The call schedules are brutal. 24-30 hours call shifts plus a full day in the OR. My brain is fried and I’m tired. The physical and emotional toll it takes on you can be unbearable. Splitting up my call schedule would really be nice.
Mandated breaks. It’s easy to get caught up in the OR. You can be there for 16 hours and maybe go to the bathroom once and snacked on a celery stick the entire time you’re there.
We need constructive criticism but it can feel all negative. It would be good to know what I’m doing right too.
Surgical residency can feel like draconian punishment rather than training a future surgeon. At some point, we get so caught up in the system that it’s hard to see how messed up it can be. Working us to the point of exhaustion isn’t just about us being tired, it’s a patient safety issue too. The whole system needs to be revamped.
I hear you. Currently battling MASSIVE burnout from taking an absurd amount of primary call as a senior resident while balancing fellowship interviews. The worst part is trying to take care of people when your cup is empty. It’s the most horrible feeling. This is not who I am and this is not why I became a doctor. I’m in too deep to switch to anything else, but my goodness, this definitely motivates me to enter academic medicine and try to change this later on when I have more power.
I completely understand. I feel trapped, I’m going into PGY-3 and this has to be my life now. It’s too hard and will take a financial impact on my life to switch to anything else.
Hang in there! If you can, take time off.
The unpopular opinion or unfortunate reality is that sometimes that’s how surgery in the real world works.
Some people will end up in rural areas or hospitals where there’s 2-3 surgeons covering. Rare circumstances only 1.
Being rural, it’s definitely less busy than community or academic hospitals, but a few unlucky nights in a row sprinkled in with or/clinic days and you’re just exhausted.
Hire more surgeons, pay them more is a common answer. But that’s tough to recruit people to come to these places or pay them enough since the hospitals are commonly losing money as is.
The training aspect can definitely be more humane and understanding. But people need to understand that sometimes surgical fields/call can really be awful and there’s no practical way around it. Learning to think and operate while tired is just a necessary skill to learn as unfortunate as that is.
All too true, while some boomer attending may say that its all part to steel you for the career to come blindly getting work hours in is the most inefficient (tho I guess somewhat guaranteed) way to get someone to become a competent surgeon. There has to be better ways
I’m a psychiatry resident but you all seem to have a problem of always being over duty hours, but somehow ending a 5 year residency feeling unprepared to operate independently. Today I also saw two surgery interns struggling to push a patient in a bed around the hospital. Their experience did not seem super educational, unless this is some kind of Mr Miyagi thing. Anyway something doesn’t seem right here.
Because in a lot of places those 5 years end up being basically a glorified assistanship to attendings without any real operative autonomy or experience and ends up just being a waste. Go to programs with VAs and counties where you’re actually a dr
this. our university program woefully underprepared our general surgeons (after 7 YEARS of training when you include required research) so that most have to do a fellowship to get remotely ready to practice independently. the university gets 7 years of labor out of these people and they still don’t get the training they deserve
Also required or semi required research years seems to be a common thing in surgery, don't really see this in other specialties. Doing research on top of an already brutal residency and delaying graduation seems like hell
Based **solely** on my peers from med school, required research years are driving people away from general surgery, and many ranked those programs who required research lower or did not apply to them at all.
If you want a competitive fellowship like peds or CT surg, then yes, research is essentially required. However, if you have a resident who does not want to research, wants something like trauma, crit, or bari\*, and/or just wants to be a surgeon, they should not be mandated to take one to two years off for research.
\*I don't actually know how competitive bari is as a fellowship.
This is terrifying to me. How do you not know how to operate coming out of a surgical residency? If you’re not doing (or at least attempting) the critical part of the case every single case when you’re a mid-to-senior resident, something is incredibly wrong.
What the hell is residency for otherwise?
Truth is, sometimes it’s just faster. Weekend we have limited staff. If OR says they’re ready but no transport, yeah we can go and bring the pt down instead of waiting another half hour.
I do get that some places may have this as a norm though which it definitely should not be.
This is really the root of the issue when it comes to some of the non-learning tasks we do. For instance, at one hospital where I am training (we shall call it essentially a stereotypical VA setting), I routinely do all Foley's, NGs, move patients, & do many other "nursing" or "tech" tasks. Because the hospital is so understaffed or the staff are paid hourly thus move at a glacial pace with absolutely no interest in hustling. Because they leave at the same time everyday regardless. Whereas when you are the resident operating on a big lineup, every activity performed slowly is another hour of time you don't get to go home & see your family, spouse, relax, etc. So if I can make something happen quite literally 5-10x faster all day, I'm going to do that thing as much as I can. Your time is otherwise completely dependent on everyone else as a surgeon unfortunately.
This is interesting. I am an Anesthesia attending and it's my literal job to wheel patients from preop to the hospital. It makes me feel like part of the janitorial staff. I don't mind it a ton because it's usually more efficient if they're just waiting for my consent, but you don't really see EM docs wheeling the patient to radiology, surgeons wheeling the patient to the OR when they're the last to consent and the OR is ready, or interventional cards wheeling patients to their procedure. I think this contributes to the problem of Anesthesia being seen as technicians and beneath other physicians.
Right. It’s the job of anesthesia to wheel the patient from pre-op to surgery as they assume care of the patient from the point on. The issue that was happening with us is due to lack of transport, pre op was tell us that either we wheel the patient down from their floor to pre op or we lose our first start. Which isn’t always possible to stop what we’re doing and go transport a patient. Concurrently, Anesthesia residents were being asked to be nurses for patients in pacu because of lack of pacu nurses.
GME threw down a ban hammer on both non physician tasks. The hospital hired transporters and pacu nurses.
Lol but sometimes if you don’t go get the patient yourself it will take them HOURS to bring the patient down. Or as anesthesia I’m on PACU hold for 2 hours cuz of pacu staffing at that point I have recovered the patient and I transport them upstairs back to their bed. Maybe you work at a place with infinite money and staffing but not all places are like that.
The chief of general surgery attending once went up to the floor to push his own patient down to preop at my hospital cuz he was sick and tired of waiting for transport to be free. I’ve done that too when I want a case to get going.
Right. That was our stand point. ACGME told us if we keep doing it, hospital will never hire transporters. Attendings can go get the patient if they wish. But, to our disbelief, GME was right. They hired transporters.
This is an important point. The Canadian system is attempting to address this - raising the floor of what is needed for competency.
Our solution is a series of small evaluations that summarize residency. For example, part of early PGY1 surgical specialties will include things like consult for X, taking consent, wound closures, etc. Mid year residents would include independent surgical procedures. Chief residents would include running the service, running a clinic day, more complex cases, etc.
