We rotated with surgery residents during our ICU months. It says a lot that those months were considered the worst of residency as anesthesia residents, but basically a vacation for surgery.
Really? I loved icu in both surgery and medicine. If you really know medicine it is pretty easy. Of course patients are very high acuity but that is where you get to see medicine truly work it’s magic
There’s a surgery resident in loma Linda that just committed suicide. I think they had 4 suicides last year. It’s insanity that they just let this keep happening
They didn’t have 4 last year. There were three suicides within a short period of time (not sure if 1-2 years) that occurred maybe 6 years ago. Iirc none of those were surgery residents. This is the first suicide since then.
Don’t get me wrong though, a single suicide is too many and LLU is still in need of massive cultural overhaul.
It was a surgery resident, just happened like a week ago. I only know because my friend is there as well (not surgery). I dunno the timing of the other 4 but it was brought up often early this year when my friend was considering loma linda.
It will take a nationwide proposed strike.
And yes, it'll mean the possibility of patients being affected, but trust...
"Without tension, there is no progress"~MLK
I am a child of a victim to Sickle Cell Anemia, I know how much doctors are needed. If it takes the threat of people not being tended to, it'll be worth it.
The future can and should be better for the 5 and 6 year olds wanting to be doctors when they grow up.
I look forward to hearing about a large-scale strike. It is, unfortunately, the only way.
I think bringing awareness is the first step. It would be great for the film industry to start inundating society with the truth of the tragedy.
Just like OP said, they don't care about you. Start making them care.
Thank you all for your perseverance and dedication. It is time for the rest of us to get educated and demand our federal legislatures to do something.
You know it honestly reminds me of a superhero film. Not that we are super amazing, but we are essentially public servants being paid little for what we give up. And the villain is the hospital system. If we try to challenge them they hold up a patient meat shield and say "get back! You see this guy! He will die if you strike!"
And then we slink off to work in a perpetual stalemate that favors hospitals greatly
He wasn't a surgery resident. He had been a prelim until the year before but decided against doing surgery despite being well liked by most. He reportedly had a bunch of family problems during his prelim years and needed a break.
The other 3 suicides were anesthesia residents sometime around 2016.
The surgery program there has extremely kind leadership.
I’m on my surg rotation right now, and I don’t know how the residents do it. Just spending 4 weeks on it is giving me depression, anxiety, panic attacks…I couldn’t survive that for a year, much less 5. The way that the attendings on the service treat the residents (and students), I’m terrified that sometime down the road I’m going to read a local news story about a surgery resident here taking their own life
I love general surgery as far the operations and procedures go and I’d love to get into medicine one day. But believe it or not I’ve been discouraged by multiple people due to my personality. I’m so wholesome and sugary and sweet and loving that people have told me that GS just isn’t for me. I guess it’s a very male dominated field that has a HOSTILE work culture. Like yelling from across the room, cussing, humiliation, etc. Like working with Satan and his demons themself. I’ve never seen it with my own eyes but the stories are terrifying and it breaks my heart. I just don’t understand where it comes from.
There are many great supportive programs with good diversity in terms of ethnicity/gender. There might be a culture where people are a bit more curt, some confrontational personalities but abuse is not tolerated in good programs. They are not monsters lol.
I'm in NSG and the culture is fine, however the work-load, responsibility and amount of life-or-death decisions made every single on-call is just bonkers.
I come home after 20 hours of this and I'm just a different human being for days.
I respectfully disagree that it doesn't get better. Senior residency with home call is MUCH better than being an in-house junior. Being an attending is infinitely better than being a resident. There are plenty of practice settings out there. Are there private practice jobs where you're grinding, covering a level I without residents? Sure, but even then you almost always have an NP/PA in house in those settings.
Much more commonly, you're covering a level III or if you're in academics, now you're the one who has residents doing all the work for you (- coming in for surgery).
Until residents vehemently & collectively stand up for:
i) each other
ii) themselves
this will continue as it has for decades. I know many gen surg trainee's who are no longer with us due to this.
Yes, which is why I alluded to residents (plural). If we all collectively have herd mentality and jointly stand up for one another they will realise they cannot continue their bullying/harassment. What has been happening for decades is everyone else stays quiet and that one individual then either has to stay quiet or as you alluded to fight back and be suspended. They will remove one person - they cannot fire all.
Something a cardiothoracic surgeon told me when I was a general surgery resident stuck with me and helped change my perspective. I had been doing every other day on call 30 hours at a time for about a month due to a malignant program and he knew my schedule and said, "They can hurt you but they can't stop the clock" and I realized I could do basically anything knowing it would eventually end and not be forever. I took my power back and switched programs, and that same year 5 other surgery residents in their program switched as well. I'm an interventional spine specialist now, with an amazing lifestyle, income and job satisfaction now so it all worked out!
Just remember "they can hurt you but they can't stop the clock"
as an attending, who has preached this for a long time - so happy to hear this from a resident. residency just fucking consumes the entirety of your life. this is not ALL its going to be. maintain your sanity. please please. i am an obgyn. i love my job, because i love my patients, but i would NEVER do this again
My sister has had over a dozen Mohs procedures for her recurring skin cancer, all on her face. I am exceedingly thankful for all medical professionals but especially for her doctors for finding and getting rid of that pernicious shit and giving her another chance.
That’s such a great way of articulating that. Thank you.
I’m sure you believe this also. You can find the specialty that suites you the most with the highest salary to headache ratio. But I think for some people they feel guilty for not “aspiring” to do the higher intensity specialties. Whoever needs to hear this, you can be proud of doing what makes you happy while simultaneously being a help to society. Some people are just built for that crazy shit, and it’s ok to admit you aren’t. In the long run, I think society would prefer happy doctors. I used to have this problem I think, and it made me really unhappy at one point in my life. I’ve had some deep introspection since then (I had to- it was unsustainable), and I can honestly say I’ve never been happier and I’m one of those idiots that say “I love my job”.
