I am crying I'm so relieved

I've just read a few posts and I'm in tears because I didn't know there were so many residents/young docs out there like my husband....so cynical and burned out and ready to just forget it all and work in anything else. I mean I knew residents for the most part are nothing like they were entering med school. But I was convinced my husband's very negative feelings towards medicine at this point were atypical. I was beginning to think he was losing his mind or something. You have no idea how stressful and emotionally draining it has been worrying over him, pepping him up over and over, basically forcing him to make tough decisions the whole way through..since the third year of med school really. He's stuck it out incredibly and works himself silly when he has too. But he hates it, really he does. He dreads starting his new job and thinks his life will be a continuation of the hell of residency. All I can do is try and keep him motivated and even nag him to keep going. He's given too much to this choice to give up now. He feels that too, but feels he's got no other choice and will be forced into unhappiness forever.

Does this negative view from a fresh trainee with burnout ever get better? A few weeks ago he swore up and down he needed antidepressants. He rebounded though like he has before and seems to be coping again. He could have taken a VA job here in Memphis that paid less and had better hours and more time off. But it's a very dangerous city and we've never liked living here. WE have no family nearby to help us with Sarah also. After so many years of being miserable about having to live here I wanted him to consider moving back to where we're from. He didn't want to because it was easier and less stressful just to stay here in an environment he's familiar with. But I knew and he admitted it that if we stayed we'd probably never leave. So we went for it..stress and all..and looked back home. The job pays more, is shift work for the most part and will have 1:3 call with two/three days off every 8 days. I thought that was pretty good, but David says it's going to suck. Compared to the horrible months he's had as a resident..working ICU and trauma especially..I would think anything would be better. All he says is, "You just don't know what I go through." I can't know, but I would think after all this time he would have gotten more used to it and not be so miserable. Am I unreasonable? I worry I've forced him to take this job back home and it indeed may be too much for him and he'll go over the edge. Or is this typical for resident's entering the private world?

Any advice from those who've been here would be greatly appreciated. I think he feels I'm the bad guy sometimes forcing him to be a doctor or something. Hell I'm the first to say people shouldn't go into medicine unless they REALLY know what they're in for. If I knew seven years ago what I know now I wouldn't have been so gung ho for him to get that white student coat, KWIM!! And he most certainly wouldn't have been. He has told anyone thinking of becoming a doctor to run the other way since he was a third year student! And now entering the private world and seeing what life as a doctor long term will be he's really negative. All I can say is that people who think doctor's are rich and live cushy life are just full of crap. No doctor ever gets paid close to what they work and to compensate for what they endure in terms of stress and thing they give up, namely time off with family and friends. No other profeession that I can think of requires so much emotionally, mentally and physically from a person than medicine..I think anyway. Maybe the military. I'm just really worried about him, us and what's to come. We at one point were looking forward to the end of residency. Now it's just like every step before...the unknown and very scary.

amy

[DCJenn]

Amy-

We've battled that a few times over the last three years. My husband is a third year peds resident and I can't tell you the number of times he's threatened to go in to Pathology because "there's no people". (right...)

Anyway, it was usually during or right before a rotation that he dreaded.
Moving is also never a fun time and maybe the thought of everything that has to happen in the next few months has your husband overwhelmed. Mine is sure wigged out right now!

(and I'm the one who's coordinating selling this house, buying the next house, organizing a move...!)

I don't know whether your husband has any end of residency requirements, but mine does- and they are the kind of thing that send him over the edge. He has a huge paper due and a presentation to the entire peds department. Plus now he's on the ward and he hates it.

Anyway, welcome- and I feel you pain!

Jenn

Amy,

We aren't quite to your stage. We are in the internship year now but my husband has been telling everyone who asks him about medicine to run the other way. He swears he would never do this again ... yet, I don't know what else we would do. This is definitely not a profession to get that cushy lifestyle and get rich. It has too much sacrifice. I am always trying to keep my husband pumped up to go to work ... even pushing him out of bed some mornings depending on the rotation. There are moments though when I see contentment on my husband's face when he was able do a procedure well or get a pat on the back from a colleague type of thing or make someone feel better. It is a hard situation to be in because you invest so much money and time that you can't just abandon it.

