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medical residency

How to Survive Medical Residency

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Regardless of your field of choice, your first year of medical residency will likely outdo year one of medical school in terms of difficulty—both mentally and physically.

We spoke with three doctors who have recently gone through it and come out the other side:

  • Shannon Lowell, University of California, Davis class of 2016. She started her general surgery residency at Oregon Health & Science University in 2016.
  • Tarak Shah, American University of Antigua College of Medicine class of 2014. He’s in his third year of internal medicine residency at the New Hanover Regional Medical Center in Wilmington, NC.
  • Chitra Akileswaran, Harvard Medical School class of 2011. She completed her residency in Obstetrics & Gynecology at the University of California, San Francisco in 2015. Dr. Akileswaran is currently a practicing obstetrician-gynecologist, a lecturer at Harvard Medical School, and co-founder of LUCY, an app for new parents to access support services as they return to work. She also has an MBA from Harvard Business School.

How Long is Medical Residency?

A medical residency is required training to become a doctor. The length of time your training takes can depend on the practice you hope to specialize in. For most, medical residency lasts at least three years, but some surgical specialties can require up to five years.

Since the path to becoming a doctor is long and can be taxing, read advice from these current doctors (and former residents) for keeping your sanity, your bank account, and your relationships intact as you complete your internship.

There Is No One Financial Solution for Residents

While doctors may eventually be among the highest earners, it takes a long time to get there, so it’s important to manage your finances carefully during your first few post-med school years.

Doctors See Biggest Decline in Debt-to-Income Ratio Over Time

Doctors’ Debt-to-Income Ratio Sees a Large Decrease Over Time

Physicians tend to start out their careers with the most debt relative to their income. However, since physicians are high earners as their careers advance, MDs are able to pay down their debt relatively quickly and they tend to experience the biggest decline in their debt-to-income ratio over time compared to other graduate degrees, like a Master of Arts, JD degree, and MBA.

How Much Do Residents Make?

According to a 2017 report on residents’ salaries and debt from Medscape, medical residents earn $57,200 per year on average. Your specialty can also dictate what you earn, with specialized surgical residents earning $60,000 on average and hematology specialists earning $69,000 on average.

Take Advantage of Loan Counseling and Forgiveness Programs

Dr. Lowell credits the loan counseling program provided by her medical school for helping her devise a student loan payoff strategy. She chose an income-based repayment plan, which means she’s making smaller, manageable payments each month, but that’s not doing much for her principal balance for now.

However, she said she plans to take advantage of loan forgiveness that kicks in once you’ve worked 10 years for a non-profit (her training itself lasts about eight years). Recent or upcoming grads who aren’t provided with great loan counseling might seek out (and even pay) an expert source (for example Doctors Without Quarters) who can help them come up with a strategy, she said.

Read more: 6 Steps to Refinancing Your Medical School Debt with Earnest

Be As Frugal As Possible

Dr. Shah took a frugal approach as a resident in order to continue making healthy student loan payments; he suggested buying a used car (if you even need a car in the first place), saving money by eating at home, and getting together with friends at their houses instead of at restaurants or bars. His advice regarding loans is to pay them off as soon as possible and to maximize 401(k) and Roth IRA investments once your loan is paid off.

Dr. Tarak Shah photo
Dr. Tarak Shah is in his third year of internal medicine residency at the New Hanover Regional Medical Center in Wilmington, NC.

Consider Student Loan Deferment

Dr. Akileswaran had an alternative approach to student loan repayment, suggesting that residents pursue deferment or even forbearance so as to avoid having to make any payments during residency.

She suggested that future high earnings (even for those in primary care) and low-interest rates on student debt meant that it made more sense for residents to make sure other bills were paid off—and they are not taking on more debt.

Use Digital Tools to Make Your Financial Life Simple

She encouraged keeping things simple with digital tools. Residents “will never be able to get to a bank during business hours,” she said. Online banking, a cash back or rewards credit card, and automation (such as direct deposit to your checking or savings and bill pay) can all help make your life easier.

Seek the Help of Financial Experts

In addition, she also recommended seeking the help of a financial planner to get profession-specific disability insurance and to advise on ways to “de-risk your finances” once you finish residency.

“Keep in mind that our training as physicians is essentially deferring earnings for seven to 15 years, while our friends were paying into their 401(k)s,” Dr. Akileswaran said. “We have to be disciplined to catch up.”

Sleep … Whenever You Can During Residency

If you’re the type of person that needs eight hours of sleep to function, make sure to take this into account when choosing a specialty.

Dr. Shah, an internal medicine resident, slept six to eight hours per night in his first year—and said he can function on a minimum of six hours when on call.

Ob/Gyn residents, on the other hand, are “notorious for working long stretches of nights and being on call during weekends,” according to Dr. Akileswaran.

Dr. Chitra Akileswaran photo
Dr. Chitra Akileswaran, Harvard Medical School class of 2011. She completed her residency in Obstetrics & Gynecology at the University of California, San Francisco in 2015. Dr. Akileswaran is currently a practicing obstetrician-gynecologist. Photo by Noah Berger.

She recalled working at least one 24 to 30-hour shift per week and sleeping only five to six hours per night on the remaining days of the week. Some of her rotations required even more of her waking hours, leaving just four hours for sleep.

Dr. Lowell, who is entering her second year of general surgery residency, estimates that she sleeps between five and six hours per night, which is dependent on the rotation, but she rarely sleeps more than six hours.

