Information about Residency Specialties

[Rapunzel]

I forgot about this thread! It really should be a sticky. Although that will forever preserve my lack of spell checking. I may edit my post just to fix all my spelling mistakes!!!

[madeintaiwan]

I'll give it a go...

1. What type of Residency: ie internal medicine, ob, fp, er, etc.
Orthopedic Surgery

2. How long is the residency (and specialty stuff afterward and the possiblilities that will make our spouses be slaves longer)
Residency is 5 years. 1 year of general surgery and 4 years of ortho. There are some programs that are 6 years and have a research year. Fellowships are typically 1 year. And it's something 90% of the graduating residents are doing fellowships these days. Applications are usually done during the beginning of PGY4, some specialties have gone match others are still old school.

3. How long are the work weeks during training?
Depending on the program, the service and what time of the year it is, anywhere from 80 to 130 hours a week. Our 130 hr experience occurred during a general surgery rotation. Most of the time, it is around 80 hours a week. Trauma and peds in the summer are a killer. There are some rotations during general surgery year that are a killer too, NSG and Vascular. A typical day is going in at 6am and getting home around 7pm or so. There are services where they have to be there at 5am and there are days that they end up operating until 2am.

4. What is the in-house/out-of-house call schedule like during training?
They have "home call" all 4 ortho years as well as the 3 ortho months during their general surgery year. The residents have to live within 30 minutes of the hospital. But again, "home call" is dependent upon which service you are on and what time of the year it is. When 'home call" occurs it is NICE. Call is typically not that bad. Monthly call schedules are dependent upon who needs time off and what not. There have been months with 1 to 2 week long stints of q2 call. PGY1-3 take primary call and have 5-6 call days per month. Everyone usually gets 2 weekend days. Secondary call goes to the PGY4s & 5s. I can't speak from personal experience, but secondary call is supposed to be sweet because they only have to go in to operate or if there is an "issue."

5. How much does an attending in that specialty earn(when do the big bucks start rolling in)
Ridiculously dependent on geographical region. For general orthopedics [goes up with specialization]: Coasts start at 250-400k, Midwest and South start at 400-800k. We know residents who have signed contracts in their early residency years [PGY1] and received stipends throughout their residency. Signing bonuses are typically 10% of the contract.

6. how long are the hours post-training(regular hours)
Depends on the hospital/practice. From my observation, I'd say most still work 60 to 80 hours a week. We know orthopods in their 60s who still work over 60 hours a week but they put 3 to 6 kids through private HS and college educations.

7. how much on-call is there post-training(home vs. in-house)
Depends on the hospital/practice. We spoke to a practice where they didn't take ANY call.

8. What is a good time to start a family with this specialty(how helpful the spouse can be and vacation times)
Ortho is not a family friendly specialty. Have children knowing that there will never be the right time and be prepared to basically be a single parent. This is even worse if you end up at a program where you are without familial support. If you're going to go into ortho, medical school would be the best time to start a family. I would say that PGY2 is the worst year to have a child, let alone START a family. PGY4 and 5 seem like popular years to have children. One of the resident's missed the birth of his child. And life goes on.

9. How much vacation time do you get post-training?
The orthopods that we know get 4 weeks or so

10. What type of people generally tend to go into the specialty (ie. peds people are more child friendly....neurosurgeons are hard to talk to....plastics spouses are superficial...)
Most of the orthpods that I know are typically REALLY laid back. Usually ex athletes. They tend to like to use their hands and build things. They are typically active and into outdoorsy activities. However, I do know a few orthopods that are raging hot headed jerks who are typically very unpleasant to be around. Orthopedics is a very male dominated field. It's something like only 9% of practicing orthopedists are female.

Very helpful thread!
When I get a little further in I guess I could add what I know For now I am learning!

[TulipsAndSunscreen]

Bump. Anyone else want to play for those of us MS3 spouses who just watched our last match passively?

