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I wrote this article for MedicsAbroad.com. (full article posted here)
My Background Story:
I was born in South Africa and I am a 5th generation South African! When I was 4 years old, my family moved to Canada, we moved around a few times across the country starting off in a remote town in Newfoundland and eventually ended up in the Greater Toronto Area where I attended middle and high school.
I knew I wanted to go into medicine very early on, so I looked at my options to go directly into medical school. For those of you unaware, in Canada and the US, you are required to do an undergraduate degree first, then MCAT, then apply to medical school after that (there are a few direct entry programs in place in the US – but competition is fierce for those and generally reserved for US citizens). Anyways, I applied to the UK and Ireland (since I could go to med school right after high school) and eventually ended up in Dublin as I loved the city and felt the most comfortable when I visited.
After graduation in 2015, I completed an intern year in Ireland working in Cork and Clonmel then moved to Philadelphia, USA to complete a year of surgical training with the University of Pennsylvania. After that I took a year off to travel and currently, I just started my first year of Family Medicine residency in NJ, USA.
Job # 1: Intern Year In Ireland 2015-2016
I completed 6 months of medicine on the Nephrology and Rheumatology teams at Cork University Hospital and 6 months of general surgery at South Tipperary General Hospital in Clonmel. Doing 6 months of med and 6 months of surgery is a requirement to get your General Irish Medical License.
Day to Day Life
Awesome hours 8-5 or even sometimes 9-4 sometimes depending on your team/your reg. When your team decides to round and if you’re on general medicine take (which basically means that your team is accepting patients that come in via the ER and do not have a primary care doctor/team) then you come in at 7am to meet in the ER and see the patients that have been admitted under your team and then continue with your day to day list. You round with your senior registrar, SHO and the attending depending on if they’re around or sometimes you round a second time with them. After that, you split up the tasks with your team and have the rest of the day to get them done. Sometimes I attended clinic (on surgery only) and I could go to the Operating Room (OR) as well.
On surgery, I also attended the day ward whenever my attending was doing day cases or scopes. This involved doing a short history on the patient’s being admitted for day surgery, inserting an IV and then telling them their results after the procedure, giving prescriptions, patient education and discharging them.
Interns in Ireland are responsible for all IV line insertions, taking labs/blood work outside of the AM phlebotomy times, inserting Foley catheters on male patients (nurses take care of females) and giving first dose IV medications.
On Call / Night Shift
During my 6 months of medicine
All the interns share the call schedule so maybe once every week or every other week, you would be on a ‘long day’ this basically means that after 5 pm till the time the night shift starts, you would cover a certain number of wards on call. Your main job would be to admit patients, insert IV lines, take blood/cultures, answer acute pages, change medications (ie – if someone was acutely hypertensive, then you’d assess them and prescribe a once stat dose), respond to vital sign changes etc. Night shift was the same – you only do 1 week and you get assigned wards and do the same tasks that you’d do on a long day.
During my 6 months of surgery
I did 24-hour call which was also shared with all the doctors on surgery whether they were an intern or senior. I had one every week and a half and was responsible for all surgical inpatients but also for the Emergency Department (ED) so if there was a patient that needed to be assessed by surgery, I would be called to assess and then inform my senior. There were multiple times where there were pediatric patients who had to be transferred to a higher level of care hospital and I was the one arranging for that transfer to happen.
Every rotation was 3 months long and you were entitled to leave on each rotation which was absolutely awesome.
All in all, it was very relaxed and I enjoyed working there. I was very lucky and worked with great teams, most of which I still keep in touch with now! We even had a few nights out and dinners with everyone even the attendings, we also had a ward 1A Christmas dinner with nurses and other medical teams which was all so much fun. The Irish in general are very welcoming, friendly and helpful. I had moved from living in Dublin for 6 years to the West coast of Ireland, to Cork – I was new there, worked with a whole new group of doctors who mainly graduated from University College Cork but I loved working with them and I made a lot of friendships with people there.
