top IM residency prograns with easier schedules

[MoLarryKerlyBLine]

You have a common misconception, a personal attack or insult is NOT an ad hominem UNLESS it *IS* the argument itself. Most insults are just that insults. My initial observation was not directed at anyone in particular and I wasn’t making an argument. I was simply letting the thread know my thoughts. If you took insult from them that’s partly on you.

Now after that I’ve made many point by point arguments about how you are incorrect and wrong. You’ve responded by simply saying I’m “grumpy” or whatever. You have still yet to mount any kind of argument against all of the attendings and residents who have also told you that you are wrong.

My suggestion is to either 1) put up or 2) shut up while slowly backing out of the thread not making any eye contact as you will continue to embarrass yourself further.

You can tap out I won’t think any more less of you than I already do.

I'll ignore the part where you got a little emotional and answer the real question at hand. I'd hate to get under your skin even more, since it seems so thin.

OK, here's evidence that a reduction in resident work hours doesn't affect patient outcomes. Resident Hour Cap Does Not Harm Patients, New Study Confirms

But I guess your anectodotal evidence of how reduced work hours is harmful to patients is better. I guess acgme work restrictions are ignoring potential patient health outcomes. And I guess I also forgot the part where I said that I CHOSE a residency program for the lifestyle. Cool

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[jdh71]

I'll ignore the part where you got a little emotional and answer the real question at hand. I'd hate to get under your skin even more, since it seems so thin.

OK, here's evidence that a reduction in resident work hours doesn't affect patient outcomes. Resident Hour Cap Does Not Harm Patients, New Study Confirms

But I guess your anectodotal evidence of how reduced work hours is harmful to patients is better. I guess acgme work restrictions are ignoring potential patient health outcomes. And I guess I also forgot the part where I said that I CHOSE a residency program for the lifestyle. Cool

I wasn't talking about caps. Were you paying any kind of attention in here? Do you need to go back and read very slowly and try some basic reading comprehension? Am I supposed to take you serious when you do none of this?

All of the attendings in here have been talking about your ability to handle patients and their varied situations after training. And this is why you need to have a rigorous environment to train in. Which includes 24hr calls. No one has been arguing more working more hours in residency in here. Have they?

Maybe you're just trolling now. It's getting hard to tell.

 

[MoLarryKerlyBLine]

I wasn't talking about caps. Were you paying any kind of attention in here? Do you need to go back and read very slowly and try some basic reading comprehension? Am I supposed to take you serious when you do none of this?

All of the attendings in here have been talking about your ability to handle patients and their varied situations after training. And this is why you need to have a rigorous environment to train in. Which includes 24hr calls. No one has been arguing more working more hours in residency in here. Have they?

Maybe you're just trolling now. It's getting hard to tell.

My bad, I forgot that the title of the thread didn't mention anything about residency programs with cush hours. I'm out because I can't be bothered with this anymore.

 

[jdh71]

My bad, I forgot that the title of the thread didn't mention anything about residency programs with cush hours. I'm out because I can't be bothered with this anymore.

 

[rokshana]

I'll ignore the part where you got a little emotional and answer the real question at hand. I'd hate to get under your skin even more, since it seems so thin.

OK, here's evidence that a reduction in resident work hours doesn't affect patient outcomes. Resident Hour Cap Does Not Harm Patients, New Study Confirms

But I guess your anectodotal evidence of how reduced work hours is harmful to patients is better. I guess acgme work restrictions are ignoring potential patient health outcomes. And I guess I also forgot the part where I said that I CHOSE a residency program for the lifestyle. Cool

Um, that wasn’t the issue...the issue discussed was that training for residents NEEDS to be rigorous...you need to see lots of patients while you have the safety net of an attending to make sure you know how to handle situations when you are an attending...and that it is EXTREMELY obvious which doctors out there had a through training experience and those that were just kinda there, biding there time. No where was there ANY mention of patient safety or outcome as an issue... the point was more that many of this upcoming generation are looking to have others do their work and that their needs are more important than the needs of the patients that they are supposed to be serving.

One develops a reputation fairly quickly in residency... everyone figures out who the slackers are... and if that microscope gets put on you, well...don’t expect any sympathy from those here when you post here that you were put on probation or dismissed...remember your attendings as PD as well as admin come from the same generation as the attendings here... and have the same work ethics.

 

[rokshana]

I'll ignore the part where you got a little emotional and answer the real question at hand. I'd hate to get under your skin even more, since it seems so thin.

OK, here's evidence that a reduction in resident work hours doesn't affect patient outcomes. Resident Hour Cap Does Not Harm Patients, New Study Confirms

But I guess your anectodotal evidence of how reduced work hours is harmful to patients is better. I guess acgme work restrictions are ignoring potential patient health outcomes. And I guess I also forgot the part where I said that I CHOSE a residency program for the lifestyle. Cool

Interesting, since you previously posted that you were looking for fellowship placement and potential as being more important than lifestyle...think you just got a little butt hurt that jdh said kids are lazy these days...

I understand the desire to put a lifestyle program ahead of a workhorse, but if your goal is cards/any other big 4 specialty, then you better be working hard anyway. I did not interview at either of those places, but on my own list, I am prioritizing fellowship placement over perceived prestige or lifestyle.

We get one shot at this, do it right. Whatever that may mean for you.

 

[Instatewaiter]

You should get your debt paid off and then get out of medicine...hopefully before you are responsible for someone’s death.
And those people taking your calls from the OSH... have absolutely no respect for you.

That's fine they have no respect bc I'm the one laughing at them. They're just a cog in the wheel to their administration that can be replaced by 100 willing bodies lining up behind them to lap up the Prestige. Prestige isn't all it is cracked up to be once you're out of training.

I'll let them speak down to me and laugh all the way to the bank since they make 40% of what I do. There is a fool in those conversations and it isn't me...

I used to be one of them and realized quickly prestige wouldn't pay my mortgage. It will get you a killer job outside of academia though.

 

[Instatewaiter]

Unfortunately in 2019 a lot of us, myself included, go into hundreds of thousands of dollars in debt and go into a specialty based on their board scores and not what they necessarily like. .

I think you don't realize that you are making a case for working/ trying harder...

 

[rokshana]

That's fine they have no respect bc I'm the one laughing at them. They're just a cog in the wheel to their administration that can be replaced by 100 willing bodies lining up behind them to lap up the Prestige. Prestige isn't all it is cracked up to be once you're out of training.

I'll let them speak down to me and laugh all the way to the bank since they make 40% of what I do. There is a fool in those conversations and it isn't me...

I used to be one of them and realized quickly prestige wouldn't pay my mortgage. It will get you a killer job outside of academia though.

Respect and prestige are two different things...having the respect of your peers is important and is frankly earned...there are plenty of people at prestigious place that don’t have the respect of their colleagues. Respect means(at least to me) I trust your judgement and medical acumen...you tell me something about your patient and I will believe you and have confidence In the medical work up and the medical decisions you have made...having been the hospitalist at the tertiary care center accepting these transfers from the OSH... well I have learned to ask a lot of questions to
Make sure some train wreck that should have gone to the icu doesn’t show up on the general floor at 1 am...usually with no discharge summary, but lots of vital signs ...

 

[VA Hopeful Dr]

I wasn't talking about caps. Were you paying any kind of attention in here? Do you need to go back and read very slowly and try some basic reading comprehension? Am I supposed to take you serious when you do none of this?

All of the attendings in here have been talking about your ability to handle patients and their varied situations after training. And this is why you need to have a rigorous environment to train in. Which includes 24hr calls. No one has been arguing more working more hours in residency in here. Have they?

Maybe you're just trolling now. It's getting hard to tell.

Yeah I'm not getting this. Most, if not all, of the attendings in this thread came up under the 80 hour rule. No one has claimed that every doctor has to work their ass off in practice for 30 years or do the old fashioned 120 hour weeks.

Its very simple: don't go for a cushy residency. Its only a few years and it will impact your whole career.

 

[sallyhasanidea]

I can also tell which of the new hospitalists that came out of weak programs based on what they panic about when asking for an ICU transfer

Can you please elaborate on this with examples of what would make you think the hospitalist is good vs. bad? And how you think their training contributed to that?

 

[jhamaican]

everyone wants to get paid as much money as possible for as little work as possible...

and the world turns...

