Residency & 2019
It's been a while since I updated this, and I guess it's probably about time! Apologies for it falling off my list of priorities ... it was a little hard to keep up with in the latter part of my intern year & I kind of forgot it existed for the entirety of my resident year.
A brief overview of what has happened since I last posted, what I'm upto now & what's on the cards for this year:
- Moved from my regional hospital to a tertiary centre
- Rotated through a mixture of vascular surgery/general surgery/surgical ward call nights, cardiology, emergency, rural relieving & intensive care.
- Went on holidays to South Africa & Namibia
- Currently on holidays in Japan but got injured immediately before coming so can't snowboard.
- Start work as an ICU registrar on Monday night next week.
Moving hospitals was a pretty big decision but a pretty easy one. I knew fairly early on that I wanted to get a rotation in ICU to figure out if I liked it enough to pursue it as a training pathway & also knew that there was absolutely no chance of getting that rotation staying where I was. Deciding where to go was pretty simple too - I figured since my chances of getting "good" rotations would probably be pretty similar everywhere I might as well move somewhere I would be happy to live for the next couple of years. In the end I got pretty lucky and happened to move somewhere I love living, where they gave me all the rotations I wanted in exchange for covering a heap of nights & eventually where I got offered an ICU registrar job.
It felt pretty weird coming into a hospital that I had never been in before, where I knew almost no-one and even though I lived in a great sharehouse the start of the year was pretty isolating. My housemates (all residents) managed to get almost exactly opposite rotations & at least two of us were always away on rural or nights terms at one of the smaller hospitals. It was the same with other residents I met at work, most of us had a mish-mash of rosters (days, lates, nights) with rarely similar time off and frequent secondments to the smaller hospitals. This was all a pretty huge shock for me after internship where we all pretty much worked 8 - 5, Mon - Fri.
In contrast to my time there as an intern I found Emergency to be the rotation where I got my life the most under control. Surgical relieving was a constantly changing beast of lates, nights and weekends where I didn't even know any of my bosses names, cardiology felt like an unrelenting rotation of discharging patients with non-cardiac chest pain ... and ED was only 8 days a fortnight, which I quickly realised was amazing. I managed to finally make time to see my friends, get to music gigs, learnt to surf in the middle of winter without a wetsuit, started rock climbing ... and then quickly threw it all away again when I got seconded to a rural hospital.
My rural job was pretty much exactly as sold to me in the JCU interview I did before starting medical school - "you are the junior doctor in charge of a rural hospital overnight" kind of situation. My bosses were theoretically 30 minutes away at all times to help with "anything and everything" but more realistically were too far away to be any help when needed urgently, so instead I found myself either sorting it out myself, calling retrievals / sitting in the back of an ambulance tearing down a mountain range with lights-and-siren, and a peripheral adrenaline infusion just hoping for the best. The roster was an absolute nightmare and seemed to completely ignore any kind of workplace agreements about maximum hours/fortnight: I worked 4 late shifts (1-11pm) where I was on-call overnight until 8am followed by 3 day shifts (8am - 4pm). The result was that I could work 10 hours, get called in at 1am and get back to sleep by 4 or 5.. only to be expected to be back at work at 8am with no option of not coming in. I think it might have worked a lot better if I was able to run things over the phone overnight rather than getting out of bed .... but in PGY2 I wasn't exactly comfortable with that as an option & much preferred to see the patients myself.
After 10 long weeks living in the middle of nowhere I got sent back home and to ICU where it seems things are a lot better in many ways. The roster is 7 on - 7 off, my bosses and registrars are super available and supportive & my partner has moved to the same city as me. I start work as a registrar immediately going onto nights for two cycles followed by two cycles of paeds ICU nights which is a little daunting, but I guess that's my job now.
Will try keep this updated as best I can!
ETA:
Hi guys, can someone explain to me the medical career after completing your degree? I'm aware that as of 2018 in NSW, you become an intern for 2 years, undergo an interview to become a resident, but I'm not sure the process that comes after, can someone explain?
Also, what are the differences in responsibility between being an intern and a resident?
Many thanks
There's a lot of "it depends" in this answer but I'll try give a general overview and if there are more specific questions then I'll answer them as best I can.
After graduating you start internship (Post-Grad-Year-1) where you have three mandatory 10-12 week terms (ED, Medicine, Surgery), 2 elective terms totalling 15 weeks and 5 weeks of paid leave. During this time you are considered to be provisionally registered, this means all your decisions are supposed to be supervised & that you aren't able to work outside of the hospital that you are interning at (i.e. no locum / additional work). Each term will have a mandatory mid-term & end-of-term assessment that you need to pass in order to have your terms counted off in internship, these are more of a safety-net for making sure interns get the support they need than they are an actual exam/assessment.
Each year while working as an intern/resident you will need to apply for your job the next year. This usually happens around June-July with offers being released a few months later (September onwards). Typically, if you have not burnt bridges you can easily reapply to stay on at the same hospital with minimal effort - hospitals like to keep their staff. If you decide to pursue a resident job in a specific field (e.g. surgical rotations only / critical care resident / paeds resident) then you will likely find yourself applying across the state/country to places where those jobs are available. Finding out where those jobs are available is a challenge in itself - they are rarely formally advertised, are typically offered in-house and often don't have a formal interview process as much as they have a "meet and greet" with the director of the unit. As such, in resident years it often is a matter of who-you-know or who you have as references that makes a significant difference to job applications.
Resident year itself is much the same as intern year but with more responsibility and less supervision. It's difficult exactly to quantify the change in responsibility as a lot of it depends on the team & the job at hand. It is likely that you will have an intern working with you that you are expected to partly supervise and who will come to you first with issues that you are expected to solve instead of escalating immediately to your registrar/consultant. You will find yourself being given a lot more night shifts now that you don't need to be supervised at all times & likely will be sent out to smaller hospitals in your catchment area for a term or two. As mentioned in my post above these smaller hospitals can (at least in QLD) be a case of you being the only doctor on call overnight manning a 24hr ED.
Resident years then progress while you get the necessary minimum number of rotations / minimum experience / meet the referees you need / sit exams / do courses etc before applying to your chosen pathway. It is possible to start some pathways/work as a junior registrar in PGY3 but more typically this is delayed a bit more. Often people will spend a year or two (or three or four) working as a resident specifically in their chosen field with progressively more and more responsibility - e.g. orthopaedic senior house officer who is also in charge of ordering necessary equipment / assisting co-ordinate the trauma list, medical senior house officer rotating through medical specialties, ED resident working in small regional hospitals with minimal supervision etc. The idea (in those cases) is that you progress incrementally until you eventually are doing the job of a registrar as a resident at which point you can step up without any issues .... unfortunately that is rarely how it works in practice!