You have the additional stress of trying to move to a new place and that is always scary. It is probably very overwhelming to your hubby as well. It will be nice for you to be closer to family though once things are settled. Q3 sounds a little busy to me. Is that on a regular basis? Having two to three days off though sounds good. It may take awhile for him to come out of the negative residency mode. I have heard it gets better though. I have to believe that!!!! I wish you all the best. I am sure others will chime in who have more experience in this area than I do. Best of luck!!

Robin

[mommax3]

Amy,

One big thing I noticed after residency is that my husband was so much more optimistic once he started getting regular amounts of adequate sleep -- and he was always fairly optimistic anyway. So I bet your husband's outlook will improve once he has jumped through the final hoop of residency and gotten some rest. Just hang in there and keep us posted.

Sally

[houseelf]

Amy,

You and your hubby are not alone. It is unbelievable what the stress of medical training can do to people. It becomes difficult to discern what issues stem from the stress and what characteristics are attributed to the person.

The best that I can tell you is that you will get through this. You will get up everyday and keep doing what you both do. You will eventually find yourself in a more reasonable, sane place. If you stick around here, you will know that you are not alone.

Kelly

[Rapunzel]

I think that a lot of doctors feel the way amy's husband does. My husband is one of the few that doesn't, but from what I understand it all has very much to do with the specialty the doctor is in (ie some specialties have horrendous hours post residency - like surgeons and some have fabulous hours post residency - like radiology). A very close friend and neighbor whose husband is in his first year post-residency (ER) actually told my husband once that if he could do it all over again he would go into radiology because of the pay and hours (for instance, in Missouri my husband found an offer for a fresh out of residency position at a radiology group starting at 300K first year, 500K second year and full partner second year, low cost of living area next to a large city and 12 weeks paid time off per year. There are residents finishing up his program who are getting 800K offers). We have heard this from many other of our physician friends - it really seems to be wrapped up in which specialty your spouse chooses. AND the differences in what to expect time and money wise between specialties don't necessarily seem to make a lot of sense (ie such horrible hours and pay for pediatricians). It is soooo difficult if you love WHAT you do but there are archaic "rules" in place that make doing what you love hard. So, in summary, I am not in the same boat entirely (although because my husband is military he will not get the astronomical pay civilian radiologists get for a while) but I do see the problem and I sympathize completely. Hopefully someday we can see some sanity in the work hours of doctors.

[Phoebe]

Amy- Your husband is definitely not alone. I think it depends on the person's coping skills, how they deal with stress and lack of sleep that influences their job satisfaction. Once a year and during stressful times, my husband threatens to walk away from medicine to become a teacher or do manual labor. My husband doesn't have the strongest coping skills when it comes to on-the-job politics and red tape, but he loves patient care. He suffers from depression diagnosed over two years ago, but I think it was there since his high school years.

My husband wouldn't trade his career for anything else when it comes down to it, he has found a specialty that allows him to do procedures and interact with families (neonatology) which is his passion. The job he has chosen still requires long hours and in-house call. I don't think our life will feel like we have left the fellowship, except for us not living on a PGY salary anymore. His specialty still isn't one of the highest paying, but it is what my husband loves.
I can't offer advice if being away from training improves things because we are in the same boat at you. I hope things look up and your husband finds more happiness from his new job than he expects.

Jennifer

[PrincessFiona]

burnout

Amy,

You are not alone...and your husband hasn't lost his mind Unfortunately, the medical training system in this country seems to be geared more towards breaking a resident's spirit (and nearly finishing off his spouse in the process ) We survived nearly 6 years of residency and were pretty stressed out by the end...my husband went from being an optimistic "save the world' idealist to a cynical, patient-hating resident. I often wondered what had happened and if things would ever be ok again. We did a two year fellowship that I thought sealed his fate. He reached a point of abhoring medicine and talked only about quitting...he spewed disappointment and anger...he was exhausted and burned out.....I didn't know whether our marriage could continue to survive the stress and unhappiness.....medicine and the madness of training permeated every part of our lives.