 

[MD46]

After working for a few years since fellowship, nothing can trump experience, I started feeling that right away when I started making my own decisions. Having seniors in practice help quite a bit, they will be your new mentors and help you with the real world **** that you couldnt have prepared for.

But I somewhat agree with one of the posters above is that working smart and not necessarily harder has its role as well.

For example: in between the hospital and clinic I see 25-30pts a day and am done with notes, chemo-orders and calls on average around 6-630 p.

My seniors with the same or some times less amount of patients are always saying they are really busy and dont leave office due to having many dictations till 8p or later.

Not willing to train with the Dragon, sticking to old school recorders with SD cards isnt helping them. I type fast and can dictate faster specially on new consults, that is working " Smater " in my opinion.

 

[xoggyux]

This is amusing, but also frustrating. Don't get me wrong, I am not surprised at the endless "old generation vs new generation" tornado of complaints. This is not new, it can be traced back for thousands of years to the dawn of human history. Presumably, this is because we are wired to not like change.
I experienced it first hand coming from a 3 generation family of physicians. My grandfather complained and criticized to end the way that the next generation (my mother) got trained and practiced medicine when she was a young doctor. My mother, in turn, complained of the way I was taught medicine and how I showed no interest in memorizing to end small details that used to be a big deal in the past but in today's practice is much more de-emphasized because of the things that now we know, she also criticizes the way I practice, etc.
Not limited to medicine either, the old engineer that used to dozens of hand calculations and used to carry tiny pocketbooks of conversion tables in his shirt pocket complains of the newer generation that rarely ever does anything by hand and have computers, CAD and composite materials to their disposition.
What about the general public? you cannot go 1 hour in any news program without hearing a remark about how Millenials are doing this wrong and behaving like this and that.

To the OP. The truth is, that attitude towards residency will have a much bigger impact on how well you get trained than the actual number of hours or how rigorous and "military-like" your program is driving you. If being a "medical slave" for 3 years is what makes a residency good... then you would see how everyone would be rushing to grab all of those residencies in New York infamous for squeezing the living soul out of their residencies, and you would expect that the vast majority of every top-notch attending in practice today went to one of those residencies... We don't see that.

I recommend you do what I did and what I recommend my medical students when they are about to apply. Choose based on the overall culture of the program/resident and how it complements your personality. 80 hours in a place that you enjoy working in is far less stressful and far more pleasant than 70 hours in a place you despise.

I know this is unpopular to say, but I don't think you actually learn much medicine in residency. I think residency is simply for the experience, the amount of actual new knowledge that I learned is minimal. Residency in my experience was not about learning new stuff but about learning how the system works and about gaining confidence in doing it myself and knowing when my limit is reached. I also think that every hour spent in residency has diminishing return compared to a previous. I learned far more in the first 6 months of internship than I did in the next couple of years combined.

 

[HoldTheCoffee]

I'm a relatively recent IM graduate and still in fellowship, but my perspective is much more in line with the old timers on this one. You can either choose to have cush hours or have good training, but not both. Of course, there's an upper limit where spending too much time in the hospital starts interfering with sleep and ability to learn/absorb information, but 24 hour calls here and there are not that limit.

 

[BigGAC1]

... All y'all arguing on this thread sound insufferable. Its threads like this that make me regret opening up SDN to begin with. Now I need a beer.

 

[jdh71]

... All y'all arguing on this thread sound insufferable. Its threads like this that make me regret opening up SDN to begin with. Now I need a beer.

life is hard

wump

wump

 

[BigGAC1]

life is hard

wump

wump

The beer helped.

 

[mercaptovizadeh]

I trained in internal medicine and pediatrics at a fairly rigorous place and am now doing a fellowship. I have to say what's overwhelming is not the hours worked but how little I know - how little we all know - and how much more there is to learn. Every specialty is expanding in its understanding of disease, diagnostics, therapeutic modalities, screening algorithms, etc. Because residency is so short, you're going to miss whole swaths of disease depending on where you train. You had better try to have the most rigorous, high volume, and "interesting" "teaching" cases. It's not just about hitting you with zebras, it's about training you how to think about a diagnostic approach, what studies to order off the cuff during an RRT and what interventions to make, running the code algorithms, efficient interviews and documentation, managing intersecting disease processes, when to rely on your consultants and when to distrust them and seek second opinions, learning about disease *outside* of your specialty so you know when to and when not to consult others, when to send people to the unit or discharge them from the ED, and most importantly the subtle and varied presentations of common disease. There's dozens of different ways pneumonia or heart failure or leukemia or adrenal crisis or... can present. You have to know at least a few of those....and see some Cryptococcus and neuroleptic malignant syndrome for good measure. The books and UTD can't tell you all the different "pictures" of disease. It's clinical experience that does that.

 

[seeinghowitgoes]

I trained in internal medicine and pediatrics at a fairly rigorous place and am now doing a fellowship. I have to say what's overwhelming is not the hours worked but how little I know - how little we all know - and how much more there is to learn. Every specialty is expanding in its understanding of disease, diagnostics, therapeutic modalities, screening algorithms, etc. Because residency is so short, you're going to miss whole swaths of disease depending on where you train. You had better try to have the most rigorous, high volume, and "interesting" "teaching" cases. It's not just about hitting you with zebras, it's about training you how to think about a diagnostic approach, what studies to order off the cuff during an RRT and what interventions to make, running the code algorithms, efficient interviews and documentation, managing intersecting disease processes, when to rely on your consultants and when to distrust them and seek second opinions, learning about disease *outside* of your specialty so you know when to and when not to consult others, when to send people to the unit or discharge them from the ED, and most importantly the subtle and varied presentations of common disease. There's dozens of different ways pneumonia or heart failure or leukemia or adrenal crisis or... can present. You have to know at least a few of those....and see some Cryptococcus and neuroleptic malignant syndrome for good measure. The books and UTD can't tell you all the different "pictures" of disease. It's clinical experience that does that.

First, I definitely agree with this, and I agree with the general sentiment that many have espoused on here that one needs volume and rigor during residency.

I guess my only contention would be that if you attend any “top” academic residency program as was mentioned by OP (all of which are at large hospitals, get referrals from all over, do advanced procedures, etc) you should have ample opportunity to run rapids, see uncommon presentations of common disease, and common presentations of uncommon ones.

If it’s choosing between the 150 bed hospital in the same city as a large academic one (have an acquaintance at such a place) vs going to a top academic program, then yes of course there is going to be difference. But that type of situation aside, to OP and other future applicants toiling with this question, I’m just not sold that other differences in schedules at top places contribute that much to making better or worse docs and do think it’s probably fine to use schedule as a tiebreaker between two places one vibes with equally.

 

[Jesus1]

This is amusing, but also frustrating. Don't get me wrong, I am not surprised at the endless "old generation vs new generation" tornado of complaints. This is not new, it can be traced back for thousands of years to the dawn of human history. Presumably, this is because we are wired to not like change.
I experienced it first hand coming from a 3 generation family of physicians. My grandfather complained and criticized to end the way that the next generation (my mother) got trained and practiced medicine when she was a young doctor. My mother, in turn, complained of the way I was taught medicine and how I showed no interest in memorizing to end small details that used to be a big deal in the past but in today's practice is much more de-emphasized because of the things that now we know, she also criticizes the way I practice, etc.
Not limited to medicine either, the old engineer that used to dozens of hand calculations and used to carry tiny pocketbooks of conversion tables in his shirt pocket complains of the newer generation that rarely ever does anything by hand and have computers, CAD and composite materials to their disposition.
What about the general public? you cannot go 1 hour in any news program without hearing a remark about how Millenials are doing this wrong and behaving like this and that.

To the OP. The truth is, that attitude towards residency will have a much bigger impact on how well you get trained than the actual number of hours or how rigorous and "military-like" your program is driving you. If being a "medical slave" for 3 years is what makes a residency good... then you would see how everyone would be rushing to grab all of those residencies in New York infamous for squeezing the living soul out of their residencies, and you would expect that the vast majority of every top-notch attending in practice today went to one of those residencies... We don't see that.

I recommend you do what I did and what I recommend my medical students when they are about to apply. Choose based on the overall culture of the program/resident and how it complements your personality. 80 hours in a place that you enjoy working in is far less stressful and far more pleasant than 70 hours in a place you despise.