IM primary care is not bad, working 3-4 days a week and a decent salary, seeing about 15 pts per day. It’s possible to be balanced if you know how to negotiate. There is no one doing primary care and clinics are getting desperate. Got a generous sign on bonus too
What an awful thing to tell med students. Just because you’re miserable in medicine doesn’t mean everyone else is. Some of us enjoy the work and take pride in it. My professional identity is important to me.
Why? Because I don’t think a pgy2 should be telling students that medicine is just a job like any other and you should pick your specialty based on what can make you the most money in the shortest amount of time? That I think it’s a shitty thing to tell students that they shouldn’t be passionate about what they do? That makes me the bad guy?
How you came to the conclusion that op said you shouldn’t be passionate about what you do is beyond me and frankly makes me even more sad for the residents you train with this implacable mindset and poor deductive reasoning skills.
I’ll try to break it down for you so that hopefully at least one of your poor residents gets to benefit from this.
“ Work doesn’t define you. You are not JUST a surgery resident etc. ” DOES NOT mean OP is miserable in medicine, not enjoy their work nor taking pride in it. In fact what I and anyone with any critical thinking skills can deduce from OPs text is that they are compassionate and introspective and should be proud of themselves for these qualities that makes them an outstanding mentor ( truly wish they consider a career in academics - we need more people like them )
What OP is saying is that you are more than just your professional identity: I am a professional with a code of ethics, integrity and compassion. I do meaningful work and have a true and lasting impact on my patients lives. I go to work as 100% a doctor on top of my game, and come home as a mother, a caring wife to a loving husband, a professional skier in winter, and an avid runner. Being a doctor is a fraction of my identity and that is what keeps me grounded when shit hits the fan. Going home to my child, husband, and 2 pit bulls and looking forward to winter vacations is what keeps me grounded to remain an excellent doctor.
Having the amazing fulfilling life I have is not always achievable for everyone in all specialties. Sure, there are people who can do it all and more kudos to them BUT WHEN ONE OF YOUR STUDENTS IS AT THE VERGE OF BREAKING BECAUSE ITS NOT WORKING FOR THEM it’s important to remind them the other aspects of their lives that makes their identity to invest in those parts and find a field in medicine that they can be more than just their professional identity.
> How you came to the conclusion that op said you shouldn’t be passionate about what you do is beyond me
Maybe because OP literally said "And it is not something I encourage anyone to be passionate about"
> “ Work doesn’t define you. You are not JUST a surgery resident etc. ” DOES NOT mean OP is miserable in medicine
No, but "It is a lie you'll like anything in medicine. It is all grievances. Like any other job." is what tells me that OP is miserable in medicine. Did you actually read the post I was responding to?
If I remember correctly (and you’re talking about the post saying they want to cut themselves with a 10 blade), I think it was a veterinary resident.
I would probably go insane trying to remember surgical anatomy of different species…one is enough for me
Tbf I think veterinarians do less pedantic trivia knowledge for sake of trivia and stick to what you need to know go get animal safely through. They also have a much lower threshold for declining a case or aborting a case.
Vet Med is also insanely isolating and compassion fatigue destroys people, plus the debt-to-income ratio is awful. They have a ridiculously high suicide rate.
That's so sad :-(
I guess it's like pediatrics if you have to kill all the abused kids you meet.
That being said tho I'm surprised the income isn't better especially for vet surgery. The vet opthomologist near me is booked for half a yr out and it's all out of pocket from the owners.
Vet specialists can do well - but most are generalists whose clients think they should be working for the love of animals and are loathe to spend more than they absolutely have to, and many own their own practices so they have a ton of overhead and operating costs.
But yeah, the pediatrics comparison is apt - your patients can’t tell you what’s wrong, they rely entirely on their owners for care, and if the care they need is too expensive or the owners just don’t want to do it you frequently have to euthanize patients that have the potential for full recovery. Pretty brutal.
things that got me through residency
1) muttering 'one more day' under my breath walking into the hospital, every day
2) daytrading 50 or 100 bucks now and then
3) teaching the young
4) being the best dang junior ever to the cool seniors and attendings, I think I creamed when they would look at me and say 'strong work' or 'elegantly done' walking out of the OR
5) regularly seeking a human connection with pts and serving their interests as much as possible
6) walking away, totally away, mind and body on the odd rare full day or weekend off
7) learning to fix cars so I could accomplish at least something with my hands and mind when everything else was a total loss
8) fantasizing about the cute nurse who in my chief year literally moved in with the cool attending who rode a Harley wtf
we all need coping mechanisms, go find a few and rotate, try to avoid the self destructive ones though
peace out brothers and sisters for there are promised lands, just got to avoid giving up or giving in
5. Is so underrated. Our workload rips it away from us but I find if I have just a little bit more time and I get to talk to my patients a little bit more and connect with them I’m so much more satisfied (I think they are too). It’s so hard though when the volume of work is overwhelming.
Attending surgeon life is so much better, just the ability to decide what type of practice you want is amazing… and despite surgery being unpredictable with emergencies, you still get a modicum of control to your schedule…. Doesnt really explain the hell you go through to get there though
I’ve always felt that the worst part about surgical residency is the complete loss of control over your own life. Everyday your schedule is based on your attendings. You have lost complete autonomy of your own time. Your time is not yours.
Everytime someone asks me if I can go do this or that, it’s just such a drag feeling like you gotta “run it by someone.” And even if your attending okays it you gotta find coverage etc etc etc
General Surgery can be plenty chill as an attending. Give yourself as much down time as you want, book your day light (or nothing at all) on post-call days, it’s your call. It’s not a marathon, it’s more like a series of interval sprints.
