Is it really like this?

[Flynn]

I'm going to be blunt -- shocker I know...

If I were in your shoes it would depend on how old I was right now. If you are 33 or older I would go for it now -- assuming you KNOW you REALLY want kids.

If you're younger I would WAIT WAIT WAIT!!!!

1.) You're not sure what program you will be in for residency. Will they follow the 80 hour work week? Many don't.

2.) Residency (I am factoring in a SURGERY residency) is SUCH a huge transition. It will be important for you and DH to work on your marriage (or try) during some of residency without the stresses of having children. Nobody knows how specifically "it" will change things in your relationship. Residency will test every bond you have. Do not underestimate the "ortho is not family friendly" comment you made in one of your previous posts. Picture it as bad as you can imagine and see what you think after that.


We had child #1 during our PGY 6 year. It was after three years of clinical and two years in the lab. It was before the 80 hour work week. #2 came during our first year of fellowship PGY 8.

Children complicate residency a great deal and put much more responsibility on the non-doc person in the relationship. However, they also force you to focus on what "really" matters.

At certain times in our residency "journey" I'm not sure I would have stuck around had we not had children. Sad but true.


I say this with a big sigh. I am happy to say we "made it" and are almost done but not without some serious baggage we collected along the way. We DID make it though and while we still have some work to do -- transitioning from training to a "real life" can be challenging for a couple who have only known "life according to residency."

Choose as wisely as you can, then do what we all do and make the best of it.

[houseelf]

What Flynn said. If you can wait, do it. ESPECIALLY considering your beloved's specialty choice.

I wouldn't change our situation for the world because DS is the best thing that ever happened to me. BUT having him during MS4 before a 7 year surgery residency plus fellowship was a damn hard way to go. Our family has come within inches of being a statistic. If things had been planned, we probably would have had number one late to midway through residency during lab years.

With that being said, the biological clock is a BIG deal. Lots of people have no problem having kids in their late thirties and up. Then again, lots of people go through heart ache because they waited. Unfortunately, none of us knows which category we fall in. IMHO, I would rather risk having a kid in at a less than opportune time rather than not having him or her at all. But that is just me. We both really wanted kids.

I guess I'm giving you advice to wait, no... go for it, NO...wait,

Not much help, am I?

Kelly

[Rapunzel]

I'd listen most closely to the spouses of surgery residents here (particularly ortho surgery).

Your life during residency is very much dependant upon your husband's specialty and how his program runs.

[Vanquisher]

I'd listen most closely to the spouses of surgery residents here (particularly ortho surgery).

Your life during residency is very much dependant upon your husband's specialty and how his program runs.

Ha, ha, ha! That'd be me! I think I am the only regular poster whose husband is in ortho.

Seriously, if you want to know, I will tell you how it is, FOR ME. It is probably not this way for everyone. I really could write forever about this, but it will be the same old negativity. I encourage you to think really hard about the decision to go into ortho. Not only is it really, really, really tough to match in (Top 3, I would say), the residency totally sucks. It is super, insanely, inhumanly hard (Top 3 for difficulty too). If he has the desire to do anything nonsurgical at all, I would suggest thinking about it. If ortho truly is the one and only thing that he wants to do, I can be here to help you along the way.

We have a research resident at this program. He did med school, a prelim surgery year, and 2 research years. He has applied for the ortho match 4 TIMES, and he still did not match this year. This is with multiple papers and surgical residency experience. His board scores were too low, and they weren't even that low. I keep thinking, is this guy ever going to give up? Sheesh! If your dh has THAT kind of drive to do ortho, well, then, maybe it's the right thing.

I am not kidding you when I say, we have 10 residents in our program, and I have personally heard 8 of them say that there were times that they seriously, seriously contemplated quitting. I know one resident who has talked to my dh several times about his thoughts of quitting. 2 years ago they actually did have a resident quit - he walked away from medicine entirely. He just decided it wasn't worth it. As for the other 2 residents, well, I haven't talked to them very much, so I couldn't tell you, but I have my suspicions. Some are married, one engaged, some are single, and some have kids. It is hard for all of them! I have the oldest kids, and I am the farthest away (by far) from my family of anyone in the program with kids or without.