I know this is unpopular to say, but I don't think you actually learn much medicine in residency. I think residency is simply for the experience, the amount of actual new knowledge that I learned is minimal. Residency in my experience was not about learning new stuff but about learning how the system works and about gaining confidence in doing it myself and knowing when my limit is reached. I also think that every hour spent in residency has diminishing return compared to a previous. I learned far more in the first 6 months of internship than I did in the next couple of years combined.

Every now and then, you read a post on SDN that actually makes a lot of sense. I am in agreement that the more experience one has, the better. But there is certainly a key difference between spending hours in the hospital and spending PRODUCTIVE hrs in the hospital. If I am spending more "productive" hours and actually learning, then by all means I have no problem staying. Very hard to argue that even 70% of one's time in the hospital is spent on productive activities. I would say to go to the program that removes the most inefficiencies from your educational process.

 

[xoggyux]

I think there is a major misunderstanding going on in this discussion. I read some of you referring to "cush" residency as if that was a real thing. Interns attending to a residency in the Bahamas drinking margaritas is not a real thing. I dismissed it as a condescending joke from the "older generation" but now I realize this is lending itself to a major equivocation fallacy that needs to be dispelled.
Maybe I live under a rock, but last time I checked, there were no real "cush" residencies out there. Just about every resident out there is going to be working long hours regardless of specialty or "quality" of their program. Even the ****tiest, less rigorous (academically speaking) programs will put their residents through 50h++ of work, which is not by any stretch of the imagination "cush". A more realistic number is 60-70+ with the intern year being 70+.
This idea that "this is not enough time" and "the quality of doctors will suffer" has been dispelled by actually real data. Furthermore, there are many other countries that have even more strict hours for doctors than the US and they are doing just fine. The number of hours alone is not a good indicator of quality. Also, given that nowadays we spend the VAST majority of work doing non-clinical SH**T such as documentation, case-manager herding, chasing family members that don't answer the phone or trying to get medical records from another institution (why do we still use FAX!!!! in 2019 to get ELECTRONIC records?).
The best experience is such that once you graduate from your program you can do the job you want. If you want to do outpatient medicine, what you really should focus is on a program with a strong outpatient presence. If you want to become a hospitalist, you want a program with broad exposure to common stuff, if you want to go into academics, then you want an academic program with plenty of opportunity for research and if you want to go into cardio fellowship you should go into a program that can open the right doors for you. In my experience, the cardiologist only knows of 2 antibiotics, Ancef, and vancomycin. If it is not covered by one of those two, the patient can die septic. And that is not a criticism (please if you are a cardiologist don't email me all angry) it is simply the way that we practice medicine. We are only human and we have learned so much (despite being so little) that a single person cannot be expected to properly practice all of it.

 

[Instatewaiter]

If it’s choosing between the 150 bed hospital in the same city as a large academic one (have an acquaintance at such a place) vs going to a top academic program, then yes of course there is going to be difference. But that type of situation aside, to OP and other future applicants toiling with this question, I’m just not sold that other differences in schedules at top places contribute that much to making better or worse docs and do think it’s probably fine to use schedule as a tiebreaker between two places one vibes with equally.

Out of training just a handful of years I will tell you there is a significant difference between a run of the mill university program and a very strong one. I suspect it is because you are surrounded by smarter residents so you push yourself harder to be better and you are surrounded by leaders in the field who push you more as well. I can tell you I started residency and felt well behind my peers because they were crazy smart.

I can tell you I have experienced this in practice as well. Just a few years out of training, other docs, especially my partners, seek out my opinion... And I'm many years their junior and in the same specialty. They all trained at reputable university programs. I have more experience from my training because of that extra volume.

 

[neoexile]

Have to admit I despise these threads.

Kids are lazy af these days.

Yup. Being a doctor isn't for the lazy.

 

[Instatewaiter]

I think there is a major misunderstanding going on in this discussion. I read some of you referring to "cush" residency as if that was a real thing. Interns attending to a residency in the Bahamas drinking margaritas is not a real thing. I dismissed it as a condescending joke from the "older generation" but now I realize this is lending itself to a major equivocation fallacy that needs to be dispelled.
Maybe I live under a rock, but last time I checked, there were no real "cush" residencies out there. Just about every resident out there is going to be working long hours regardless of specialty or "quality" of their program. Even the ****tiest, less rigorous (academically speaking) programs will put their residents through 50h++ of work, which is not by any stretch of the imagination "cush". A more realistic number is 60-70+ with the intern year being 70+.
This idea that "this is not enough time" and "the quality of doctors will suffer" has been dispelled by actually real data. Furthermore, there are many other countries that have even more strict hours for doctors than the US and they are doing just fine. The number of hours alone is not a good indicator of quality. Also, given that nowadays we spend the VAST majority of work doing non-clinical SH**T such as documentation, case-manager herding, chasing family members that don't answer the phone or trying to get medical records from another institution (why do we still use FAX!!!! in 2019 to get ELECTRONIC records?).
The best experience is such that once you graduate from your program you can do the job you want. If you want to do outpatient medicine, what you really should focus is on a program with a strong outpatient presence. If you want to become a hospitalist, you want a program with broad exposure to common stuff, if you want to go into academics, then you want an academic program with plenty of opportunity for research and if you want to go into cardio fellowship you should go into a program that can open the right doors for you. In my experience, the cardiologist only knows of 2 antibiotics, Ancef, and vancomycin. If it is not covered by one of those two, the patient can die septic. And that is not a criticism (please if you are a cardiologist don't email me all angry) it is simply the way that we practice medicine. We are only human and we have learned so much (despite being so little) that a single person cannot be expected to properly practice all of it.

Oh there certainly are cush residencies where less is expected of the residents. The term cush doesn't just have to do with hours worked. I work at a hospital with one of these cush residencies.

I think you are making generalizations in what the data says. There is only data suggesting extra call hours didn't deleteriously hurt patient outcomes... Mainly because there are multiple levels of oversight as an intern (nurses, resident +/- fellow + attending)

Those other countries with fewer hours that you cite overcome shorter hours per year by extending training with more years or defacto extra training years with junior attending years.

 

[neoexile]

Oh there certainly are cush residencies where less is expected of the residents. The term cush doesn't just have to do with hours worked. I work at a hospital with one of these cush residencies.

I think you are making generalizations in what the data says. There is only data suggesting extra call hours didn't deleteriously hurt patient outcomes... Mainly because there are multiple levels of oversight as an intern (nurses, resident +/- fellow + attending)

Those other countries with fewer hours that you cite overcome shorter hours per year by extending training with more years or defacto extra training years with junior attending years.

People who want "cush" are missing the point of what it takes to become a doctor. Being a doctor means you have to give 110% to make sure you know your patients, you are reading constantly and you are making sure they go home to their family safely. You have to be comfortable with your own knowledge base and be confident when talking to patients and families.

I'll tell you the people who strike out are the ones that dont take the time to know what is going on with their patient at all. One of my worst experiences was when I had under someone who couldnt be bothered to return my calls (even tho he was scheduled that night) and one of my patients was crashing. Patient could have died as a result, but thank God, I have my attendings that I can reach.

Laziness kills patients. I'm sorry, but it does. And Im not guilty of not being lazy. But holy hell, when you miss something and your patient is dying, you'll be cursing yourself the entire day (assuming you have any ounce of good in you), because you missed that important finding or werent diligent in knowing all data.

 

[Instatewaiter]

People who want "cush" are missing the point of what it takes to become a doctor. Being a doctor means you have to give 110% to make sure you know your patients, you are reading constantly and you are making sure they go home to their family safely. You have to be comfortable with your own knowledge base and be confident when talking to patients and families.

I'll tell you the people who strike out are the ones that dont take the time to know what is going on with their patient at all. One of my worst experiences was when I had under someone who couldnt be bothered to return my calls (even tho he was scheduled that night) and one of my patients was crashing. Patient could have died as a result, but thank God, I have my attendings that I can reach.

Laziness kills patients. I'm sorry, but it does. And Im not guilty of not being lazy. But holy hell, when you miss something and your patient is dying, you'll be cursing yourself the entire day (assuming you have any ounce of good in you), because you missed that important finding or werent diligent in knowing all data.

I couldn't agree more.