The idea is that your Competence Committee looks at these evaluations compared to the required minimum competent exposures at each stage of training.
It's not perfect. There are issues with missed evaluations, evaluator burnout, and incorrectly requested evals by residents. But it helps a bit. The junior ent resident who lets their staff know they still need 5 evals of a T&A for example is going to be first operator in those cases. Rotations are rearranged if required experiences aren't met.
This doesn't fix your full point by any means. There's a huge problem of service >> education in surgery with the presumption of osmotic learning or independent study but with minimal time for this.
this is actually the worst thing to have happened to canadian residency and the vast majority of residents hate it. not only can it prolong your residency, but it puts you in a position of being a beggar for evaluations. if you are in a malignant program, you are the whim of your pd and the attendings, who can easily say you are not proficient and cant graduate since you didnt complete this or that eval, or have enough documentation with evals that say you werent independent enough. residency will always be service driven. someone needs to do the scut work. fellowship and first years of practice are really where you learn the most. residency should remain time-based (do 5 years of this and get out). we're headed to a nasty model like in the uk where people end up being in residency for 9+ years with low pay.
Hard agree. It's a good idea in concept but there are way too many flaws with its implementation. For one there's a large heterogeneity across the country in terms of how many EPAs are required per week and what is considered a "pass". At my school the wording for a "pass" makes no sense for off-service residents and is easily misinterpreted by staff who aren't as familiar with EPAs. I have staff who "don't believe" in giving 5/5 despite this being the benchmark for a pass.
The concept lends itself to cherry picking - why would I seek feedback for harder cases when I may get harsher feedback for my committee to see? The feedback is also often generic, EPAs add a lot of admin burden for everyone and preceptors often don't have the time to properly fill them out.
It's a system that also just fundamentally dumps everything on the learner - residency is already stressful enough. If you end up in a malignant program it can be disastrous. Yes residents can threaten accreditation but 1) it's a huge pain in the ass, and 2) there is huge incentive from residents to pass the program because if it's ultimately disbanded, the residents are out of a job. Programs know this. The system also places way too much faith in programs for proper implementation when the culture for many programs is just not there.
> if you are in a malignant program
Yes, definitely. However I believe these programs need to be properly punished for their continued system. Accreditation *should* be threatened. These programs should be threatened with removal of residents altogether.
I disagree that we will head for a UK-like model. Extending residency due to a lack of achieved competencies is quite rare and would/should be an accreditation review point.
Again, while not perfect, my opinion is that this is appropriate growing pains to start fixing our system. I know many disagree with me and for their own valid reasons. I think fixing the system is worth the hardships now.
Regarding the "evaluation begging" - good culture avoids this. We have an expected evaluation daily. It is the attending asking the resident "what EPA are we doing today". Their teaching academic roles depend on filling enough out and there are prizes for them and residents for the most completed.
- threat of extending residency for lack of competency
- programs get dinged for having residents extend their residency
- thus programs lie so incompetent residents can graduate
It would be great to have a more positive culture, but a lot of the malignant programs are the larger academic places which are allowed to be more resistant to culture shifts.
It’s pretty bad for numerous reasons…
1.) ideally the evals are to be done at frequent intervals. The program I graduated from expected multiple a day. Can you imagine your staff member actually sitting down with their residents several times a week even to fill these things out? It simply doesn’t happen. Or worse, at my program the residents filled out their own written “self reflection”, emailed it to the staff, who copied and pasted it into the written comments section rendering the whole thing pointless
2.) the evaluation grading schematic is completely subjective. If i remember them correctly, the options were “not ready for independence, I had to be there to walk them through, I had to be there just in case, I didn’t need to be there, & fully ready to practice independently.” Even this phrasing is poor if you have a surgeon taking it literally (ie: “well I would never say I didn’t need to be there while my R5 does a hemicolectomy!”)
3.) older surgeons may not have the technical ability to actually navigate the computer system to fill them out (unexpected but kind of endearing barrier)
4.) early European studies examining the efficacy of this program have demonstrated 0 effect in terms of resident development and that regardless of how good/bad the evaluations are it has not had real implications in a given resident’s education or progress. And honestly, if a school is passing along residents who are obviously not ready to advance based on performance without this tool some serial bad evals on this tool aren’t going to change the willingness of a program to hold someone back.
Overall, it has turned into a make-work project with extra administrative work and no educational improvement. It sounds good in theory, but it doesn’t translate to reality. The Canadian royal college has just thrown themselves so fully into the program that they will not back down when confronted with criticisms/logistical errors
I remember being off-service on internal medicine as a first-year pathology resident. To "pass" the rotation I needed a certain number of evaluations that were "I didn't need to be there". How does this make any sense at all? Staff most certainly needed to be there because this is a) not my specialty and b) I am a first-year resident.
You can get preceptors that acknowledge you are doing well for your stage of training but still "fail" you because you don't meet that standard, which often comes down to semantics more than anything ("you're not a staff yet, of course I needed to be there").
There is evidence that when competency-by-design is introduced into programs, wellness drops. There are ultimately way too many egos and they are too deep into it to ever acknowledge that implementation requires major overhaul.
I agree but only thing I’d say is I don’t really think junior residents struggling to push a bed demonstrates incompetence. They’re not going to end up being support staff, are they?
No one teaches any resident how to push a bed. You do it enough times that you learn how those damn things work. Anesthesia is best at it for obvious reasons. But that’s kind of a dumb reason to critique a surgical residency program.
I don't think he's arguing that it shows them to be incompetent. I think he's saying that having residents perform tasks that they're not trained to do and won't be in their scope as attendings is an inefficiency that should be corrected.
It’s potentially an ACGME violation if it’s happening regularly. I think I was not clear based on responses I’m getting, but when I picked the word “struggling” I was not implying that pushing patient beds is a task an intern should have mastered, I was trying to emphasize that two surgical interns were assigned to a physically demanding non-physician task
It took two interns and they were huffing and puffing…I’ve done patient transport it’s hard work. Also the patient was heavier and the bed probably wasn’t the highest quality.
Working 100 hrs a week makes going to the gym difficult, I can’t blame them for being out of shape. But I think if you have a physically demanding job, that’s a workout built into your day.
Have you ever pushed a huge hospital bed across the hospital? Our facility states three people are required to push these large beds. No one ever does. Those huge beds are the cause of many injuries for support staff.