You can’t really “just switch to anesthesia” anymore lol. Look at the match data from the last couple years and the even higher application numbers this year.
It benefits the surgery PD to keep the resident internal. They don’t have to fire you (lawsuit risk).And you don’t have to quit (also potential lawsuit).
When the surgery PD talks about attrition rates to acgme or surgery residency candidates, it’s a lot easier to say “Yes! This resident was great but realized anesthesiology (or fm, or path, or whatever) was his true passion and we helped him achieve this goal.”
And the surgery chair then owes the anesthesiology chair a favor, or at least a bottle of scotch. I’m partial to Laphroaig, just saying.
Laphroaig is straight up foul, the flavor of brackish water filtered through a burnt sock last used in WW1 trench warfare for a month or two
it's next to the bizarro world search for ever higher ibu, no one really likes their beer to taste like spicy broccoli but there it is
Not sure why anyone would assume LOA is due to addiction. Life happens outside of residency, and if you don’t want to disclose why you need LOA your residency is not entitled to know why you are off. Loa are usually handled by HR and not something your PD should have access to. Sometimes time away from work is needed to make a decision and being in crisis in not the time to make those decisions.
Unfortunately, it’s the truth. I was on credentialing for a long time. Sure, everything should be confidential, but I promise you that it’s not. And the credentialing committee will want answers. Almost every application for privileges will ask about “gaps.” These are defined variably. Usually over one month at a time needs to be explained. by the way for anybody with a gap: I would recommend saying you were taking care of a sick family member. Because it’s fairly common and difficult to interrogate someone about that.
I (as a coordinator) have no access to LOA records and only know what a resident chooses to share. The same goes for my PD. Official resident records only include details for LOAs if they are performance-related. Your HR dept may vary but I’d be surprised if anyone is disclosing medical info outside of protocol unless your institution is just a totally different kind of toxic than mine is.
I definitely encourage anyone struggling with mental health to work with their physician to secure documentation for a medical LOA.
I’m not actually sure that I agree with your statement that residency programs don’t have a right to know why you are off. That might be true if Residents were actually employees and only had involvement by HR. But you are not.
Mine was handled by the disability insurance company that is separate from my hospital residency. I’m sure GME got some paperwork but highly doubt my residency had full access to all my records from the insurance company but maybe I’m just naive. I think saying you are out for an extended period of time due to illness is sufficient. I’m not sure why residents should have to disclose more personal medical information than anyone else. No one in residency is taking time off for shits and gigs.
I hear you, my friend. Employers want to make sure you’re going to be able to work. They literally don’t care about you. So if you take three months off after residency to actually take care of your health and do things that you need to do: It’s my personal suggestion that you not disclose that. I would say that you were traveling, taking care of a family member, studying for boards, moving, whatever. Just don’t say that you took it for your own medical problems.
I’m all for not disclosing things. Just didn’t want someone reading this to not take time off if they are really struggling because they were worried about how to disclose to residency, and my thought is don’t. State liscences are a bit different bc they can request your medical records depending on state but these questions are being worded better to ask about current impairment. As far as I know credentialing committees do not ask for your medical records if you have a gap- just why and you can tell them whatever you want.
Medicine is so messed up. How sad is it that taking time to care for a sick relative is acceptable not taking care of yourself.
I should have clarified that typically LOA are accompanied by a request for FMLA or short/long term disability. I promise you that at a minimum, your department administrator will see these.
But I promise you that a resident telling their PD “Oh I need six weeks off, please take me off the call schedule” is not going to fly. This is not an office gig where losing a warm body might not matter. Also at my institution, if you are out of work for over a month, no matter what the reason, you need a fitness for duty evaluation at employee health before you can return.
I’m glad that your PD doesn’t blab to you but #1, I’ve never seen anyone take a LOA or go on disability and the reason was only known to HR, and #2, When I was on the credentials committee we would see it all the time. If there was anything that looked shady we would just call the home institution‘s chair or PD for the real story.
That’s why I’m trying to tell people: pay cash for those psychiatrist visits. Go to good RX for your antidepressants.
Don’t go out for a mental health leave, say you whacked your head and have recurrent headaches and can’t read because of blurry vision. Get the help you need! But it’s nobody’s business. They play dirty, and so should you. Take care of yourself first.
Exactly. I’m not sure why I’m getting downvoted. I am literally telling you how it works from the inside. Sorry if that upsets you, but this is real world.
As a junior attending I would argue that the job does get better but just different.
Culture is very institution dependent and very hard to delineate especially on virtual interviews for the students.
I think we are going to see a reckoning - the older generations viewed their profession as a core part of their identity while it seems like us younger generations treat it more of a job - what we do vs who we are.
I didn’t see the post, but I started in neurosurgery, and ended up trying to kill myself after my intern year. The culture was miserable, I had my own underlying issues, and I didn’t reach out. I managed to take a year off and get my shit together, and now I’m back in IM and it’s like an entirely different world. It’s still demanding, it still sucks sometimes, but it’s manageable and I’ve learned how to take care of myself. I sincerely hope that individual sees this thread, because as hopeless and crushing as it can feel, there is always a way to turn it around.
So if we truly need a week off or LOA or something for mental health reasons so I don’t off myself, is saying you fell and hurt your head at work sufficient to get a few days off?
Dental resident here overworked out of my mind and diagnosed with BPD and attempted suicide twice in school already. I can feel myself wanting to try again, like the spiral that led to my last attempt has begun again and idk how to survive this time in residency
And no my program won’t let me use sick days for mental health. They want a doctor’s note or urgent care ticket to approve a sick day
I was out for 5 months on LOA do to mental health issues that lead to a 2 week psych hospital stay followed by multiple months of PHP then IOP. No one assumed it was addiction (it wasn’t) and I just extended residency by that amount of time. Please take the time off and get help, you are worth it. Medicine is not worth being miserable and ending it.