We are likely delaying a year for a trip abroad but I'd still love to hear from anyone else since he'll probably pick before we leave. Urology and EM are now at the top of the list.

[oceanchild]

I hadn't posted one, not that it's really helpful for your targeted specialties...

1. What type of Residency: ie internal medicine, ob, fp, er, etc.
Pediatrics

2. How long is the residency (and specialty stuff afterward and the possiblilities that will make our spouses be slaves longer)?
Residency is 3 years. I think all peds fellowships are also 3 years.

3. How long are the work weeks during training?
There are a lot of 80 hour weeks. Some months are closer to 40. I don't think we've ever gone over 80 here.

4. What is the in-house/out-of-house call schedule like during training?
No home call. This is actually a night float program, but when there is call it is in the hospital. PL-1 has 4 call-free months, and I think that goes up to 6 by PL-3 (not certain).

5. How much does an attending in that specialty earn (when do the big bucks start rolling in)?
Everything I've heard puts starting peds attendings in the $100K-$150K range, but it's hard to say for sure. My husband wants to do PICU, which is at the top of pediatric subspecialist compensation, and I think the average for that is $250K. Peds is weird in that some fellowships will actually decrease your earning potential.

6. How long are the hours post-training (regular hours)?
Depends on SO many things. My husband says PICU is moving toward ER-style shift work - we'll see. You can do hospitalist or clinic work for a place like Kaiser and have close to 40 hour weeks.

7. How much on-call is there post-training (home vs. in-house)?
Depends on subspecialty, practice type, etc. I don't really have any idea.

8. What is a good time to start a family with this specialty (how helpful the spouse can be and vacation times)?
PL-3 is the popular choice in this program. They'll cover for anything, though. It's peds, they love kids, and everybody helps each other out. Plus it's a big program, so there are lots of ways to cover.

9. How much vacation time do you get post-training?
I don't really know. Probably depends on how hard you want to work.

10. What type of people generally tend to go into the specialty (ie. peds people are more child friendly....neurosurgeons are hard to talk to....plastics spouses are superficial...)?
Yes, yes, they all love kids. Peds residents are also pretty low-key, less competitive, generally friendly with each other. Also female - only 25% of pediatrics residents nationally are male.

My boyfriend is starting PGY-1 in General Surgery. I am hyper-planning. So nice to see that some survive it, even if you do become the mayor of crazytown. Ugh... I've heard rumors that his program has Q15 and no pre-call. I'll believe it when I see it.

I especially like your list of personality traits. DBf admits that he is doing this all because he wants to be certain that he will be 100% in charge at all times.

[GreyhoundsRUs]

Hi Maggie! Why don't you hop over to the introduction thread and tell us more about yourself

Bump. Anyone else want to play for those of us MS3 spouses who just watched our last match passively?

We are likely delaying a year for a trip abroad but I'd still love to hear from anyone else since he'll probably pick before we leave. Urology and EM are now at the top of the list.

DH is in a demanding residency and I can be a little bitter, so you might want to talk to some of the EM spouses that are DONE for a (hopefully) rosier picture Feel free to PM me too if you have any questions.

1. What type of Residency: ie internal medicine, ob, fp, er, etc.
EM

2. How long is the residency (and specialty stuff afterward and the possiblilities that will make our spouses be slaves longer)?
Residency is 3 or 4 years. Fellowships can add another 1 to 3 years but it is not common to do a fellowship. My DH, of course, is considering one.

