Things I wish I had known about Residency . . .

I knew going into it that this whole process of Jon becoming a fully practicing physician would be a long road, and the hardest part is the end- - Residency. Now that it is here, it is true- it can be brutal. But as I said, I expected that.

There are still things I wish I had known going into it:

1. A huge percent of Residents develop clinical depression or anxiety- - it is extremely common because of the kind of schedule and stress they are under. Many can't make it without some kind of medication. It would have been good for us to know to watch out for this, and not be completely taken by suprise and for me to think it was my fault.

2. Not all Residencies, even in the same specialty, are the same and require the same things. I am finding out we really should have asked certain questions when he was interviewing. Truly, you do HAVE to go where you "match", but if possible, at least rank higher the ones who fit your interests and abilities the best.

For example, our residency program requires residents to complete 3 hospital service (FMS- Family Medicine Service) rotations each year. Most other rotations are not so bad (there are a few other exceptions), and even ones Jon really enjoys, but this one is the one where they are overworked, under-rested, and super stressed out (at least this is how it is for my hubby- the hospital is not is favorite place to practice medicine). By talking to a friend who's husband completed a family medicine residency somewhere else, I am finding out they only had to do it ONCE every year!!

Another way programs differ is how they handle the night shift for these kinds of hospital rotations. Many other places use a "night float" where they divide up the graveyard shift, or just have to take call from home (call from home doesn't work too well here because the hospitals are too busy- they wouldn't be "home" much). Our program does it with 30 hour shifts. So usually a couple of times a week on this rotation Jon will work a 30 hour overnight shift (7am ish to 1pm ish - - though sometimes depending on patient volume he ends up going in earlier and coming home later). This week's schedule will end up being something like this: Monday 7am to 6pm, Tuesday 6am to Wednesday 1pm (30 ish hours), Wednesday 6 or 7am to 6pm. Thursday 7am to 6pm, Friday 7am to 6pm, Saturday 7am to Sunday 1pm (30 hours), Monday it starts all over with a different two days overnight. Lack of sleep is huge with that kind of schedule. And so much is expected of these super tired Residents. The smallest of mistakes, whether it is possibly harmful to the patient or not, is NOT tolerated.

Time off is also handled very differently with each program. If you are moving a long way from family, you would want to make sure the program will allow sufficient time for you to travel to see family. Luckily - the way our program does it works well for us since our family mostly is fairly close. We could even make it to San Diego and back with the one week off that is allowed.) So- here you can only get 5 days off during a rotation (which switches every 4 weeks), and certain rotations NO time off is allowed (FMS and OB and a few others). Again, our friends from the other program would save up their vacation time to take a three week trip to see their family half the country away. That wouldn't be possible here.

3. D.O.'s (Osteopaths) need to really ask whether or not OMT (the osteopathic manipulations) are taught or allowed in practice, and if so, how often. I feel this is important for D.O.s - to keep up on this skill (if even just for that section of the board tests)- and not all programs are accommodating, even if they are dually accredited programs (M.D./D.O. programs).

4. Having a baby while husband is in residency IS NOT the same as having a baby during medical school. For the women doctors- I am not sure if this is true, but for us WIVES of the student or resident, it was a very different experience (at least for me). One advantage during residency is he could actually get paid time off (up to 5 days in a rotation- luckily for us, I had Tyler during his last week of one rotation, so he was able to take more time off). To their credit, the program here was great about making sure Jon was scheduled for easier rotations where Jon was allowed to take time off. When Lillian was born during school, he was in a clinical rotation and could only get a few days - - though he made sure to schedule a fairly easy student rotation and they were super understanding of him needing to get off, and be done early. Other than that- everything else was harder. Through the pregnancy and during the early days with a new-born (Jon had to go back to his "FMS" rotation when Tyler was a few weeks old), I needed to handle things at home without as much help from Jon. Don't get me wrong, he is a good dad and helps when he can, but with crazy hours, lots of stress, lack of sleep, and a lot of pressure from his superiors - - help for me is often just not possible. The time he had off was crucial because of my c-section - - but the months following (and during my sick and emotionally fragile first several months of pregnancy) were fairly brutal. As a student, the pressure was different and he definitely could be around a lot more. Since he was getting good reviews from his different rotations his mood and confidence was fine so when Lillian was born it seems like he had so much extra energy for help with things at home. He DID have some fairly brutal student rotations, but they would only last four or so weeks then he would move on to a whole new set of doctors to work under (unlike now). Maybe I am remembering wrong and it was harder that I remember? I don't know. Whatever the case, I do have to say that I don't regret either birth during this process (Lillian and Tyler)- - I can't imagine our family without them- - so the extra hard work was WORTH IT for them. I do also feel like it has made me a stronger person.

5. Somethings seemingly small- but I a realizing it isn't so small a detail - - the residents have to do their paperwork and charting on their own time. It is easy to overlook the paperwork side of medicine, but charting is extremely important. Even though there are thankfully laws against working a resident more than 320 hours in a four week rotation (80 hour average), they still have to do their paperwork on their own time. Currently it seems like if he even takes a break for one Saturday or spends an evening watching TV, he falls way behind. There is always this cloud of paperwork (AND studying for boards) hanging over him, no matter how rough his day was, or how many hours he has worked. As Jon starts to interview for positions in clincs- the charting system and paperwork days allowed are super important to Jon because that can make or break his work week.




So- through all of this . . .
I have to say that I do feel like we are are where we are supposed to be at this time in our lives- and truly it is a blessing to live so close to our family in Spokane. Sometimes I may seem to be complaining, but I recognize that being somewhere else may not be better or as family friendly. The program has been overall pretty good too, with some of the accommodations they gave us during some of our difficult times last year and trying to make sure these new doctors are being properly trained. Yakima has been a great place to live (we may even stay . . . ), and truly I have become a stronger person for me and my four children. I wouldn't go back and change anything. Yet still . . . I wish had known these things so I could have better prepared myself . . .