We are two years out now and our lives are very, very different. I would be lying if I said that my husband was completely satisfied with medicine. The effects of residency/fellowship training haven't completely worn off. For every 10 wonderful patients, that 1 that comes in and threatens to sue and is beligerant and rude seems to spoil things for him. I don't see the same glimmer in his eye that I once did about medicine....but he is much more positive than he used to be. Each year things have gotten better, and I see that the people who have been out of training even longer than we have are doing even better.....so there is hope...It will just take time to get through the process of 'healing' from medical training.

We're here for you anytime.

Kris

[PrincessFiona]

amy

Amy,

I was reading through your intro and it looks like your hubby has decided to go the hospitalist route? Does he know already what his schedule will be? Hospitalist jobs can be either really good or really bad depending on where you end up.
The hospitalist turnover rate here is really, really high (I hate to be the black cloud ) The group here works one week of days and has one week off/one week of nights and one week off/ and one week of morning shift with one week off...In essence, they are only working 3 weeks out of 6....but in this year alone, two are going to be leaving to do fellowships and one quit and went into practice.
The problem? Feeling like a glorified resident....Anything that the other docs don't want to do (read: scutwork) gets handed off to the hospitalists.....

It really depends on the program that he's looking at and their attitude about taking on the scutwork, I think.

Kris

Hi Amy!!

Welcome to a wonderful site for support for medical spouses... My husband is finishing up his residency this year too and I have the same questions as you do... about what it will be like out of residency!!! Better, I hope!!

Amy & Kris, I would be interested in any other information about hospitalists just to acquire more information about hospitalists. I never heard the term until Bob started job hunting... and then, we had people calling him up & askin' about whether he was interested in a hospitalist opportunity...

Great to have to here, Amy. Hi to Kris!!

Christy

[Meenah]

Amy,
Welcome, you will find the website a wonderful support group, which you may find you need even if you are done with training!!!! My husband is a Pulmonologist. He is in private practice, but acts as a hospitalist for quite a few docs in the area. They have their own practice, but if a patient needs to be admitted he is their attending, and when they are discharged they go back to their own docs. He only stays on if they need a pulmonologist. This works well for him and for the others, because they really don't like the hospital part and my husband thrives on it. He isn't a "hospitalist" because he is not employed by the hospital, but has his own practice. My husband cannot afford to give up his office practice, and he is too much of a liberal/radical to work for someone else!!!! Best of luck to you, I look forward to getting to know you.
Luanne

Re: amy

David originally wanted to do ER work but didn't match so he decided to go the internal medicine route and stay where he was trained in Memphis. He hates clinic work here..poorly operated and decided that he really wasn't cut out for outpatient care. So hospitalist work seemed to satisfy his desire for shift work and also to delete outpatient care. The group he is joining is employed solely by the hospital and is around three years old. It functions very differently than many of the other independent groups around the area in that it only sees patients of certain doctors that desire their services. It's not a fee situation or anything. The local private docs just ask the hospitalists to take their inpatient care and in return the privates are very supportive of them in terms of taking back patients when they need time off or are short handed. They don't take any and everything so that eliminates the scutwork. There are currently only two docs working this hospital. They work day shift, take at home call every third night (they share it with the privates since they're short handed) and have weekends off (private docs take their patients back at 5p.m. Friday). With David and another doc coming on to make four they plan to go to a seven day coverage with 1:3 call still and two-three days off every 8 days. Their census is around 15 patients each daily and their call nights vary, but aren't too bad really. I think they said they might have to go in maybe once a month at most. Considering the call nights David has seen here in Memphis with them often going over a cap of 15 admits by the middle of the evening and still admitting 10 patients on top of that, this should be a breeze for him. That program you were talking about sounds alike like a program at St. Thomas Hospital in Nashville. They take any unassigned inpatient and all private patients from participating docs both locally and out of town. They get killed daily and have a fairly large group. In addition they do IM consults and rotate the code pager. Thankfully David won't have to worry with either of those things at this job. The St. Thomas groups does 7 on and 7 off also. David thought about working for them but decided this group sounded more reasonable in terms of patient acceptance. This group he's joining eventually wants to go independent once they get enough docs on board and the hospital is really supportive of them and interested in their input on many things, so that's good. We'll see....

