Rank the hardest years from med school through fellowship

[osprey099]

Just curious what other people think. For those going into IM subspecialties with 3 year fellowships (GI, cards, h/o, pulm/crit), how would you rank the toughest years from hardest to least hardest starting from med school? Rank in terms of combination of hours spent working/studying, amount of anxiety/stress, etc.

My personal rank from hardest to least hardest:
1. MS3
2. PGY1
3. PGY4 (first year fellow)
4. MS2
5. PGY2
6. PGY5
7. MS1
8. PGY3
9. PGY6
10. MS4

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[Lefty Doodle]

Hardest to least:
Pgy1
MS1
MS2
Pgy2
Pgy3
F2
F1
M3
M4

Sorry didn’t read you wanted three year.

(IM residency endocrine fellowship)

 

[Detective SnowBucket]

Just curious what other people think. For those going into IM subspecialties with 3 year fellowships (GI, cards, h/o, pulm/crit), how would you rank the toughest years from hardest to least hardest starting from med school? Rank in terms of combination of hours spent working/studying, amount of anxiety/stress, etc.

My personal rank from hardest to least hardest:
1. MS3
2. PGY1
3. PGY4 (first year fellow)
4. MS2
5. PGY2
6. PGY5
7. MS1
8. PGY3
9. PGY6
10. MS4

Jesus if MS1 is #7 then imma die. Im just half way through M1 and I'm ready to go die now

 

[end stage fibro]

Jesus if MS1 is #7 then imma die. Im just half way through M1 and I'm ready to go die now

chin up. it gets more interesting and bearable as well. felt like i was actually learning to be a doctor instead of chugging random minutiae

also year 1 of attendinghood is no walk in the park

 

[ordersol7]

If we are talking personal stress:
1. M3
2. M4 (match anxiety)
3. PGY-1
4. PGY-2
5. PGY-3.
6. M2
7. M1
8. PGY-4 (current fellowship year pulm/cc)

In terms of raw workload
1. PGY-1
2. PGY-2
3. PGY-4
4. M3
5. PGY-3
6. M2.
7. M1
8. M4

 

[aafisahar]

PGY 1
PGY 4
MS3
MS2
PGY2
PGY3
MS1
MS4

 

[gutonc]

M1 (only because I'd taken enough time between UG and med school that my study skills were crap and I had to start from scratch)
M2 (Mostly because of Step 1...which I legit took on a Scantron sheet)
PGY1
First year fellowship (I did the Research Pathway so technically this was my PGY3, but would be PGY4 for most
M3 (This was actually kind of fun, but man was I lost most of the time)
PGY2
The rest were a mix between vacation and a slightly more intense job than I had working part-time at a coffee shop when I was in college.

 

[whoknows2012]

PGY1
PGY5 (first year fellow after chief year)
MS3
MS1
MS2
PGY2
PGY3
PGY6
PGY7
MS4

**first year attending is anywhere between #1 by a long shot to somewhere in the middle depending on the day-how many new acute leuks I have, difficult family discussions, etc

 

[Mehena]

PGY1
MS3 (just from frequent rotations to different services, location or teams(too much politics and brown-nosing, shelf exam & figuring out career what-not)
PGY4
PGY5 (1st half currently)
PGY2
M1
M2
M4
PGY3
Hospitalist for 1year at a busy place but much less stressed out than my training years so far.

 

[greatnt249]

My ranking is based on how I remember these years in the moment I was experiencing them rather than in hindsight.

MS3--between required yet otherwise uninspiring rotations and lack of electives; somewhat soul-crushing being on rotations for 8 straight weeks for only the occasional interesting moments
PGY1--learning curve that everyone has to deal with
MS1--sheer volume of material to study compared to undergraduate work
MS2--figuring out how to study for Step 1
PGY4--suddenly expected to be the subspecialty "expert" even though you're essentially just out of residency and can barely read an echo, much less do one
PGY2--supervisor to interns but overall less paperwork (paperwork being the bane of my existence, would probably love job much more if not for the paperwork)
PGY5--having to know early on in year what you intend to do after fellowship (ie interventional/EP without much experience in either department to that point to even make that decision somewhat daunting)
PGY3--mostly electives, stress was in applying for fellowship
PGY6--pretty much all electives, knocked out required night float/inpatient service rotations early to be able to "coast" rest of year
MS4--mostly electives filling out year, stress in sub-internship rotations but these were only 4 weeks at a time compared to 8

 

