Resident Readiness General Surgery (5 page)

Answers

You can have it all, just not all at once.

Motto of the Association of Women Surgeons

The responsibilities of a surgical resident are impressive and can be overwhelming. One of the biggest challenges is that the hours are unpredictable and inflexible. There are few jobs that require 14-hour shifts, 12 days in a row, including holidays and weekends. Sick days and personal days are pretty much nonexistent, except for extreme circumstances; it’s hard to take any time off when you know your team and your sick patients are depending on you. As a physician, maintaining the health and safety of your patients is paramount, occasionally at the expense of your own. This commitment to duty means many missed family dinners, friends’ weddings, and other important milestones. These time demands frequently detrimentally impact interpersonal relationships. Therefore, it is important for the surgical resident to have a robust set of tools for the recognition and management of work–life conflicts.

On the bright side, the surgical world is changing and is, overall, much more humane today. Thanks to work-hour restrictions, residents are finding
time for social outlets, meeting significant others, and starting families. There are many more female surgical attendings today, some of whom are also married with children. However, the relentlessness of resident work responsibilities will consume a much greater proportion of time, and for a much longer duration, than arguably anything else a medical student has faced thus far. Think of it as a transition from running the 100-yd dash to a marathon. While it may be possible to put off personal responsibilities during a tough medical student rotation or 2, life cannot be managed that way for the 5 to 7 years of a surgery residency. Therefore, it is imperative to be aware before starting residency about the dilemmas one will face and to have some idea about how to manage them.

Six Tips for Managing Your Personal Life While in Residency

1.
Prioritize your loved ones.
Those who support us have to sacrifice a lot on our behalf. We are absent from our parents’ houses at many holidays, and, when we are there, we are likely napping. Our girlfriends and boyfriends tolerate us showing up late at restaurants or missing friends’ weddings. Therefore, we owe it to them to show them our appreciation. On days off, make a date night. Call your mother.

Don’t forget birthdays or anniversaries. Above all, remember we chose this life; your family and friends didn’t. They may want to hear an interesting anecdote or 2, but they don’t want to hear how miserable you are. Put on a good face—and don’t forget to ask about their lives, too!

2.
Get organized.
Use an online calendar, such as Google Calendar, to organize your work and personal responsibilities. Automate all your bill payments. Use an online money management system such as
Mint.com
to track your budgets and account balances. Set up reminders for conference presentations, American Board of Surgery In-training Exams (ABSITEs), and birthdays.

3.
Manage (or outsource) your household chores.
It’s hard to stomach spending your 1 day off a week scrubbing a toilet. If your budget can handle it, look into getting a bimonthly cleaning service. Or cut your jobs into smaller sections: do 1 load of laundry during the week. Drop your car off and have them change the oil
and
get it smog tested. Think of your time in terms of how much per hour you are worth: if outsourcing an activity would cost you less than $20 an hour, perhaps your time is worth more than that.

4.
Stay active.
Physical activity is not only important for health but also a great way to blow off frustration and stress. It’s also a much healthier coping mechanism than going to the bar after work every night. Try hitting the gym first. Bike to work if you can. Take the stairs on rounds.

5.
Don’t procrastinate.
As a resident, you will have more responsibilities than just patient care; you will have to read for conferences, prepare for cases, present at morbidity and mortality, and perhaps present even at Grand Rounds or other department-wide conferences, not to mention excelling on the ABSITE. Therefore, give yourself a reading plan and stick to it; get a textbook you like (popular ones include Greenfield, Cameron, and Sabiston) and make yourself read a chapter a month. Your ABSITE performances and your poise on the podium go far in establishing your reputation with the department attendings.

6.
Know when to ask for help.
The pressures on a resident can feel overwhelming, and a poor patient outcome or being yelled at by an attending having a bad day can trigger an emotional crisis when you are exhausted and angry. Some residents cope by “kicking the can down the road,” that is, abusing or blaming friends, family, or colleagues. Most “problem residents” are not mean or insensitive; they are likely depressed and overwhelmed. Many may be scared at appearing weak by showing emotion after the death of a patient to whom they were particularly attached or by a family crisis. Residency doesn’t slow down for grief, which can be an extremely isolating, and dangerous, situation. Alcohol, and even drug, use and abuse are often prevalent in these situations and should trigger an immediate, confidential discussion with an employee assistance program or program director. For less serious issues, residents should have a cadre of people they feel comfortable turning to for professional issues, such as one of their chief residents, junior attendings, or their academic mentors. Having a more senior person in your corner can go very far, both for career development and during the periodic academic review process.

FAMILY PLANNING

Most residents begin their training in their mid-twenties and finish in the early to mid-thirties, which is the traditional time to start a family. Therefore, many residents will face the decision regarding how to best time this. Starting a family during surgical residency requires impeccable planning and comes with a large and new collection of demands on your time and energy. If the resident is female, it will also pose additional demands, both physical and emotional.

At times, a resident may feel that it is impossible to be both a successful parent and a surgical resident. Without a doubt, it is very challenging to balance being a successful physician, spouse, and parent. Part of the answer may be that, while it is impossible to be perfect at all 3 roles, one can strive to be “good enough” every day. Below are some practical tips to help.

