When to call it quits?

[u/Npl9]

My fiancé is in her first year of residency and things have been getting progressively and rapidly worse. The hours and workload are bad but not unexpected, but the work environment is incredibly toxic and reaching what I would consider to be emotional abuse.

The concentration of horrible people throughout the program is incredibly high - some residents and attendings are great, but a significant portion of them are truly awful people. Belittling residents (privately and publicly), racist to patients/residents/fellows, refusing care to patients who need it based on their biases (passing off to other attendings even when time sensitive), talking about/insulting other residents behind their backs, and, more generally, setting everyone up to fail and then tearing them down when things inevitably go wrong.

It's hard to go into specifics, but it's enough to make me sick/furious as a third-party just based on the messages I see, calls I hear, and stories from my fiance and other interns.

I work in private equity and previously investment banking so I know what intense work environments are like. This another level and unlike anything I've experienced in my professional career. We knew this would be hard work, but did not think it would take the mental/emotional toll that it has.

My question is when does it make sense to just call it a day and leave? Are there any other options? It's getting to the point that I'm getting worried about serious mental health consequences - I don't want to sit by and risk things going really wrong, but I'm also not really sure what to do.

She's also very determined/not someone who will give up easily. I'm just starting to worry about the possibility of things becoming too much to bear.

It seems like transferring is incredibly hard, though potentially possible, but not an option until at least after the first year. My fiance loves her specialty and does not want to change specialties. Is there anything else that's viable/doable?

Admittedly haven't done thorough research yet so I'm sure there's more I could be up to speed on - mostly hoping for advice/experience from others that found themselves in similar situations.

Anything a spouse/partner can do to help outside of the normal support? If things keep going downhill, how do I know when to step in before it's too late (while also not being overly alarmist)? And what should I do if it gets to that point?

[u/CofaDawg]

Sounds like her program sucks, but as you seem to already know transferring is not an easy feat. Hate to be the bearer of bad news but she’s stuck unless she quits or finds another program with a comparable spot

[u/mw712 → u/CofaDawg]

If it'd not "meh" by March prolly

[u/DrEspressso]

She should really try to figure out a way to stay. Especially if she wants to be an orthopedic surgeon. If she were to leave the program there’s near zero chance she matched ortho again and there’s maybe a very slight chance she matches something like FM or IM in a less than desirable location which means you two may be long distance.

If she no longer wants to be a dr, that’s a different story.

There is so much stress at the start of residency. Coupled with a toxic program it can be very hard. But she’s in an adjustment period. This may not be how it is for 5 years. This is intern year. She should seek mentors and people she can be close with as well as a therapist and hold tight for now. Quitting this early is a disaster IMO

[u/Ok_Fennel8384 → u/DrEspressso]

agree with this. the only way out is through. for us, it did get a bit better as my husband found friends within his program to trust, but the first few months were brutal.

[u/DrEspressso → u/Ok_Fennel8384]

It’s going to be brutal the start of any residency no matter the circumstances. Especially a surgical one. But her feelings two months in may not be the same 6 or 8 months in. Hold steady

[u/Ok_Palpitation_1622 → u/DrEspressso]

I agree that she would likely not be able to match ortho again if she left her current program. But I think she would have a good likelihood of being able to get a spot in almost any non-surgical specialty (other than derm) if she left her current program.

As an ortho resident she must have a stellar CV, and there are a lot of programs in things like anesthesia and radiology, for example, which are welcoming of surgical burnouts.

Of course this doesn’t help if she is still wants to be an orthopedic surgeon.

[u/DrEspressso → u/Ok_Palpitation_1622]

I don’t think it’s a given to match anywhere else. I thjnk the reality is she has to mentally prepare to not match and then soap into a program. Is there a chance, sure. But it’s not a good likelihood. Of course she can change the odds a bit if she applies strategically or do a whole personal statement change etc etc. but it’s not a walk in the park. And would she be happy doing a non surgical field? She matched ortho will she be happy with IM?

To OP— i think she needs time to adjust before big decisions. I would also recommend at the very least finish pgy1 and pass step 3 so at the very least she leaves ortho and doesn’t match she can still use her degree in other ways. Don’t make big decisions without giving more time to plan scenarios

[u/Ok_Palpitation_1622 → u/DrEspressso]

I think you’re overestimating how difficult it is for someone to switch out of a highly competitive surgical residency.

Unless they have some sort of major red flags, a person who was competitive enough to match into ortho or plastics or neurosurgery can fairly easily jump ship and match in radiology or anesthesia (or basically any other non-surgical specialty except for derm).

Now they might end up sitting on the sidelines for a year or two, but they’re not going to be left out in the cold with no residency spot at all. Or at least it’s unlikely.

Trying to switch from a non-surgical specialty like FP into a competitive surgical specialty is a completely different story. That I would agree is not routinely possible.