[tantacles]

oooo I love this thread. FYI, I'm med-peds, so I get 4 PGY years. From hardest to easiest:

1. MS1
2. PGY-1
3. MS2
4. MS3
5. PGY2
6. PGY3
7. PGY4
8. MS4

 

[ShuperNewbie]

So far:

1. PGY1
2. Attending Year 1 (COVID in NYC... No Bueno)
3. MS3
4. MS2
5. PGY2
6. MS1
7. PGY3
8. Attending year 2
9. Vacation/I mean MS4

Let's see how PGY4 year fits into this mix

 

[CatFactorial]

1. Fellowship year 1 H/O
2. Fellowship year 3 (current, PGY6)
3. PGY2
4. PGY1
5. Fellowship year 2
6. PGY3
7. MS3
8. MS2
9. MS4
10. MS1

Also need to bear in mind life stuff. Got a dog PGY2. Moved, got a human PGY4. Got another dog PGY6. I was entirely on my own MS1, studied a ton, yet watched an obscene amount of netflix.

 

[Chemist0157]

PGY1
PGY2
Renal fellow 1
Renal fellow 2
PGY3
MS1
MS3
MS2
MS4

I'm tempted to place MS1 and MS3 higher, but it's just hard to compete with actually being a physician and its responsibilities, calls, weekends. MS1 wasn't even that bad past first 12 weeks with anatomy.

 

[DrMetal]

None of the above.

The hardest years are as an attending, when you realize you spent all those years in education and training, only to find:
- a population that no longer listens to physicians (would rather listen to their FB friends)
- a population that basically does/gets whatever the F it wants (in our now 'boutique style' 'you-get-what-you-want' style of medicine)
- a system that will soon replace you with an 'independent' NP/PA (see the >20 states that just passed that legislation)
- a system that has deemed you obsolete, b/c you took too long to study, to train, and you're too expensive to pay, to maintain, and to insure.

Where was that teaching in medical school/residency?

 

[bobow98]

Worst

1. PGY1 - just sucks all around
2. MS3 - what is my role and why the f*ck am I even here?
3. PGY2 - MICU call anyone?
4. MS2 - Studying for Step 1 was awfully boring
5. Everything else was actually a lot of fun

Best

1. PGY 6 (Pre-attending)
2. MS4
3. PGY 5
4. PGY3
5. MS1 was great except anatomy lab

 

[Thebestofus]

Hardest to least hard:

First year of fellowship
First year of residency
Second year of fellowship
Everything else

 

[SeldingerTechneek]

Toughest -> least tough:

PGY1
Attending year 1
MS3
PGY2
MS2
MS1
PGY3
MS4

(I do miss the dedicated long holiday breaks of med school)

 

[jdh71]

Who TF is saying M3?! Lol.

Ok. Ok. It’s a subjective thing. I’ll respect other’s reality on this one.

It’s all the year of “firsts” (and I can grudgingly see how M3 might be a “first”). But first year of residency, first year of fellowship, and first year as an attending. Those are all pretty damn hard. Internship learning how to actually be a doctor. First year fellowship taking home call every other night for a year and learning when a problem is a bedside one. First year on your own making your own calls and it’s just hard when people die (and clinic is just the worst - you don’t get enough in fellowship).

 

[bobow98]

Who TF is saying M3?! Lol.

Ok. Ok. It’s a subjective thing. I’ll respect other’s reality on this one.

It’s all the year of “firsts” (and I can grudgingly see how M3 might be a “first”). But first year of residency, first year of fellowship, and first year as an attending. Those are all pretty damn hard. Internship learning how to actually be a doctor. First year fellowship taking home call every other night for a year and learning when a problem is a bedside one. First year on your own making your own calls and it’s just hard when people die (and clinic is just the worst - you don’t get enough in fellowship).

I think a lot of us felt out of place and useless M3 and were kind of going through the motions to try to get a decent grade. It's hard at least for me when my purpose is not clear in the work place.

I can see how clinic time is specialty dependent. If you are pulm crit, your hospital rotations are going to suck in terms of stress and hours, and your clinics will be fewer. In oncology, hospital rotations were all consultation based and clinic/research were heavily emphasized. Sometimes I used to moonlight just because I missed the hospital.

 

[Tesselate]

Just curious what other people think. For those going into IM subspecialties with 3 year fellowships (GI, cards, h/o, pulm/crit), how would you rank the toughest years from hardest to least hardest starting from med school? Rank in terms of combination of hours spent working/studying, amount of anxiety/stress, etc.