 

[xoggyux]

Oh there certainly are cush residencies where less is expected of the residents. The term cush doesn't just have to do with hours worked. I work at a hospital with one of these cush residencies.

I think you are making generalizations in what the data says. There is only data suggesting extra call hours didn't deleteriously hurt patient outcomes... Mainly because there are multiple levels of oversight as an intern (nurses, resident +/- fellow + attending)

Those other countries with fewer hours that you cite overcome shorter hours per year by extending training with more years or defacto extra training years with junior attending years.

What is it that you mean by cush then? Give me some examples of what you consider a cush residency...

I am not making any generalization. There is virtually no hard data that says that fewer hours are deleterious for training of residents (whom are already working 70h+) and there is plenty of data that do in fact suggest that it has no impact on patient care and a beneficial impact on resident satisfaction and other markers. Physician (attendings and residents) depression and suicide is all the rage now... burnout is all the rage now. You can't go 2 issues of your favorite medical journal/magazine without reading some column or article or research on the topic. Many factors come into play, financial, stress, caregiver stress, false expectations, etc... This is a big issue.

Also, keep things into perspective... the OP is asking for a "top 20 program with the easier schedule" TOP 20.... no matter if he/she ends up going to the 20th in that list... he/she is expected to get excellent training regardless of how easy/hard the schedule is. Again, I think a bunch of you are blowing this out of proportion. The guy is not asking to train medicine in Paris drinking wine.... he/she is merely looking to not bust his ass in some sort of nonsense. Some programs seem to go the extra mile to make people's life miserable. For instance my program would make resident show up to clinic from 9am-5pm on holidays to do nothing... no patient scheduled... just sit there or use a PTO "because we were getting paid, we needed to be there..." as if somehow the 70h that I reported the week prior (and the 10+ hours I "forgot" to report to not get the program (and myself) in trouble were not enough.

For instance, the OP mentions 24h call... I see little to no reason for 24h calls existing. They certainly are very unpopular, almost non-existing once you get out of training... Even if you get a few hours of sleep in a call room, It is very likely you are not absorbing any meaningful experience after the 12th or 14th hour of that 24h shift. Is that what you call "good training"? Sleep deprivation is a real thing. Meanwhile, plenty of programs have created night float in which residents get exactly the same night experience without losing their brain cells from not sleeping.

 

[Lexdiamondz]

What is it that you mean by cush then? Give me some examples of what you consider a cush residency...

I am not making any generalization. There is virtually no hard data that says that fewer hours are deleterious for training of residents (whom are already working 70h+) and there is plenty of data that do in fact suggest that it has no impact on patient care and a beneficial impact on resident satisfaction and other markers. Physician (attendings and residents) depression and suicide is all the rage now... burnout is all the rage now. You can't go 2 issues of your favorite medical journal/magazine without reading some column or article or research on the topic. Many factors come into play, financial, stress, caregiver stress, false expectations, etc... This is a big issue.

Also, keep things into perspective... the OP is asking for a "top 20 program with the easier schedule" TOP 20.... no matter if he/she ends up going to the 20th in that list... he/she is expected to get excellent training regardless of how easy/hard the schedule is. Again, I think a bunch of you are blowing this out of proportion. The guy is not asking to train medicine in Paris drinking wine.... he/she is merely looking to not bust his ass in some sort of nonsense. Some programs seem to go the extra mile to make people's life miserable. For instance my program would make resident show up to clinic from 9am-5pm on holidays to do nothing... no patient scheduled... just sit there or use a PTO "because we were getting paid, we needed to be there..." as if somehow the 70h that I reported the week prior (and the 10+ hours I "forgot" to report to not get the program (and myself) in trouble were not enough.

For instance, the OP mentions 24h call... I see little to no reason for 24h calls existing. They certainly are very unpopular, almost non-existing once you get out of training... Even if you get a few hours of sleep in a call room, It is very likely you are not absorbing any meaningful experience after the 12th or 14th hour of that 24h shift. Is that what you call "good training"? Sleep deprivation is a real thing. Meanwhile, plenty of programs have created night float in which residents get exactly the same night experience without losing their brain cells from not sleeping.

Someone trying to weasel their way out of a hard day's work isn't someone worthy of a T-20 programme...

 

[neoexile]

What is it that you mean by cush then? Give me some examples of what you consider a cush residency...

I am not making any generalization. There is virtually no hard data that says that fewer hours are deleterious for training of residents (whom are already working 70h+) and there is plenty of data that do in fact suggest that it has no impact on patient care and a beneficial impact on resident satisfaction and other markers. Physician (attendings and residents) depression and suicide is all the rage now... burnout is all the rage now. You can't go 2 issues of your favorite medical journal/magazine without reading some column or article or research on the topic. Many factors come into play, financial, stress, caregiver stress, false expectations, etc... This is a big issue.

Also, keep things into perspective... the OP is asking for a "top 20 program with the easier schedule" TOP 20.... no matter if he/she ends up going to the 20th in that list... he/she is expected to get excellent training regardless of how easy/hard the schedule is. Again, I think a bunch of you are blowing this out of proportion. The guy is not asking to train medicine in Paris drinking wine.... he/she is merely looking to not bust his ass in some sort of nonsense. Some programs seem to go the extra mile to make people's life miserable. For instance my program would make resident show up to clinic from 9am-5pm on holidays to do nothing... no patient scheduled... just sit there or use a PTO "because we were getting paid, we needed to be there..." as if somehow the 70h that I reported the week prior (and the 10+ hours I "forgot" to report to not get the program (and myself) in trouble were not enough.

For instance, the OP mentions 24h call... I see little to no reason for 24h calls existing. They certainly are very unpopular, almost non-existing once you get out of training... Even if you get a few hours of sleep in a call room, It is very likely you are not absorbing any meaningful experience after the 12th or 14th hour of that 24h shift. Is that what you call "good training"? Sleep deprivation is a real thing. Meanwhile, plenty of programs have created night float in which residents get exactly the same night experience without losing their brain cells from not sleeping.

The whole point of a 24 + 4 call is that you have better continuity of care. You know your patients and if something went wrong with your patient, you'd be the best one to ensure the patient safety within those 24 hours.

Hard work doesnt exist because people want to make other people's lives miserable. Hard work exists because its necessary. Patients unfornuately will code at the WORST times. They will have a 12 second pause when you are about to go home. Or become so short of breath all of sudden to the point you have to upgrade them to the ICU. Or maybe someone gets delirium and now they have no access......

=/ But a person who just wants it "cush" will understand none of this. And if someone still wants "cush" despite knowing all this, I'm uncertain if this is the right job for that someone.

 

[rokshana]

What is it that you mean by cush then? Give me some examples of what you consider a cush residency...

I am not making any generalization. There is virtually no hard data that says that fewer hours are deleterious for training of residents (whom are already working 70h+) and there is plenty of data that do in fact suggest that it has no impact on patient care and a beneficial impact on resident satisfaction and other markers. Physician (attendings and residents) depression and suicide is all the rage now... burnout is all the rage now. You can't go 2 issues of your favorite medical journal/magazine without reading some column or article or research on the topic. Many factors come into play, financial, stress, caregiver stress, false expectations, etc... This is a big issue.

Also, keep things into perspective... the OP is asking for a "top 20 program with the easier schedule" TOP 20.... no matter if he/she ends up going to the 20th in that list... he/she is expected to get excellent training regardless of how easy/hard the schedule is. Again, I think a bunch of you are blowing this out of proportion. The guy is not asking to train medicine in Paris drinking wine.... he/she is merely looking to not bust his ass in some sort of nonsense. Some programs seem to go the extra mile to make people's life miserable. For instance my program would make resident show up to clinic from 9am-5pm on holidays to do nothing... no patient scheduled... just sit there or use a PTO "because we were getting paid, we needed to be there..." as if somehow the 70h that I reported the week prior (and the 10+ hours I "forgot" to report to not get the program (and myself) in trouble were not enough.

For instance, the OP mentions 24h call... I see little to no reason for 24h calls existing. They certainly are very unpopular, almost non-existing once you get out of training... Even if you get a few hours of sleep in a call room, It is very likely you are not absorbing any meaningful experience after the 12th or 14th hour of that 24h shift. Is that what you call "good training"? Sleep deprivation is a real thing. Meanwhile, plenty of programs have created night float in which residents get exactly the same night experience without losing their brain cells from not sleeping.

