Residency: Long Hours and Lifetime Connections

In this TikTok Live video, Jeremy Faust, MD, editor-in-chief of MedPage Today, and Adriana Wong, MD, MPH, a fellow in reproductive endocrinology and infertility (REI) at the Los Angeles General Medical Center, discuss the intricacies of the residency process. Faust and Wong talk post-Roe changes in ob/gyn education, long hours and sleepless nights, and professional relationship building during this stage in your career.

Part 1 of this series can be viewed here.

The following is a transcript of their remarks:

Faust: Alright, let's talk about your field. Probably ob/gyn more than any field has had the biggest political shake-up ever, because 1 minute abortion was a constitutional right, and the next minute it was illegal in a bunch of states. I don't think that affects where you practice, right? But what's your sense of how it's affecting practices for residents and even just faculty around the country?

Wong: Well, it actually does play into the way that reproductive endocrinology may go, because some people may attribute some meaning to what an embryo may be or what management for an ectopic or a missed abortion should be in the setting of IVF. So yeah, there are a lot of IVF or REI doctors who are starting to become more politically active because of that.

But for general ob/gyn residents and residency programs everywhere, you see this huge shift in how we are going to get the residents the training that they need to be able to handle these situations. At my residency program in California, we've actually started to take residents from a residency program in Texas, because they wanted to be able to come and learn how to do D&Cs [dilation and curettage] and D&Es [dilation and evacuation] as well. We've been able to take, I think, every 1 to 2 months a new resident from their program.

We've been so happy because we take a lot of pride in our ability to train residents at our program in those skills, but you see that people are not really as interested in going to programs where they're not going to be getting that training.

Faust: Right. There's statistics from surveys coming out this year saying -- I'm looking at these numbers here -- more than three-quarters of residents wouldn't even apply for residency in states where you had legal consequences for providing abortion care, which makes sense to me. You're going through residency, it's hard enough to not get sued or arrested.

Let's go back to the wellness piece, because I actually think the big line in the sand is duty hours -- that's it. And I kind of feel like the only way that duty hours will ever change is probably either through some regulation, which did not work. They tried, right?

Wong: Yeah, they still try.

Faust: They still try and it doesn't work. Or through unionization, which I think probably would work. But then you get into the whole question of what you're talking about, which is: are you ready at the end of 4 years? I really support the residents doing something that makes their life less toxic, but where do you come down on unionization, and is that going to solve the problem?

Wong: Yeah, I kind of separate those issues in my mind. I think the union is one thing that may bring additional benefits, and then the work hours- and duty hours-thing is separate because that tended to be regulated by my program and the GME [graduate medical education].

But I felt like the duty-hours thing just wasn't that big of an issue, because we were pretty good at self-reporting our hours. I was admin chief as a fourth year, and we really rarely had people who went over 80 hours a week, and they had the opportunity to submit their time sheets along the way. So if at the third week of the month, they knew that they were on the trajectory to go over hours, then we could adjust their schedule, and we very rarely had to do that. So that's good and reassuring.

I think people forget that it's over the span of 4 weeks; the average has to be 80 hours. So even if you work 100 hours one week, as gruesome as that is, you will probably not work 80 hours throughout the course of the whole month and it works out completely fine and you get great training.

I know that there are people in other surgical subspecialties that probably do actually spend 90 hours a week at the hospital, but that just wasn't my situation.

Faust: I agree that there are these moments where you get a little bit of a piling on of hours and then it ebbs and flows. I actually don't mind that. I think, even now, I'll work, not clinically, but I'll be working on something, and I add up the hours and it's just insane how much time I'm spending on it because I love it and I want to do it. It's not sustainable, but in the short-term it's cool.

What I think I really have trouble with are these 30-hour shifts. These overnight calls -- back in the day, it was like "Yeah, you were on call." That meant you would sleep and they'd wake you up when they needed you. That's not the case for 30-hour shifts. It's like, you're lucky to get an hour of sleep and by the morning you're a zombie, right? I mean, do you think that those are really necessary?

Wong: I don't think so. I mean, even sometimes a 28[-hour shift] on labor and delivery is so insane. You know that you're going to go so cross-eyed if you have to do a C-section in those final hours. I think that is pushing it.

Faust: Yeah. I also push back on the continuity of care piece. I'm like, "Yeah, you'll [still] get continuity care tomorrow. They'll come back; they'll still be there." There's this idea that you lose continuity if you actually go to sleep. I don't think there's much [difficulty] learning. We have so many advantages; we have the medical chart. I'll sign a chart and a day later I will open it to see how they did in the OR; how did that go? That is continuity of care. I didn't need to stay up all night waiting for that information.

Wong: Or do it yourself, do that surgery yourself, or whatever.

Faust: I'll take your case while you sleep, and then I'll tell you how it went and you get the follow-up, and then in reverse you do mine while I sleep and then tell me how it went. It's fine. I would love to see that go away.

Wong: Yeah. I think that would be a very meaningful shift.

Faust: I'm always interested in what I call 'diplomatic relations:' how are the specialties getting along? I always worry with emergency medicine [EM] that they love us and they hate us. I mean, I'm not asking how is EM in your hospital, but just in general with the other residencies, do you feel like you know them and you know each other and there's a bond? Or is it just like "No, we're like warring factions?"

Wong: I think it depends probably on where you go. At the place where I initially did residency in Florida, I felt like we were closer with other surgical subspecialties, like I had a lot of friends in anesthesia and other surgical subspecialty residency programs. But I feel like there isn't as much co-mingling at the other program that I was at. I think it might just be based on the structure of the programs, and where you are rotating, and whether you're all at the same main hospital in terms of when you pick up the phone and you're getting a consult from the ED [emergency department]. I feel like that kind of perspective just shifts depending on what year you are.

I always felt so overwhelmed whenever I would get a call from the ED as an intern, and it's kind of easy to either get mad or antagonize that other person that's on the other side of the phone, but those people become your friends throughout the years.

Faust: Yeah, I know. It's funny you end up having certain people that you bonded with and that you can rely on and vice versa. They're like -- it's probably the worst analogy -- but they're like war buddies. You've been through it together. Those bonds are actually there for life, which, ironically, it's probably the extraordinary difficulty of residency that forges those relationships and stuff.

Wong: Absolutely. If someone that you trust is calling saying that you need to run down to the trauma bay, I'm gonna run.

Faust: Yeah, that's true. You want to have your speed dial of people that you [trust], and everyone's speed dial is going to be different. It might be who you happen to rotate with on a certain thing, but it's fun to have those people, those fellow travelers across specialties. I know who my neurology friends are, I know who my ortho [orthopedics] pals are, ob[/gyn], and all that. So it's kind of fun.

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