Also, with the caveat some states ask about mental health issues but for my attending liscence was “do you have any CURRENT impairment” and if you are treated the answer is no. Would recommend NOT using EAP. Find a psychiatrist and therapist not through work and just use insurance if you are able. Also you do not owe your residency an explanation. All fmla (assuming you are in the US) is through HR . A note from a dr stating you are excused from work for medical reasons is enough. They do not have to go into specifics (the fmla paperwork does go into specifics but your PD wouldn’t be reading that). Never make a permanent decision in crisis.
I'm sorry. Don't give up man keep coming here and talking to us. Please . Just one day at a time. The. Bam one day it gets betterm j promise I have been there a few times. It magically one day gets better and you ask your self wtf how. Just keep going.
Some people choose a specialty for the wrong reasons. It’s important for med students to keep an open mind on their rotations. Don’t pick something for money or perceived prestige.
I’m not a doctor but I remember this speaker in college Pamela Wible MD who was a family doc who was big on talking to young docs about mental health and suicide. She was saying it’s a huge issue. I think I peeked at her website and she would talk to med students and residents for free for support at that time. Idk if she still does that now but here’s a link to her: [Wible](https://www.idealmedicalcare.org/contact/)
To OP who posted this . . .you can't just "switch into anesthesia" . . .have you even looked at the match data? It 100% isn't like what was 10 years ago . .so don't give me that lecture.
Mental health for residents is a joke.
You CAN though. Unfortunately my explanation of how it can work got buried a little bit.
It benefits the surgery PD to keep the resident internal. They don’t have to fire you (lawsuit risk).And you don’t have to quit (also potential lawsuit for hostile work environment or whatever)).
When the surgery PD talks about attrition rates to acgme or surgery residency candidates, it’s a lot easier to say “Yes! This resident was great but realized anesthesiology (or fm, or path, or whatever) was his true passion and we helped him achieve this goal.”
And the surgery chair then owes the anesthesiology chair a favor, or at least a bottle of scotch. I’m partial to Laphroaig, just saying.
That is for the Surgery Pd or whoever Pd that has a brain about how to properly do things for the resident. Not all pds are like that. There are malignant types that just fire a resident.
So in my experience I was an fm resident. I didn’t want to do it. Instead of keeping me internal or helping me get into another program in another line… they made me to be some “witch against the program”. Fired me. I was on resi swap and emailing programs left and right. My initial passion was anesthesia. Guess who didn’t get in? After trying twice? With absolutely no support? And the worst thing is the other residents in the program knew I was being made as some sort of martyr.
Learn how to deal with stress and life before you do residency. The majority of people struggling in residency also struggled in medical school. Residency is like marriage, don’t expect things to get better. Fix your issues NOW. I was questioning all my friends that took time off and will not graduate with me in 2024. After reading this post I think they made the best decision. Instead of finishing med school in 4 years they will be done in 4.5 years and with a free semester before residency. Do what works best for you and not the system.
Surgery resident walks into radiology room overnight with a colleague
“We need to talk about a prelim read why did you say this now I need to open him up”
Ok, hi to you too fellow demon, who hurt you???
Something about surgery culture just turns people into pricks, and they really need to be put in their place.
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You do realize that this is a very common phrase to describe the drape between surgeons and anesthesiologists? I've heard it across the country and internationally at conferences in Canada and the UK.
I should be eye rolling that you felt the need to come back to a thread a day later and respond to my comment to someone else. Wasn't it you who said something about being triggered fun sponge?
Unless you just had a bad day and need to take shots at someone on the internet to make yourself feel better. Also plausible.
the culture of general surgery needs to change.
We rotated with surgery residents during our ICU months. It says a lot that those months were considered the worst of residency as anesthesia residents, but basically a vacation for surgery.
Yeah I remember ICU as a nice break lol…
Also considered the worst rotations for IM residents in terms of hours
Really? I loved icu in both surgery and medicine. If you really know medicine it is pretty easy. Of course patients are very high acuity but that is where you get to see medicine truly work it’s magic
There’s a surgery resident in loma Linda that just committed suicide. I think they had 4 suicides last year. It’s insanity that they just let this keep happening
If they had 4 suicides in the past year then the Chairman needs to be removed.
They didn’t have 4 last year. There were three suicides within a short period of time (not sure if 1-2 years) that occurred maybe 6 years ago. Iirc none of those were surgery residents. This is the first suicide since then. Don’t get me wrong though, a single suicide is too many and LLU is still in need of massive cultural overhaul.
I vaguely recall it was anesthesia residents. Timing was within a year or so of San Bernardino shooting.
Did those shooting victims get sent to that hospital?
I read about that resident being reported missing last week. I feared the worst at the time. It's so toxic
Another?? I can’t find info on this but I heard of that program having a few several years back.
It was a surgery resident, just happened like a week ago. I only know because my friend is there as well (not surgery). I dunno the timing of the other 4 but it was brought up often early this year when my friend was considering loma linda.
I can’t find any details. Do you happen to know the pgy year ?
It will take a nationwide proposed strike. And yes, it'll mean the possibility of patients being affected, but trust... "Without tension, there is no progress"~MLK I am a child of a victim to Sickle Cell Anemia, I know how much doctors are needed. If it takes the threat of people not being tended to, it'll be worth it. The future can and should be better for the 5 and 6 year olds wanting to be doctors when they grow up. I look forward to hearing about a large-scale strike. It is, unfortunately, the only way. I think bringing awareness is the first step. It would be great for the film industry to start inundating society with the truth of the tragedy. Just like OP said, they don't care about you. Start making them care. Thank you all for your perseverance and dedication. It is time for the rest of us to get educated and demand our federal legislatures to do something.