I have had serious discussions :argue: with my husband no less than 10 times about quitting in the 1 year and 8 and a half months we have suffered through residency. Intern year was much easier than 2nd year here. That is different from program to program, but I can tell you that they definitely look the other way at the 80-hour rule for a lot of ortho residencies. The trouble is, you never know which programs really stick to the hours, and which don't. They all say they do.

So, that's just the tip of the enormous iceberg, and seriously, we can chat about this over the phone if you want, so you can ask questions, and I can answer honestly how it is for me. There are others who definitely get behind this residency thing much more than I can, being supportive and courageous. I can't do that. I love my husband. I miss my husband. My kids miss their father. It sucks.

If I knew in MS3 what we know now, my husband would not be going into ortho. Period.

[houseelf]

I will be circumspect and say that there are LOTS of ways around the 80 hour work week requirement and I would venture to guess that many surg programs have a damn hard time being in full compliance.

However, the pretend 80 hour work week has made a significant change in our life. It used to be a special sort of hell. Now it is just hell.

Kelly

[Flynn]

Kelly Wrote:

It used to be a special sort of hell. Now it is just hell.

A big AMEN from me!!!!!!!!!!!!!

[houseelf]

Flynn,

Do you have any opinion, IN GENERAL, of most surg programs' compliance with the 80 hour work week?

Would you agree that it is frowned upon when a would be applicant spends time inquiring about the 80 work week?

Kelly

[Vanquisher]

They are totally crazy here about the 80 hour work week. I mean crazy, if you work over that you will be in huge trouble from your residency director and its not just lip service, they really do expect you to work within the guidelines. This is the case in DHs program and several others here. I will see if he can find out anything about ortho and general surgery.

Tara

We are very lucky, I know

I so wish it was that way here! My dh vioates the rules every week. If he happens to be under 80 hours (rare), he violates the 24-30 hour rule. He is defnitely seeing new patients after 24 hours, in the O.R., and just last week he worked 38 hours straight, that's a full workweek for some people.

http://www.acgme.org/DutyHours/dutyHrs_Index.asp

1. Duty hours are defined as all clinical and academic activities related to the
residency program; i.e., patient care (both inpatient and outpatient),
administrative duties relative to patient care, the provision for transfer of
patient care, time spent in-house during call activities, and scheduled
activities such as conferences. Duty hours do not include reading and
preparation time spent away from the duty site.

2. Duty hours must be limited to 80 hours per week, averaged over a fourweek period, inclusive of all in-house call activities.

3. Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as 1 continuous 24-hour period free from all clinical, educational, and administrative duties.

4. Adequate time for rest and personal activities must be provided. This
should consist of a 10-hour time period provided between all daily duty
periods and after in-house call.

1. "Duty hours do not include reading and preparation time spent away from the duty site."


Oh they take full advantage of this!!! "Home-call" means if nothing whatsoever is going on at the hospital, you can go home. Trouble is, there is always something going on!

2. We violate this one every month. A few months he has AVERAGED 110. Not most months, but a few.

3. Most months we get this, but there have been exceptions.

4. In order for this one to be followed, he would have to be home by 7:00 every night. It does not happen. Most of the time though, I would say this one is the least aggregiously broken.

1. In-house call must occur no more frequently than every third night,
averaged over a 4-week period.

2. Continuous on-site duty, including in-house call, must not exceed 24
consecutive hours. Residents may remain on duty for up to 6 additional
hours to participate in didactic activities, transfer care of patients, conduct
outpatient clinics, and maintain continuity of medical and surgical care.
[as further specified by the RRC]

3. No new patients may be accepted after 24 hours of continuous duty.
[as further specified by the RRC]

4. At-home call (or pager call) is defined as a call taken from outside the
assigned institution.

a) The frequency of at-home call is not subject to the every-thirdnight
limitation. At-home call, however, must not be so frequent
as to preclude rest and reasonable personal time for each resident.
Residents taking at-home call must be provided with 1 day in 7
completely free from all educational and clinical responsibilities,
averaged over a 4-week period.

b) When residents are called into the hospital from home, the hours
residents spend in-house are counted toward the 80-hour limit.

c) The program director and the faculty must monitor the demands of
at-home call in their programs, and make scheduling adjustments
as necessary to mitigate excessive service demands and/or fatigue.