3. How long are the work weeks during training?
The good news: during EM rotations residents are allowed to work a maximum of 60 hours in the ER. This does not include "signing out" time (usually about an hour or two), conference time, research, etc. DH's program never exceeds this, but they almost always meet it I would encourage anyone interested in ER to try and get into a program that works 8 or 10 hour shifts. DH's program is all 12 hour shifts and they are killer. With sign out and travel a 12 hour shift is always closer to 14. If you have kids, this means that they either go to bed late or don't see their parent for days. We thought that there would be less shifts per week because they are longer, i.e. more days off, but do the math....5 12's per week is like 7 and a half eights per week. Hmmm, wonder how they manage that? Seriously, 12 hour shifts suck. I can't stress that enough!!
The other thing to consider is the type of shifts, i.e. day, evening, nights. Because of the 12 hour shifts this program has mostly just days or nights. And there are about 4 months of nights each year. Rough. Having a mixture of days, evenings and nights is probably more typical of a post - training schedule.
As a rule I think residents work less hours overall with each year of training in EM. Haven't noticed that here yet but I am holding my breath for PGY4.
I know the more you see the more you learn, it is a great program, etc, etc. But the long hours are getting old!!!

4. What is the in-house/out-of-house call schedule like during training?
No call! His pager only beeps when the battery runs out.

5. How much does an attending in that specialty earn (when do the big bucks start rolling in)?
We have heard everything from 150 to 300++. No idea really until we start job hunting.

6. How long are the hours post-training (regular hours)?
I'm told that it will be 14 to 16 shifts per month. Sounds good to me.

7. How much on-call is there post-training (home vs. in-house)?
I'm hoping none or very little!

8. What is a good time to start a family with this specialty (how helpful the spouse can be and vacation times)?
Probably in attendinghood since there is much more time off, if you are young enough to wait. We were not! One thing to bear in mind is that with the always changing schedule you cannot rely on the doctor to be around at the same time each week to watch kids, if you want to take a class or work, etc. I have considered signing up for various classes but cannot rely of DH being available on a Sunday morning or Tuesday night or whatever. Obviously this is not a problem if you have family or a regular babysitter available. I know this is a general problem with medicine but it seems like other specialties can have some regularity of hours or know that they will be home by x o'clock each night. And this is something that will continue through attendinghood.

9. How much vacation time do you get post-training?
DH seems to think that you can have as much as you want. We'll see.

10. What type of people generally tend to go into the specialty (ie. peds people are more child friendly....neurosurgeons are hard to talk to....plastics spouses are superficial...)?
The adreniline junkie, type - A stereotype seems to be true, at least in this program. But it is a big name, big city, high volume hospital that gets lots of action. Not sure how DH ended up here......

[Deebs]

Kristy,
You have it pretty much right on. The only people I've heard of who have easier training in EM than what you've described have a really tough time finding jobs (which is amazing considering there will be a shortage of board-certified emergency physicians until at least 2020). Like any specialty, there are residencies that are less demanding than others. Considering what an EP needs to learn in just 3-4 years, the demanding residencies do tend to produce better docs (I speak from professional experience, not just looking at DH's program).

The thing about vacations in EM - you basically eat what you kill. We have yet to see a place that doesn't work like this - docs get paid for the number of shifts (or hours) he/she works. Sometimes there is a shift differential for nights. Basically, DH could work it out to take a month or two off - he just wouldn't get paid a dime. This month, he has a week long conference. He doesn't get paid for that time (I'm not saying he should), so he is squeezing 16 shifts into 23 days time. That might seem like he has a lot of time off, still, but the day off after a string of nights is basically not a day off because he needs to sleep and recover. If I take those days out of the equation, and also subtract the days that he has meetings or conference calls, he has two days this month that he is absolutely not working.

[peggyfromwastate]

1. What type of Residency?
ENT (Otolaryngology)

2. How long is the residency (and specialty stuff afterward and the possiblilities that will make our spouses be slaves longer)

Residency is usually 5 years but some programs are talking of making it 6 years to give the resident some time for research. Our program is 5 years.

3. How long are the work weeks during training?

This really varies. The first year was a surgical intern year with all the general surgery interns. It was busy, but some rotations were definitely worse than others (I vaguely remember vascular surgery and neurosurgery being tough). I would say during a surgical intern year to expect to work in direct patient care for the 80 hours. So expect to not see your spouse much, because you can add to the 80 hours the commute time, some extra time for conferences and academics (aka weekend-killers), and *team building* stuff.