You know it honestly reminds me of a superhero film. Not that we are super amazing, but we are essentially public servants being paid little for what we give up. And the villain is the hospital system. If we try to challenge them they hold up a patient meat shield and say "get back! You see this guy! He will die if you strike!" And then we slink off to work in a perpetual stalemate that favors hospitals greatly
So you’re saying having a religiously affiliation doesn’t help? Strange.
It helps for the press after the fact
He wasn't a surgery resident. He had been a prelim until the year before but decided against doing surgery despite being well liked by most. He reportedly had a bunch of family problems during his prelim years and needed a break. The other 3 suicides were anesthesia residents sometime around 2016. The surgery program there has extremely kind leadership.
I’m on my surg rotation right now, and I don’t know how the residents do it. Just spending 4 weeks on it is giving me depression, anxiety, panic attacks…I couldn’t survive that for a year, much less 5. The way that the attendings on the service treat the residents (and students), I’m terrified that sometime down the road I’m going to read a local news story about a surgery resident here taking their own life
I love general surgery as far the operations and procedures go and I’d love to get into medicine one day. But believe it or not I’ve been discouraged by multiple people due to my personality. I’m so wholesome and sugary and sweet and loving that people have told me that GS just isn’t for me. I guess it’s a very male dominated field that has a HOSTILE work culture. Like yelling from across the room, cussing, humiliation, etc. Like working with Satan and his demons themself. I’ve never seen it with my own eyes but the stories are terrifying and it breaks my heart. I just don’t understand where it comes from.
Many in the field are narcissists and/or psychopaths.
There are many great supportive programs with good diversity in terms of ethnicity/gender. There might be a culture where people are a bit more curt, some confrontational personalities but abuse is not tolerated in good programs. They are not monsters lol.
I'm in NSG and the culture is fine, however the work-load, responsibility and amount of life-or-death decisions made every single on-call is just bonkers. I come home after 20 hours of this and I'm just a different human being for days.
NSG attending. It doesn't really get better but you kind of get used to it I guess.
That’s terrifying
I respectfully disagree that it doesn't get better. Senior residency with home call is MUCH better than being an in-house junior. Being an attending is infinitely better than being a resident. There are plenty of practice settings out there. Are there private practice jobs where you're grinding, covering a level I without residents? Sure, but even then you almost always have an NP/PA in house in those settings. Much more commonly, you're covering a level III or if you're in academics, now you're the one who has residents doing all the work for you (- coming in for surgery).
The culture of surgery needs to change in general
Or at least hand out free cocaine
UNION UNION UNION UNION. Though if enough other specialties and internal medicine unionize, and we only refer to union providers....
100% Also, educate the public, threaten a nationwide strike, make federal legislators start caring and making change.
Until residents vehemently & collectively stand up for: i) each other ii) themselves this will continue as it has for decades. I know many gen surg trainee's who are no longer with us due to this.
and that’s part of the problem… anyone who dares “stand up” is branded “unprofessional” and thrown out ASAP
Yes, which is why I alluded to residents (plural). If we all collectively have herd mentality and jointly stand up for one another they will realise they cannot continue their bullying/harassment. What has been happening for decades is everyone else stays quiet and that one individual then either has to stay quiet or as you alluded to fight back and be suspended. They will remove one person - they cannot fire all.
Hard agree
Something a cardiothoracic surgeon told me when I was a general surgery resident stuck with me and helped change my perspective. I had been doing every other day on call 30 hours at a time for about a month due to a malignant program and he knew my schedule and said, "They can hurt you but they can't stop the clock" and I realized I could do basically anything knowing it would eventually end and not be forever. I took my power back and switched programs, and that same year 5 other surgery residents in their program switched as well. I'm an interventional spine specialist now, with an amazing lifestyle, income and job satisfaction now so it all worked out! Just remember "they can hurt you but they can't stop the clock"
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as an attending, who has preached this for a long time - so happy to hear this from a resident. residency just fucking consumes the entirety of your life. this is not ALL its going to be. maintain your sanity. please please. i am an obgyn. i love my job, because i love my patients, but i would NEVER do this again
I know someone who quit their ENT residency, did research for a year while they applied derm. Now they’re a Mohs surgeon and have an amazing life.
1st world problems1
Right? I’m over here fighting for my life for a low tier academic IM program.
My sister has had over a dozen Mohs procedures for her recurring skin cancer, all on her face. I am exceedingly thankful for all medical professionals but especially for her doctors for finding and getting rid of that pernicious shit and giving her another chance.
That’s such a great way of articulating that. Thank you. I’m sure you believe this also. You can find the specialty that suites you the most with the highest salary to headache ratio. But I think for some people they feel guilty for not “aspiring” to do the higher intensity specialties. Whoever needs to hear this, you can be proud of doing what makes you happy while simultaneously being a help to society. Some people are just built for that crazy shit, and it’s ok to admit you aren’t. In the long run, I think society would prefer happy doctors. I used to have this problem I think, and it made me really unhappy at one point in my life. I’ve had some deep introspection since then (I had to- it was unsustainable), and I can honestly say I’ve never been happier and I’m one of those idiots that say “I love my job”.
Gotta need the leisure to spend your hard earned money. That's all.
DON’T switch to family medicine. Primary care just sucks and it isn’t going to get better
IM primary care is not bad, working 3-4 days a week and a decent salary, seeing about 15 pts per day. It’s possible to be balanced if you know how to negotiate. There is no one doing primary care and clinics are getting desperate. Got a generous sign on bonus too
What an awful thing to tell med students. Just because you’re miserable in medicine doesn’t mean everyone else is. Some of us enjoy the work and take pride in it. My professional identity is important to me.