I take it you have not done a 24 hour call...if you had, you would know that some of the best training comes from those overnight calls...and you would be surprised that it’s not as unpopular...I remember when I interviewed at UConn they said that the residents voted to have a q4 overnights as opposed to a night float system...
I’m glad I had some 24 h overnights( NF on weekdays, overnights on the weekends)...I learned a lot on those call days and nights...

 

[michaelrack]

Yeah I'm not getting this. Most, if not all, of the attendings in this thread came up under the 80 hour rule. No one has claimed that every doctor has to work their ass off in practice for 30 years or do the old fashioned 120 hour weeks.

I am old and will make that claim. Bring back the 110 hour weeks (120 hour weeks were only done by surgeons), and 24 hour calls/36 hour days

 

[VA Hopeful Dr]

What is it that you mean by cush then? Give me some examples of what you consider a cush residency...

I am not making any generalization. There is virtually no hard data that says that fewer hours are deleterious for training of residents (whom are already working 70h+) and there is plenty of data that do in fact suggest that it has no impact on patient care and a beneficial impact on resident satisfaction and other markers. Physician (attendings and residents) depression and suicide is all the rage now... burnout is all the rage now. You can't go 2 issues of your favorite medical journal/magazine without reading some column or article or research on the topic. Many factors come into play, financial, stress, caregiver stress, false expectations, etc... This is a big issue.

Also, keep things into perspective... the OP is asking for a "top 20 program with the easier schedule" TOP 20.... no matter if he/she ends up going to the 20th in that list... he/she is expected to get excellent training regardless of how easy/hard the schedule is. Again, I think a bunch of you are blowing this out of proportion. The guy is not asking to train medicine in Paris drinking wine.... he/she is merely looking to not bust his ass in some sort of nonsense. Some programs seem to go the extra mile to make people's life miserable. For instance my program would make resident show up to clinic from 9am-5pm on holidays to do nothing... no patient scheduled... just sit there or use a PTO "because we were getting paid, we needed to be there..." as if somehow the 70h that I reported the week prior (and the 10+ hours I "forgot" to report to not get the program (and myself) in trouble were not enough.

For instance, the OP mentions 24h call... I see little to no reason for 24h calls existing. They certainly are very unpopular, almost non-existing once you get out of training... Even if you get a few hours of sleep in a call room, It is very likely you are not absorbing any meaningful experience after the 12th or 14th hour of that 24h shift. Is that what you call "good training"? Sleep deprivation is a real thing. Meanwhile, plenty of programs have created night float in which residents get exactly the same night experience without losing their brain cells from not sleeping.

Umm, what?

Lots of 24 hour calls exist outside of training.

Cardiology, pulm/cc, GI, Neuro, OB, all surgeons, anesthesia all do them everywhere I have ever worked. Basically anything that needs overnight coverage and isn't EM or hospitalist still does 24 hour call.

 

[xoggyux]

Someone trying to weasel their way out of a hard day's work isn't someone worthy of a T-20 programme...

Did you have a point or were you just trying to make it official with a condescending/elitist post? You don't know that. Only the program director of those programs can decide if the OP is truly worthy or not of those spots.

The whole point of a 24 + 4 call is that you have better continuity of care. You know your patients and if something went wrong with your patient, you'd be the best one to ensure the patient safety within those 24 hours.

Ok, I'll bite. Show me the study or the evidence/data that shows that what you are saying is true.
The reality is that out of residency... this type of schedule is virtually unheard of. The majority of IM hospital schedules are shift-based (either 8h or 12h) either with morning people + nocturnists or by rotating day people with assigned "night weeks". So patient care and continuity of care are only important for residents, right? Attendings, which ultimately are the ones responsible for the patient, they don't really matter... Right.
Not to mention that I can flip your argument in your face... What about getting the training to being able to properly cross-coverage your colleges' patients efficiently. After all, this is a must in all specialties practices and even on general internal medicine. Residents need proper training in how to efficiently assess the situation on a patient that they did not admit, they did not follow for 5 days and now the patient is deteriorating and needs adjustment of treatment.

Hard work doesnt exist because people want to make other people's lives miserable. Hard work exists because its necessary.

Bull****. Plenty of time hard work is the product of inefficient, complacent people that are too stubborn to change.
It was not common, but it certainly happened a few times that I was done with my work, the attending left the hospital and we were not going to see any more consults and it was 2-3pm but my program forces me to simply stay around until 5pm. Same **** with holidays, I would get lucky and have a clinic day that fell into a holiday. The clinic would be closed without scheduled patients, no attending on-site and we would have to show up at 9am and sign out at 5pm and just sit around in a cubicle... You become numb to stupid waste of time when it is a systematic issue. Believe me, even in the most demanding residencies there is a bunch of stupid **** that residents end up doing which adds no value to patient care, just serves to serve as a system of control. Or scheduled academic block, you had to spend 8h at the hospital even though you could be spending that time studying more efficiently at home, attending to a medical conference? or simply leaving early if you finished your research project at 2pm instead of 5pm. Again, if you analyze objectively and unbiased, most schedules end up having hours/week of idiotic waste of time. I am not someone that will try to hide from work, but I abhor wasting my time in non-sensical BS.

I take it you have not done a 24 hour call...if you had, you would know that some of the best training comes from those overnight calls...and you would be surprised that it’s not as unpopular...I remember when I interviewed at UConn they said that the residents voted to have a q4 overnights as opposed to a night float system...
I’m glad I had some 24 h overnights( NF on weekdays, overnights on the weekends)...I learned a lot on those call days and nights...

And I learned a lot when I was doing days, and I learned a lot when I was doing nights. And I can make the argument that my mind was rested for every one of those 12h shifts and likely at a better shape than someone who did not sleep for 24h to absorb that knowledge. Do you propose a mechanism by which working uninterrupted 24h periods vs 2x as many 12h shifts provides superior learning? I'll save you some time, there is none. Just a bunch of people hypothesizing that 24h is better training and real data showing that it lends itself for more mistakes. The reality is that there is a balance between "continuity of care" and fatigue and for every hour you spend working on something (and this is not limited to medicine, but it applies to EVERYTHING) there is diminishing return for your next hour you spend. The first hour you spend practicing your piano lessons is by far more beneficial than the 8th consecutive hour, you might, in fact, be doing deleterious things by the time you get to that 8th hour, your posture might be all wrong due to fatigue and your ear might have grown tired and used to the "wrong" rhythm and if you keep going into the 9th, 10th, 11th hour in that way you might end up undoing all the hard work that you did in your first 1-4hours of practice. Same applies to medicine except you might end up mistakenly prescribing Apixaban to Jerry instead of Gerry.

Umm, what?

Lots of 24 hour calls exist outside of training.

Cardiology, pulm/cc, GI, Neuro, OB, all surgeons, anesthesia all do them everywhere I have ever worked. Basically, anything that needs overnight coverage and isn't EM or hospitalist still does 24-hour call.

Those are different. Most of those people don't do their call in-site. They leave the hospital at a reasonable hour and then they are available via phone and just have to show up within a certain amount of time in case they are needed physically. The hospital doesn't keep a cath lab staffed overnight, they simply make people be available within ~30mins of a STEMI alert and that includes the cardiologist, there is no reason for the cardiologist to sleep on a hospital bed when he will end up waiting 30 mins for the rest of the team to arrive. Same thing with GI, Neurointerventional, etc.
Critical care seems to have moved to the 12h shifts model so your point is mute. In fact, it supports my argument.
Surgery is a bit trickier. Certainly, most surgeons don't have to do a formal "resident style" stay in the hospital call. Most of them leave the hospital when they are done and are available via the phone/page and just have to show up if there is an emergency. Anesthesia and trauma surgeons might have to be in-house in trauma centers.

 

[shemer77]

I've heard mayo is pretty chill

 

[Instatewaiter]

The reality is that out of residency... this type of schedule is virtually unheard of. The majority of IM hospital schedules are shift-based (either 8h or 12h) either with morning people + nocturnists or by rotating day people with assigned "night weeks".

Residency isn't just about mimicking what attendinghood is like. It is about training you to be a good attending. There are a lot of things in residency that are "unheard of" as an attending, which have tremendous value in molding you into a competent attending.