My personal rank from hardest to least hardest:
1. MS3
2. PGY1
3. PGY4 (first year fellow)
4. MS2
5. PGY2
6. PGY5
7. MS1
8. PGY3
9. PGY6
10. MS4

pgy-2, ms1, Pgy-1 >> pgy-3

 

[deleted980918]

First year cardiology fellowship in a busy program trumps ms1->pgy3 by a wide margin.

 

[Nespresso]

I feel there’s a lot of variation here depending on the fellowship and program for fellowship. 90% of the programs for GI told me it is much better than residency due to having more golden weekends and being more interested in the subject matter which makes it overall easier.
I can see cardiology PGY4 being rough at certain programs. Our programs GI fellows look very rested and have a very chill schedule (lots of fellows) and the cards fellows are extremely overworked, constantly called in on call, and seem tired/depressed.

 

[disorder]

PGY1 (1 golden weekend, 1. 10 months inpatient.)
PGY4 (Cards fellow)
PGY5 (3 months of night float!)
M1
M2
M3
PGY6
PGY2
PGY3
M4

 

[onconconconconc]

pgy1
ms3
pgy2
pgy3
pgy4 (heme/onc)
pgy5
ms2
ms1
pgy6
ms4

 

[PugsAndHugs]

PGY1 (1 golden weekend, 1. 10 months inpatient.)

Ew what horrible residency program is this...?

 

[disorder]

Ew what horrible residency program is this...?

I won't mention it because 1) it's a fantastic place to train and this should not inhibit anyone from matching here 2) it has since changed.
I will say it's not a podunk program and is highly respected.

 

[whoknows2012]

Ew what horrible residency program is this...?

I had 3-4 golden weekends intern year. 4 months of nights (including ED and units) and 7 total months of floors. The few golden weekends and 4 months of nights were particularly brutal (though maybe not as brutal as prior poster ???)

after a particularly brutal self inflicted wound of undertaking 1 month straight of nights, (as compared to working 5.5 weeks of nights in 2 blocks over over 8 week period) I developed shingles. Highly recommend against ever subjecting yourself to that

 

[rokshana]

I had 3-4 golden weekends intern year. 4 months of nights (including ED and units) and 7 total months of floors. The few golden weekends and 4 months of nights were particularly brutal (though maybe not as brutal as prior poster ???)

after a particularly brutal self inflicted wound of undertaking 1 month straight of nights, (as compared to working 5.5 weeks of nights in 2 blocks over over 8 week period) I developed shingles. Highly recommend against ever subjecting yourself to that

A month of nights or shingles?

 

[ShuperNewbie]

I had 3-4 golden weekends intern year. 4 months of nights (including ED and units) and 7 total months of floors. The few golden weekends and 4 months of nights were particularly brutal (though maybe not as brutal as prior poster ???)

after a particularly brutal self inflicted wound of undertaking 1 month straight of nights, (as compared to working 5.5 weeks of nights in 2 blocks over over 8 week period) I developed shingles. Highly recommend against ever subjecting yourself to that

hoooooly guacamole dude haha. That sounds brutal. I thought my intern year was bad but it was NOTHING compared to this. A guaranteed 2 golden weekends after a month of wards is absurdly clutch.

 

[PugsAndHugs]

I had 3-4 golden weekends intern year. 4 months of nights (including ED and units) and 7 total months of floors. The few golden weekends and 4 months of nights were particularly brutal (though maybe not as brutal as prior poster ???)

after a particularly brutal self inflicted wound of undertaking 1 month straight of nights, (as compared to working 5.5 weeks of nights in 2 blocks over over 8 week period) I developed shingles. Highly recommend against ever subjecting yourself to that

I’m so happy I made the decision to choose QOL over prestige/ranking. I have 10 golden weekends intern year and 6 weeks of nights. I did this because I knew in med school that I was not going into a competitive fellowship.

 

[disorder]

I had 3-4 golden weekends intern year. 4 months of nights (including ED and units) and 7 total months of floors. The few golden weekends and 4 months of nights were particularly brutal (though maybe not as brutal as prior poster ???)

after a particularly brutal self inflicted wound of undertaking 1 month straight of nights, (as compared to working 5.5 weeks of nights in 2 blocks over over 8 week period) I developed shingles. Highly recommend against ever subjecting yourself to that

Sounds similar. 6 ward months. 3 ICU months q3-4 24hr. 1.5mo nights.
You’re stronger for it.