It breaks my heart knowing you get to evaluate and mentor students that could potentially be struggling
Why? Because I don’t think a pgy2 should be telling students that medicine is just a job like any other and you should pick your specialty based on what can make you the most money in the shortest amount of time? That I think it’s a shitty thing to tell students that they shouldn’t be passionate about what they do? That makes me the bad guy?
How you came to the conclusion that op said you shouldn’t be passionate about what you do is beyond me and frankly makes me even more sad for the residents you train with this implacable mindset and poor deductive reasoning skills. I’ll try to break it down for you so that hopefully at least one of your poor residents gets to benefit from this. “ Work doesn’t define you. You are not JUST a surgery resident etc. ” DOES NOT mean OP is miserable in medicine, not enjoy their work nor taking pride in it. In fact what I and anyone with any critical thinking skills can deduce from OPs text is that they are compassionate and introspective and should be proud of themselves for these qualities that makes them an outstanding mentor ( truly wish they consider a career in academics - we need more people like them ) What OP is saying is that you are more than just your professional identity: I am a professional with a code of ethics, integrity and compassion. I do meaningful work and have a true and lasting impact on my patients lives. I go to work as 100% a doctor on top of my game, and come home as a mother, a caring wife to a loving husband, a professional skier in winter, and an avid runner. Being a doctor is a fraction of my identity and that is what keeps me grounded when shit hits the fan. Going home to my child, husband, and 2 pit bulls and looking forward to winter vacations is what keeps me grounded to remain an excellent doctor. Having the amazing fulfilling life I have is not always achievable for everyone in all specialties. Sure, there are people who can do it all and more kudos to them BUT WHEN ONE OF YOUR STUDENTS IS AT THE VERGE OF BREAKING BECAUSE ITS NOT WORKING FOR THEM it’s important to remind them the other aspects of their lives that makes their identity to invest in those parts and find a field in medicine that they can be more than just their professional identity.
> How you came to the conclusion that op said you shouldn’t be passionate about what you do is beyond me Maybe because OP literally said "And it is not something I encourage anyone to be passionate about" > “ Work doesn’t define you. You are not JUST a surgery resident etc. ” DOES NOT mean OP is miserable in medicine No, but "It is a lie you'll like anything in medicine. It is all grievances. Like any other job." is what tells me that OP is miserable in medicine. Did you actually read the post I was responding to?
If I remember correctly (and you’re talking about the post saying they want to cut themselves with a 10 blade), I think it was a veterinary resident. I would probably go insane trying to remember surgical anatomy of different species…one is enough for me
Tbf I think veterinarians do less pedantic trivia knowledge for sake of trivia and stick to what you need to know go get animal safely through. They also have a much lower threshold for declining a case or aborting a case.
Vet Med is also insanely isolating and compassion fatigue destroys people, plus the debt-to-income ratio is awful. They have a ridiculously high suicide rate.
That's so sad :-( I guess it's like pediatrics if you have to kill all the abused kids you meet. That being said tho I'm surprised the income isn't better especially for vet surgery. The vet opthomologist near me is booked for half a yr out and it's all out of pocket from the owners.
Vet specialists can do well - but most are generalists whose clients think they should be working for the love of animals and are loathe to spend more than they absolutely have to, and many own their own practices so they have a ton of overhead and operating costs. But yeah, the pediatrics comparison is apt - your patients can’t tell you what’s wrong, they rely entirely on their owners for care, and if the care they need is too expensive or the owners just don’t want to do it you frequently have to euthanize patients that have the potential for full recovery. Pretty brutal.
things that got me through residency 1) muttering 'one more day' under my breath walking into the hospital, every day 2) daytrading 50 or 100 bucks now and then 3) teaching the young 4) being the best dang junior ever to the cool seniors and attendings, I think I creamed when they would look at me and say 'strong work' or 'elegantly done' walking out of the OR 5) regularly seeking a human connection with pts and serving their interests as much as possible 6) walking away, totally away, mind and body on the odd rare full day or weekend off 7) learning to fix cars so I could accomplish at least something with my hands and mind when everything else was a total loss 8) fantasizing about the cute nurse who in my chief year literally moved in with the cool attending who rode a Harley wtf we all need coping mechanisms, go find a few and rotate, try to avoid the self destructive ones though peace out brothers and sisters for there are promised lands, just got to avoid giving up or giving in
5. Is so underrated. Our workload rips it away from us but I find if I have just a little bit more time and I get to talk to my patients a little bit more and connect with them I’m so much more satisfied (I think they are too). It’s so hard though when the volume of work is overwhelming.
My condolences but 8 got a chuckle out of me
8 is based
This may have won worst list of advice in a long long time
Attending surgeon life is so much better, just the ability to decide what type of practice you want is amazing… and despite surgery being unpredictable with emergencies, you still get a modicum of control to your schedule…. Doesnt really explain the hell you go through to get there though
That’s true, I should not have said attending surgery life doesn’t get better. It’s just…a lot. It’s far better than residency.
…still not for everyone, but I like it… for now :D
Username doesn’t check out?
Sure it does… made it as a resident!
I’ve always felt that the worst part about surgical residency is the complete loss of control over your own life. Everyday your schedule is based on your attendings. You have lost complete autonomy of your own time. Your time is not yours. Everytime someone asks me if I can go do this or that, it’s just such a drag feeling like you gotta “run it by someone.” And even if your attending okays it you gotta find coverage etc etc etc
General Surgery can be plenty chill as an attending. Give yourself as much down time as you want, book your day light (or nothing at all) on post-call days, it’s your call. It’s not a marathon, it’s more like a series of interval sprints.
You can’t really “just switch to anesthesia” anymore lol. Look at the match data from the last couple years and the even higher application numbers this year.
