Residency, Block One

Well, I just finished up my first block of residency. Starting on my home rotation of Family Medicine, I got a chance to dive right into what I hope to be doing for the rest of my career. It's been a very busy transition (hence the complete lack of posting), but in a mostly good way. Here are my first impressions.

1) Increased Responsibility

This hit harder than I expected, and faster. I see my own patients. I review most of them with my preceptor, but not all of them. My preceptor sees my patients usually only when I ask them to. I can write my own prescriptions now - I even have a stamp with my name on it for those! It's a wonderful freedom in many respects, as I don't have to couch every single encounter based on what I think my preceptor wants. Instead, I can give my own impression and hedge only when I'm uncertain about the best answer.

Yet, that means when I mess up, it's all on me. And I've definitely messed up. No big screw-ups - life-or-limb cases are fortunately not that common in Family Medicine and I know enough to at least confirm my thoughts with my preceptor in these cases - but certainly less-than-optimal actions that could have been handled better. I recognize that's part of the learning process and that in my first rotation is very much expected, but it still hits a bit harder now than it did in medical school. As a student, if a patient's treatment was sub-optimal because of my mistake, outside of a clearly negligent decision, much of the fault would lie with the educational system that either failed to properly train or supervise my actions. Now those factors still matter, as I'm still a trainee, but as an employee, I share far more in that responsibility.

2) Rush, Rush, Rush

When I started my rotation, I got a slow introduction. Lots of time for patient appointments. Arguably too much time. I was getting bored going into my second week, and started asking to see more patients. Then I got ramped up to a full schedule in my third week. It. Was. Crazy. I managed to keep up with my schedule, yet only at the expense of my note-writing. On the busier days, I was at the clinic hours afterwards finishing my notes and completing other paperwork.

Nevertheless, I mostly kept my head above water and I'm fairly proud of that fact. At the end of my block, I was handling a workload roughly what I can expect as an early PGY-2 and while I wasn't nearly as consistent or efficient as the PGY-2's in the office (who were nothing short of amazing), I at least did the job. As I gain some more experience and familiarity, I'm hoping the late nights of note-writing well decrease.

That said, even my current "full schedule" pace is about half what it will be in full practice. Even with the advantages of a shorter lunch (currently I get over an hour, which I don't really need), lighter note requirements (my notes are detailed now, especially compared to the 2-3 lines most of my preceptors write), an extra exam room (I get a single room now), and no delays caused by checking with a preceptor, I'm nowhere near being able to operate at full speed. Yet, I've got 25 more blocks, including many family medicine blocks, to get up to that pace, so there's still plenty of time.

3) Home Call is Not Like In-House Call

One of the interesting quirks to my residency program is that we do a full home call on our Family Medicine blocks. It's not particularly frequent (about one weeknight every 2 weeks and one weekend every 2 months) and in many Family Medicine centres, it wouldn't be too busy. Except at my centre. Our weekend call is Friday night through until Monday morning. I got at least two dozen calls during that time, some of which were simple and straight-forward, others which took a fair bit of time to sort out. Ended up having to do a fair bit of driving, either to see patients in clinic over the weekend or to visit patients in the nursing home we cover.

The main advantage of home call is that you can still do life-stuff when you're not actively working. That's pretty great, since you can get a lot done if you don't get called often. It's way better than in-house call in that respect, where you're basically working a 24-hr shift that may involve some long breaks if you're lucky, but which doesn't allow you to do anything outside of the hospital. Yet, since my home call was over 60 hours long and was reasonably busy - during the day, I rarely got more than an hour off - I didn't get much opportunity to get anything done and developed some rather intense pager anxiety. It's surprisingly hard to "switch off" on the third day of being page-able at any time!

4) Conclusions

Overall, I'm enjoying residency more than I did medical school. There's a bit more independence and some clear ways to progress forward over time. Getting paid rather than paying insane amounts of tuition is a significant benefit, as finances are now slowly moving in the right direction. Month-long blocks rather than two week rotations provides a bit of stability, and the ability to take vacations provides some much-needed flexibility, though the schedule remains fairly hectic.

Life still isn't yet where I'd like it to be - I spend too much time at work or on work and don't have enough consistency or control over my own schedule to prioritize other aspects of living. I'll be glad to finally finish up in two years' time and to experience the supposed wonder of full, independent practice. Nevertheless, residency feels closer to my ultimate lifestyle goals than medical school did and what sacrifices are necessary feel more like they're in the service of meaningful progress than they did as a medical student.