PGY 2 worse than PGY 1??

[cardsurgguy]

Slow night on the ICU the a few weeks ago talking with our resident and the resident said something that really surprised me.
I was just wondering if this was one man's opinion or if this was the majority view.


So we were talking about residency and what not and I was saying how intern year must have been hell and that he must be glad he's now a PGY 2 (soon to be PGY 3 in July).

He said something that surprised me...He said PGY 2 was worse than Internship year.

I was shocked to hear this. The stereotype is that intern year is the hardest residency year because you have responsibility because you're a doctor and not a med student having somebody else sign the orders you write, but since you just finished med school, you have no idea what the hell you're doing (relatively speaking, as compared to what you will be like in the future during junior/senior resident years and as an attending).

I said this to him and he didn't disagree with any of that. But he added a few other things to defend his viewpoint. He said that as an intern, you're not really allowed to do anything above your head and you're actually kind of put on a leash of what you could do since everybody knows you're an intern and have no idea what you're doing. He said you always have a junior/senior resident on to call to get answers to something you don't have.

But, with PGY2, now you're the resident who the interns are calling with questions that you're expected to have the answers to. He said your responsiblity level goes way up PGY2 because of this fact relative to intern year. On some floors, you're the highest level resident and only have the attending to call as a PGY2, while this would never be the case as an intern.


So in summary, he said in his opinion, PGY2 was worse than PGY1.

Is this a very small minority view or do many of you share this viewpoint?

Like I said, I'm really curious because this is the first time I've heard this and it's the opposite of what the commonly accepted viewpoint is.


PS - He was Peds if anybody is curious.

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[mysophobe]

Great. I thought this was as bad as it gets.

 

[DRDARIA]

Slow night on the ICU the a few weeks ago talking with our resident and the resident



I said this to him and he didn't disagree with any of that. But he added a few other things to defend his viewpoint. He said that as an intern, you're not really allowed to do anything above your head and you're actually kind of put on a leash of what you could do since everybody knows you're an intern and have no idea what you're doing. He said you always have a junior/senior resident on to call to get answers to something you don't have.

But, with PGY2, now you're the resident who the interns are calling with questions that you're expected to have the answers to. He said your responsiblity level goes way up PGY2 because of this fact relative to intern year. On some floors, you're the highest level resident and only have the attending to call as a PGY2, while this would never be the case as an intern.

I wonder if the word "worse" maybe is being used a little differently. I have heard from many PGY2s that it is more stressful at first because of the increased responsibility. However, I think a lot of it might depend on the personality of the individual. Some people may have more difficulty with having to supervise and be responsible for others, i.e. the interns-- where as others may find it to be not such a big deal. Of course, since I'm just starting my intern year, I can't say, but I'm basing this theory on jobs I've had with increasing responsibility, and having to supervise other people. I've found that it can be quite a shock to people when their roles are suddenly changed, but most come to enjoy it pretty quickly.

 

[radonc]

i thought being a pgy-2 medicine was worse just because i had to follow up on 24 patients, instead of 12. plus, i was left with writing postcall notes/orders/scut after the postcall intern left at noon. in addition, if anything got went wrong, it was on me. also, i was the go to guy in the ICU. however, the pluses of being a pgy-2 (much less note writing, no pre-rounding, managing, less call) are to be noted as well. the change of guard is part of residency...

 

[cardsurgguy]

Great. I thought this was as bad as it gets.

Haha, just occured to me that it probably isn't the best time of year to post a message like this...

How's life as a surgery intern going so far for ya?

I wonder if the word "worse" maybe is being used a little differently. I have heard from many PGY2s that it is more stressful at first because of the increased responsibility. However, I think a lot of it might depend on the personality of the individual. Some people may have more difficulty with having to supervise and be responsible for others, i.e. the interns-- where as others may find it to be not such a big deal. Of course, since I'm just starting my intern year, I can't say, but I'm basing this theory on jobs I've had with increasing responsibility, and having to supervise other people. I've found that it can be quite a shock to people when their roles are suddenly changed, but most come to enjoy it pretty quickly.

This could be true. It could be an aspect about him that doesn't like being in charge of people.
Probably isn't the fact he's not used to being a PGY2. As I said, this conversation took place a few weeks ago and he's going to be a PGY 3 in a few weeks coming up.
But who knows, maybe it's just him specifically.

 

[oldbearprofessor]

Although internship is the largest "transition" of training due to being responsible as a doctor for the first time, your friend is entirely correct, that, for pediatrics, in many if not most programs, PL-2 is by far the "hardest" year. Interns in pedi tend to do floor admissions (work hard and take a lot of call) but floor patients aren't usually that sick in pedi and when interns are in the PICU or NICU they have a lot of supervision.

