The Joys of Residency … Seriously

“The days are long, but the years are short.” That’s what they told us when residency began three years ago and after having completed my last day of residency today I couldn’t agree more. Like finishing anything meaningful, graduating residency is bittersweet. There’s no doubt I am ecstatic to be done, but I’m also going to miss the rigorous environment that’s a right of passage for all physicians. After completing residency I can honestly say that it’s not as bad as people make it out to be and definitely worth everything you put into it.

I’ve been asked what books to read and what to expect for residency and each time I respond the same, nothing can really prepare you for it. The learning curve is steep.

For any medical decision making there is always someone you can look to for help, whether it’s your senior resident, fellow or attending. There is a hierarchy in medicine that still exists and while some people hate it, it’s necessary as you start taking care of people’s lives. During your intern year you may feel like a workhorse, running from one task to the next, but by the time you’re a senior resident a flow and confidence has settled in. There is an appreciation for every patient encounter. You see people at their most vulnerable position and it’s a privilege. There’s the woman who has never felt comfortable undressing in front of anyone, but has been waiting all day in the clinic just so she can show you the lump she feels in her breast. There’s the patient diagnosed with diabetes but can’t seem to figure out how to control his sugars, so you demonstrate how to use insulin and draw a table for him to record his levels. When he comes back weeks later to proudly show you his numbers in the normal range you can’t help but feel like his success is your success.

These days I find that every article or conversation regarding medical school and residency training has a negative and discouraging theme. Topics of discussion often include the long years and cost of training to the loss of physician autonomy within the healthcare system. Some age old issues continue to be debated, such as the fairness of the match in deciding the location of your job to the safety of a 24- hour (or longer) work shift for interns and residents alike. These are all valid concerns, many of which I’ve faced myself, but shouldn’t deter anyone from entering a profession where you have the peace of knowing that each day you are trying to help another human being.

To begin, let’s talk about what everyone fears and dreads- the hours! Yes, you’re going to have to work and make sacrifices.  I remember as an intern I was talking to a fellow intern about our upcoming “golden” weekend. Her sister heard our excitement and asked us what it meant to have a “golden” weekend. In unison we responded, “When you have both a Saturday and Sunday off!” She looked at us puzzled, “So, like, a normal weekend?” Most of residency you’ll work 6 days a week. Even during a lighter rotation, clinic or elective block, there are scheduled weekend shifts in order to give other residents working in the inpatient setting a day off. An 80- hour workweek is the limit set by the Accreditation Council for Graduate Medical Education (ACGME). This is not to say there aren’t instances when residents work longer than 80 hours, there are and I have. But it’s hard to leave work on time when the family of the patient who you’ve been taking care of all week finally flies in and wants to speak to the doctor who knows their loved one best. Having knowledge of the patient and his care is one of the reasons the shifts in residency are so long, in order to minimize hand offs between residents thus decreasing potential mistakes. Aside from the 24-hour call (which is brutal) the hours you work in residency are manageable and not every week in the year is 80 hours. No matter what you choose to do in life, you have to put the time in and it’s unfortunate that residency has gotten a reputation that you’re working longer hours than other professions. What if you’re a stockbroker, or a lawyer working on a deadline, or a single mother working three part time jobs- aren’t they all working long hours? What about the teacher working the coveted 40-hour workweek, but came in early to tutor the student who didn’t do well on his last math quiz, stayed late to meet with his parents, ran the after school program and coached the soccer team. Working long hours should not be a reason you choose to pursue a career outside of medicine nor should it be a reason for current doctors to feel like they’re being treated unfairly.

For many, the issue with the workweek is that we don’t get compensated for the hours we work. No such thing as overtime pay, bonuses for doing a good job, etc. To be fair, as residents we aren’t earning money for the hospital and are practicing under the license of our supervising physician. The compensation for the time we study and train does eventually come. At times it’s hard to think of the long run though when your friends have been working for years since college and have reached milestones like buying their first home while you’re still thinking about medical school debt. But as my friend from Eastern Europe once reminded me, if as Americans we are willing to pay into a 30 year mortgage for a home, doesn’t a monthly payment towards an education and lifelong career seem more worth it? I think so. The length of our training always seems to be an area of contention as well. “You have to go to school forever to become a doctor.” Well, how many people straight out of college land their dream jobs? Is everyone that is 22 years old content with the first position they get out of college or are they always looking for the next promotion or even make the decision to go back to school? Neither the workload, nor the money and time spent on becoming a doctor should deter anyone from the field of medicine.

I look back on the days of residency, even the ones when I cried in the stairwell after the loss of a patient or missed my subway stop because I fell asleep exhausted after a long shift, and I wouldn’t trade it for anything. Ask anyone what’s most important in life and usually health is on the top of the list. To assist patients and families in understanding their diagnosis, to make them feel physically and emotionally better and to be able to provide them with the tools to take care of themselves is a rewarding experience. Health is the greatest wealth and to have learned to take care of people’s health continues to be an incredible education. A part of me can’t believe that residency is actually over, but I guess what they say is true- the years are short.