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Which years of neurology residency are the worst and the best and why?
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From what I've noticed at my program so far:
PGY-2 >>> PGY-3 >> PGY-1 > PGY-4
PGY-2 >>> PGY-3 >> PGY-1 > PGY-4
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PGY2>PGY1>PGY4>PGY3 for me
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As a PGY3:
PGY2>>>PGY1>PGY3. 4 months of stroke service as a PGY2, not to mention 3-4 months of other primary services and night float, is no joke. I felt like the drop-off in difficulty when transitioning to third year was noticeable, even with ongoing night float rotations and a few more scattered rotations on stroke services. I'm finally able to pursue more of my outpatient interests and get ready for fellowship applications, lots to look forward to this year.
My prelim year was borderline abusive. The prelims here (and elsewhere, I'm sure) are utilized constantly on primary services and MICU practically the entire year to allow the categorical IM residents more time in outpatient clinic. Very rare to have less than 70-75 hours per week on any rotation, quite often > 80-90. Still not nearly as difficult as PGY2 but possibly more soul-crushing.
PGY4 is supposed to be even easier than PGY3, unless you become a chief (no thank you). No stroke rotations unless you're into that kind of thing (again no thank you). No night float. Couple months of consult services. A lot of electives to help prep for fellowship or general practice. Seems like a good time overall, at least relative to the rest of residency.
PGY2>>>PGY1>PGY3. 4 months of stroke service as a PGY2, not to mention 3-4 months of other primary services and night float, is no joke. I felt like the drop-off in difficulty when transitioning to third year was noticeable, even with ongoing night float rotations and a few more scattered rotations on stroke services. I'm finally able to pursue more of my outpatient interests and get ready for fellowship applications, lots to look forward to this year.
My prelim year was borderline abusive. The prelims here (and elsewhere, I'm sure) are utilized constantly on primary services and MICU practically the entire year to allow the categorical IM residents more time in outpatient clinic. Very rare to have less than 70-75 hours per week on any rotation, quite often > 80-90. Still not nearly as difficult as PGY2 but possibly more soul-crushing.
PGY4 is supposed to be even easier than PGY3, unless you become a chief (no thank you). No stroke rotations unless you're into that kind of thing (again no thank you). No night float. Couple months of consult services. A lot of electives to help prep for fellowship or general practice. Seems like a good time overall, at least relative to the rest of residency.
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PGY2>PGY3= PGY1>PGY4 at my program. The best thing is we don’t cross 60 hours in my PGY1 (60 is cap here).
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PGY2> PGY1=PGY4>PGY3.
I think most programs are similar. Which means heavy inpatient neurology for PGY2, then PGY1=PGY4 (but for different reasons, managing other interns/pgy2 and being a senior has its own unique challenges). Followed by the easier outpatient rotations for PGY3.
I think most programs are similar. Which means heavy inpatient neurology for PGY2, then PGY1=PGY4 (but for different reasons, managing other interns/pgy2 and being a senior has its own unique challenges). Followed by the easier outpatient rotations for PGY3.
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I'm a little surprised to see so many people saying PGY1 is one of the easier years. Are these categorical programs or prelims? Did you know it would be easier going in/when you were interviewing for these programs?
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Yes, it's a very well known fact that PGY-2 is a killer year with inpatient neuro. So I knew coming in that PGY-1 would be easier than at least that year. Plus if you are in a categorical program, in PGY-1 you do alot of off service rotations which are usually lax except for the IM and ICU months. The Psych, FM, EM, Cards, Nephro, and sleep medicine months at my program are very manageable, and that's already half of the year. Even the Neuro months are somewhat doable because they pair all interns with a senior during those months.
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Rotations like cards, EM, psych in PGY1 are suuuuuper chill. In the medicine inpatient rotations, you are considered off service- so if you want you could take fewer patients than the IM residents and be fine. Even on my IM inpatient services I get off by 3pm (alongwith the IM residents- and we then just hang out). Overall I’ve found that IM residency is significantly easier than neuro. PGY2 neurology is considered the hardest non surgical year in the entire field of medicine, with crushing 12 hour shifts full of bs stroke codes for AMS and stat general consults. Pgy3 is more chill but in smaller sized programs like mine can still be heavy. PGY4 is chill ofcourse.
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PGY2 > PGY1 >> PGY4 > PGY3.
This is hugely dependent on your intern year. My program had a very rigorous intern year where much of the year was spent on six days/week, twelve hour-day shifts on the wards. We had the same expectations as the IM residents, but a heavier schedule; I think I did 32 weeks of wards and 8 weeks of ICU. My hours were certainly longer during intern year than any other year.
PGY2 year was overall easier than PGY1 year during the day, but gets the #1 spot due to junior call, which is much more intense than senior call.
At my program, PGY3 year was half outpatient.
PGY4 year = lots of elective but also heavy inpatient senior rotations, which could get intense.
This is hugely dependent on your intern year. My program had a very rigorous intern year where much of the year was spent on six days/week, twelve hour-day shifts on the wards. We had the same expectations as the IM residents, but a heavier schedule; I think I did 32 weeks of wards and 8 weeks of ICU. My hours were certainly longer during intern year than any other year.
PGY2 year was overall easier than PGY1 year during the day, but gets the #1 spot due to junior call, which is much more intense than senior call.
At my program, PGY3 year was half outpatient.
PGY4 year = lots of elective but also heavy inpatient senior rotations, which could get intense.
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Typically how many weeks of inpatient service did you have in each of your neuro years? For me, it’s 36 weeks PGY2, 30 weeks PGY3, 22 weeks PGY4 (unless you choose like neuroICU on electives). PGY1 I have 40 weeks of inpatient wards (but it’s super relaxed). Wondering if this is normal or more than usual.
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Some inpatient senior rotations are harder than others, as some are like medicine (one junior, generally census < 10) while others have census of 20-30 with 2-3 juniors. The hours are similar, but I'll call the former "light" and the latter "heavy."
On average:
PGY2 - 38
PGY3 - 20 light, 4 heavy
PGY4 - 7 light, 20 heavy
Numbers include night float (one month/year every year) but not 24-hour call (~45 times during residency). Odd number because of 9 of our 12 weeks of peds are inpatient.
If you do inpatient electives these numbers can be much higher. Most inpatient-minded people do 8-12 weeks additional inpatient.
Census varies but with 4 adult inpatient teaching services the total census probably averages around 80. Overall I think the weeks/year are about average, or maybe slightly more. About half of residents go inpatient for careers, so maybe that suggests more of an inpatient focus.