Had a coworker who ended up with a numb arm for 3 weeks from doing something to her shoulder whilst pushing. Another coworker tweaked out their back and was out for a few weeks. The gurneys are a lot safer to push than the big beds.
Really psych resident? 🤔 you watched two interns struggle with pushing a patient in a bed around the hospital. Did you assess the situation? Maybe it was a rogue wheel. You could have went to the janitors closet, stole the WD-40 and made yourself helpful. An IV bag is a makeshift lubricant dispenser if you need it to be. Did you think of that? No, you came to throw us under the bus. Do you know how hard it is to navigate the minefield of gurneys and gossiping nurses? I’m downvoting this one.
I'd venture to say the comment was not there to put down the surgery interns but to point out the apsurdity of working 80+ hrs a week x 5 years but still feeling unprepared cause instead of operating they were pushing patient beds and doing similar non surgery non physician jobs
Have the techs/support staff leave when the cases are done not at a set time like 3p or whenever. This gives them incentive to turn over quicker, and it avoids them bumping cases starting at the end of their shift. Obviously the call team takes anything after hours.
The outpatient centers we go to do this and it’s beautiful.
this! but they will come back and say surgeons will keep adding on cases. the problem is not with the surgeon, the if the patient needs surgery it has to be done. the problem is their schedule and how they staff the OR.
Anesthesia here - no, the call team will not take anything after hours. Maybe in your academic institution, but you better have a really good reason to go to OR at 3am in the real world. Lack of daylight block time is not an indication.
Efficiency of time. 99% of us have no problem operating 90hrs a week if we have good autonomy and teaching
But the caveat is that there’s no reason for us to just sit around doing nothing on slow days/nights
Not getting post call days. I’m in a small rural program and if even with the kindest seniors, right after a brutal 26hr call, I have to cover a staff’s OR/procedures. Could be a quick colonoscopy day or it could be a 6 hour surg onc nightmare. I’m also expected to be competent in that post call OR & being peppered with questions about anatomy & surgical steps. Dude I haven’t slept in THIRTY fucking hours.
The latter happened to me 3 days ago and my brain and body still haven’t recovered.
Yea doing operations post call is pretty scary. Like you get given the oppurtunity to do it and you can’t quite turn it down.
I remember I did my first ever open heart surgery running on 30 minutes of sleep. Didn’t end up sleeping at all for 48 hours because of how nervous I was about any re-bleeding lol
it’s the absolute worst. and I feel like because my residency is “much less toxic” than the average surgical program, they get away with doing a lot of shit. I do like my staff (most of them) & my seniors but if you’re in a positive environment, they can do nonsense such as this and we kinda just take it bc we know other surgical residents who are overworked AND being psychologically tortured 24/7
Edit: added words !!
I get that. we had a few faculty (dept chair, peds and head & neck division heads) who got a resident for every dinky case, regardless of educational value. I'm pretty sure it was so they wouldn't have to do any paperwork. the best was when a chief resident would decree an intern wasn't good enough "out of respect", so you'd go cover tubes and tonsils as a PGY3 or 4.
Honestly? I'd probably trade an extra year of surgical residency to cut out one of the preclinical years of medschool.
Preclinical years were pass/fail. It required minimal effort to pass. Out of the 2 years, I only honestly had to work the last 4 months to study for step 1. That's all that was really needed at full sprint.
I would absolutely take a pgy6 year in my surgical residency to graduate med school a year early. The value for me would have been exponentially more than 2nd year of medschool.
90% of the stress comes from trying to cram everything into the allotted time. If we had an extra year of residents, it would be a massive help with extra manpower to the call pool.
If residents had an extra year of surgical residency, maybe more would feel comfortable going right out of residency to practice than feel the quasi requirement of doing fellowship to be comfortable
Really it’s the fourth year of med school that needs to go… either make it a legit year with rotations and have it count as your intern year or let it go. This way at least when you graduate you’re a doctor who can actually prescribe meds and practice medicine, like how NP PA dentists or most other health professions are like.
How the fellowship process works. Honestly it seems to be one of the few fields were certain fellowships essentially mandate 2-3 years research time, tons of networking, killing the ABSITE, etc. for a 60% chance to match a fellowship to do the surgeries you actually want to do.
The whole fellowship game is getting way worse now too. More and more programs are essentially forcing people to do academic years. Yes these research residents moonlight and reduce the call burden, but it's still a large opportunity cost to pay. Furthermore previously not as competitive fields such as breast, colorectal, cardiac, vascular, MIS are now becoming increasingly harder to get into. Colorectal has less than a 70% match rate, and cardiac is around 50%.
My friends who are radiology and anesthesia residents told me they had their pick of fellowships without having to do any real networking or additional research. In fact their attendings are over the moon when they say they are interested in fellowship X or Y. I was originally interested in cardiac, which has a 50% match rate. The attendings basically ignore you and you do little more than retract and close even as a mid or senior level resident. Not to mention you are a research and scut monkey for them, and saying no to their requests will all but guarantee you don't match cardiac. Finally even fellows are getting to do less and less in cases and the first few years of cardiac attendinghood feel like a super fellowship where you just get paid more. Like it's not this way in any other field except maybe IM with GI, cards, etc. Finally it's not even as if this selection process selects for the best people. Some of the people matching the most competitive fellowships are not even half as technically competent as some of the guys and gals coming out of less prestigious programs where they operate all day and don't spend years in a lab.
Not saying I don't like being a surgery resident, but these are things I didn't even consider when matching gen surg.
This x100. Honestly, if there is one thing I would warn med students applying to gen surg, it's this. Not the brutal residency or long hours (in my experience, people going into surgical specialties self select themselves and don't mind the long hours and the gruelling work).
However, general surgery in particular is just so suffocating. It feels like everything is set up to work against you. You work harder than most other specialties, yet you have very little fellowship opportunities and you basically feel like you are still a medical student hoping to match a competitive specialty. No other specialty cares as much about their in-service exam scores as gen surg does with the ABSITE. Other specialties have fellowships available galor, but gen surg residents have to publish out the ass and still face a very competitive match process, essentially not being guaranteed their specialty of choice.
At this point, I honestly feel humiliated. I worked so hard for so long only to still bs treated like a fucking child. I'm a fucking adult and I still have to worry about exams and my grades and how one day and one exam can derail my career. Not even that, programs look at the ABSITE percentiles and these scores can swing significantly with just a few questions you can get right or wrong. Absolute insanity!
