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I've been meaning to post this for a year or so, but here it goes.
One thing matters when you rank your options. One thing above all else.
You'll encounter a lot of advice and methodology for ranking programs; people will record sedations, talk about osteotomy numbers, talk about their areas of concentration versus weakness, etc. That's all bull****. I mean, listen to it, listen between the lines, but don't weight it too heavily. Those numbers come from resident logs, which are about as accurate as Trump playing jeopardy. You can easily code a double jaw case with a genioplasty as a single osteotomy, or four, depending on how you want to go about it. I can make a basic lac at 2 am in the ED a complex closure and reconstruction, or I can record a simple closure. Then you have the whole area of how disciplined are the residents at logging in the first place --- I'm a solid year behind always, and it's a crap shoot when i do attempt to log. But I'm rambling --- the point is that these numbers are not indicative of anything. You should be able to tell from just context clues how busy a program is or how productive their clinic is. That's all you need to know. Implant numbers might be accurate, as that's usually pretty well logged and hard to fudge. Nevertheless, any program can give you the skills necessary to go into private practice, and context and reputation are enough to let you know if the program can prepare you for hospital or academic practice. Do not focus on comparing numbers.
The single most important thing is: will you be happy here. Residency will be the end of your 20s, for many of us, the end of our free youth. They can be hard, miserable years, they can be bittersweet, or they can be amazing. I cherish this time, I will sorely miss this experience. I spent 3 months externing, and during that time I heard 3 attendings make statements that stuck with me:
1. Alpert at Louisville: "You don't have to run residency like a damn Greek tragedy." Great statement from a great surgeon at a great program.
2. "Residency makes you guys kind of a robot. When it's over, you have about 2 years to reclaim your humanity, or you'll be robots forever, and itll hurt all your relationships." This was from an attending at a meeting where he/she announced to the residents that he/she was retiring early from the program. This was a red flag to me. At the time, this program was very strict and didactic, and I believe this statement was true to this program.
3. "Residency is hard. It's the hardest thing you'll ever do. It's not supposed to be fun, it's something you just get through. Just remember there's a light at the end of the tunnel." Said with a totally somber, dead on the inside glare. This was from a surgeon speaking to a pre-OMS club. I won't name his program, and I disagree with the latter sentiment of his statement. If you hate your program that much, well **** man, that sucks for you. Looking for a light at the end of the tunnel is no way to burn 4-6 years of your life.
My point here is the contrast between Alpert's statement and the last 2. You can go to a STRONG program where the residents are still happy. During your time, you will meet residents at good programs who do not like residency, and it tends to be all the residents of that program, versus groups who are happy and enjoy their situation. I don't have a good method for how you sort out at interviews what kind of program it is -- it's not as simple as is this a malignant program. Are the residents all friends or just acquaintances? Everyone says friends, but do they actually hang out outside? Ask them, if they say "Haha, not really, I mean we all get along really well, but we spend 80 hours a week together, so after work I kind of want to see someone else." Red flag. Look guys, you won't have a wealthy of time and opportunity to meet other people --- if you're not hanging out with your OMS coresidents, I assume you're hanging out with general surgery residents. Coresidents that go to bars together, have tacky sweater Christmas parties, go to movies together -- watch games together, those are friends. Furthermore, what's the personality of the director. The Director of a program's personality will trickle down into the residents, for better or for worse. That might be the single best predictor. Reddy is both our boss and our mentor, he doesn't go grab beers with us because he maintains that important boss position at the end of the day, but he's also somewhere between a friend and a father figure for us. He will cut up and joke with us, he's joking half the time if not more, and he's hard to push into actual anger...but it is possible. His lightness and laid back attitude, and his general nature, flows through the attitude of the program.
Besides the inner workings of the program, will the city make you happy? Will it give you the things you need? Will you be making enough money for the lifestyle you want? You won't have a ton of free time, but you will have more than you expect as time goes on. Will your spouse be happy? That's critical. How is the hospital? Is the cafeteria sparse? You'll be eating that food every day for 4-6 years. How's the weather compared to what you're used to? Figure out what's important for your day to day sanity.
5 years in, I can walk through the ED at 3 am holding a 15 blade, white coat open in the air like some kinda guy-in-front-of-a-fan-with-80s-power-ballad-playing-background-music, heading to I&D some ****ty dental abscess for the millionth time on some troll, and I still dont regret my decision. I enjoy what I do. I enjoyed my year of general surgery in spite of the insane work hours and weight of what I was doing BECAUSE I had amazing gen surg co-residents and attendings. It just drove home how important it is, because it's true for all medical residencies.
You have to sit down and ask yourself what will keep you happy. The answer is not sedations and BSSOs. If you are happy, if you enjoy the company of your coresidents, time will fly and you will MISS it. I am excited to be a chief next year, but anxious to leave this part of my life behind, and that's how it should be. I won't leave as a robot, I'll leave as a fully fleshed out physician who can appreciate what matters without sacrificing my humanity in the process. I walk too fast, sleep too little, have limited faith in humanity left (I have seen some ****), but I'm not depressed and I still have maintained some level of normalcy. And I love what I do. Residency doesn't have to be run like a Greek tragedy.