“I don’t think you’ll find a surgery resident who would ever say there is a level of sleep at which we can’t do our job,” Dr. Lowell said. Whether it’s an operation or admitting a patient, “you just do it.”

Naps Are Important Too

Both Dr. Akileswaran and Dr. Lowell swear by naps, even if it’s after your shift and before your drive home. They both pointed out that the amount of sleep you get really depends on the rotation—lighter rotations are a good time to catch up on sleep before the next tough stretch.

Create a Sleep Routine and Good Sleep Environment

In terms of the sleep you do get, Dr. Akileswaran advocated for a consistent routine (and might even sacrifice a small amount of sleep in order to maintain that routine). Whether it’s a meal, shower, reading a book, or all of the above, if you need some time to yourself at the end of the day, getting into a routine can help your quality of sleep. On that note, she recommended also abiding by good sleep hygiene—keeping your room dark or using an eye mask, and finding a quiet place to sleep, or using a noise machine or earplugs.

Maintaining Your Relationships as a Resident

In the hospital, “you will not make it out the door at the end of the day” without the help of everyone around you, according to Dr. Lowell.

Befriend the Hospital Staff

She stressed the importance of getting the nurses on your side by “taking their concerns seriously, explaining your thinking to them when you disagree … and thanking them when they go out of their way to help.”

Dr. Shannon Lowell photo
Dr. Shannon Lowell graduated from University of California, Davis and started her general surgery residency at Oregon Health & Science University in 2016.

Also, case managers are another important resource (and important people to befriend), because without them wanting to help you, patients may sit in the hospital for days.

Pharmacists can also “save your butt” with urgent questions, medication reconciliation, and discharge instructions. Senior residents, she says, are who you’ll learn the most from. Dr. Shah also said senior residents were invaluable in his first year.

Both Dr. Lowell and Dr. Akileswaran said befriending fellow residents was important.

“[They] look out for [you], help each other get out of the hospital,” said Dr. Lowell, “and make sure people feel supported.”

Continue to Connect With Your Class

Dr. Akileswaran encouraged residents to go to every class gathering (happy hours, brunch, or other organized activities), trade battle scars via a WhatsApp group (or start one!), and play an active part in forming the culture of your program.

Seek Out a Mentor for Your Career

It can also be incredibly valuable to have a mentor, particularly for networking opportunities. Dr. Shah said his mentor’s letter of recommendation played a huge role in landing his fellowship.

Dr. Lowell said she had the help of a doctor who is very well-respected in the surgery world. Now that she’s started her residency, she meets with a mentor every six months (as part of her program).

Managing the Rest of Your Life During Residency

With a hectic schedule, it’s important for residents to hack their life in any way possible to make some of the more mundane tasks and responsibilities more manageable.

Outsource Household Tasks

Outsourcing errands and housework is a common strategy amongst residents. Dr. Akileswaran recommended spending $100-$200 per month for help with cleaning, laundry, grocery shopping, and other home-related tasks—despite the extra expense.

Dr. Lowell swore by Amazon and autopay bills and pointed out that having a significant other to help with housework was a huge benefit, though not a luxury every resident will have.

Prioritize Self-Care

Taking care of yourself, both mentally and physically, is of utmost importance, the doctors said.

Dr. Lowell said her resident-life evenings were down to a science, and she typically managed two or three tasks every night in a given evening. She said she had learned to make conscious choices between eating, showering, studying (for residents, this could be prepping for a big case), doing something social, spending time with family and/or significant other, exercising, errands, and housework. Each person is different, she says, so it’s important to prioritize which two or three of those tasks or activities per night you care about in order to stay “happy and sane.”

“Self-care is incredibly undervalued in residency, all around,” said Dr. Akileswaran. “Sacrifice is what’s respected, including of your own comfort and well-being.”

That said, she urged residents to maintain “one small ritual of self-care.” That might be fitness, massage, meditation, therapy, or something else that makes you “feel human.”

She said she was also a big fan of routine in residency, and not just at bedtime.

“Similar to building muscle memory in the operating room, routines reduce the cognitive load devoted to decision-making, which you will need to conserve for actual patient care,” she said. “[It helps] make sure you aren’t missing anything important.”

Embrace Technology

Dr. Akileswaran recommended a Bluetooth headset if you’re driving to work, as this can be a great time to catch up with friends and family.

She also leveraged various technologies for note-taking and clinical learning, such as Dropbox to store publications and Evernote to aggregate all her notes from talks, Grand Rounds, didactic teaching, and her own learning from cases.

When you finish residency, she said, you’ll have an “incredible living database to draw from.”

Vacations Still Exist—Sometimes

Dr. Shah used upcoming vacations as “the light at the end of the tunnel,” and said trip-planning was one way to help stay in touch with family and friends.

Unplug or Consider a Staycation

Dr. Akileswaran recommended a vacation style that was about “completely unplugging”— including from your pager and phone. One key caveat: She also budgeted at least one day back at home before your first day of work so that you can settle in and readjust from jetlag.

“Prioritize your time in the most beneficial way for you,” suggested Dr. Lowell; for some people, that’s traveling and for others, it might be a stay-cation complete with a lot of sleep.

Also, you have to compromise, even when there are special events.

“Our time as residents is not our own, and we are completely subjected to the schedules created for us—sometimes we get to put in requests… but sadly nothing is ever guaranteed or promised,” Dr. Lowell added.  That doesn’t mean you shouldn’t ask, she says, but do so respectfully and understand that making a request is putting an extra burden on the person making your schedule.

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Disclaimer: This blog post provides personal finance educational information, and it is not intended to provide legal, financial, or tax advice.