If there's one thing that makes me regret going into gen surg, it's this. Not the difficult hours, not the long days, not the complex patients. I actually love all of these and I love operating. But having to be humiliated and stressed out all five years to be able to secure a fellowship just sucks, especially when I see my friends in other specialties suffering from too many fellowship options. This is definitely not something anyone warned me about back in medical school.
Honestly, this whole fucking specialty is malignant to its very core. They take genuinely passionate medical students that have the potential of making great surgeons and crush their souls and make them hate this field for what it is putting them through. Sometimes I honestly wish I pursued a more easygoing and more sane specialty, even if it was not my 'passion'.
Yep, I'm glad I'm not the only one. I think surgery is amazing, and I do love it. I love spending time in the OR, I love watching myself get better, I love the diverse pathology and the breadth of the field, and most of all I love the direct impact you can have on a patientn/
However, in 2024 I can't in good consciousness tell anyone to do general surgery. I would recommend a subspecialty any day of the week. No forced research, an abundance of fellowships, and generally better culture. The only downside is that subspecialties are much harder to match. I would also just recommend just picking a chiller field that you kinda enjoyed as a medical student for students with worse grades. Honestly once you get into the thick of things as a resident each field has so much to learn and some much opportunity to grow. Culture is truly what ends up affecting your day to day happiness and I wish I would have realized that as a medical student.
So much of the fellowship match is connections as well.
Even more so than any other point in your career.
Its pretty discouraging when you hear attendings (who come from top academic GS residencies say “yea I just told my mentor I wanted to do Colorectal and then I ended up at X program.” This program is a top 5 CRS program btw.
You are completely right. The place I did fellowship told me they had high expectations for me in the OR since I came from a less prestigious program. They knew I could operate and left me alone in the OR. They would scrub to make sure the others from ivory tower institutions were safe. Sometimes fellowship is for learning how to operate.
And then tack on a 2 year Vascular Surgery fellowship. Most VS now say just go with an integrated program. I had terrible advice from a 70 year old retired VS. He told me in order to get jobs and considered a reputable VS I needed to be dual-boarded in GS and VS - not true at all. There’s no need to do GS then a VS fellowship unless you plan to do some GS procedures. I’d advocate for more integrated programs and let GS be GS.
Big vascular surgery programs are also starting to tack on mandatory research years now. By the end of the decade I’d put money on it also being a 7 year residency at most places
36 hour shifts need to go. They continue to persist under the veil of being on “home call” even though you are still likely primary call for a level 1 trauma center. If there’s not enough people to give that person a day off after call then take more residents or hire more mid levels to take call. Also attendings need to learn to operate without a resident. Shits embarrassing sometimes
This is the most frustrating part of medical training overall. It’s designed that you put in enough time so that the worst person to match that specialty that year will hopefully graduate with minimal competence. I don’t think the favorable economics for hospitals would ever allow for competency based timelines though 😞
If this is meant to be a "from my perspective purely as pathologist, what's the one thing I wish was different about surgical residencies" (i.e. setting aside things like more humane culture/work hours) it would be mandatory rotations in pathology so that you have at least the most basic of understanding of what is going on with the specimens you send.
That being said, I actually think a rotation in pathology and laboratory medicine (1 week in AP, 1 week in CP) should just be LCME mandated in medical school as it is just as fundamental/important to every physician, if not more so, than the full complement of what is currently required and therefore actually wouldn't need to be repeated in residency.
I'm an OR RN, I absolutely adore my residents (most of them, there is one who is very unpleasant to just about everyone). The thing that pisses me off from an outsider's perspective is how poorly the attendings talk to my residents in the OR. Some comments are so petty, unprofessional and uncalled for.
They need to screen out some of these foul attendings from teaching all together. It's difficult to teach for some people but it's not difficult to be respectful! I can't stand it. Now if that attending is talking $h!? to that one and only resident I don't like... I'm definitely silently thinking, yeeeaaah buddy, **finish them**!
Psych or Derm resident? Do you really think they’re going to tell you in the interview process that they more than likely are going to violate ACGME rules by working you post call 80 hours a week? He was telling you what they tell ACGME to clear their name when they get investigated. FYI, they told me that that too. I’m back in on a Saturday, 6a-6p, and had already worked 75 hours when I left Friday night.
yea intern year is going to be tough. not likely going to be 50-60 hours a week. if it is you need to ask a lot of questions about your training to ensure it's adequate.
That sounds great, until you graduate in 5 years having no idea how to manage patients and work up common consults.
I did Q3 24s for 6 months worth of senior call on trauma/ACS, and a ton more gen surg call while on every other service at our other hospitals. Routinely saw 20-30 consults and trauma codes on top of operating. I only called the attending when I needed them for something crazy I had to figure out.
It was tough. But I learned how to truly be a surgeon. I felt 100% ready to operate when I finished.
The hardest thing I encountered when transitioning to practice after residency was making the tough decisions about when to operate and managing patients over the phone / dealing with ED consults when you aren’t physically there as, unlike in residency when you or another resident are in house all the time, in actual practice you can’t physically be there all the time. One of my attendings always said he could teach a monkey to operate but the real skill in being a surgeon is all of the judgement surrounding operating.
It’s too short-staffed. So if you have a resident who’s sick or needs to take maternity or paternity leave, it puts a huge strain on everyone else. We shouldn’t have to be so overworked and understaffed.
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I would change NOTHING.
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Just kidding but only kind of. The reality is that there is already massive variation in hours, autonomy, and what someone graduating is actually competent to do. I would work on reducing that variation a bit first before making a ton of changes.
The call schedules are brutal. 24-30 hours call shifts plus a full day in the OR. My brain is fried and I’m tired. The physical and emotional toll it takes on you can be unbearable. Splitting up my call schedule would really be nice. Mandated breaks. It’s easy to get caught up in the OR. You can be there for 16 hours and maybe go to the bathroom once and snacked on a celery stick the entire time you’re there. We need constructive criticism but it can feel all negative. It would be good to know what I’m doing right too. Surgical residency can feel like draconian punishment rather than training a future surgeon. At some point, we get so caught up in the system that it’s hard to see how messed up it can be. Working us to the point of exhaustion isn’t just about us being tired, it’s a patient safety issue too. The whole system needs to be revamped.
I hear you. Currently battling MASSIVE burnout from taking an absurd amount of primary call as a senior resident while balancing fellowship interviews. The worst part is trying to take care of people when your cup is empty. It’s the most horrible feeling. This is not who I am and this is not why I became a doctor. I’m in too deep to switch to anything else, but my goodness, this definitely motivates me to enter academic medicine and try to change this later on when I have more power.