You keep railing against the fact that there aren't any trials about clinical competency with a call system... there also aren't trials trialing if walking on a sidewalk is safter than crossing a highway.

]Not to mention that I can flip your argument in your face... What about getting the training to being able to properly cross-coverage your colleges' patients efficiently.

Your ignorance about the system against which you are arguing as well as your attitude is amusing. What do you think actually happens during 24 hour calls? You admit and you cross cover the patients of your colleagues. The difference is you get to see the most important 24 hours of the patient's hospital stay that you wouldnt during a night float system. This also allows weaker residents (say those who failed a year in the Carribbean and barely matched) to skate by without maturing.

Your attitude is common in people we jokingly call TWKs- third world killers. Those who trained outside the US and are a dangerous combination of lazy and stupid...



good luck in the rest of your career. I hope you change your attitude.

 

[rokshana]

Did you have a point or were you just trying to make it official with a condescending/elitist post? You don't know that. Only the program director of those programs can decide if the OP is truly worthy or not of those spots.


Ok, I'll bite. Show me the study or the evidence/data that shows that what you are saying is true.
The reality is that out of residency... this type of schedule is virtually unheard of. The majority of IM hospital schedules are shift-based (either 8h or 12h) either with morning people + nocturnists or by rotating day people with assigned "night weeks". So patient care and continuity of care are only important for residents, right? Attendings, which ultimately are the ones responsible for the patient, they don't really matter... Right.
Not to mention that I can flip your argument in your face... What about getting the training to being able to properly cross-coverage your colleges' patients efficiently. After all, this is a must in all specialties practices and even on general internal medicine. Residents need proper training in how to efficiently assess the situation on a patient that they did not admit, they did not follow for 5 days and now the patient is deteriorating and needs adjustment of treatment.



Bull****. Plenty of time hard work is the product of inefficient, complacent people that are too stubborn to change.
It was not common, but it certainly happened a few times that I was done with my work, the attending left the hospital and we were not going to see any more consults and it was 2-3pm but my program forces me to simply stay around until 5pm. Same **** with holidays, I would get lucky and have a clinic day that fell into a holiday. The clinic would be closed without scheduled patients, no attending on-site and we would have to show up at 9am and sign out at 5pm and just sit around in a cubicle... You become numb to stupid waste of time when it is a systematic issue. Believe me, even in the most demanding residencies there is a bunch of stupid **** that residents end up doing which adds no value to patient care, just serves to serve as a system of control. Or scheduled academic block, you had to spend 8h at the hospital even though you could be spending that time studying more efficiently at home, attending to a medical conference? or simply leaving early if you finished your research project at 2pm instead of 5pm. Again, if you analyze objectively and unbiased, most schedules end up having hours/week of idiotic waste of time. I am not someone that will try to hide from work, but I abhor wasting my time in non-sensical BS.


And I learned a lot when I was doing days, and I learned a lot when I was doing nights. And I can make the argument that my mind was rested for every one of those 12h shifts and likely at a better shape than someone who did not sleep for 24h to absorb that knowledge. Do you propose a mechanism by which working uninterrupted 24h periods vs 2x as many 12h shifts provides superior learning? I'll save you some time, there is none. Just a bunch of people hypothesizing that 24h is better training and real data showing that it lends itself for more mistakes. The reality is that there is a balance between "continuity of care" and fatigue and for every hour you spend working on something (and this is not limited to medicine, but it applies to EVERYTHING) there is diminishing return for your next hour you spend. The first hour you spend practicing your piano lessons is by far more beneficial than the 8th consecutive hour, you might, in fact, be doing deleterious things by the time you get to that 8th hour, your posture might be all wrong due to fatigue and your ear might have grown tired and used to the "wrong" rhythm and if you keep going into the 9th, 10th, 11th hour in that way you might end up undoing all the hard work that you did in your first 1-4hours of practice. Same applies to medicine except you might end up mistakenly prescribing Apixaban to Jerry instead of Gerry.



Those are different. Most of those people don't do their call in-site. They leave the hospital at a reasonable hour and then they are available via phone and just have to show up within a certain amount of time in case they are needed physically. The hospital doesn't keep a cath lab staffed overnight, they simply make people be available within ~30mins of a STEMI alert and that includes the cardiologist, there is no reason for the cardiologist to sleep on a hospital bed when he will end up waiting 30 mins for the rest of the team to arrive. Same thing with GI, Neurointerventional, etc.
Critical care seems to have moved to the 12h shifts model so your point is mute. In fact, it supports my argument.
Surgery is a bit trickier. Certainly, most surgeons don't have to do a formal "resident style" stay in the hospital call. Most of them leave the hospital when they are done and are available via the phone/page and just have to show up if there is an emergency. Anesthesia and trauma surgeons might have to be in-house in trauma centers.

So that would be a no...so you really don’t know the benefit...where as the rest of us who see the benefit of overnight call have done both...overnight calls as well as NF and shift work.

What year are you? At best i would say you are a very early 2nd year...realize residency is not about mimicking what you will do as an attending...its to traiN you to have the knowledge and clinical acumen to be able to work without the safety net that is residency...how do you think we attendings have learned to maintain coNtinuity of care as an attending? Because we learned the skills as residents...those first 24 hrs are the most crucial in pt care...you take ownership of your patient because you spend that time deeply involved in their care....this attitude of shift work lends to making this just a job...and it’s not...if that’s what you want, well you probably should have a picked more non clinical specialty like pathology or radiology.

And btw...it’s moot...not mute.

 

[Lexdiamondz]

I think it's pretty telling that there is unanimous agreement among the attendings and near-unanimous agreement among the senior residents that "cush" = bad. This thread is done.

Did you have a point or were you just trying to make it official with a condescending/elitist post? You don't know that. Only the program director of those programs can decide if the OP is truly worthy or not of those spots.

Don't be daft. If you lack the work ethic to handle 24h call q4 how on earth do you expect to outcompete the tens of thousands of other applicants in IM for a T-20 residency spot? It's got nothing to do with elitism or condescension - it takes hard work to get to the top.

 

[neoexile]

I think it's pretty telling that there is unanimous agreement among the attendings and near-unanimous agreement among the senior residents that "cush" = bad. This thread is done.

Just to qualify it a bit. You need to work hard and be damn sure you know your patients. But when it's time to go home and your patients are stable, its times for you to go home. You turn off the phone and let the world turn without you.

When you are working, you are working. You are working hard and long to make sure your patients are safe. When it's time to go home, you leave your work at work and just chill out. This is where it's cush and how you avoid burnout

 

[xoggyux]

Residency isn't just about mimicking what attendinghood is like. It is about training you to be a good attending.

Do you realize of how discordant those two sentences are?
"The way to train to become a good attending is to look at what they do, and do something different..."
This Mr. Miyagi-kind of philosophy does not really translate into the real world very well.

Let's go over an example. You are in your 9-5 "Cush" clinic job. You see your new patient, Mr. Anderson. Mr. Anderson is a 32-year-old male in great physical health and no medical conditions. During the review of the system, he states that he is doing otherwise well but that he is feeling a bit fatigued since he started his new job and he has been drinking a lot of caffeinated drinks (coffee, energy drinks, etc.) You look down to the notes that the PA took before you from the patient and you glance that it is scribbled "medical resident." Based on this conversation, I am lead to believe that you will reassure him and give him a pep talk and try to pick up his enthusiasms. You might say things like "the sharpest swords are forged in the hottest fires" or the "best generals fought in the biggest wars" or "the best doctors worked 120h/week and did not complain"... Except he interrupts you right there and corrects you saying that there must have been a mistake, he is not a medical resident, he is an air traffic controller (or a pilot, or a trucker). Do you see what I am getting at here or do I have to keep painting this scenario for you?

You keep railing against the fact that there aren't any trials about clinical competency with a call system... there also aren't trials trialing if walking on a sidewalk is safer than crossing a highway.

First off. I'd be the first to admit that the data on this is weak. Thing like "Intensity", "how rigorous", "demanding" etc are highly subjective not to mention that arranging a trial that could give us a straight answer is not only extremely difficult, impractical and with countless of ethical implications. Regardless, the point I was making is that what little evidence does exist actually supports my point and contradict yours. It is quite big of you to come here and state something as a matter of fact when you are clearly using nothing more than your opinion, and if it is just that... it seems kind of petty going around internet forums suggesting that those that think different to you are lazy and unprepared. It is the equivalent of "if you cry you are lesser of a man", "if you admit you are depressed you are saying that you are damaged" kind of attitude.