In most programs, PL-2s are supervisors, and have more ICU time. In many programs without fellows, they may be alone at night in the NICU or have relatively little if any backup between them and the attending at home. Night-call is often fairly busy and they are expected to manage some fairly sick people without backup. Some programs delay this responsibility until PL-3 year and have PL-2's mostly doing subspecialty rotations. But many put the hardest year as the PL-2 year. In general (big generalization here), I think that the tendency to delay the hardest rotations and most stress in pedi until the second or third year is a bit different from internal medicine where interns are put under more pressure to manage very sick patients. We tend to delay that responsibility more in pedi.

But of course, by then, you are prepared to handle it!

Regards

OBP

 

[toxic-megacolon]

At least as a PGY2 you don't have to take "intern call" the most painful concept in existence.

Typical call on an interns call night:

-3 am-
Nurse: "Doctor, sorry to page you but just letting you know the patient's 2am vitals are normal, or the patient is really lonely and I don'tknow what to do"
Intern: "Are you serious?"

I'm eagerly looking forward to the end of managing that type of "floor work" in the middle of the night.

 

[DOtobe]

At least as a PGY2 you don't have to take "intern call" the most painful concept in existence.

Typical call on an interns call night:

-3 am-
Nurse: "Doctor, sorry to page you but just letting you know the patient's 2am vitals are normal, or the patient is really lonely and I don'tknow what to do"
Intern: "Are you serious?"

I'm eagerly looking forward to the end of managing that type of "floor work" in the middle of the night.

I had my LAST INTERN CALL EVER last night!!!! Took all my willpower to not do cartwheels out to my car this morning.

 

[CANES2006]

I had my LAST INTERN CALL EVER last night!!!! Took all my willpower to not do cartwheels out to my car this morning.

Congrats!! I'm releived to have just survived my first intern call ever on the labor and delivery floor last night!

 

[Blade28]

Slow night on the ICU the a few weeks ago talking with our resident and the resident said something that really surprised me.
I was just wondering if this was one man's opinion or if this was the majority view.


So we were talking about residency and what not and I was saying how intern year must have been hell and that he must be glad he's now a PGY 2 (soon to be PGY 3 in July).

He said something that surprised me...He said PGY 2 was worse than Internship year.

As an intern on a busy trauma service, there's a ton of work but it's not difficult, per se. In a week, when I become the 2 on the service, I'll be down in the trauma bay initiating resuscitation, and I'll also be in charge of the floor. There'll be a brand-new intern seeing the floor patients (remember, this is trauma in JULY).

So yes, the prospect of becoming a PGY-2 terrifies me.

 

[Flea girl]

Congrats!! I'm releived to have just survived my first intern call ever on the labor and delivery floor last night!

Congrat to you too! You have already started? I have first call this Sat before I even start on the floor! Needless to say, I really hope that I survive the night !

 

[njbmd]

Hi there,
Remember this: As an intern (PGY-1) you are not expected to know anything but expected to become very good at carrying out orders etc. As a PGY-2 you need to know something and put it in practice. For some folks, this is a difficult transition to make. You are the main resource person for the incoming PGY-1 folks.

Overall, I was glad to be done with my PGY-1 year as I started residency under the pre-80-hour work week. While I had more to do during my PGY-2 year, I had more reading and home time too.

njbmd

 

[Hard24Get]

But, with PGY2, now you're the resident who the interns are calling with questions that you're expected to have the answers to. He said your responsiblity level goes way up PGY2 because of this fact relative to intern year. On some floors, you're the highest level resident and only have the attending to call as a PGY2, while this would never be the case as an intern.


So in summary, he said in his opinion, PGY2 was worse than PGY1.

Going by that philosophy, being an attending must be the worse thing ever!

 

[AJM]

Going by that philosophy, being an attending must be the worse thing ever!

Very true. I know many young attendings, and they uniformly have said that the transition from residency/fellowship to being attendings was by far more stressful than any of their years of training.... mostly because the buck truly stops with you as the attending and there's no one around who you can routinely run things by with.

But I agree with the others -- as a soon-to-be PGY-5, the hardest and most stressful year I've had in my training was my PGY-2 year. The biggest stressor I felt was that as the PGY-2 I was the go-to in-house person at nights, and there was usually no one more senior around to help out if things got hairy... that, and you follow at least twice as many patients as each intern (at my program it was often more than that), so you get double the stress. By the end of the PGY-2 year you get kind of used to that role, so subsequent years don't seem nearly as bad. (the other thing that made PGY-2 suck for me was that it was the first year of the 80-30 workweek, so I had to work much longer hours than the interns in order to keep the interns in compliance with the work hours.... that, and I had to walk to work 5 miles uphill, both ways, in the snow.... )

But then again, I've seen the new interns on the floors the last couple of days, and they are absolutely freaked out. So I've decided that the first 2 weeks of internship are definitely the worst part of training.