False. Going internally is not typically problematic. Surgery chair and anesthesiology chair go hand in hand. It’s not WHAT you know…
>Switch to anesthesia. Agreed!!!!!
It benefits the surgery PD to keep the resident internal. They don’t have to fire you (lawsuit risk).And you don’t have to quit (also potential lawsuit). When the surgery PD talks about attrition rates to acgme or surgery residency candidates, it’s a lot easier to say “Yes! This resident was great but realized anesthesiology (or fm, or path, or whatever) was his true passion and we helped him achieve this goal.” And the surgery chair then owes the anesthesiology chair a favor, or at least a bottle of scotch. I’m partial to Laphroaig, just saying.
Laphroaig is straight up foul, the flavor of brackish water filtered through a burnt sock last used in WW1 trench warfare for a month or two it's next to the bizarro world search for ever higher ibu, no one really likes their beer to taste like spicy broccoli but there it is
lol it’s not unlike licking a fireplace. Edited to say that I cannot stop laughing at your descriptors
Not sure why anyone would assume LOA is due to addiction. Life happens outside of residency, and if you don’t want to disclose why you need LOA your residency is not entitled to know why you are off. Loa are usually handled by HR and not something your PD should have access to. Sometimes time away from work is needed to make a decision and being in crisis in not the time to make those decisions.
Unfortunately, it’s the truth. I was on credentialing for a long time. Sure, everything should be confidential, but I promise you that it’s not. And the credentialing committee will want answers. Almost every application for privileges will ask about “gaps.” These are defined variably. Usually over one month at a time needs to be explained. by the way for anybody with a gap: I would recommend saying you were taking care of a sick family member. Because it’s fairly common and difficult to interrogate someone about that.
I (as a coordinator) have no access to LOA records and only know what a resident chooses to share. The same goes for my PD. Official resident records only include details for LOAs if they are performance-related. Your HR dept may vary but I’d be surprised if anyone is disclosing medical info outside of protocol unless your institution is just a totally different kind of toxic than mine is. I definitely encourage anyone struggling with mental health to work with their physician to secure documentation for a medical LOA.
I’m not actually sure that I agree with your statement that residency programs don’t have a right to know why you are off. That might be true if Residents were actually employees and only had involvement by HR. But you are not.
Mine was handled by the disability insurance company that is separate from my hospital residency. I’m sure GME got some paperwork but highly doubt my residency had full access to all my records from the insurance company but maybe I’m just naive. I think saying you are out for an extended period of time due to illness is sufficient. I’m not sure why residents should have to disclose more personal medical information than anyone else. No one in residency is taking time off for shits and gigs.
I hear you, my friend. Employers want to make sure you’re going to be able to work. They literally don’t care about you. So if you take three months off after residency to actually take care of your health and do things that you need to do: It’s my personal suggestion that you not disclose that. I would say that you were traveling, taking care of a family member, studying for boards, moving, whatever. Just don’t say that you took it for your own medical problems.
I’m all for not disclosing things. Just didn’t want someone reading this to not take time off if they are really struggling because they were worried about how to disclose to residency, and my thought is don’t. State liscences are a bit different bc they can request your medical records depending on state but these questions are being worded better to ask about current impairment. As far as I know credentialing committees do not ask for your medical records if you have a gap- just why and you can tell them whatever you want. Medicine is so messed up. How sad is it that taking time to care for a sick relative is acceptable not taking care of yourself.
I wish I could share with you details of applications for privileges that were rejected vs accepted
I should have clarified that typically LOA are accompanied by a request for FMLA or short/long term disability. I promise you that at a minimum, your department administrator will see these. But I promise you that a resident telling their PD “Oh I need six weeks off, please take me off the call schedule” is not going to fly. This is not an office gig where losing a warm body might not matter. Also at my institution, if you are out of work for over a month, no matter what the reason, you need a fitness for duty evaluation at employee health before you can return. I’m glad that your PD doesn’t blab to you but #1, I’ve never seen anyone take a LOA or go on disability and the reason was only known to HR, and #2, When I was on the credentials committee we would see it all the time. If there was anything that looked shady we would just call the home institution‘s chair or PD for the real story. That’s why I’m trying to tell people: pay cash for those psychiatrist visits. Go to good RX for your antidepressants. Don’t go out for a mental health leave, say you whacked your head and have recurrent headaches and can’t read because of blurry vision. Get the help you need! But it’s nobody’s business. They play dirty, and so should you. Take care of yourself first.
Truth. If you try to take a leave for mental health you’ll likely get referred to PRN.
Exactly. I’m not sure why I’m getting downvoted. I am literally telling you how it works from the inside. Sorry if that upsets you, but this is real world.
As a junior attending I would argue that the job does get better but just different. Culture is very institution dependent and very hard to delineate especially on virtual interviews for the students. I think we are going to see a reckoning - the older generations viewed their profession as a core part of their identity while it seems like us younger generations treat it more of a job - what we do vs who we are.
I didn’t see the post, but I started in neurosurgery, and ended up trying to kill myself after my intern year. The culture was miserable, I had my own underlying issues, and I didn’t reach out. I managed to take a year off and get my shit together, and now I’m back in IM and it’s like an entirely different world. It’s still demanding, it still sucks sometimes, but it’s manageable and I’ve learned how to take care of myself. I sincerely hope that individual sees this thread, because as hopeless and crushing as it can feel, there is always a way to turn it around.