Eight Tips for Being a Successful Parent and Surgical Resident

1.
Plan early (aka “When is the right time?”).
One of the first challenges is trying to plan an inherently unpredictable event (conception) within the rigid time constraints of residency. Many residencies offer the opportunity to spend 1 or 2 years dedicated to research, and many surgical residents choose to start their families then. The more flexible and manageable hours of this time are better suited to having a child, especially if the mother is the resident. However, this may not be an option for everyone. If not, consider waiting until after intern year, traditionally a call-heavy period. You should also consider avoiding your fifth year, a very heavy operative year that is fundamental to your surgical education. The fifth year is also the time where you may need to travel for fellowship interviews. If this is not possible, try to avoid being off during call-heavy months. Also, the sooner you tell your program director, the better he or she will be able to plan, which will reduce stress on your colleagues and your bosses, which can only be to your advantage.

2.
Build good will.
If you know you plan to have a child, especially during clinical time, be aware that you may inadvertently be burdening other residents with extra call responsibility. This may not be appreciated, especially by residents without children or partners, or by those who chose to delay childbearing because of their professional demands. Therefore, waiting until later in your residency, once you have established a relationship of being hard-working, reliable, and a team player, can allow you to “cash in” when you need time off. Make sure you have always been the one to take up someone’s offer to switch calls or cover for other residents.

3.
Have a good support system (aka emergency backup).
There will be many times when you literally will just not be able to be there for your child, whether you are in the trauma bay actively resuscitating a patient, or have to stay late to finish a difficult colon resection. You need to have a child care partner who will understand the vagaries of our profession and who will be able to be there when you cannot. This point is perhaps the most important to stress; although we are accustomed to delayed gratification, some spouses may not want or be able to be. Make sure that you have very open conversations with your partner prior to delivery so that expectations are clear about what you will and won’t be able to do. Also, be aware that, even though you are tired, once you are a parent you will need to put aside your own needs when you get home and focus on those of your child and partner. You may have to wait until the baby is down before you read that chapter on pancreatic cancer. Above all, make sure your partner knows how much you value his or her contributions to the family. Tell him or her daily, and help out whenever you can.

This does not mean you need to marry a stay-at-home mom (or dad). You don’t necessarily need to be married at all. Many residents get quite a bit of help from their parents or neighbors. Or, if a partner has a decent income, do what many dual-doctor families do: hire help. Nannies are frequently the most convenient (albeit most expensive) child care option outside of the family. Regardless, it is essential to have reliable regular and backup child care.

4.
Be flexible.
You and your partner may not be able to get pregnant at the ideal time. It might happen before you are ready or later than you planned. Just remember that there is truly no good time to have a child during residency. You may have to reorganize your call or rotation schedules. Also, don’t get discouraged. It may not happen in the time frame you wanted, but will usually still happen.

5.
Organize your priorities.
Once you have a child, he or she will take up the majority of your leisure time, what little of it you had. Gone are the days of coming home from a long day in the hospital and sitting in front of the TV with a beer, thumbing through surgical journals. You’ll need to prepare mac and cheese, give baths, and read
Goodnight Moon
for the 120th time. Your time for reading for conferences will often have to wait until the last kiss goodnight or mean getting up an hour earlier in the morning. It will also be important to know when to delegate; this is an especially difficult dilemma with new work-hour restrictions; all good surgical residents loathe the thought of being referred to as “shift workers.” However, many of us have workaholic bents and need to force ourselves to pass off the 6
PM
“appy in the ER” to the covering resident if we have a steaming spouse and a screaming child waiting for us.

6.
Know when to let go.
You will not be able to be involved in the day-to-day activities of your child and trying to will create undue stress for both you and your caregiver. Create a plan with your caregiver regarding updates, phone pictures, and, above all, establish care guidelines in a written, signed contract. Find alternative ways of touching base: Skype in at bedtime from your phone, record your voice reading a favorite bedtime story, or ask your spouse to bring the baby to hang out with you in the call room.

7.
Have a mentor.
This is perhaps the most important point. Find a surgeon early on who is respected in his or her career
and
who makes time for family life. This doesn’t have to be a woman, just someone who can give you tips about your career path and sometimes the much-needed perspective that, like most things, residency will eventually end.

8.
Know the rules for maternity leave.
Rules will depend on your institution, but most programs will allow 6 weeks maternity leave. Per the American Board of Surgery (ABS), no resident can take more than 4 weeks off
in any academic year, with the exception of maternity leave, in which the resident can take 6 weeks. Be aware, however, that this includes
all
time off in a year, including vacation, interviews, and conference time. Per the ABS, “For documented medical problems or maternity leave, the ABS will accept [a minimum of] 46 weeks of training in
one
of the first three years of residency and [a minimum of] 46 weeks of training in
one
of the last two years, for a total of [not less than] 142 weeks in the first three years and 94 weeks in the last two years. Unused vacation or leave time cannot be applied to reduce the amount of full-time experience required per year without prior written permission from the ABS. Such requests may only be made by the program director.” Most programs will pay for 4 weeks of vacation and then may allow some sick time. After that, most will pay short-term disability at 80%. Know the updated rules:
http://www.absurgery.org/default.jsp?policygsleave
, but also check with your GME office.

TIPS TO REMEMBER

Find a personal and academic mentor early on in surgery residency.