How Some Programs Make it Work by Cheri Milligan
“What specialty is your husband in?”
“Neurosurgery”
“Oh, I’m so sorry!”
If I have to hear that conversation one more time when meeting a residents’ wife that I don’t know I might just have to hurt someone. Neurosurgery gets such a bad rap. “The hours are horrid”, “The doctors are all full of themselves” or “They have terrible bedside manners”. The things I’ve heard which are negative about my husband’s chosen specialty could fill a book the size of the latest Harry Potter novel.
Neurosurgery isn’t the most family friendly specialty; I’ll be the first to admit it. However I don’t feel it is the worst. My husband is a resident at one of the top programs in the country based on completed surgical cases. They are exempt to 88 hours versus the regular 80. I feel the difference is that my husband’s program truly sticks to the 88 hour rule. In the last year my husband has averaged 71.4 hours in an ACGME four week period. He has worked a week of 101 hours, but he has also worked a week of 47 hours in a non-vacation week. They have been able to stick to the 88 hours because the program has aggressively implemented scheduling changes which do not sacrifice patient care and continuity.
The program has brought in two PA’s and is trying to hire a third to assist the Chiefs. The Chiefs have a Chief junior (PGY-2) on their team at all times. The Chief and his or her team handle all cases that come in through the ER. The 11, soon to be 12, attendings each have their own practice. Some of their interests overlap but for the most part they individually cover all of the neurosurgical specialties. Each attending gets a resident. That resident covers 1-2 attendings for the quarter. That resident rounds on their patients each morning and evening while operating with one attending per day. At the same time that resident is assigned to an OR. That OR is usually staffed by their attending but if their attending finishes early for the day another attending could take over the room. Therefore another resident’s load is lightened and all residents finish at similar times for the day. This ensures that, most of the time, one resident doesn’t work for three hours while another works for 12. Work hour violations are also reviewed monthly in a conference attended by all residents and attendings so that solutions can be found.
One aspect of my husband’s program that some people see as a drawback is that he carries his pager at all times. He is the first point of contact for the nurses if they have a question on one of his patients. If one of his attendings’ previous patients has a question they call the operator which calls my husband. Since this call is taken from home and is not excessive it does not violate the ACGME duty rules. Some spouses prefer that when their husband is home, they’re home – no pager, no intrusions. In my opinion that isn’t a reality in this profession regardless of where you are in the training program. There are nights when my husband gets paged once an hour but that is a rarity, not the norm. My husband is on night call, in the hospital, seven nights this quarter and on weekend day or night call, in the hospital, four weekends this quarter. As the residents become more senior their call nights and weekends decrease until Chief year when all bets are off.
So what is my point? My point is that there are programs in this profession that have taken the steps to ensure that their residents get the education they need while having a life.
How do you find them?
Ask questions!
When you’re interviewing for residency ask the program coordinator to put you in contact with an upper level spouse or a resident spouse. The programs that want their residents to have a life outside of the hospital will not have a problem giving you that information. Many programs even arrange for applicants to meet with other residents for an informational lunch.
Don’t be afraid to ask questions about the cost of living, local school districts, cultural activities and the residency program itself. It is perfectly acceptable to inquire about what other resident’s and their spouses like most and least about the program. In addition, find out about any spouse support group and how to contact them.
If one of the top neurosurgery programs, based on completed cases, can keep their residents under the 80 hour rules, every other specialty should be able to do the same.