 

[Instatewaiter]

tier 1: Pgy1 by far nothing else was even close. 10.5 months of q3 or q4 call.


Tier 2: pgy3

Tier 3
Ms1
Ms3
Ms2
Pgy4

Tier 4: others

Honorable mention: Hardest month out of it all was in pgy5

 

[TAVR4life]

Fellowship PGY4
Fellowship PGY5
Residency PGY1
Medical School Y3
Medical School Y1-2
Residency PGY3
Fellowship PGY6
Medical School Year 4

Fellowship is by far the toughest years in terms of both medical knowledge, procedural and technical skill, volume and hours worked.

 

[WheezyBaby]

Based on perceived (not necessarily actual) difficulty

M1, PGY1, M2, PGY2, PGY3, attending, PGY4, M4

I expect PGY5-7 and repeat attending transition will be somewhere near the top of the list

 

[1Cor1557]

Just curious what other people think. For those going into IM subspecialties with 3 year fellowships (GI, cards, h/o, pulm/crit), how would you rank the toughest years from hardest to least hardest starting from med school? Rank in terms of combination of hours spent working/studying, amount of anxiety/stress, etc.

My personal rank from hardest to least hardest:
1. MS3
2. PGY1
3. PGY4 (first year fellow)
4. MS2
5. PGY2
6. PGY5
7. MS1
8. PGY3
9. PGY6
10. MS4

This, dead on (GI)

 

[sluggs]

MS1
MS2
MS3
PGY2
PGY1
F1
PGY3
F2
MS4

 

[BigRedBeta]

Interesting question: I'm not IM, peds with 3 year Peds Critical Care Fellowship.

Ranks based mostly on overall gestalt of misery and how likely I would want to repeat the year

Worst/would never want to repeat:
MS2
MS1
PGY 4 (F1)
PGY 1
PGY 6 (F3 - job search was terrible)
MS3
PGY 5 (F2)
PGY 2
PGY3
MS 4

 

[InternistDO]

No year has ever topped my MS1 for pure stress and general unpleasantness (my school had mandatory attendance and exams that were almost q weekly). Intern year is wonderful compared to that.

 

[osprey099]

Just curious what other people think. For those going into IM subspecialties with 3 year fellowships (GI, cards, h/o, pulm/crit), how would you rank the toughest years from hardest to least hardest starting from med school? Rank in terms of combination of hours spent working/studying, amount of anxiety/stress, etc.

My personal rank from hardest to least hardest:
1. MS3
2. PGY1
3. PGY4 (first year fellow)
4. MS2
5. PGY2
6. PGY5
7. MS1
8. PGY3
9. PGY6
10. MS4

Just thought it'd be interesting to bring up this topic again. I just completed by PGY4 (first year fellowship) in heme-onc. I can attest that the ranking I provided above is pretty accurate for my journey (albeit, I have not experienced PGY5 or 6 yet).

 

[gutonc]

Just thought it'd be interesting to bring up this topic again. I just completed by PGY4 (first year fellowship) in heme-onc. I can attest that the ranking I provided above is pretty accurate for my journey (albeit, I have not experienced PGY5 or 6 yet).

My experience was PGY4<PGY1. No in-house overnights (except when moonlighting) but home call was arguably worse. Also, the "they're just interns" thing doesn't come around again as a first-year fellow. The ER never calls the MICU intern and asks what vent settings and pressors they'd prefer the septic and hypoxic patient be sent up to the ICU on, but they'll ask the July 1 PGY4 fellow what the common side effects of the Phase 1 drug XL872AL are and can it be responsible for neutropenic priapism with acute pancreatitis, and what should we do about it.

PGY6>M4 because the big money is just on the other side so it's much easier to put up with the (minimal) bulls**t during that year.

ETA: I realized I may not have been clear with my <>, plus I messed it up above, now changed. PGY4 was worse than PGY1, PGY6 is way better than M4.

 

[dozitgetchahi]

None of the above.

The hardest years are as an attending, when you realize you spent all those years in education and training, only to find:
- a population that no longer listens to physicians (would rather listen to their FB friends)
- a population that basically does/gets whatever the F it wants (in our now 'boutique style' 'you-get-what-you-want' style of medicine)
- a system that will soon replace you with an 'independent' NP/PA (see the >20 states that just passed that legislation)
- a system that has deemed you obsolete, b/c you took too long to study, to train, and you're too expensive to pay, to maintain, and to insure.

Where was that teaching in medical school/residency?