One thing matters when you rank your options. One thing above all else.
You'll encounter a lot of advice and methodology for ranking programs; people will record sedations, talk about osteotomy numbers, talk about their areas of concentration versus weakness, etc. That's all bull****. I mean, listen to it, listen between the lines, but don't weight it too heavily. Those numbers come from resident logs, which are about as accurate as Trump playing jeopardy. You can easily code a double jaw case with a genioplasty as a single osteotomy, or four, depending on how you want to go about it. I can make a basic lac at 2 am in the ED a complex closure and reconstruction, or I can record a simple closure. Then you have the whole area of how disciplined are the residents at logging in the first place --- I'm a solid year behind always, and it's a crap shoot when i do attempt to log. But I'm rambling --- the point is that these numbers are not indicative of anything. You should be able to tell from just context clues how busy a program is or how productive their clinic is. That's all you need to know. Implant numbers might be accurate, as that's usually pretty well logged and hard to fudge. Nevertheless, any program can give you the skills necessary to go into private practice, and context and reputation are enough to let you know if the program can prepare you for hospital or academic practice. Do not focus on comparing numbers.
The single most important thing is: will you be happy here. Residency will be the end of your 20s, for many of us, the end of our free youth. They can be hard, miserable years, they can be bittersweet, or they can be amazing. I cherish this time, I will sorely miss this experience. I spent 3 months externing, and during that time I heard 3 attendings make statements that stuck with me:
1. Alpert at Louisville: "You don't have to run residency like a damn Greek tragedy." Great statement from a great surgeon at a great program.
2. "Residency makes you guys kind of a robot. When it's over, you have about 2 years to reclaim your humanity, or you'll be robots forever, and itll hurt all your relationships." This was from an attending at a meeting where he/she announced to the residents that he/she was retiring early from the program. This was a red flag to me. At the time, this program was very strict and didactic, and I believe this statement was true to this program.
3. "Residency is hard. It's the hardest thing you'll ever do. It's not supposed to be fun, it's something you just get through. Just remember there's a light at the end of the tunnel." Said with a totally somber, dead on the inside glare. This was from a surgeon speaking to a pre-OMS club. I won't name his program, and I disagree with the latter sentiment of his statement. If you hate your program that much, well **** man, that sucks for you. Looking for a light at the end of the tunnel is no way to burn 4-6 years of your life.
My point here is the contrast between Alpert's statement and the last 2. You can go to a STRONG program where the residents are still happy. During your time, you will meet residents at good programs who do not like residency, and it tends to be all the residents of that program, versus groups who are happy and enjoy their situation. I don't have a good method for how you sort out at interviews what kind of program it is -- it's not as simple as is this a malignant program. Are the residents all friends or just acquaintances? Everyone says friends, but do they actually hang out outside? Ask them, if they say "Haha, not really, I mean we all get along really well, but we spend 80 hours a week together, so after work I kind of want to see someone else." Red flag. Look guys, you won't have a wealthy of time and opportunity to meet other people --- if you're not hanging out with your OMS coresidents, I assume you're hanging out with general surgery residents. Coresidents that go to bars together, have tacky sweater Christmas parties, go to movies together -- watch games together, those are friends. Furthermore, what's the personality of the director. The Director of a program's personality will trickle down into the residents, for better or for worse. That might be the single best predictor. Reddy is both our boss and our mentor, he doesn't go grab beers with us because he maintains that important boss position at the end of the day, but he's also somewhere between a friend and a father figure for us. He will cut up and joke with us, he's joking half the time if not more, and he's hard to push into actual anger...but it is possible. His lightness and laid back attitude, and his general nature, flows through the attitude of the program.
Besides the inner workings of the program, will the city make you happy? Will it give you the things you need? Will you be making enough money for the lifestyle you want? You won't have a ton of free time, but you will have more than you expect as time goes on. Will your spouse be happy? That's critical. How is the hospital? Is the cafeteria sparse? You'll be eating that food every day for 4-6 years. How's the weather compared to what you're used to? Figure out what's important for your day to day sanity.
5 years in, I can walk through the ED at 3 am holding a 15 blade, white coat open in the air like some kinda guy-in-front-of-a-fan-with-80s-power-ballad-playing-background-music, heading to I&D some ****ty dental abscess for the millionth time on some troll, and I still dont regret my decision. I enjoy what I do. I enjoyed my year of general surgery in spite of the insane work hours and weight of what I was doing BECAUSE I had amazing gen surg co-residents and attendings. It just drove home how important it is, because it's true for all medical residencies.
You have to sit down and ask yourself what will keep you happy. The answer is not sedations and BSSOs. If you are happy, if you enjoy the company of your coresidents, time will fly and you will MISS it. I am excited to be a chief next year, but anxious to leave this part of my life behind, and that's how it should be. I won't leave as a robot, I'll leave as a fully fleshed out physician who can appreciate what matters without sacrificing my humanity in the process. I walk too fast, sleep too little, have limited faith in humanity left (I have seen some ****), but I'm not depressed and I still have maintained some level of normalcy. And I love what I do. Residency doesn't have to be run like a Greek tragedy.