Your ignorance about the system against which you are arguing as well as your attitude is amusing. What do you think actually happens during 24 hour calls? You admit and you cross cover the patients of your colleagues. The difference is you get to see the most important 24 hours of the patient's hospital stay that you wouldnt during a night float system. This also allows weaker residents (say those who failed a year in the Carribbean and barely matched) to skate by without maturing.

Your attitude is common in people we jokingly call TWKs- third world killers. Those who trained outside the US and are a dangerous combination of lazy and stupid...



good luck in the rest of your career. I hope you change your attitude.

And this is the essence of what you have been trying to say all this time. It all boils down to insults and internet trolling. Did you learn this working 24h shifts in your top program?

Just so you know, I immigrated to this country 10 years ago, escaped a communist dictatorship and did not know 1 bit of English when I arrived in the last 1 year of high school. Still managed to get into university right away while working 30h+ part-time, volunteering, etc. GPA 3.7 MCAT 27 (before the change), not great but quite decent to someone with less than 3 years of knowing the language and working my ass off. Through my residency, I scored 95 percentile, 90 percentile, and 97% percentile respectively. Prior to becoming a doctor, I was trained in classical music and 8h of piano practice a day was the norm for me, not playing super Nintendo. If you think your dismissals are in any way, shape or form an embarrassment for me, think again. I put my record against yours any time of the day and I am proud of my medical school and training. Call me lazy all you want, you are making a fool of yourself doing so.

So that would be a no...so you really don’t know the benefit...where as the rest of us who see the benefit of overnight call have done both...overnight calls as well as NF and shift work.

What year are you? At best i would say you are a very early 2nd year...realize residency is not about mimicking what you will do as an attending...its to traiN you to have the knowledge and clinical acumen to be able to work without the safety net that is residency...how do you think we attendings have learned to maintain coNtinuity of care as an attending? Because we learned the skills as residents...those first 24 hrs are the most crucial in pt care...you take ownership of your patient because you spend that time deeply involved in their care....this attitude of shift work lends to making this just a job...and it’s not...if that’s what you want, well you probably should have a picked more non clinical specialty like pathology or radiology.

And btw...it’s moot...not mute.

Oh, I see... Residents need to do it in 24h hours because this is the optimal way to take care of patients, you are there for the "most important" 24h of the patient's hospitalization, you don't miss a fart, micturition or defecation of the patient. But as soon as you finish residency.... all of that beneath you.
Again, at this point, you are just making "facts" up.

 

[IMreshopeful]

Did you have a point or were you just trying to make it official with a condescending/elitist post? You don't know that. Only the program director of those programs can decide if the OP is truly worthy or not of those spots.


Ok, I'll bite. Show me the study or the evidence/data that shows that what you are saying is true.
The reality is that out of residency... this type of schedule is virtually unheard of. The majority of IM hospital schedules are shift-based (either 8h or 12h) either with morning people + nocturnists or by rotating day people with assigned "night weeks". So patient care and continuity of care are only important for residents, right? Attendings, which ultimately are the ones responsible for the patient, they don't really matter... Right.
Not to mention that I can flip your argument in your face... What about getting the training to being able to properly cross-coverage your colleges' patients efficiently. After all, this is a must in all specialties practices and even on general internal medicine. Residents need proper training in how to efficiently assess the situation on a patient that they did not admit, they did not follow for 5 days and now the patient is deteriorating and needs adjustment of treatment.



Bull****. Plenty of time hard work is the product of inefficient, complacent people that are too stubborn to change.
It was not common, but it certainly happened a few times that I was done with my work, the attending left the hospital and we were not going to see any more consults and it was 2-3pm but my program forces me to simply stay around until 5pm. Same **** with holidays, I would get lucky and have a clinic day that fell into a holiday. The clinic would be closed without scheduled patients, no attending on-site and we would have to show up at 9am and sign out at 5pm and just sit around in a cubicle... You become numb to stupid waste of time when it is a systematic issue. Believe me, even in the most demanding residencies there is a bunch of stupid **** that residents end up doing which adds no value to patient care, just serves to serve as a system of control. Or scheduled academic block, you had to spend 8h at the hospital even though you could be spending that time studying more efficiently at home, attending to a medical conference? or simply leaving early if you finished your research project at 2pm instead of 5pm. Again, if you analyze objectively and unbiased, most schedules end up having hours/week of idiotic waste of time. I am not someone that will try to hide from work, but I abhor wasting my time in non-sensical BS.


And I learned a lot when I was doing days, and I learned a lot when I was doing nights. And I can make the argument that my mind was rested for every one of those 12h shifts and likely at a better shape than someone who did not sleep for 24h to absorb that knowledge. Do you propose a mechanism by which working uninterrupted 24h periods vs 2x as many 12h shifts provides superior learning? I'll save you some time, there is none. Just a bunch of people hypothesizing that 24h is better training and real data showing that it lends itself for more mistakes. The reality is that there is a balance between "continuity of care" and fatigue and for every hour you spend working on something (and this is not limited to medicine, but it applies to EVERYTHING) there is diminishing return for your next hour you spend. The first hour you spend practicing your piano lessons is by far more beneficial than the 8th consecutive hour, you might, in fact, be doing deleterious things by the time you get to that 8th hour, your posture might be all wrong due to fatigue and your ear might have grown tired and used to the "wrong" rhythm and if you keep going into the 9th, 10th, 11th hour in that way you might end up undoing all the hard work that you did in your first 1-4hours of practice. Same applies to medicine except you might end up mistakenly prescribing Apixaban to Jerry instead of Gerry.



Those are different. Most of those people don't do their call in-site. They leave the hospital at a reasonable hour and then they are available via phone and just have to show up within a certain amount of time in case they are needed physically. The hospital doesn't keep a cath lab staffed overnight, they simply make people be available within ~30mins of a STEMI alert and that includes the cardiologist, there is no reason for the cardiologist to sleep on a hospital bed when he will end up waiting 30 mins for the rest of the team to arrive. Same thing with GI, Neurointerventional, etc.
Critical care seems to have moved to the 12h shifts model so your point is mute. In fact, it supports my argument.
Surgery is a bit trickier. Certainly, most surgeons don't have to do a formal "resident style" stay in the hospital call. Most of them leave the hospital when they are done and are available via the phone/page and just have to show up if there is an emergency. Anesthesia and trauma surgeons might have to be in-house in trauma centers.

Okay. You’re clearly speaking from inexperience.

I did 24h calls for MOST of my rotations in residency besides covering night float for a couple floor rotations. Every ICU, cancer floor, cardiology, etc rotation required 24+4. It made me a better doctor being able to manage sick patients and allowed me to learn how to manage and stabilize patients when they were at the most critical point in their hospital course.

As for exhaustion... sure, there were nights where I was beat. I have admitted 6-10 sick patients to an ICU, stabilized them with lines and tubes, got scans, all while getting called for Tylenol and bowel regimen orders and decompensating patients. I knew my limits and when to ask for help. When I started my fellowship I was prepared for the proverbial crap hitting the fan. Going to a “cush” program where you have five icu patients with DKA and on a little CPAP for asthma is not going to teach you how to become a good doctor.

There is a limit... I don’t think that it is more manly or brave or more hard working to stay late for the sake of staying late, which some “top” programs encourage, but beyond that there is an immense value to spending more time in the hospital in training.

Again, I think this is pure inexperience talking

 

[IMreshopeful]

Do you realize of how discordant those two sentences are?
"The way to train to become a good attending is to look at what they do, and do something different..."
This Mr. Miyagi-kind of philosophy does not really translate into the real world very well.

Let's go over an example. You are in your 9-5 "Cush" clinic job. You see your new patient, Mr. Anderson. Mr. Anderson is a 32-year-old male in great physical health and no medical conditions. During the review of the system, he states that he is doing otherwise well but that he is feeling a bit fatigued since he started his new job and he has been drinking a lot of caffeinated drinks (coffee, energy drinks, etc.) You look down to the notes that the PA took before you from the patient and you glance that it is scribbled "medical resident." Based on this conversation, I am lead to believe that you will reassure him and give him a pep talk and try to pick up his enthusiasms. You might say things like "the sharpest swords are forged in the hottest fires" or the "best generals fought in the biggest wars" or "the best doctors worked 120h/week and did not complain"... Except he interrupts you right there and corrects you saying that there must have been a mistake, he is not a medical resident, he is an air traffic controller (or a pilot, or a trucker). Do you see what I am getting at here or do I have to keep painting this scenario for you?