After the intern year you start the ENT training. This also varies depending on where you are training. Our worst rotation has been the Children's hospital rotation, which DH did over the winter. Winter is brutal for ENTs in general with all the colds, etc. DH worked an average of 100 hours a week during that rotation. Add to that an average of 10 hours a week in commuting time, so it wasn't a happy time for us. The other rotations have mostly been between 60-70 hours a week, for the most part. ENTs are involved in cancer surgeries which are very complicated and require microvascular reconstructions, and those surgeries often turn into all day and all-night things. So there are late nights associated with "big whacks".


4. What is the in-house/out-of-house call schedule like during training?
Intern year you take call in-house with the general surgery interns. At least that's how we did it. I can't remember what it was exactly, and I know he didn't have to take call every rotation, but I think when he did take call it was usually q3 or q4.

Second and third years of training he was the junior resident for ENT. So if any ENT issues came into the ER or there was a patient on the wards with an ENT issue, DH was the first call. So he got a LOT of calls. It is home call, which sucked because when he got called in to the hospital he usually worked a good 3 or 4 hours on whatever he was called for, but he still had the full day of work the following day. When he was taking in-house call he at least in theory had a short day following his night of taking call. In theory. As a junior resident, I would say he went in about 50% of the time to answer calls. The worst was Childrens. He was called back all but 2 nights of the four months he took q3 call there. And I don't know how they know it, but word travels that the ENT is in house and he'd always get extra calls/consults when he was "already at the hospital". So, be weary of the glories of "home call".

4th and 5th years of ENT he is 2nd call so I anticipate that it will be much better. He will cover one week at a time. The 1st call ENT should be able to handle most cases. It's been estimated that as 2nd call you only have to go in to help the junior resident about 30% of the time or so, which isn't bad considering the junior has to take care of all the paperwork.

5. How much does an attending in that specialty earn(when do the big bucks start rolling in)

We are in the military system and it's not exactly like the civilian sector when it comes to pay. From what I understand about civilian pay, it's all in the specialty you go in. If you do mostly the *bread and butter* of ENT (tubes, tonsils, adenoids) with or without a fellowship you can get anywhere from 250 to 400 or so. As a head and neck cancer specialist, expect 200-250, which is a shame because they do the hardest surgeries, but they get paid the least. As a facial plastics surgeon you can do facelifts, botox, nose jobs, chin advancements, you name it all day and make from 400-???. DH knows of some who make well over $1 mil a year as a facial plastics specialist.

6. how long are the hours post-training(regular hours)

For military, it's all about the lifestyle baby. DH can expect to work about 4 days a week, give or take. As an attending, it's all about how much you want to do, and what kind of ENT you are. Hours are the worst for Head and Neck Cancer guys (lots of clinic time, very sick patients, and LONG surgeries with not the greatest outcomes). A typical bread and butter ENT would work 5 days a week, 9-5 in his clinic with 2 days of OR a week (in the hospital usually, but some plastic surgeons do the procedures in the clinic). I would expect an attending to work around 60 hours a week.

7. how much on-call is there post-training(home vs. in-house)

Again, this really varies as to what specialty you are. If you are a general ENT, you'll probably be in a group, so how much call you cover depends on how many members there are in your group. Getting called in for a regular ENT is pretty rare. For a facial plastics it's actually more common b/c they cover trauma, and fistfights and what not happen at all hours of the day.

8. What is a good time to start a family with this specialty(how helpful the spouse can be and vacation times)

Hmmm, in an ideal world maybe after you're done with residency? Who knows. We had kids before medical school, so it's all relative.

9. How much vacation time do you get post-training?

Varies. With the military, I think they can take 30 days or something. But I'm not sure anyone is keeping track. Out there in the scary real world, I think that this depends on the group you are in and the vacation scheduling there.


