Friday, June 22, 2007

Life's Not Fair

I just met our new crop of interns. Technically, we aren't supposed to call them interns anymore. We're supposed to call them PGY-1s (as in Post Graduate Year 1; I'm a PGY-4). Whatever. Tomato / tomato. Ok, that doesn't really come through in print...

They seem nervous, but ready to be moving on to the next chapter in their lives.

I got a few emails from them, as I sent out the schedule. Things like, "I have wards block 1, can you make sure I don't have call for the following 4 dates?" or "I have a wedding in Canada to go to, so can I have 2 days off in a row in the ICU?" Both of these emails have caused me to shake my head in wonder. What's happening to the doctors of the future?

First of all, when on the wards, you're q4. That means every 4th night you're on call. That means asking for multiple days to NOT be on call is not going to work. The ICU is worse, because you're q3. That's a darn rough schedule. There's no way to get 2 days off in a row, because you're on, post, off...on-post-off...etc etc. Don't ask me for 2 days in a row off, when it's not mathematically possible.

When I was a 3rd year med student, we didn't have the rules we do now -- can't work more than 80 hours in a week, can't be on call more frequently than q3, can't work more than 30 hours in a row... My first rotation was surgery. I did vascular surgery for 3 weeks. I got 1 day off. Total. I got in to the hospital at 4am daily. I didn't leave until 7 or 8pm when I wasn't on call. When I was on call (q3), I'd get in a 4a, stay over and work, then leave at 6 or 7 the next night. It sucked. When I was on OB, we were q2 for the few days before Thanksgiving. My roommate R. and I did 4 days of q2. I got done the Wed before Thanksgiving and went to bed at 8p. I didn't wake up until 4p on Thanksgiving. I almost missed the big lunch at my friend's in Baltimore.

Do I think we should go back to that? No. I was miserable, my classmates were miserable, and I'm sure patient care suffered. However, it did teach me that residency is work. It's more than a job, it's your LIFE. For 3 years. In my email to the new interns, I wrote: "Here's your schedule for block 1. I have done my best to accommodate requests. Unfortunately, you will miss a lot of things this year. You will miss birthdays and anniversaries and holidays and religious holidays and graduations. You will work on your birthday and your child's birthday and most major holidays. Residency requires a lot of sacrifice."

I heard through the grapevine that one of the R2s was upset because of her schedule. She said it wasn't fair that she has 2 more weeks of call than a lot of her friends. I said to her, "You know what? Life's not fair." To my shock, that answer didn't satisfy her. Perhaps if she did a few q2s or worked 18 days without a day off, perhaps then she'd see things differently.

I can only hope that these new residents remember my words of warning. Perhaps I should put a sign up in my office...


Lil Kate said...

Sounds like they: 1) don't understand how good they have it; and 2) don't understand that this isn't a normal 9-5 job where you get paid vacation and sick days (and to somewhat dictate your own schedule). I like the email you sent them, but maybe you need to remind them that you own them, and all of their time. :)

Julia said...

wow... sounds like the next generation of doctors are a doozy! Yeah, being a doc isn't a 9-5 job. If you want to be able to request holidays, birthdays, anniversaries off...... FIND A NEW JOB!!!! Tell them that when they are the head honcho of some hospital, then they can make their own schedule.... until then.... SUCK IT UP!!
You're doing great!!

Lil Kate said...

By the way - you didn't show up on my stat counter!! Weird. Did you actually click on the link and go to my page??