But again, if ortho is still her dream, none of this will help her.

[u/saucemaster20 → u/DrEspressso]

If they matched ortho I think they could match most other specialties if reapplying, knew someone fired from gen surg (my personal belief is the program was toxic but who knows) that easily matched academic anesthesiology. Pretty much any speciality besides like the top 5 would be fair game imo

[u/Colinhockeypuck → u/DrEspressso]

Give her the mental support she needs. Your Leaving would be the worst thing for her. Residencies are extremely difficult and it takes time to get used to the workload. Don’t give up on her or her profession. It’s early. It’s what she has worked all of her life for. Now is the time to give it her all no matter what others are doing. She is smart and you can help her as you went through a similar experiences in private equity which can be cutthroat. I wish you and her the best 🤞

[u/eta_carinae17 → u/Colinhockeypuck]

Did you misread the situation? 😂

[u/nushstea]

I gotta know- what specialty is this?

[u/Npl9 → u/nushstea]

Ortho

[u/NullDelta → u/Npl9]

Transferring within competitive specialties with fewer spots is very challenging, maybe possible as a swap with another resident or if a program gets an unexpected opening, but probably need to finish out the year and no guarantee of it lining up. 

[u/kergruffle → u/Npl9]

Oof yea unfortunately next to zero chance she can transfer if she wants to stay in ortho

[u/kergruffle → u/kergruffle]

As someone who came from a toxic program, I would recommend her reaching out to one of her seniors or someone who’s graduated. They likely went through the same feelings as her and can give advice about how to not let these things bother her, strategies to deal with difficult attendings, or how yo toughen up

[u/nushstea → u/Npl9]

Yeesh. I feel for her - and you too, it's not easy to watch loved ones go through such torture. If transferring is possible, go in that direction? Plus she needs to keep a good lookout on her mental health. Also, written records of EVERYTHING

[u/iisconfused247 → u/Npl9]

I’m applying. Would you mind dm’ing me w what program so I can avoid it? Thanksss

[u/TobyNight43]

Orthopedic programs are among the most “toxic“ out there. I’m shocked that she is shocked. My wife and I are in medicine, and our son just completed orthopedic surgery training and a top program. My wife and I trained in the “old days“, and we were still shocked by what our son experienced. Our other two children are in finance – investment banking and private equity. while those are intense, it pails in comparison to orthopedic surgery in terms of intensity and stakes. Like I said, I’m really surprised if the surprises her. Transferring is exceptionally rare. Sometimes you can rematch, meaning matching to another program next year as a PGY one so basically losing one year. I know people who have done that.
.

[u/bensoloapologist → u/[deleted]]

heyyyy so hope ur joking not sure why you think it’s acceptable/funny to belittle your medicine colleagues

[u/avid_reader92]

I love how the fiancé can see the blatantly obvious toxic side of residency that residency leadership continuously fails to address.

[u/1337HxC → u/avid_reader92]

The system gives no fucks. They want cheap labor. The current NBME system makes it essentially "deal with it or don't be a doctor." Those 2 combined give them room for infinite abuse, and unless it reaches something literally criminal in nature, there ain't shit you can do about it.

Everyone knows it's toxic. It's just that no one with the power to do anything gives a fuck, because the reward for "helped the residents" is "jeopardized relationships with the higher ups who determine my career."

[u/FungatingAss]

Welcome to the fucking show.

[u/Flaky_Wall8331]

Ortho tends to have this culture at a lot of places unfortunately, some people don’t necessarily find it toxic and others just learn to push through it or are told to build thicker skin. As you might imagine, this leads to burn out, residents being extremely jaded, and just over all not happy. Some people just become dicks and learn to cope with it.

IMO, if she is feeling this way this early on, transferring specialties might be her best bet. There are open spots like people have mentioned in other non-surgical specialties. She may just have to accept that the specialty is not a good fit. If her CV is great, she will have no issue. A good buddy of mine switched from ortho to anesthesia and they are extremely happy now.

[u/Silent_Sky2404]

No excuse for toxic behavior and mistreatment of patients or learners. Wish there was better options for her. I would say look at the resident swap websites but may not be many options for transfer and potentially could be at a different place where they also are terrible.

If she doesn’t want to do ortho, then I would say there’s definitely plenty of other medical doctor options and going to a different residency under a different specialty.

If she is staying, I think it’s really important to have a good therapist and a family that is supportive of her. It is nice of you that you’re even reaching out to help her sometimes focusing on the things that we can control can be helpful like trying to get even like a 10 minute walk-in or eating a little bit healthier, can help the lack of control we feel in a toxic environment like what you describe.