1. They follow this. There are weeks when he is Q-2 for for 10 days, but it averages out.

2. They violate this everytime they are on-call.

3. They violate this everytime they are on-call.

4. I have already discussed how they take advantage of this loop-hole.

a) Rest and reasonable personal time? Seriously? Nothing about this is restful or reasonable.

b) Really? This one is news to me. They sure don't act like the hours count.

c) Ha, ha, ha!!!

[Vanquisher]

Flynn,

Do you have any opinion, IN GENERAL, of most surg programs' compliance with the 80 hour work week?

Would you agree that it is frowned upon when a would be applicant spends time inquiring about the 80 work week?

Kelly

Kelly, I have no idea if most programs comply or not, but I would say that it is HIGHLY frowned upon to ask, as in there is no way we're ranking that guy.

"What, you aren't a team player? Can't handle the hours? This guy is going to dump his responsibility. Blah, blah, blah."

[houseelf]

"What, you aren't a team player? Can't handle the hours? This guy is going to dump his responsibility. Blah, blah, blah."

Amen and a high five sister.

My husband is a perpetrator of this mentality.

:!

Kelly

It used to be a special sort of hell. Now it is just hell.

Kelly

But I thought the perk was that you got to be 'special'. Now you lose even that!!!

[Flynn]

The term here is "shift work."

crap ass attending: (at last years banquet)
"And I would like to thank our very talented pool of residents for NOT seeing their job as "shifts." More specifically for respecting the ebb and flow of medicine. Your job does not start at 6 if you are a doctor and end specifically at 6. You must respect the patient's needs and therefore do your best. Hours compliance is extremely important....(nice dramatic pause)...but nothing is more important than patient care."

Translation: YOU BETTER stay extra hours and not bellyache about it because if the attendings have to pick up the slack due to the 80 hour work week -- heads will roll.

BLAA BLAA BLAA BLAA BLAA

There are a few attendings here who are very respectful of the hours but if you are a good resident, they tend to lean on you more I think. Being good = working more because you are asked to do special stuff with said attending and it's supposed to be a perk.

Never ask about hours. Never. When 80 hour work week went into effect, some senior residents complained that the "new guys" were "way too into the new rule. Suck it up and quit whining."

So the short answer to Kelly's question is YES.
Try to be compliant -- but if you're not, no biggie for most attendings.

[Sheherezade]

Be careful Flynn. You're about to be an attending wife. And from what I've read (and experienced elsewhere), that work has rolled upstairs. In fact, there are many articles specifically about increasing surgical attending work hours. Of course, you'll be in private practice, so you won't have any residents I suppose. Will you?

Honestly....it's nice to advocate for the residents. More sleep would be a good idea, but so would smaller patient load and more support staff. Unfortunately, that takes money and hospitals are loath to part with it in.

[Flynn]

Let me tell you, I looked HARD at that possibility and we picked the job that

A.) has no residents but lots of mid levels to "buffer" the docs
B.) there is no "old boy network" that is to say....more work = better doc
C.) we looked at the hours of the other partner for the last two years and her hours were much better then training hours -- and they will split the work and hopefully have some growth.

It's the "best" aspects of private practice -- or at least that's what it overwhelmingly seems. You never can truly KNOW until you are there I imagine.

I admit it -- after 9 years in a big time, academic program I ABHORE everything that has to do with academic medicine. (Is that fair? Nope -- but it's honest!) That is until one of my family members need a special procedure that is ONLY done there . Then, I'm all for it. :>

[DCJenn]

My beloved husbnad is already attempting the sales pitch about next year.

"You know, we won't have any residents or fellows and there is only one other Army side child neurologist (and um, ONE on the Air Force side) so don't think my hours are going to get any better. There is no 80 hour workweek for staff...blah, blah, blah."

You know what I said? I said, and it was not nice, but I don't care. I said,

"Bite me, you'll be home in time for me to go to yoga. period."

I haven't sacrificed six years of my life for him to be gallavanting about the hospital in a non-emergency field....there is no emergency that requires the neurologist! Bitch about the pediatricians, bitch about the er docs, bitch about the nurses (although I wouldn't) but you WILL be home so that I can go to yoga.

I so, so, so hate medicine sometimes.

Jenn

PS- which again, is why I choose to see the Army nurse practitioners. I've had MUCH better care from the well-rested and sane nurses than from the docs. and the radiology techs are all really cute enlisted guys.

ok, I'll stop.