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The Surgical Residency Years: Lifestyle Considerations The following article is a synopsis of remarks delivered by practicing surgeons to medical students attending a roundtable discussion at the 1999 Clinical Congress in San Francisco. The session was sponsored by the American College of Surgeons Committee on Surgical Education in Medical Schools. The ideas reflected in this commentary are strictly the opinions expressed and statements made by various committee members based on their personal observations and experiences. You've decided to pursue a career in surgery. Not only will you be training for a rigorous and specialized profession, you will be embarking upon a whole new way of life. A career in surgery is rewarding in many ways. The adrenaline rush you get from taking a patient in extremis and making them better helps make up for the unpredictability of your lifestyle. Especially during residency, things may seem out of control at times, but after residency, you will have more control over your time. For all surgeons, the lack of control is easily outweighed by the career satisfaction. Understanding that surgery residencies make life very unpredictable, some prospective surgical residents become equivocal about making other major lifestyle changes, such as getting married and starting a family during their residency years. However, there is no single lifestyle preference that applies to everyone. Some surgical residents find that they need the social and emotional support that a spouse and family can offer during their residency years. Others find it is far easier to focus entirely on residency training, delaying marriage until after they begin surgical practice. Some surgeons prefer to be married to someone who works in the same profession because they can empathize with each other. Otherwise, they believe, it may be difficult for their spouse to understand why the surgical resident can never seem to commit to family, home, and other social activities. Although two married surgical residents can greatly empathize with each other, they also have one big mutual disadvantage: time. The time demands on two married surgical residents are enormous, even if one resident is pursuing a career path in a specialty that gives him or her a better measure of control over the daily schedule. Two-resident couples may greatly benefit from the early realization that there are many things in life that can be outsourced in managing family life--such as online grocery shopping--to make time for the kids or family activities. If you marry before or during the surgical residency years, remember to make professional decisions that will take your spouse into consideration; particularly if he or she is not a medical professional. Your spouse will need a strong support system during your surgical residency years, particularly if you are raising young children. Applying for a residency position in a geographic area where there is a strong support network for your spouse is important. This support network can take the form of family and friends who live in the area, or social alliances that can be formed with other residents and their families. In fact, you should inquire about any formal networking groups for spouses during the residency interview. As for planning when to start a family--that issue is an important discussion topic for any married couple, particularly when one or both spouses are pursuing a surgical residency. Certainly, the rigors and demands of surgical training make pregnancy a much bigger challenge than in other careers. Furthermore, the course of a pregnancy obviously cannot be predicted. For women, a complicated pregnancy can sometimes delay completing a residency. There are no time limits for how long it takes you to complete a surgical residency, although the American Board of Surgery does require that you complete 96 weeks of clinical work in your last two years of training. "Time off" for extenuating circumstances (whether they be pregnancy or other illness related) are usually resolved with your program director. Because of difficulty anticipating one's schedule, some surgical residents decide that the best time to start a family is after residency training is complete. Some women find that the years spent in research during or after their residency offer them a far more accommodating schedule to begin a family. However, if you decide that you are going to combine surgical residency training with raising a family, get ready to become very organized. Finding excellent child care services in the home or through a day care facility will be a great challenge for you and your spouse, just as it is for all working parents. So plan ahead. You also need to plan for backup support. Children in day care do get sick and are sent home. Day care practitioners will generally not adjust their policies on calling a parent at work to pick up a sick child based on what the parent does for a living. Many medical centers now have on-site day care with extended hours that are more accommodating to surgical residents' work schedules. If you are interviewing for a residency position and you are planning for parenthood during the residency years, it is legal to ask if a program has a pregnancy policy (although you are better off to ask the residents this). Don't expect a residency program to rearrange the whole schedule to accommodate your pregnancy, and remember (legally) no program can dismiss you solely for becoming pregnant. Once you are in a residency training program, if you get pregnant, let your program director know about your situation as soon as possible. That way it will be easier for all parties involved to make accommodations for a pregnancy during residency training. Surprises make accommodation more difficult. You might also ask your colleagues (or the residents who have been in the program for awhile) for their perspective on how the administration deals with pregnancy issues to prepare yourself for any type of reported scenario. The professional demands on your time and energy during a residency can be exhausting. Likewise, personal responsibilities to home and family can drain the momentum from your professional life. If professional counseling is available to assist you in balancing all of your responsibilities, take advantage of it. If you find that you need assistance to cope with all of the competing demands in your life during residency training, don't be shortsighted or too proud to accept professional counseling help--whether it be for marriage or family problems, professional guidance on improving your interpersonal skills, or specialized help for a substance abuse problem. (Every state medical society has a program for substance abuse treatment and enrollment is confidential.) Typically residents are not released from a residency program due to academic problems, but they can be due to behavioral problems. Don't jeopardize your career potential by denying yourself professional counseling assistance. The time you devote to attending counseling sessions will be time well spent, and it will benefit you and your family for many years after. What goal should you set for your surgical residency? The answer is elementary: to come through it as a well-trained surgeon. You definitely need to become a good surgeon, but you also want to be a good person. Remember, you cannot meet every need in your life only through work. The concepts of "balance" and "becoming a well-rounded person" are very important. However, your perspective will definitely tilt during residency training as you devote the vast majority of your time and attention to your residency training obligations. Be prepared for it, but also think ahead. Think beyond the years of your residency and remember that a surgical residency is not a surgical career. A surgical residency typically runs five to seven years, but a surgical career can span three to four decades. Once you begin surgical practice, you will have a greater measure of control over your schedule and obligations. Then, you can decide how to fill that time, with additional "work" or with more time for family and other activities that bring you personal fulfillment. Learning to keep work in its place is certainly a challenge for a young and ambitious practicing surgeon. Because so much of a surgeon's work takes place in the operating room, a surgeon's life seems constantly focused on "the next big event." But you should put as much thought and energy as possible into developing your personal life as you do your surgical career. Don't fall into the trap of being so "career-oriented" that you find your life is empty once your surgical career ends. In order to achieve that all-important sense of balance, work to set your personal and professional life on parallel planes. The key? Spend time with the people you love and choose a medical speciality that will allow you to do something that you love. With both of these key ingredients in place, the balancing act will follow.
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