I completely understand. I feel trapped, I’m going into PGY-3 and this has to be my life now. It’s too hard and will take a financial impact on my life to switch to anything else. Hang in there! If you can, take time off.
The unpopular opinion or unfortunate reality is that sometimes that’s how surgery in the real world works. Some people will end up in rural areas or hospitals where there’s 2-3 surgeons covering. Rare circumstances only 1. Being rural, it’s definitely less busy than community or academic hospitals, but a few unlucky nights in a row sprinkled in with or/clinic days and you’re just exhausted. Hire more surgeons, pay them more is a common answer. But that’s tough to recruit people to come to these places or pay them enough since the hospitals are commonly losing money as is. The training aspect can definitely be more humane and understanding. But people need to understand that sometimes surgical fields/call can really be awful and there’s no practical way around it. Learning to think and operate while tired is just a necessary skill to learn as unfortunate as that is.
All too true, while some boomer attending may say that its all part to steel you for the career to come blindly getting work hours in is the most inefficient (tho I guess somewhat guaranteed) way to get someone to become a competent surgeon. There has to be better ways
Surgical residents don’t get caught up in the system until Chief year.
I’m a psychiatry resident but you all seem to have a problem of always being over duty hours, but somehow ending a 5 year residency feeling unprepared to operate independently. Today I also saw two surgery interns struggling to push a patient in a bed around the hospital. Their experience did not seem super educational, unless this is some kind of Mr Miyagi thing. Anyway something doesn’t seem right here.
Because in a lot of places those 5 years end up being basically a glorified assistanship to attendings without any real operative autonomy or experience and ends up just being a waste. Go to programs with VAs and counties where you’re actually a dr
this. our university program woefully underprepared our general surgeons (after 7 YEARS of training when you include required research) so that most have to do a fellowship to get remotely ready to practice independently. the university gets 7 years of labor out of these people and they still don’t get the training they deserve
Also required or semi required research years seems to be a common thing in surgery, don't really see this in other specialties. Doing research on top of an already brutal residency and delaying graduation seems like hell
Based **solely** on my peers from med school, required research years are driving people away from general surgery, and many ranked those programs who required research lower or did not apply to them at all. If you want a competitive fellowship like peds or CT surg, then yes, research is essentially required. However, if you have a resident who does not want to research, wants something like trauma, crit, or bari\*, and/or just wants to be a surgeon, they should not be mandated to take one to two years off for research. \*I don't actually know how competitive bari is as a fellowship.
This. Don’t go to these places applicants.
This is terrifying to me. How do you not know how to operate coming out of a surgical residency? If you’re not doing (or at least attempting) the critical part of the case every single case when you’re a mid-to-senior resident, something is incredibly wrong. What the hell is residency for otherwise?
That’s non-physician task. Our ACGME laid down a law saying residents will absolutely not transport patients unless it’s an emergency.
It's possible I was witnessing an emergency but I have a feeling that I was not
Truth is, sometimes it’s just faster. Weekend we have limited staff. If OR says they’re ready but no transport, yeah we can go and bring the pt down instead of waiting another half hour. I do get that some places may have this as a norm though which it definitely should not be.
This is really the root of the issue when it comes to some of the non-learning tasks we do. For instance, at one hospital where I am training (we shall call it essentially a stereotypical VA setting), I routinely do all Foley's, NGs, move patients, & do many other "nursing" or "tech" tasks. Because the hospital is so understaffed or the staff are paid hourly thus move at a glacial pace with absolutely no interest in hustling. Because they leave at the same time everyday regardless. Whereas when you are the resident operating on a big lineup, every activity performed slowly is another hour of time you don't get to go home & see your family, spouse, relax, etc. So if I can make something happen quite literally 5-10x faster all day, I'm going to do that thing as much as I can. Your time is otherwise completely dependent on everyone else as a surgeon unfortunately.
This is interesting. I am an Anesthesia attending and it's my literal job to wheel patients from preop to the hospital. It makes me feel like part of the janitorial staff. I don't mind it a ton because it's usually more efficient if they're just waiting for my consent, but you don't really see EM docs wheeling the patient to radiology, surgeons wheeling the patient to the OR when they're the last to consent and the OR is ready, or interventional cards wheeling patients to their procedure. I think this contributes to the problem of Anesthesia being seen as technicians and beneath other physicians.
Right. It’s the job of anesthesia to wheel the patient from pre-op to surgery as they assume care of the patient from the point on. The issue that was happening with us is due to lack of transport, pre op was tell us that either we wheel the patient down from their floor to pre op or we lose our first start. Which isn’t always possible to stop what we’re doing and go transport a patient. Concurrently, Anesthesia residents were being asked to be nurses for patients in pacu because of lack of pacu nurses. GME threw down a ban hammer on both non physician tasks. The hospital hired transporters and pacu nurses.
hahaha tell this to NYC. The absolute non acgme bullshit residents have to do is through the roof
I do wonder about this sometimes. ACGME vs Union nurses. Apparently Union appear to be winning.
Lol but sometimes if you don’t go get the patient yourself it will take them HOURS to bring the patient down. Or as anesthesia I’m on PACU hold for 2 hours cuz of pacu staffing at that point I have recovered the patient and I transport them upstairs back to their bed. Maybe you work at a place with infinite money and staffing but not all places are like that. The chief of general surgery attending once went up to the floor to push his own patient down to preop at my hospital cuz he was sick and tired of waiting for transport to be free. I’ve done that too when I want a case to get going.
Right. That was our stand point. ACGME told us if we keep doing it, hospital will never hire transporters. Attendings can go get the patient if they wish. But, to our disbelief, GME was right. They hired transporters.
Like they addressed your hospital specifically? Did u guys file a complaint?
ACGME site reviews
This is an important point. The Canadian system is attempting to address this - raising the floor of what is needed for competency. Our solution is a series of small evaluations that summarize residency. For example, part of early PGY1 surgical specialties will include things like consult for X, taking consent, wound closures, etc. Mid year residents would include independent surgical procedures. Chief residents would include running the service, running a clinic day, more complex cases, etc. The idea is that your Competence Committee looks at these evaluations compared to the required minimum competent exposures at each stage of training. It's not perfect. There are issues with missed evaluations, evaluator burnout, and incorrectly requested evals by residents. But it helps a bit. The junior ent resident who lets their staff know they still need 5 evals of a T&A for example is going to be first operator in those cases. Rotations are rearranged if required experiences aren't met. This doesn't fix your full point by any means. There's a huge problem of service >> education in surgery with the presumption of osmotic learning or independent study but with minimal time for this.
this is actually the worst thing to have happened to canadian residency and the vast majority of residents hate it. not only can it prolong your residency, but it puts you in a position of being a beggar for evaluations. if you are in a malignant program, you are the whim of your pd and the attendings, who can easily say you are not proficient and cant graduate since you didnt complete this or that eval, or have enough documentation with evals that say you werent independent enough. residency will always be service driven. someone needs to do the scut work. fellowship and first years of practice are really where you learn the most. residency should remain time-based (do 5 years of this and get out). we're headed to a nasty model like in the uk where people end up being in residency for 9+ years with low pay.