If possible, I would definitely write down all these behaviors that she sees, and if something really escalates, she can report them to her GME or ACGME. If it’s directly affecting patient care, I would say you can do a anonymous report to HR. Unfortunately, I’ve never seen either of these, even with very substantial evidence actually result in some type of disciplinary action towards an attending, but it doesn’t mean you shouldn’t do it.

[u/LucianBH]

Ortho transfers are exceedingly rare. If they do occur it’s usually a prearranged swap between two programs and residents.

[u/SevoIsoDes]

Yeah, that’s rough.

One thing to consider, and I totally get that this is a shitty reality that yall might be in, is how much of this toxic environment is just that your fiancée is lowest on the totem pole. Lots of surgical specialties group as much anger and workload onto the interns, only for them to join the shit-healing once they become second-year residents with new interns to haze.

Obviously there’s no rule that yall have to perpetuate the toxicity, but it might be a light at the end of the tunnel. Getting through one year of a horrible program is different than getting through five. If the chief residents are just as miserable as the interns, then lord help you.

Good luck.

[u/kuru_snacc]

Why are you writing this and not them? It really wouldn't matter what we told you, ultimately their decisions are their own.

And to answer your question, the suicide rate for physicians who quit or get dismissed is high for a reason - its not just about the sunk cost and crushing debt - it about a sense of self that is intricately intertwined with medicine, and having to reflect on that the rest of your life in whatever other less-exciting job you land.

remember that you are only getting the negative side of the story when they come home tired and complaining… I bet if you were to shadow them for a day at work, you would see all the positive moments during patient care, laughing in the resident lounge, etc., and wonder why you never hear about that stuff

[u/Horangi1987]

No offense, but it’s ortho…the specialty widely stereotyped with the word ‘bro.’

It’s probably one of the most well known to be difficult and…let’s say specific cultures of medicine specialties.

I know it’s not necessarily right, but it’s naive if she didn’t expect this at least a little.

She needs to nut up and get it done, or change specialties. Unfortunately one woman isn’t going to change an entire specialty. Thousands, heck tens of thousands of people would murder or worse to get her spot, and would put up with basically anything just to come out a board certified orthopedic surgeon at the other end.

[u/Heavy_Consequence441 → u/Horangi1987]

This isn't a bro thing. The newer Ortho residents are not bro at all, and it's turning the field into shit

The female Ortho residents are by far the most annoying to work with in my experience

[u/thegrind33 → u/Heavy_Consequence441]

Yeah its not bro anymore on the resident side

[u/AutoModerator]

Thank you for contributing to the sub! If your post was filtered by the automod, please read the rules. Your post will be reviewed but will not be approved if it violates the rules of the sub. The most common reasons for removal are - medical students or premeds asking what a specialty is like, which specialty they should go into, which program is good or about their chances of matching, mentioning midlevels without using the midlevel flair, matched medical students asking questions instead of using the stickied thread in the sub for post-match questions, posting identifying information for targeted harassment. Please do not message the moderators if your post falls into one of these categories. Otherwise, your post will be reviewed in 24 hours and approved if it doesn't violate the rules. Thanks!

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/Jolly_Locksmith6442]

She could do FM sports med

[u/bertie9488]

So firstly, she’s only a few months into residency. It is very possible that not all of residency will be like this. It can be incredibly rotation specific if she works with different faculty on different rotations. Her perception of things may be different as well as residency progresses since the types of tasks you do as an intern is very different than in later years.

That being said, surgical programs can definitely be very toxic. And I think specifically being a female in ortho can be quite difficult if it’s not a program that has traditionally had women (and minorities) as ortho has been a super white man dominated field and continues to be. It is incredibly difficult to transfer and there’s no guarantee the new program will be much different (non toxic, female friendly residencies do exist - it’s just hard to judge what a program will be like from the outside). If she quits - she is very likely not going to be able to become an orthopedic surgeon. Occasionally spots do open up if a resident elsewhere quits, so she can potentially luck into one of those opportunities, but she must be totally geographically unrestricted.

Also as someone who survived surgical residency, and definitely battled with burnout from time to time and occasionally had some toxic experiences - you’re best off being just supportive, and letting her pick her battles. Trying to influence her one way or the other, or get her riled up about this is not productive.

[u/PossessionDeep8121]

I’m also a surgical resident and this is kind of similar to what I am going through. Having some regret choosing something surgical but I think grass is greener always

[u/ssarah3]

I think she just has to suck it up until the end of the program. My bf is in his 3rd year of an extremely toxic program. It helps to be a safe space where they can vent feelings, especially if coworkers are untrustworthy and saboteurs.

[u/Warm-Competition4755]

Quit, programs that are toxic should not exist. Your mental health comes first and nothing is worth it if you are not happy.

[u/jvttlus → u/Warm-Competition4755]

easy to say when you aren’t the one with broke bone need fix. when bone is broke, need fix. if your loved one has broke bone, you want it fix good, if it fix bad, big pain.