Yeah. Agree. For me:

Year 1 attending - it’s all you, bro. I started a new rheumatology practice at a hospital system that had never had a rheumatologist previously. It was a “major growth experience”, shall we say. What made it easier/more pleasant than the training years was finally making a living wage and actually having some autonomy and agency in the process (and, most importantly, if your job sucks you can FINALLY quit and get a different one rather than just having to eat whatever **** your “superiors” serve up with a smile, or lose the whole “doctor” thing forever).

PGY-1 - yeah, that sucked.
PGY-5 - my rheumatology fellowship was surprisingly tough. I had accumulated a ton of patients at this point, and myself and my co fellows were all working our asses off until the bitter end.
MS3 - was challenging but I actually kinda liked the diversity of the experiences that year.
MS2 - the year you study for boards etc.

 

[dozitgetchahi]

My experience was PGY4>PGY1. No in-house overnights (except when moonlighting) but home call was arguably worse. Also, the "they're just interns" thing doesn't come around again as a first-year fellow. The ER never calls the MICU intern and asks what vent settings and pressors they'd prefer the septic and hypoxic patient be sent up to the ICU on, but they'll ask the July 1 PGY4 fellow what the common side effects of the Phase 1 drug XL872AL are and can it be responsible for neutropenic priapism with acute pancreatitis, and what should we do about it.

PGY6>M4 because the big money is just on the other side so it's much easier to put up with the (minimal) bulls**t during that year.

My experience was PGY4>PGY1. No in-house overnights (except when moonlighting) but home call was arguably worse. Also, the "they're just interns" thing doesn't come around again as a first-year fellow. The ER never calls the MICU intern and asks what vent settings and pressors they'd prefer the septic and hypoxic patient be sent up to the ICU on, but they'll ask the July 1 PGY4 fellow what the common side effects of the Phase 1 drug XL872AL are and can it be responsible for neutropenic priapism with acute pancreatitis, and what should we do about it.

PGY6>M4 because the big money is just on the other side so it's much easier to put up with the (minimal) bulls**t during that year.

Oh yeah. The first day I held the rheum dept call pager as the “consult fellow”, I was pretty shocked at the questions asked. My very first page came from a number in the US Virgin Islands - I call it back and it’s some random ER doctor who is demanding that I teach him how to manage ANCA vasculitis in some random patient who had just shown up in his ER. (Neither the pt nor this ER doc had any affiliation with our institution.) Next page is some ER resident at our institution asking if some obscure medication causes lupus. And on and on.

 

[dozitgetchahi]

I had 3-4 golden weekends intern year. 4 months of nights (including ED and units) and 7 total months of floors. The few golden weekends and 4 months of nights were particularly brutal (though maybe not as brutal as prior poster ???)

after a particularly brutal self inflicted wound of undertaking 1 month straight of nights, (as compared to working 5.5 weeks of nights in 2 blocks over over 8 week period) I developed shingles. Highly recommend against ever subjecting yourself to that

My intern year, I did a 6 month consecutive block of wards and night float. At the end of that block, I finally had a consult block - and I remember it took nearly the entire goddamn month to feel relatively “normal” again. I can remember standing in clinic that first week off wards and just having the strangest combination of sleep deprived brain fog and near depersonalization…

 

[osprey099]

My experience was PGY4<PGY1. No in-house overnights (except when moonlighting) but home call was arguably worse. Also, the "they're just interns" thing doesn't come around again as a first-year fellow. The ER never calls the MICU intern and asks what vent settings and pressors they'd prefer the septic and hypoxic patient be sent up to the ICU on, but they'll ask the July 1 PGY4 fellow what the common side effects of the Phase 1 drug XL872AL are and can it be responsible for neutropenic priapism with acute pancreatitis, and what should we do about it.

PGY6>M4 because the big money is just on the other side so it's much easier to put up with the (minimal) bulls**t during that year.

ETA: I realized I may not have been clear with my <>, plus I messed it up above, now changed. PGY4 was worse than PGY1, PGY6 is way better than M4.

Everyone says life gets better after first year of fellowship so I'm eagerly awaiting that life (2 more weeks)! Our fellowship is very front loaded in that you complete all of your inpatient requirements and majority of weekend call in the first year. For PGY5 and 6, we just do 3-4 weekend calls each year and the rest is clinic/research. I guess the light is at the end of the tunnel finally..

 

[timpview]

Being an Attending has been twice as busy (and harder) than anything I saw in fellowship. But I’m also a q4 heavy call burden specialty.