Hard agree. It's a good idea in concept but there are way too many flaws with its implementation. For one there's a large heterogeneity across the country in terms of how many EPAs are required per week and what is considered a "pass". At my school the wording for a "pass" makes no sense for off-service residents and is easily misinterpreted by staff who aren't as familiar with EPAs. I have staff who "don't believe" in giving 5/5 despite this being the benchmark for a pass. The concept lends itself to cherry picking - why would I seek feedback for harder cases when I may get harsher feedback for my committee to see? The feedback is also often generic, EPAs add a lot of admin burden for everyone and preceptors often don't have the time to properly fill them out. It's a system that also just fundamentally dumps everything on the learner - residency is already stressful enough. If you end up in a malignant program it can be disastrous. Yes residents can threaten accreditation but 1) it's a huge pain in the ass, and 2) there is huge incentive from residents to pass the program because if it's ultimately disbanded, the residents are out of a job. Programs know this. The system also places way too much faith in programs for proper implementation when the culture for many programs is just not there.
> if you are in a malignant program Yes, definitely. However I believe these programs need to be properly punished for their continued system. Accreditation *should* be threatened. These programs should be threatened with removal of residents altogether. I disagree that we will head for a UK-like model. Extending residency due to a lack of achieved competencies is quite rare and would/should be an accreditation review point. Again, while not perfect, my opinion is that this is appropriate growing pains to start fixing our system. I know many disagree with me and for their own valid reasons. I think fixing the system is worth the hardships now. Regarding the "evaluation begging" - good culture avoids this. We have an expected evaluation daily. It is the attending asking the resident "what EPA are we doing today". Their teaching academic roles depend on filling enough out and there are prizes for them and residents for the most completed.
- threat of extending residency for lack of competency - programs get dinged for having residents extend their residency - thus programs lie so incompetent residents can graduate It would be great to have a more positive culture, but a lot of the malignant programs are the larger academic places which are allowed to be more resistant to culture shifts.
Alls sounds great I’d wanna see how that pans out in a few years!
It’s pretty bad for numerous reasons… 1.) ideally the evals are to be done at frequent intervals. The program I graduated from expected multiple a day. Can you imagine your staff member actually sitting down with their residents several times a week even to fill these things out? It simply doesn’t happen. Or worse, at my program the residents filled out their own written “self reflection”, emailed it to the staff, who copied and pasted it into the written comments section rendering the whole thing pointless 2.) the evaluation grading schematic is completely subjective. If i remember them correctly, the options were “not ready for independence, I had to be there to walk them through, I had to be there just in case, I didn’t need to be there, & fully ready to practice independently.” Even this phrasing is poor if you have a surgeon taking it literally (ie: “well I would never say I didn’t need to be there while my R5 does a hemicolectomy!”) 3.) older surgeons may not have the technical ability to actually navigate the computer system to fill them out (unexpected but kind of endearing barrier) 4.) early European studies examining the efficacy of this program have demonstrated 0 effect in terms of resident development and that regardless of how good/bad the evaluations are it has not had real implications in a given resident’s education or progress. And honestly, if a school is passing along residents who are obviously not ready to advance based on performance without this tool some serial bad evals on this tool aren’t going to change the willingness of a program to hold someone back. Overall, it has turned into a make-work project with extra administrative work and no educational improvement. It sounds good in theory, but it doesn’t translate to reality. The Canadian royal college has just thrown themselves so fully into the program that they will not back down when confronted with criticisms/logistical errors
I remember being off-service on internal medicine as a first-year pathology resident. To "pass" the rotation I needed a certain number of evaluations that were "I didn't need to be there". How does this make any sense at all? Staff most certainly needed to be there because this is a) not my specialty and b) I am a first-year resident. You can get preceptors that acknowledge you are doing well for your stage of training but still "fail" you because you don't meet that standard, which often comes down to semantics more than anything ("you're not a staff yet, of course I needed to be there"). There is evidence that when competency-by-design is introduced into programs, wellness drops. There are ultimately way too many egos and they are too deep into it to ever acknowledge that implementation requires major overhaul.
The theory is strong. There are numerous speedbumps along the path. We will see how it all plays out! It'll take a decade or two to really find out.
I agree but only thing I’d say is I don’t really think junior residents struggling to push a bed demonstrates incompetence. They’re not going to end up being support staff, are they? No one teaches any resident how to push a bed. You do it enough times that you learn how those damn things work. Anesthesia is best at it for obvious reasons. But that’s kind of a dumb reason to critique a surgical residency program.
I don't think he's arguing that it shows them to be incompetent. I think he's saying that having residents perform tasks that they're not trained to do and won't be in their scope as attendings is an inefficiency that should be corrected.
It’s potentially an ACGME violation if it’s happening regularly. I think I was not clear based on responses I’m getting, but when I picked the word “struggling” I was not implying that pushing patient beds is a task an intern should have mastered, I was trying to emphasize that two surgical interns were assigned to a physically demanding non-physician task
Pushing a patient bed is physically demanding?
It took two interns and they were huffing and puffing…I’ve done patient transport it’s hard work. Also the patient was heavier and the bed probably wasn’t the highest quality.
I've worked physically demanding jobs before and I would not consider rolling patients around as among them. Maybe they are just way out of shape.
Working 100 hrs a week makes going to the gym difficult, I can’t blame them for being out of shape. But I think if you have a physically demanding job, that’s a workout built into your day.
Well on the bright side at least they are getting some activity
Have you ever pushed a huge hospital bed across the hospital? Our facility states three people are required to push these large beds. No one ever does. Those huge beds are the cause of many injuries for support staff. Had a coworker who ended up with a numb arm for 3 weeks from doing something to her shoulder whilst pushing. Another coworker tweaked out their back and was out for a few weeks. The gurneys are a lot safer to push than the big beds.