It was really awesome working there- the lifestyle and hours were very chill with each rotation being a 3 months block and you get a lot of vacation days off. With regards to actual hours – it was generally 8-5pm, no set leaving time – you basically left once all your tasks are done and nothing is outstanding. You also work only 1 week of night shift every rotation and you cover wards doing small tasks and reviewing patients that the nurses call about – overall quite easy!
I also got paid more working in Ireland for fewer hours than what I currently get paid, got paid overtime, including getting paid more on Sundays and holidays and had more weekends off work. The biggest downfall of Ireland is the lack of progression throughout the years especially if you are non-EU and the length of training is long without a guaranteed consultant post in the end. But I completed the year, got signed off and now hold a General Irish Medical License registration – which was my main goal.
Throughout the year, I had applied for US residency positions and went on interviews intermittently throughout the year. I even flew to the US from Ireland for 3 days only for an interview. I matched to UPenn Surgery so after my intern year in Ireland ended, I moved 7 years of belongings back to Canada then had to move to Philadelphia – if at this stage I wasn’t sick of moving, little did I know that I had a lot more moving to do over the following years!!
Job # 2: PGY1 Surgical Resident (Preliminary) With The University Of Pennsylvania In Philadelphia 2016-2017
My dreams and aspirations throughout medical school were to be a Plastic Surgeon, running my own private operating rooms and clinical practice. However, when I actually worked in the field, experienced the hours, stress, exhaustion and drive needed to complete residency in itself – it was really hard to stay motivated for those dreams and I came to realize that there were other avenues that could get me to a similar dream where I would be equally if not even happier with the outcome – but here’s my experience working as a surgeon!
Day to Day Life
Every day was roughly the same with some rotations being busier with longer hours. A typical day would be coming in at 5:15 am to print lists, update labs and get signout from the night intern and then meet the rest of the team (generally comprised of the chief resident, PA/NPs and sometimes another mid-year resident) for rounds. Immediately after rounds, I would finish any tasks, call consults, complete daily progress notes and then either head over to the OR or clinic or stay on the floor depending on what my role was for the day. It depended on the rotation. Sometimes, I would be running my own OR with the attending, so that means I would be responsible to keep the flow going, getting the patient in the room, prepping them, operating with the attending, then rolling them out to Post-anaesthesia Care Unit (PACU) and taking care of any outstanding paperwork for either admission to the floor or discharge home.
It was honestly quite busy because even though I am operating, I am still the intern who is responsible for the patients on the floor, answering pages, responding to nursing calls etc. On days when I would be on the floor, I would be doing wound dressing/VAC changes, responding to calls from nursing staff, helping to organize outpatient follow-up, social work issues, dealing with nutrition concerns, checking up on patients throughout the day and of course, completing a lot of paperwork.
At any time, there could be new admissions either direct transfers (a lot of them get transferred by the PennStar helicopter- how cool!) or admissions straight from clinic, so I would be responsible for starting those, writing the H+P note, doing medication reconciliation and then presenting to my chief resident or attending to make a plan.
On clinic days, I would see patients independently and then write the note, present to the attending and either get consent forms signed for surgery or order further testing as needed to prep for surgery. For patients who were operated on that day, I would be responsible for doing a post-op check usually 4 hours after their case ended.
My usual day would end around 7 pm after PM rounds (sometimes with the attending after their OR cases finished – sometimes this could mean finishing later than 7 pm), I would be responsible for updating the chief resident on all the day’s events, updating the list and then signing out to the night intern.
On Call / Night Shift
There was a lot of on calls since it was done by rotation which meant sharing call between 2 or sometimes/rarely 3 people. This meant that out of 4 weekends, I would be working 2-3 of them. Some would be working Sat and Sun-day or working overnight Sunday. The responsibilities on the weekend call were to cover your service and also 1-2 other services. In the AM, I would round with the chief resident on the services which could mean rounding with one chief then meeting another chief to round on another service’s patients. After rounds, I would complete tasks, call consults, write progress notes and then during the day would be either admitting or discharging patients and responding to pages and acute issues.
