Things Should Get Better After Residency Training

by The Darwinian Doctor

Residency training is tough, but things should get better after training.  If it doesn’t, something’s wrong!

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I wrote an article recently about the fact that people who marry doctors in training are saints.  The video I made about the subject got over a million views across social media, which I think speaks to the truth to this statement.  Residency training is incredibly tough on doctors-in-training, but it can be just as difficult on the doctor’s family.  I’m talking about the partners, spouses, and kids that have no choice but to endure the physical and emotional absence of the physician as they go through residency together.  

Read more: People Who Marry Doctors in Training are Saints

In the comments, one person wanted some assurance that it gets better after residency training.  I responded by making this video below.  In it, I described how the lifestyle of a physician absolutely should improve after residency training.  I also argued that if it doesn’t improve, it’s my opinion that there’s something wrong.  

Please let me explain. 

Doctor work hours

In residency, it’s common for trainees to work about 80 hours a week.  I trained in an era before work hour restrictions, so my weeks were often 80-100 hours long.  It’s a lot of hours at the hospital, which doesn’t leave much time left over for friends and family.  

But there is a light at the end of the tunnel.  Although the surveys vary, it seems that after training, attending doctors work on average 5060 hours a week.  This is obviously far fewer hours than doctors worked in residency training.  

So on average, that’s 3-4 hours more leisure time every single day of the week!  That’s a lot of extra time that can be spent on self-care like exercise and also extra time to spend with friends and family. 

Some doctors work (a lot) more than others

Whenever I talk about these statistics, I always get comments saying something like this:  “I’m married to an OB/Gyn who has worked 100 hours a week for the last 30 years!”

The specialty is actually unimportant.  It’s perfectly possible to work crazy hours in every single specialty even after residency.  (Except perhaps dermatology.  I’ve never heard of a dermatologist who works more than 50 hours a week.)

The difference is choice

The major difference between doctors who work long hours in training and doctors who work long hours as an attending is choice.  

Doctors in residency training have no choice about their hours.  Generally, residents stay at work until the work is done (at least until the 80 hours a week limit).  And depending on the patient and operative volume at their program, there can be a lot of work.  

For example, in my residency for urologic surgery, this is how my day was generally structured:

  • Round on inpatients and new admissions in the morning
  • Assist in surgeries during the day
  • Round again on the patients after the operating room. 
  • Sign out and go home (unless we were on overnight call)  

We had very little control over how many surgical cases were scheduled for the day.  That was up to our attending physicians.  We also had no control over the inpatient census.  That was again dependent on our attendings or the surrounding regional hospitals that would transfer patients to us during the day.  

One of the most challenging aspects of residency training is the lack of control.  Although med students ostensibly choose residency programs via their match list, in reality that’s not true.  The residency matching algorithm is like the man behind the curtain in the Wizard of Oz, ultimately pulling the strings that in my case sent me to Los Angeles instead of Philadelphia or New York.  

Attending physicians have control

The big difference that I want to emphasize is that attending level physicians have control over their lives in a way that is very different from residency training.  

What about the OB/Gyn physician that is working 100 hours a week for 30 years straight?  I would argue that the only reason they are doing this is because they love it!  There are those among us that find the ultimate satisfaction in delivering patient care.  I take my hat off to these physicians.  

What I find concerning and what I would like to combat are physicians that are many years beyond training, but are working far too many hours for their liking.  There may be a number of reasons for this that might make this seem like an inescapable reality, but all of these reasons are in fact imaginary handcuffs.  

Imaginary handcuffs

I’ve written about the concept of “golden handcuffs” before.  This applies to people who feel trapped in their jobs due to the need for the high level of income they receive for doing the work.  I felt trapped by golden handcuffs for the first few years of my attending job in Southern California.  With the work hours, overnight call, and my commute, my weeks were generally 60 hours a week.  This was about 10 hours too many for my liking.  But I felt that I had to just bear with the status quo for a number of reasons, including fear of criticism from my chief and the feeling like I needed to work a lot to cover my family’s cost of living

Read more: Physicians are trapped by golden handcuffs

What I eventually realized is that I had far more control over my life than I gave myself credit for, and that my golden handcuffs were in fact all in my head.  Here were a few of the options open to me:  

  • Decrease my cost of living
  • Politely refuse administrative duties
  • Decline optional overtime
  • Change my job
  • Increase my income from other sources

Over the course of my medical career so far, I’ve done all of these things.  (Except perhaps refuse administrative duties. That was never my strong suit.)

Read more: Life | Medicine | Real Estate: Year End Review 2023

You are in control

So here’s the point.  On average, doctors work far fewer hours after residency training.  That’s an excellent fact, because the hours in training are frankly brutal.  They take a mental and physical toll on resident physicians and also on their loved ones.  

If you are working too many hours as an attending physician and it’s not by choice, something is wrong.  

What you must realize is that you’re in control of your life.  This goes for anyone, not just doctors.  There are many ways to change the circumstances of your day to day.  

Does it take courage and the burning desire to make a change?  Yes.  

But if you have gotten to a point where you aren’t happy with your day to day work life, it’s time to make a change.  

Take a breath and write down all the ways that you can change your life for the better.  Then take action and get it done!

– The Darwinian Doctor

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Since everyone is different, it may not be appropriate to generalize my doctorly advice to your own situation. Please run all medical, life, and financial advice by your own physician or financial professionals before applying it to your own life! Consider all information for your entertainment only!

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