Amy,

I was reading through your intro and it looks like your hubby has decided to go the hospitalist route? Does he know already what his schedule will be? Hospitalist jobs can be either really good or really bad depending on where you end up.
The hospitalist turnover rate here is really, really high (I hate to be the black cloud ) The group here works one week of days and has one week off/one week of nights and one week off/ and one week of morning shift with one week off...In essence, they are only working 3 weeks out of 6....but in this year alone, two are going to be leaving to do fellowships and one quit and went into practice.
The problem? Feeling like a glorified resident....Anything that the other docs don't want to do (read: scutwork) gets handed off to the hospitalists.....

It really depends on the program that he's looking at and their attitude about taking on the scutwork, I think.

Kris

I think that a lot of doctors feel the way amy's husband does. My husband is one of the few that doesn't, but from what I understand it all has very much to do with the specialty the doctor is in (ie some specialties have horrendous hours post residency - like surgeons and some have fabulous hours post residency - like radiology). A very close friend and neighbor whose husband is in his first year post-residency (ER) actually told my husband once that if he could do it all over again he would go into radiology because of the pay and hours (for instance, in Missouri my husband found an offer for a fresh out of residency position at a radiology group starting at 300K first year, 500K second year and full partner second year, low cost of living area next to a large city and 12 weeks paid time off per year. There are residents finishing up his program who are getting 800K offers). We have heard this from many other of our physician friends - it really seems to be wrapped up in which specialty your spouse chooses. AND the differences in what to expect time and money wise between specialties don't necessarily seem to make a lot of sense (ie such horrible hours and pay for pediatricians). It is soooo difficult if you love WHAT you do but there are archaic "rules" in place that make doing what you love hard. So, in summary, I am not in the same boat entirely (although because my husband is military he will not get the astronomical pay civilian radiologists get for a while) but I do see the problem and I sympathize completely. Hopefully someday we can see some sanity in the work hours of doctors.

Boy, I didn't know radiology paid that well! Internists whether private or hospitalist just don't make that much ever. They make a little more if they specialize, but still not that much. I think David would be hard pressed to find himself earning $300,000 five years post residency and that would probably be his cap as an IM doc in most private situations anyways with all the overhead and liability issues.

Christy,

A hospitalist is a fairly new field I suppose. It's come to be because of the harsh world of private practice I think in today's world of medicine. There is so much to worry with in starting your own practice or even joining an established one. As an internist before this new option you pretty much only had one choice...private practice with both outpatient clinic work and inpatient care for your patients. David doesn't care for clinic work and hated the idea of having to both take care of inpatients and run a busy clinic also..too much like residency I suppose. As a hospitalist you only do inpatient care. There are two categories..either a private group who offers their services to other private doctors so they don't have to worry with inpatient care or hospitalists employed by a hospital and therefore salaried by that hospital. With the private situation your salary can fluctuate drastically depending on your patient load/productivity. If you're salaried there isn't a fluctuation, you simply earn a set amount and that's it. David opted for the salaried situation because he didn't like the unknown of the independent group situation. It's shift work also, once you go home there are no calls about work...no pharmacy calls, patient calls, nurse calls etc. You go home around 6 p.m. and don't think about medicine until your at the hospital the next day. You admit the patient, take care of them while they are in house and then turn them back over to their regular private doc when they are discharged. It's a pretty good alternative to the typical options for private internists and family docs.

Hi Amy!!

Welcome to a wonderful site for support for medical spouses... My husband is finishing up his residency this year too and I have the same questions as you do... about what it will be like out of residency!!! Better, I hope!!

Amy & Kris, I would be interested in any other information about hospitalists just to acquire more information about hospitalists. I never heard the term until Bob started job hunting... and then, we had people calling him up & askin' about whether he was interested in a hospitalist opportunity...

Great to have to here, Amy. Hi to Kris!!

Christy

[DCJenn]

Amy-

Just an FYI but the military is currently using hospitalists as well. From what my husband has said, everyone is very pleased with the results.

Jenn