10. What type of people generally tend to go into the specialty?

People who like surgery but think ENT is "less toxic" than general surgery. People who like a variety of surgeries in the head and neck area, but do not want to deal with brains (that's neurosurgery). ENTs are also very detail-oriented, and have to care about aesthetics (there are a lot of facial injuries and you have to be able to stitch very small stitches). Of course they are nerds, because they are doctors. They also have to be OK with being referred to as a "snot doc". I want to get DH a vanity license that says "SNOT DOC" when he's done with residency.

I think there is a ton of variety in this field, and so it would really suit a lot of people. But ENT is pretty clinic-heavy for a lot of surgeon types, so that's something to consider. Of every patient that gets referred to ENT for DH, only about 30-50% go on to have surgery. That annoys DH because he wants to be in the OR all the time.

[spotty_dog]

9. How much vacation time do you get post-training?
DH seems to think that you can have as much as you want. We'll see.

Kirsty, the way it works here, the physician is contracted to provide 120 hours of staffing per month. If we want, we can request a specific distribution of those hours, like doing them all in the second two weeks of the month. That leaves two weeks at the beginning of the month to be "vacation". We try not to make too many requests since DH is still new to the group and we don't want to make waves. But a week every couple of months is no big deal -- and most months end up with a 3-4 day stretch in there that we can use for a mini-break.

The only people I've heard of who have easier training in EM than what you've described have a really tough time finding jobs (which is amazing considering there will be a shortage of board-certified emergency physicians until at least 2020). Like any specialty, there are residencies that are less demanding than others. Considering what an EP needs to learn in just 3-4 years, the demanding residencies do tend to produce better docs (I speak from professional experience, not just looking at DH's program).

I'd love to hear more about this correlation. As far as I know DH's program is one of the more respected in the specialty, but they pride themselves on leaving their residents with enough downtime to have a life. By your statement, my husband was trained by an inferior program and is an inferior physician. Fortunately we are past having to struggle for a job, in fact we had a signed contract for our ideal location and a high level of compensation by October of PGY-3. Dodged that bullet, LOL!

People who are drawn to NSG tend to be perfectionists, assertive, comfortable being in control, completely intolerant of stupidity (not of ignorance...of stupidity...people not learning from their mistakes), competitive BUT can be team players, love a challenge, kind of adrenaline junkies (if they weren't NSGs, they'd have been fighter pilots or astronauts or Navy SEALs or something), and have a complete passion for the brain.

GMW: I read this today and just had to laugh. I would love for you to write a new one considering now you have seen the gamet of NS. I think it would be a good reflection!

The part that got me was about how it's a person who is completely intolerant of stupidity: so true! I mean wow! I feel like you were writing from my brain!: perfectionists, assertive, has to be in control, team player, but like leading in the ICU. Likes knowing that when they walk into the ICU, they have the ultimate say on their patient care.

[alison]

They have the ultimate say until the anesthesiologist cancels the case!

Lol I love that! It's not healthy to have such a big head lol

[GrayMatterWife]

People who are drawn to NSG tend to be perfectionists, assertive, comfortable being in control, completely intolerant of stupidity (not of ignorance...of stupidity...people not learning from their mistakes), competitive BUT can be team players, love a challenge, kind of adrenaline junkies (if they weren't NSGs, they'd have been fighter pilots or astronauts or Navy SEALs or something), and have a complete passion for the brain.

GMW: I read this today and just had to laugh. I would love for you to write a new one considering now you have seen the gamet of NS. I think it would be a good reflection!

The part that got me was about how it's a person who is completely intolerant of stupidity: so true! I mean wow! I feel like you were writing from my brain!: perfectionists, assertive, has to be in control, team player, but like leading in the ICU. Likes knowing that when they walk into the ICU, they have the ultimate say on their patient care.

My thought, upon re-reading my own words: Damn, was I dead-on. Times 1000. Yep, that's the typical NSG.