The night shift was an entire rotation so I completed 2 months total of night shifts. It was 1 month at a time – very different to how it was in Ireland where they only do 1 week at a time. I covered Vascular and Plastic Surgery for both months of night shift, which included getting handover for a lot of post-op checks, vascular sheath pulls, plastic surgery flap checks etc. I also had to titrate heparin drips pending aPTTs, manage hypertension on nicardipine drips and admit patients overnight who come in pre-op or any other acute admissions (mainly AAA emergency patients). It was a long month but I actually liked it as I was able to be fully responsible for the patients with no other residents around. Only the fellow or chief resident would be on call with me, but they would be at home so if there were any issues, I would have to contact them via phone and they would come in – otherwise, I was basically independent which I enjoyed! I also got to know the nursing staff better which makes a big difference when you’re covering two big busy services alone overnight – trust me, you want to never get on a nurse’s bad side, make friends not enemies! Also, a lot of the OR cases ended late so I would be the one responsible to update the list, complete any outstanding admission orders for them and take care of them overnight. I also was able to study for my USMLE Step 3 exam while on night float and so I wrote the exam a month later, thank goodness that’s out of the way – no more board exams until the final board certification to be able to work independently!!
We were only allowed 2 weeks off for the entire year 🙁 and sick days were essentially frowned upon because if there was no intern, then the team was down one member with no one else to cover. Harsh, I know especially for someone like me who loves to travel and explore – it was a very different lifestyle than what I’m used to and looking for.
It was tough, imagine working 80-90 hours a week every single day of every week for the year and working through 2-3 of 4 weekends per month. It was also isolating at times because I worked at 5 different hospitals, usually alone on the floor without seeing any colleagues since most of them were either operating or in the clinic, so often times, I would have to go to the OR frequently to update my chief or attending on sick patients or admissions.
I learned a LOT, I saw and was really lucky to be able to operate on almost every case (30% of them was me as the first assist!), dealt with emergencies, rapid responses, diagnosed an MI/stroke/PE/acute bleeding, dealt with post-operative complications (most times independently).
I learned how to stay calm in any situation especially after working in the trauma bay and seeing everything from motor vehicle accidents, gunshot wounds, stabbings, unconscious patients, IV drug abusers – literally everything. It was extremely busy and since it was with UPenn, we got transferred very sick patients and saw complex cases. The co-residents, attending, nurses, everyone was amazing, I learned a lot, was taught a lot and really got along with everyone there. For me though, my biggest challenge was with work-life balance. There really was no balance, it was mainly work work work and I often found myself too tired after working 12-14 hours a day every day to be myself = workout, get exploring the area or even want to go out to buy groceries. There would be a few months at a time where I barely was outdoors, barely saw the sun (or would see it on rounds from patient’s rooms) and that is what really affected me. Although in the end after 6-10 years of residency, I would be earning well and living a good life, it still wasn’t worth going through all of that as a resident (+on a residents salary) in my late 20s/early 30s, when I valued other things in life more than my job. That was a HUGE turning point for me and it was a very difficult decision to make, leaving my dream job of surgery to pursue something totally different. I took a big risk, but hey sometimes getting a strong feeling about something, taking a leap of faith and believing in your own journey, makes it all worth it.
Year Off 2017-2018
I decided to take a year off of working to travel and really experience life. After not being able to feel like myself for an entire year, I knew I had to do it. So I set off on a worldwide adventure with intermittent breaks at home or in the US on interviews for Family Medicine residency spots.
Since I decided to switch from surgery to Family Medicine, I had to re-apply, I had a program try to transfer me and give me credits for my year in surgery, but it was so hard to match up what I rotated on, with the requirements for FM, so I had to start from the beginning and re-apply and interview all over again.
The rest of my year was absolutely amazing, I followed my dreams and traveled a LOT. Here’s the breakdown Bali, Singapore, Hong Kong, Australia, New Zealand, Bahamas, Aruba, Curacao, Colombia, Panama, Costa Rica, Ireland, Portugal, Brazil, Argentina, Peru, Colombia round 2, Cuba, USA a bunch of times to California for a month and them the various spots on the East Coast all the way from NYC to Key West, Florida.