First off. I'd be the first to admit that the data on this is weak. Thing like "Intensity", "how rigorous", "demanding" etc are highly subjective not to mention that arranging a trial that could give us a straight answer is not only extremely difficult, impractical and with countless of ethical implications. Regardless, the point I was making is that what little evidence does exist actually supports my point and contradict yours. It is quite big of you to come here and state something as a matter of fact when you are clearly using nothing more than your opinion, and if it is just that... it seems kind of petty going around internet forums suggesting that those that think different to you are lazy and unprepared. It is the equivalent of "if you cry you are lesser of a man", "if you admit you are depressed you are saying that you are damaged" kind of attitude.


And this is the essence of what you have been trying to say all this time. It all boils down to insults and internet trolling. Did you learn this working 24h shifts in your top program?



Oh, I see... Residents need to do it in 24h hours because this is the optimal way to take care of patients, you are there for the "most important" 24h of the patient's hospitalization, you don't miss a fart, micturition or defecation of the patient. But as soon as you finish residency.... all of that beneath you.
Again, at this point, you are just making "facts" up.

Instatewaiter is hardly a troll... he did his residency at JHH. He’s an attending cardiologist. He is speaking as someone who is trained very very well. I know a lot of folks who’ve have trained there and yes, some love the smell of their own farts and think they walk on water because they trained there, but it’s undoubtedly good training. You might want to listen.

 

[rokshana]

Instatewaiter is hardly a troll... he did his residency at JHH. He’s an attending cardiologist. He is speaking as someone who is trained very very well. I know a lot of folks who’ve have trained there and yes, some love the smell of their own farts and think they walk on water because they trained there, but it’s undoubtedly good training. You might want to listen.

He’s not going to of course...until he becomes an attending...

 

[xoggyux]

Okay. You’re clearly speaking from inexperience.

I did 24h calls for MOST of my rotations in residency besides covering night float for a couple floor rotations. Every ICU, cancer floor, cardiology, etc rotation required 24+4. It made me a better doctor being able to manage sick patients and allowed me to learn how to manage and stabilize patients when they were at the most critical point in their hospital course.

As for exhaustion... sure, there were nights where I was beat. I have admitted 6-10 sick patients to an ICU, stabilized them with lines and tubes, got scans, all while getting called for Tylenol and bowel regimen orders and decompensating patients. I knew my limits and when to ask for help. When I started my fellowship I was prepared for the proverbial crap hitting the fan. Going to a “cush” program where you have five icu patients with DKA and on a little CPAP for asthma is not going to teach you how to become a good doctor.

There is a limit... I don’t think that it is more manly or brave or more hard-working to stay late for the sake of staying late, which some “top” programs encourage, but beyond that there is an immense value to spending more time in the hospital in training.

Again, I think this is pure inexperience talking

Do you think I did not see the same crashing patients that you saw? Why 24h? what makes that number so magic? why not 36h? or even 48h? I am sure we can make some 25-30-year-young people stay awake for 2 straight days...
You are a doctor... when you get a patient that is sleep deprived what is it that you recommend him/her? What is it that you would tell the air-traffic controller that goes to work for 24h shifts every so often? Would you even bother to report this? Would you like to be a passenger on a plane being flown by a pilot that just finished a 12h flight and is about to start a second 12h flight back with you in it?

There is a limit...

And that limit happens to be precisely 24h call every 4 days I take it right?

 

[rokshana]

Do you think I did not see the same crashing patients that you saw? Why 24h? what makes that number so magic? why not 36h? or even 48h? I am sure we can make some 25-30-year-young people stay awake for 2 straight days...
You are a doctor... when you get a patient that is sleep deprived what is it that you recommend him/her? What is it that you would tell the air-traffic controller that goes to work for 24h shifts every so often? Would you even bother to report this?



And that limit happens to be precisely 24h call every 4 days I take it right?

Not really quite sure why you keep posting...you apparently think you know how things should work and aren’t responsive to other, frankly more experienced and better trained opinions ...as pointed out there are posters here who actually HAVE trained at a top 20 program, than yours.
You are inexperienced and will learn soon enough that once you are out of training, how much you will wish that your training was more rigorous.

I thank god everyday that trained at a place that expected more out of me...it was rigorous but with little scut...and even the scut had its role.

And btw...if you think the non clinical BS stops after residency, you are in for a rude awakening...you will be amazed at how much crap your attending shields you from...and you will be expected to be an expert on come the first day as an attending.

 

[xoggyux]

Not really quite sure why you keep posting...

Sometimes I ask myself the same question. I thought because it is cool to debate important topics with other like-minded individuals but then I am up for a rude awakening when people with over 3 decades worth of education lowers themselves to childish insults and ad-hominem attacks because their opinion gets challenged and their egos are fragile as glass.

 

[rokshana]

Sometimes I ask myself the same question. I thought because it is cool to debate important topics with other like-minded individuals but then I am up for a rude awakening when people with over 3 decades worth of education lowers themselves to childish insults and ad-hominem attacks because their opinion gets challenged and their egos are fragile as glass.

I dont believe anyone here has attacked you...pointing out you are inexperienced is not an attack...it’s the truth.

And maybe together we have 3decades of experience but we are not that old...

 

[Instatewaiter]

Do you realize of how discordant those two sentences are?
"The way to train to become a good attending is to look at what they do, and do something different..."
This Mr. Miyagi-kind of philosophy does not really translate into the real world very well.

But they're not discordant at all. That you can't see that supports what everyone has been telling you during this thread- you don't have the knowledge or experience, especially not to have the attitude you do.

Let's use an analogy- those who become the best swimmers train not just by swimming but also by running, biking and lifting weights. As an Olympic swimmer they will never be running or lifting weights.


Second, please learn to be a bit more concise. These walls of text are annoying.

 

[xoggyux]

I dont believe anyone here has attacked you...pointing out you are inexperienced is not an attack...it’s the truth.

And maybe together we have 3decades of experience but we are not that old...

This is a forum, right? A place for debate. In formal debate, an ad-hominem attack is when one side points out characteristics of the other side rather than the position that the other side is debating. For instance
Debater A "Aspirin prevents MI"
Debater B " What do you know? your GPA was only 2.0"
That is an ad-hominem attack.
You ignore everything about my points and go straight to question my credentials rather than discussing the topic. This strategy is meant to fool observers into thinking that you know your stuff and your point is stronger than it actually is, but really it is merely a deflection.

Not to mention the hinting/insinuation of laziness and/or gross incompetence. Don't get me wrong, It really does not bother me. My ego is not so fragile for me to get offended at that, nor do I need external approval from a random stranger on an internet forum.

So again, if this is the limit of what you can debate and you are just going to keep doing attacks to my motives or academic preparation rather than address the actual points perhaps you won't see me replying much of what you write from now on.

 

[Instatewaiter]

Sometimes I ask myself the same question. I thought because it is cool to debate important topics with other like-minded individuals but then I am up for a rude awakening when people with over 3 decades worth of education lowers themselves to childish insults and ad-hominem attacks because their opinion gets challenged and their egos are fragile as glass.

Something isn't an ad hominem when it proves why your point is less valid. We are talking about why there is value in the top 20 programs delivering rigorous training including 24 hour shifts.

You are someone who hasn't put in anywhere near the rigorous effort needed to get close to one of these programs. You lack the requisite insight into what it takes to succeed and be aleader in the field... You couldn't get into a US medical school and and instead of trying harder, went to the carribean. At the carribean you couldn't even put in the requisite effort to PASS your classes and failed an entire year ... and almost got kicked out if not for an appeal. You barely squeeked by a pass on step 1.

Your preceding story reeks of the same cockiness and lack of insight that your effort on this thread does.

And you're lecturing us in what appropriate effort is for success and knowledge when you don't have the experience and have clearly never put in the requisite effort. Honestly I can't think of anyone less qualified than you.