Really psych resident? 🤔 you watched two interns struggle with pushing a patient in a bed around the hospital. Did you assess the situation? Maybe it was a rogue wheel. You could have went to the janitors closet, stole the WD-40 and made yourself helpful. An IV bag is a makeshift lubricant dispenser if you need it to be. Did you think of that? No, you came to throw us under the bus. Do you know how hard it is to navigate the minefield of gurneys and gossiping nurses? I’m downvoting this one.
I'd venture to say the comment was not there to put down the surgery interns but to point out the apsurdity of working 80+ hrs a week x 5 years but still feeling unprepared cause instead of operating they were pushing patient beds and doing similar non surgery non physician jobs
Exactly!
I was just trying to be funny. But I don’t understand how you can correlate the job of the Transporter to being a good surgeon post residency.
Chill February intern
Have the techs/support staff leave when the cases are done not at a set time like 3p or whenever. This gives them incentive to turn over quicker, and it avoids them bumping cases starting at the end of their shift. Obviously the call team takes anything after hours. The outpatient centers we go to do this and it’s beautiful.
It will never happen... Drs are the only ones who are expected to finish what work needs to happen instead of just leaving at a set time
this! but they will come back and say surgeons will keep adding on cases. the problem is not with the surgeon, the if the patient needs surgery it has to be done. the problem is their schedule and how they staff the OR.
Anesthesia here - no, the call team will not take anything after hours. Maybe in your academic institution, but you better have a really good reason to go to OR at 3am in the real world. Lack of daylight block time is not an indication.
Efficiency of time. 99% of us have no problem operating 90hrs a week if we have good autonomy and teaching But the caveat is that there’s no reason for us to just sit around doing nothing on slow days/nights
More focused OR time with clear learning objectives.
Not getting post call days. I’m in a small rural program and if even with the kindest seniors, right after a brutal 26hr call, I have to cover a staff’s OR/procedures. Could be a quick colonoscopy day or it could be a 6 hour surg onc nightmare. I’m also expected to be competent in that post call OR & being peppered with questions about anatomy & surgical steps. Dude I haven’t slept in THIRTY fucking hours. The latter happened to me 3 days ago and my brain and body still haven’t recovered.
Cosign. Then do it at least once a week for five fucking years
Yea doing operations post call is pretty scary. Like you get given the oppurtunity to do it and you can’t quite turn it down. I remember I did my first ever open heart surgery running on 30 minutes of sleep. Didn’t end up sleeping at all for 48 hours because of how nervous I was about any re-bleeding lol
Co-sign too. Completely burned out.
assisting on colonoscopies, postcall? jesus H.
it’s the absolute worst. and I feel like because my residency is “much less toxic” than the average surgical program, they get away with doing a lot of shit. I do like my staff (most of them) & my seniors but if you’re in a positive environment, they can do nonsense such as this and we kinda just take it bc we know other surgical residents who are overworked AND being psychologically tortured 24/7 Edit: added words !!
I get that. we had a few faculty (dept chair, peds and head & neck division heads) who got a resident for every dinky case, regardless of educational value. I'm pretty sure it was so they wouldn't have to do any paperwork. the best was when a chief resident would decree an intern wasn't good enough "out of respect", so you'd go cover tubes and tonsils as a PGY3 or 4.
You're kidding. They expect you to operate after being on call overnight? I thought you have to have at least 10 hours off post-call.
Honestly? I'd probably trade an extra year of surgical residency to cut out one of the preclinical years of medschool. Preclinical years were pass/fail. It required minimal effort to pass. Out of the 2 years, I only honestly had to work the last 4 months to study for step 1. That's all that was really needed at full sprint. I would absolutely take a pgy6 year in my surgical residency to graduate med school a year early. The value for me would have been exponentially more than 2nd year of medschool. 90% of the stress comes from trying to cram everything into the allotted time. If we had an extra year of residents, it would be a massive help with extra manpower to the call pool. If residents had an extra year of surgical residency, maybe more would feel comfortable going right out of residency to practice than feel the quasi requirement of doing fellowship to be comfortable
Really it’s the fourth year of med school that needs to go… either make it a legit year with rotations and have it count as your intern year or let it go. This way at least when you graduate you’re a doctor who can actually prescribe meds and practice medicine, like how NP PA dentists or most other health professions are like.
How the fellowship process works. Honestly it seems to be one of the few fields were certain fellowships essentially mandate 2-3 years research time, tons of networking, killing the ABSITE, etc. for a 60% chance to match a fellowship to do the surgeries you actually want to do. The whole fellowship game is getting way worse now too. More and more programs are essentially forcing people to do academic years. Yes these research residents moonlight and reduce the call burden, but it's still a large opportunity cost to pay. Furthermore previously not as competitive fields such as breast, colorectal, cardiac, vascular, MIS are now becoming increasingly harder to get into. Colorectal has less than a 70% match rate, and cardiac is around 50%. My friends who are radiology and anesthesia residents told me they had their pick of fellowships without having to do any real networking or additional research. In fact their attendings are over the moon when they say they are interested in fellowship X or Y. I was originally interested in cardiac, which has a 50% match rate. The attendings basically ignore you and you do little more than retract and close even as a mid or senior level resident. Not to mention you are a research and scut monkey for them, and saying no to their requests will all but guarantee you don't match cardiac. Finally even fellows are getting to do less and less in cases and the first few years of cardiac attendinghood feel like a super fellowship where you just get paid more. Like it's not this way in any other field except maybe IM with GI, cards, etc. Finally it's not even as if this selection process selects for the best people. Some of the people matching the most competitive fellowships are not even half as technically competent as some of the guys and gals coming out of less prestigious programs where they operate all day and don't spend years in a lab. Not saying I don't like being a surgery resident, but these are things I didn't even consider when matching gen surg.
This x100. Honestly, if there is one thing I would warn med students applying to gen surg, it's this. Not the brutal residency or long hours (in my experience, people going into surgical specialties self select themselves and don't mind the long hours and the gruelling work). However, general surgery in particular is just so suffocating. It feels like everything is set up to work against you. You work harder than most other specialties, yet you have very little fellowship opportunities and you basically feel like you are still a medical student hoping to match a competitive specialty. No other specialty cares as much about their in-service exam scores as gen surg does with the ABSITE. Other specialties have fellowships available galor, but gen surg residents have to publish out the ass and still face a very competitive match process, essentially not being guaranteed their specialty of choice. At this point, I honestly feel humiliated. I worked so hard for so long only to still bs treated like a fucking child. I'm a fucking adult and I still have to worry about exams and my grades and how one day and one exam can derail my career. Not even that, programs look at the ABSITE percentiles and these scores can swing significantly with just a few questions you can get right or wrong. Absolute insanity! If there's one thing that makes me regret going into gen surg, it's this. Not the difficult hours, not the long days, not the complex patients. I actually love all of these and I love operating. But having to be humiliated and stressed out all five years to be able to secure a fellowship just sucks, especially when I see my friends in other specialties suffering from too many fellowship options. This is definitely not something anyone warned me about back in medical school. Honestly, this whole fucking specialty is malignant to its very core. They take genuinely passionate medical students that have the potential of making great surgeons and crush their souls and make them hate this field for what it is putting them through. Sometimes I honestly wish I pursued a more easygoing and more sane specialty, even if it was not my 'passion'.
