Mentors have said to me that today's surgical residents have it easier than residents of the past because of better adherence to work hour restrictions and a trend toward increased wellness efforts to combat burnout. Is there any truth to this or is this the medical version of walking "uphill both ways" to school.
Is it true that surgical training is becoming less intense and more humane?
- Thread starter Skarl
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I have heard that also. I have also heard the opposite. This question is not worth your time.
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It’s probably better than it was in the 1979s and 1980s. (I don’t know, I didn’t go through it then.) At least officially the pyramidal structure is gone. Still long hours and a lot of work tho. My residency and fellowship have been relatively benign although certainly not low hours or everyone holding hands and singing campfire songs...
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It is better but it is not easy. No one takes every other night call anymore. There are no pyramid systems. But it is still extremely rigorous. Malignancy still varies from non-existent to extreme.
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It is both better and easier. Seems to be better the further away from academics that you get - academic/university type places, particularly those with very large names, err towards the more malignant side mostly due to the hierarchy inherent in these places (at both the attending and resident level). This is not universal. Those places tend to be more competitive environments in general which also probably drives it - more push to get into a prestigious fellowship, more push to get recognized in residency to do so, more competitive and more tension. Residency for me at a large suburban community program was never easy, but it was nothing like the horror stories of even the last decade you hear from some places. Never consistently broke 80 hours, maybe only 2-3 weeks a year in PGY1-2 years, later years were closer to 60-70 hours, work load was more evenly distributed between all five years and not dumped on the lower people on the totem pole.
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Strongly depends on where you are: some places are just as bad as the old days (if not worse); some places adhere strictly to the workhours.
It's not always where you expect.
It's not always where you expect.
Don't go into surgery counting on it being humane. It may be, but it's not a safe bet. If it would really bother you to be in an intense, possibly (or frankly) malignant environment, you should reconsider. Although apparently urology is pretty benign. I think ENT can be a little of both.
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Depends on your frame of reference. Compared to the days where you literally resided in the hospital and people were doing coke to deal with the long hours it is more humane. Compared to other specialities probably not. I expected something closer to the former and was pleasantly surprised. Expect the latter and you will be unpleasantly surprised.
Everyone always claims the generation after them is coddled and doesn't have to work as hard. As a PGY-5 I already have people in my class making those claims about the current interns/PGY-2's. Cracks me up because I remember how offensive it was to be working 80-100hrs a week and get told I had it easy. We did have q2 in house calls for 30 hrs for 6 weeks straight on trauma when I was PGY-2 -- that was deemed inhumane and has been done away with, but now you have to spread those same calls over your PGY-2 and PGY-3 year, so it's the same pain, just more spread out...
Basically anyone who has gone through what surgery residency puts you through has somewhat of a persecution complex and it affects some louder mouthed attendings more than others. I think each generation has unique challenges to deal with in medicine, if you look at some of the old consult lists from two decades ago they might see 20 patients in 24hrs, but have the added inefficiency of plain radiographs, hand written charts and orders which ate up more of their time. Whereas we can have 40-50 patients seen in 24hrs, but we have much more support staff than they used to have for blood draws, transports, imaging techs, and we can look information up immediately online.
Basically anyone who has gone through what surgery residency puts you through has somewhat of a persecution complex and it affects some louder mouthed attendings more than others. I think each generation has unique challenges to deal with in medicine, if you look at some of the old consult lists from two decades ago they might see 20 patients in 24hrs, but have the added inefficiency of plain radiographs, hand written charts and orders which ate up more of their time. Whereas we can have 40-50 patients seen in 24hrs, but we have much more support staff than they used to have for blood draws, transports, imaging techs, and we can look information up immediately online.
D
deleted50541
I've thought about this more and more over the years in my journey. I too recall the older attendings talking about smaller patients lists, but patients were often admitted prior to surgery and stayed much longer too. Plus all of the inefficiencies related to basic patient care that we take for granted (lab work, imaging, charting, etc.).
My training occurred during a period of transition from paper charts to EMR. Mid-level support was also minimal to non-existent when I started, but fairly common by the time my training was complete. As chief resident, I was stunned by how much of my previous duties as an intern/junior resident were now delegated to PAs/NPs, which I felt were a vital part of my training. But on the other hand, it freed the interns/junior residents up to be in the OR more and be more attentive in the OR when their pagers weren't going off non-stop from floor calls and consults. It also saved them from a lot of excessive paperwork, freeing their time to study more it seemed. Or at least getting more sleep instead of dictating a stack of d/c summaries at 1AM while falling asleep in one's chair.
I just loved rewinding through the long gaps of silence on the dictation to where I left off before passing out.
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The death penalty is more humane now than it used to be too.
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The hours are still long, but It is definitely more user friendly everywhere then it was before 1998, mostly due to the fact that the overnight call is so much less then before. I had 4 out of my 5 years (including PGY 5 year) where I was doing q2 call in house at a level 1 trauma center 4-5 months each year and q3 in house everywhere else PGY1-3. Being able to sleep in your own bed and not be paged all night is a completely different experience.
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I see from your flair that you are a fellow now. Do you think going to a "humane" community program made matching to a fellowship significantly harder? Also, where there any "green flags" when you interviewed at your residency program that made you think it was more humane or did you just get lucky?
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It made matching into my fellowship significantly harder yes, but I'm in surg-onc. About half of residents from my program got their top choices in fellowship for CT, vascular, colorectal, plastics, MIS, bariatrics, etc. About 1/4 went straight into practice or went to noncompetitive/non ACGME fellowships, and about 1/4 struggled to get into a fellowship. I'm not sure how that reflects compared to an academic program, maybe others can chime in.
The only 'green flag' I can recall is that the residents who were interviewing took a genuine interest and were super excited at having us to interview. I think that was reflective of a program where the work is well distributed and the PGY4s and 5s have a big role in teaching the 1s and 2s rather than there being more hierarchy. But maybe I'm just making that up in my head. You can genuinely tell that residents are happy or not when you interview though.
The only 'green flag' I can recall is that the residents who were interviewing took a genuine interest and were super excited at having us to interview. I think that was reflective of a program where the work is well distributed and the PGY4s and 5s have a big role in teaching the 1s and 2s rather than there being more hierarchy. But maybe I'm just making that up in my head. You can genuinely tell that residents are happy or not when you interview though.
