This multi-instiutitonal study published in September was a piece that caught my eye for a few reasons.
First and foremost, as a faculty member who has a love for tilting at windmills and fighting for the underdog, I’m always trying to figure out how to best support our residents who are great doctors but struggle with some aspect or another of surgical training. The truth is that surgical residency, even in the “new world order” of the 80-hour-workweek, is hard. Granted, there are times that it is harder than others, particularly during high-stress rotations or on rotations with particularly challenging faculty members, but even at it’s best it’s never easy. While lots of work continues to look at who leaves- or who thinks about leaving and will admit to it- what we’re capturing less-well so far is the why. As someone who loves stories and has fallen in love with quantitative research, I want the long version of the why in all of its messiness. Sure, there is a subpopulation of folks who get into surgery residency and discover that the “fit” of the profession is off for them. My observations, though, lead me to believe that this is indeed a subpopulation and that the stories, particularly those from “high attrition” programs (as identified in the Gifford study), are more rich than a simple statement of, “It wasn’t working for me.”
As usual, there is also a personal angle to my interest in this study’s findings. I was very nearly part of those attrition statistics.
The last part of internship was great. The first few months of second year? Far less great. I struggled with my role as someone who still felt responsibility for running the floor but who was also expected to be in the OR more. Technical skills didn’t come as quickly and easily to me as they do to some. My rotation schedule for the year would likely have worked well for someone with more innate technical prowess or who didn’t feel the same call to making sure the patients were getting ideal care, but for me it was a near-disaster. Then, in the depths of the winter, I descended into every-other-night call in the ICU. Remember, this was pre-work hours, when not only was every-other-night call okay, but you weren’t out by Noon the next day either. While I loved the intellectual challenges of the ICU and didn’t mind the hours (most of the time- if your co-resident took vacation you got to move in for the week), I also didn’t see the sun for more than very limited time periods for 10 weeks. December and January days in Utah remain tough for me even with control over my schedule, and then…well, in hindsight I would say I was clinically depressed. I also knew that I was incredibly unhappy and the only logical way to fix the unhappy was to pick a new specialty.
So I did. I went back to my “Plan A” from medical school, and started talking to our Pediatrics folks about a switch into pediatrics to be followed by a critical care fellowship. The trouble was that the time of year- January- wasn’t conducive to a major specialty switch anytime soon, likely not for another whole academic year. I had gone to my program director in surgery and told him that I was leaving, but that I would finish the year. He was either wise or foolish enough to not believe me.
Then I got out of the ICU and the days got longer. I went to services where I had a handful of faculty members who were able to engage on technical skills in a way that worked for me. Surgery became fun again. By April, I had decided that I wanted to stay and I had great support from some faculty who had been patiently getting me up to speed. And, fortunately, there was that issue of the program director suspecting things would work themselves out at some point.
Had one of any number of factors been any different, I might well be writing my blog from the perspective of a pediatric intensivist. But I do believe that I am where I am supposed to be, doing what I am supposed to be, and so while in January of 2000 it felt a bit like all forces were aligned against me, I no longer believe that was true. If anything, it proved the need to sustain when things are hard because things ultimately unfold like they should.
I understand why people leave surgery. I’ve supported and stayed friends with more than a few who have done so. I’m also really glad to have failed- miserably- at leaving.
*(With a nod to Patsy Cline’s song of the same title)