Residency is unquestionably a trying time. However, it can seem even more intimidating, given certain initial misperceptions often developed by medical students and retained by first-year residents. After completing my intern year, here are some things I learned about certain false notions regarding residency. No Time As a medical student, the most daunting fear I had about residency was that I would not have time for anything but work. Over the years, I have come to consider myself a master at time management, as much as anyone can be. As a student, you can prioritize your time however you would like, so long as your work gets done. I figured that as a resident, I could kiss my time goodbye. Now, 1 year into residency, I've realized two things. First, I always have time for the things I prioritize. The tricky questions are always, "How should I prioritize things?" and "How much time will I actually have to spend?" After all, a lot of my time is definitely spent at work, either at the hospital or clinic. Even after the last patient has left the clinic for the day, I sometimes still have to finish up my notes. But, honestly, it isn't that bad! Of course, some months are harder than others. I oscillate back and forth between working as few as 50 and as many as 80 hours per week, depending on the rotation. Yet through it all, I have found time to stay committed to my priorities. For example, I always find time to write for myself, simply because I love to do so. I love going to spin class for exercise and have been able to regularly exercise throughout the year. The only caveat is that while on certain rotations, I may only be able to go to spin class once per week instead of three times. And, of course, I still find time for loved ones. The solution to having more limited time as a resident is simply to understand that you can ultimately do what you want to do with your free time; you just cannot do everything all at once. You have to go with the ebb and flow of each rotation. No Money Okay, so this one is sort of true. Money is always an issue and is a bigger problem for some more than others. However, in the same way that prioritizing and budgeting time is important in residency, so is prioritizing and budgeting expenses. Unavoidably, residents are underpaid. I once did the math. On average, residents get paid $56,500 per year. This takes into account residents at all different levels of training and different specialties. If you assume that we work an average of 60 hours per week, our pay comes out to about $18 per hour before taxes. Sure, this is a lot more than the federal minimum wage of $7.25 per hour. However, remember that newer trainees get paid less, and certain residents work more than 60 hours per week. In any case, once you consider the years of school and training it takes to become a physician, and six figures of educational date most residents have (medical students had a median debt of $183,000), residents are underpaid. So what is a resident to do? Simple: budget, budget, budget. You can still go out to dinner, go to the movies, and go on vacation, but you may not be able to do so as often as you like. Also, figuring out how to prioritize your expenses is important. For example, I live alone. Therefore, it is often more cost-effective for me to buy lunch or dinner rather than make it at home (when you consider the time and energy that go into buying and preparing food). That said, another resident might decide to never, ever spend money on take-out. Another example is that I like to get a manicure at least once per month. It is destressor I have come to rely on since high school. Someone else might think spending money on nails is frivolous. You ultimately decide how to spend your money. No Autonomy Medical students often worry that they will have too much or too little autonomy as a resident. The truth is, it all depends on your level of comfort. Residents always work under the supervision of an attending physician. However, attendings are more or less physically present and available, depending on the situation. For example, on an inpatient rotation, you will always round with an attending physician in the morning who will approve your clinical plan before you carry it out. However, at night, the attending is often not in the hospital; therefore, you have to carefully consider your clinical plan and also when and for what reason it is appropriate to call the attending physician for help. The level of autonomy varies not only on the basis of the setting, but also on the time of year. As a green intern, I had to discuss every single one of my clinic patients with my preceptor before sending the patient out the door. My preceptor would also come in to examine the patients with me. However, over time, as I grew as a clinician, my preceptor came in only to examine patients for whom I specifically requested help. Now, as a second-year resident, I am only required to formally precept certain patients whom I select; if a patient is straightforward enough, I can manage them independently—then my attending reviews my clinic note/documentation later in the day or week. Too Much Paperwork Again, this misperception is somewhat accurate, but it varies on the basis of the clinical setting and timing. As an intern, my main job on inpatient rotations was to see patients each morning, write progress notes, call consultants, and follow up on test results. This means that, yes, more of my time was spent doing paperwork than seeing patients. However, on an outpatient rotation, such as when I see my own continuity patients in clinic, the only paperwork I have to complete is a note for the encounter. This means that I can spend a significant amount of time speaking with and examining my patient and work on the note simultaneously while in the room. Speaking and writing a note at the same time is an art form in and of itself. However, I become more and more efficient every day, which allows me to have less paperwork at the end of a clinic day. Apart from the clinical setting, your level of training and specialty affect how much paperwork you have to do. For example, switching from the role of intern to second-year or third-year resident means that you have more of a supervisorial role. This means that in many cases, residents are not responsible for writing notes (interns are responsible for this), and residents can focus more on leading a team and making independent clinical decisions. Furthermore, someone like me, who is training to become a primary care physician, will have more intervisit tasks to complete for patients compared with subspecialists. For example, I may have to fill out preauthorization forms for a patient to receive a certain medication, whereas a specialist who sees my patient to perform a procedure, such as colonoscopy or skin biopsy, may have little paperwork to fill out for my patient. Residency is a great time of change. You will be forced to make decisions about how to spend your time and money and ultimately shape your career trajectory. From one rotation to another, and certainly from one year of training to another, your role on the team and level of expertise will be in flux. Therefore, what may be a misperception about residency to one trainee may turn out to be a truth and reality to another. Your choice of specialty and level of training influences what your residency experience will be like. No matter the training program in which you find yourself, you are certain to learn a lot and evolve as a physician. Source
