency that has that perfect combination of perfectly streamlined, predictable work hours, adequate help, brilliant ancillary staff, and mind-explodingly good didactic curriculum. It always has been, and always will be an extremely volatile, labile, high-stress environment, where anything can and will go wrong all at the same time, and THEN you'll get another stroke alert. And every single second you are exposed to those situations makes you smarter, faster, stronger, and just a bit less likely that you'll end up killing someone when you're on your own one day.

Do you see the burden of responsibility? And each member of the team carries a similar burden.

I'm not a parent, but I can imagine that parenting is likely a similar experience.

So doing both, now, you are looking at a pretty rigorous schedule.

As your potential future colleagues, we just want you to be aware of that.

As for having NPs and PAs... when you first start residency, these mid-levels will be 100x smarter and more efficient than you. They are much more likely to be supervising you until you can show them your can hold your own.

 

[Mjolner]

I think we all realize we are being fairly harsh on the OP, but it comes from a good place. I think at the core of what we are saying to you, WiredEntropy, is that we do not want to paint you a false portrait of green meadows, butterflies, and teddy bear hugs and call it residency. Residency is hard on everyone, and that's it. There is absolutely no neurology residency that has that perfect combination of perfectly streamlined, predictable work hours, adequate help, brilliant ancillary staff, and mind-explodingly good didactic curriculum. It always has been, and always will be an extremely volatile, labile, high-stress environment, where anything can and will go wrong all at the same time, and THEN you'll get another stroke alert. And every single second you are exposed to those situations makes you smarter, faster, stronger, and just a bit less likely that you'll end up killing someone when you're on your own one day.

Do you see the burden of responsibility? And each member of the team carries a similar burden.

I'm not a parent, but I can imagine that parenting is likely a similar experience.

So doing both, now, you are looking at a pretty rigorous schedule.

As your potential future colleagues, we just want you to be aware of that.

As for having NPs and PAs... when you first start residency, these mid-levels will be 100x smarter and more efficient than you. They are much more likely to be supervising you until you can show them your can hold your own.

Are Midlevels a big thing in neuro??

 

[typhoonegator]

Are Midlevels a big thing in neuro??

They certainly exist, but in most of academia they are not implemented to the same degree that they are on the inpatient services of surgical teams, who can more easily afford them. Some programs have integrated them better than others, but the bottom line is that a lot of NP/PAs who are good don't want to have to deal with a new crop of residents every year, and a lot of academic hospitals aren't willing to pay the competitive salaries to attract them away from other often less volatile opportunities. Also, no PA/NP in their right mind would be willing to just do everyone else's scut for them, nor would it be appropriate. Would you want to go through all that school just to write discharge summaries for entitled PGY-2's all day? Heck no. So they follow their own patients, with the knowledge that a good portion of their patient load will be the "less educational" patients, like some of the low-risk EMU admissions or the IT methotrexate patients who come and go every week. They may be able to act as a resource to get things done because they know literally everyone important in the hospital, but that doesn't mean they'll do your work for you. Midlevels are awesome, but they aren't a panacea for perceived non-educational patient-related activities.

And it warms my heart as an attending to see that residents, even though we all acknowledge that aspects of the system aren't glamorous or educational or fun, still understand that these mundane activities really do contribute to your overall career progression and perspective on modern medicine. It is by no means a perfect system, and there are so many inefficiencies that it will make your head spin, but it is also reality. And sadly, when you're older and your kids look to you more and more for advice and support and validation (as mine do), you'll be an attending, and there will be no more signouts or ACGME regulations or seniors to bail you out when you want to go home. It gets much easier over time, but because you get better at it, not because you find someone else to do it for you.

WiredEntropy, I said I would lay off this thread and I failed miserably at that. Your tone has ruffled some feathers, but I think your goals are very reasonable and literally no one wants to go to a residency with limitless scut and crap didactics. Nor do program directors want to develop such a residency. Ultimately, these are ups and downs at every program but at the end of the day, these is less variation than you might think. Yeah, patient volume and acuity are not always equivalent, and some programs have incredibly dedicated educational faculty, but there are tradeoffs no matter what -- tradeoffs that wouldn't necessarily come across in a survey or a US News ranking. So my only advice in your search for the best residency fit is to apply very broadly, interview everywhere you can, and make the most informed decision based on your own experiences. At least then you'll be in a position to live with your decision.