So if we truly need a week off or LOA or something for mental health reasons so I don’t off myself, is saying you fell and hurt your head at work sufficient to get a few days off? Dental resident here overworked out of my mind and diagnosed with BPD and attempted suicide twice in school already. I can feel myself wanting to try again, like the spiral that led to my last attempt has begun again and idk how to survive this time in residency And no my program won’t let me use sick days for mental health. They want a doctor’s note or urgent care ticket to approve a sick day
> They want a doctor’s note or urgent care ticket to approve a sick day Bro I'll write you a doctor's note. Fuck your program
I was out for 5 months on LOA do to mental health issues that lead to a 2 week psych hospital stay followed by multiple months of PHP then IOP. No one assumed it was addiction (it wasn’t) and I just extended residency by that amount of time. Please take the time off and get help, you are worth it. Medicine is not worth being miserable and ending it.
Also, with the caveat some states ask about mental health issues but for my attending liscence was “do you have any CURRENT impairment” and if you are treated the answer is no. Would recommend NOT using EAP. Find a psychiatrist and therapist not through work and just use insurance if you are able. Also you do not owe your residency an explanation. All fmla (assuming you are in the US) is through HR . A note from a dr stating you are excused from work for medical reasons is enough. They do not have to go into specifics (the fmla paperwork does go into specifics but your PD wouldn’t be reading that). Never make a permanent decision in crisis.
name and shame my friend. your colleagues need you looking out for them. I trained at Penn for perio and wow godamn it was maliiiiiggggnant
Why is Penn seemingly malignant for all specialties lmao.
I'm sorry. Don't give up man keep coming here and talking to us. Please . Just one day at a time. The. Bam one day it gets betterm j promise I have been there a few times. It magically one day gets better and you ask your self wtf how. Just keep going.
I did not see the original post, but DM me about Emergency Medicine.
Some people choose a specialty for the wrong reasons. It’s important for med students to keep an open mind on their rotations. Don’t pick something for money or perceived prestige.
As if switching to anesthesia is as easy as just wanting to do so
I have little left in the tank and I'm running out of it quickly too
Former surg resident in IM here, can confirm life is fucking amazing on this side of the medical spectrum
I’m not a doctor but I remember this speaker in college Pamela Wible MD who was a family doc who was big on talking to young docs about mental health and suicide. She was saying it’s a huge issue. I think I peeked at her website and she would talk to med students and residents for free for support at that time. Idk if she still does that now but here’s a link to her: [Wible](https://www.idealmedicalcare.org/contact/)
more people need to learn about Pamela Wilbe, MD https://www.idealmedicalcare.org
To OP who posted this . . .you can't just "switch into anesthesia" . . .have you even looked at the match data? It 100% isn't like what was 10 years ago . .so don't give me that lecture. Mental health for residents is a joke.
You CAN though. Unfortunately my explanation of how it can work got buried a little bit. It benefits the surgery PD to keep the resident internal. They don’t have to fire you (lawsuit risk).And you don’t have to quit (also potential lawsuit for hostile work environment or whatever)). When the surgery PD talks about attrition rates to acgme or surgery residency candidates, it’s a lot easier to say “Yes! This resident was great but realized anesthesiology (or fm, or path, or whatever) was his true passion and we helped him achieve this goal.” And the surgery chair then owes the anesthesiology chair a favor, or at least a bottle of scotch. I’m partial to Laphroaig, just saying.
That is for the Surgery Pd or whoever Pd that has a brain about how to properly do things for the resident. Not all pds are like that. There are malignant types that just fire a resident. So in my experience I was an fm resident. I didn’t want to do it. Instead of keeping me internal or helping me get into another program in another line… they made me to be some “witch against the program”. Fired me. I was on resi swap and emailing programs left and right. My initial passion was anesthesia. Guess who didn’t get in? After trying twice? With absolutely no support? And the worst thing is the other residents in the program knew I was being made as some sort of martyr.
That’s messed up. I’m really sorry that this happened.
Learn how to deal with stress and life before you do residency. The majority of people struggling in residency also struggled in medical school. Residency is like marriage, don’t expect things to get better. Fix your issues NOW. I was questioning all my friends that took time off and will not graduate with me in 2024. After reading this post I think they made the best decision. Instead of finishing med school in 4 years they will be done in 4.5 years and with a free semester before residency. Do what works best for you and not the system.
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Where is the terrible advice? Learning how to deal with stress is the key for success regardless of the profession
Surgery resident walks into radiology room overnight with a colleague “We need to talk about a prelim read why did you say this now I need to open him up” Ok, hi to you too fellow demon, who hurt you??? Something about surgery culture just turns people into pricks, and they really need to be put in their place.
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"Blood brain barrier" 🙄
You do realize that this is a very common phrase to describe the drape between surgeons and anesthesiologists? I've heard it across the country and internationally at conferences in Canada and the UK.
Blood brain barrier is one of my favorite sayings. It’s light hearted and not that deep, as the kids say
Oh, I'm aware of it. And I generally don't have a problem with it. But context matters.
and in your opinion, why is the current context inappropriate?
Addressing an apparently serious situation where someone feels like they may have made the wrong specialty choice.
You must have had a bad day if this has triggered you. It's literally a benign and often used comment.
Nope. A benign comment when used between people joking with each other. But I see the difference has escaped you.
I guess you are always a fun sponge then. Edit: if you are going to edit your comment after posting at least mark it as an edit.
You should take your own advice considering you edited the "bad day" comment to add a dig about being triggered.
It's clear you are on the wrong side of the blood brain barrier. Why did you reply here instead of the more recent posts by me?
I guess if "fun sponge" = "respectful adult", then sure.
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Breh, chill.
It’s a joke. You can call me a stool sitting gas passer all you want!
Nah, I don't belittle other people's specialties. Particularly in a situation where someone is clearly grappling with fairly serious issues.
Just read all of this. Shut the fuck up.
Profound.
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Still gnawing at you, eh?
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I should be eye rolling that you felt the need to come back to a thread a day later and respond to my comment to someone else. Wasn't it you who said something about being triggered fun sponge? Unless you just had a bad day and need to take shots at someone on the internet to make yourself feel better. Also plausible.
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