Job # 3: PGY1 Family Medicine Resident At JFK Medical Centre In Edison, NJ, USA 2018-Present
Day to Day Life
It depends on the rotation that I am on. Some rotations are easier than others and only require 8-5pm and some such as the family medicine inpatient service or obstetrics (where you hold a pager) require longer hours with signout at 7 pm.
Every morning we attend “Morning Report” which is basically the night team signing out to everyone and the day team presenting all the current family medicine inpatients and discussing their plans. We review imaging and sometimes discuss other pertinent things. Other times, we have team meetings for the clinic to talk about new protocols or have office meetings. Usually, after this, I report to my day job, so for example, I am currently on pediatric inpatient service which means that I come in, review labs and overnight events for patients I am following, write a note and present during rounds. If there is a new patient admitted overnight then I talk to the parents/patient about the history of presenting complaint, and what brought them to the hospital and then present a full report at rounds. At 10:30 am, we do patient-centered rounds which mean that all doctors, residents, students, nurses, nursing manager/coordinator, social worker, dietician etc, attend, and each patient is presented to everyone either by myself or the student including a full assessment and plan. Rounds can take anywhere from 30 mins to 3+ hours depending on the census. For the rest of the day, we get taught lectures from the pediatric hospitalist, admit patients or deal with any issues going on with the current in patients. My day ends at 5 pm on this rotation. The other rotations that I’ve done so far are two weeks of obstetrics, two weeks of night float then two weeks of pediatric emergency room.
I also have a half day of clinic every week where I see 4-5 patients, most of them are new patients where I am the primary care doctor, but some are established patients – I see anything from newborns to children to adults and the elderly. I precept all clinic cases with the attending who is on for the clinic day but for the most part, I am the managing physician who completes the note, orders tests, sends referrals, completes paperwork and then calls to follow up with results to the patient.
On Call / Night Shift
Certain rotations such as obstetrics, night float, and family medicine inpatient do not do weekends on call. Otherwise the other rotations, you either work Friday 24 hours and Sunday 12 hours or Saturday 24 hours. As the intern, you hold the family medicine pager and obstetrics pager and are responsible for pages for any inpatients, to do death pronouncements around the hospital, attend code blues and do CPR and evaluate/manage/deliver obstetric patients. You also are responsible to see the postpartum patients and report to the hospitalist with updates.
I am allowed to take a vacation on only 4 rotations with a max of 5 days per month. So far with my schedule, I can’t take any days off until February.
I am really happy I made the switch and I am liking my residency program and my experiences here so far! It is lovely living in the US again especially being close to NYC – one of my favorite cities in the world! I have a better work-life balance and despite having all my hard rotations first and not being able to take a vacation until Feb, I am still feeling much more like myself and am enjoying everything so far! The program has a good balance of hospital rotations vs outpatient clinic and I find that I am getting enough exposure to everything for my own training goals. I am looking forward to next year when I can choose electives and get a chance to train in what I am interested in for my future practice! The attendings and co-residents are all great and I’m feeling settled and less stressed- so glad I don’t have to re-apply again, and no more moving for the next 3 years!
I hope that this long summary of my 3 very different jobs helped with my journey through medicine and surgery. It was really a rollercoaster of emotions, experiences and personal growth but I believe that we all have a path and sometimes it takes longer to get there than you anticipated. My journey has brought me to places in the world that I never would’ve foreseen if you asked 16 year old me, but I have lived and learned A LOT and I am truly grateful for all that I’ve gone through. I learned so many skills including the ability to stay calm and logical in any situation (skills I gained working in surgery) which has helped in my profession but also in life. I have had to adapt to many situations including dealing with patient populations from all different races, cultures and speaking languages other than English. I am no longer scared or fearful to answer a worrisome page, I am not nervous when I have to assess a septic or very sick patient, or run to a code call or deal with a challenging person. I have come across everything from sexist, racist and overall rude patients and also the most lovely, grateful and appreciative patients. In reality, the life of a doctor isn’t like how you see on TV and it involves A LOT of hard work, sweat, and tears. For me, it’s a love-hate relationship but I’m looking forward to seeing where the future will bring me.
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