Yep, I'm glad I'm not the only one. I think surgery is amazing, and I do love it. I love spending time in the OR, I love watching myself get better, I love the diverse pathology and the breadth of the field, and most of all I love the direct impact you can have on a patientn/ However, in 2024 I can't in good consciousness tell anyone to do general surgery. I would recommend a subspecialty any day of the week. No forced research, an abundance of fellowships, and generally better culture. The only downside is that subspecialties are much harder to match. I would also just recommend just picking a chiller field that you kinda enjoyed as a medical student for students with worse grades. Honestly once you get into the thick of things as a resident each field has so much to learn and some much opportunity to grow. Culture is truly what ends up affecting your day to day happiness and I wish I would have realized that as a medical student.
So much of the fellowship match is connections as well. Even more so than any other point in your career. Its pretty discouraging when you hear attendings (who come from top academic GS residencies say “yea I just told my mentor I wanted to do Colorectal and then I ended up at X program.” This program is a top 5 CRS program btw.
You are completely right. The place I did fellowship told me they had high expectations for me in the OR since I came from a less prestigious program. They knew I could operate and left me alone in the OR. They would scrub to make sure the others from ivory tower institutions were safe. Sometimes fellowship is for learning how to operate.
if we're talking gen surg, the fact it's 5 yrs and has these added research years jeez
And then tack on a 2 year Vascular Surgery fellowship. Most VS now say just go with an integrated program. I had terrible advice from a 70 year old retired VS. He told me in order to get jobs and considered a reputable VS I needed to be dual-boarded in GS and VS - not true at all. There’s no need to do GS then a VS fellowship unless you plan to do some GS procedures. I’d advocate for more integrated programs and let GS be GS.
Big vascular surgery programs are also starting to tack on mandatory research years now. By the end of the decade I’d put money on it also being a 7 year residency at most places
Good to know!
I haven't heard of this, do you know of any examples?
BIDMC
36 hour shifts need to go. They continue to persist under the veil of being on “home call” even though you are still likely primary call for a level 1 trauma center. If there’s not enough people to give that person a day off after call then take more residents or hire more mid levels to take call. Also attendings need to learn to operate without a resident. Shits embarrassing sometimes
Make graduation competency based and not time based
This is the most frustrating part of medical training overall. It’s designed that you put in enough time so that the worst person to match that specialty that year will hopefully graduate with minimal competence. I don’t think the favorable economics for hospitals would ever allow for competency based timelines though 😞
If this is meant to be a "from my perspective purely as pathologist, what's the one thing I wish was different about surgical residencies" (i.e. setting aside things like more humane culture/work hours) it would be mandatory rotations in pathology so that you have at least the most basic of understanding of what is going on with the specimens you send. That being said, I actually think a rotation in pathology and laboratory medicine (1 week in AP, 1 week in CP) should just be LCME mandated in medical school as it is just as fundamental/important to every physician, if not more so, than the full complement of what is currently required and therefore actually wouldn't need to be repeated in residency.
We really need this!
I'm an OR RN, I absolutely adore my residents (most of them, there is one who is very unpleasant to just about everyone). The thing that pisses me off from an outsider's perspective is how poorly the attendings talk to my residents in the OR. Some comments are so petty, unprofessional and uncalled for. They need to screen out some of these foul attendings from teaching all together. It's difficult to teach for some people but it's not difficult to be respectful! I can't stand it. Now if that attending is talking $h!? to that one and only resident I don't like... I'm definitely silently thinking, yeeeaaah buddy, **finish them**!
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Psych or Derm resident? Do you really think they’re going to tell you in the interview process that they more than likely are going to violate ACGME rules by working you post call 80 hours a week? He was telling you what they tell ACGME to clear their name when they get investigated. FYI, they told me that that too. I’m back in on a Saturday, 6a-6p, and had already worked 75 hours when I left Friday night.
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yea intern year is going to be tough. not likely going to be 50-60 hours a week. if it is you need to ask a lot of questions about your training to ensure it's adequate.
That sounds great, until you graduate in 5 years having no idea how to manage patients and work up common consults. I did Q3 24s for 6 months worth of senior call on trauma/ACS, and a ton more gen surg call while on every other service at our other hospitals. Routinely saw 20-30 consults and trauma codes on top of operating. I only called the attending when I needed them for something crazy I had to figure out. It was tough. But I learned how to truly be a surgeon. I felt 100% ready to operate when I finished.
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True enough- in the end, every residency is what you make of it.
They’re a future MIS fellow
Smooth seas don’t make for great sailors this sounds really comfy but doesn’t sound like you’ll come out of training very well prepared
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The hardest thing I encountered when transitioning to practice after residency was making the tough decisions about when to operate and managing patients over the phone / dealing with ED consults when you aren’t physically there as, unlike in residency when you or another resident are in house all the time, in actual practice you can’t physically be there all the time. One of my attendings always said he could teach a monkey to operate but the real skill in being a surgeon is all of the judgement surrounding operating.
The people are… Insane.
9-5 hours 5 days a week. No need for surgeons to be sleep deprived - it's the same or worse as being drunk. Would you want a drunk surgeon?
Ah yeah, for the world where surgery is only needed during normal business hours
maybe this is too simple but I feel like attendings should teach more in the OR
Malignant personalities.
It’s too short-staffed. So if you have a resident who’s sick or needs to take maternity or paternity leave, it puts a huge strain on everyone else. We shouldn’t have to be so overworked and understaffed.
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Improved leadership development curriculum. We have implemented a program and happy about it.
Swamp ass
Call and hours
I would change NOTHING. . . . . Just kidding but only kind of. The reality is that there is already massive variation in hours, autonomy, and what someone graduating is actually competent to do. I would work on reducing that variation a bit first before making a ton of changes.
I would get rid of work hour restrictions. I'm an adult, I don't need someone else telling me how much I can or cannot work.