Question about residency work hours

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Hi everyone

Thanks for reading this. I am about to attend medical school and one thing that has been really bugging me is the 80hrs work load for the residents with 30hrs of continuous work shift. What i don't get is how is anyone capable of staying awake for 30 hrs straight, yet people do it all the time since there are residents becoming and attending. Someone enlighten me on this? Would I be able to make it since I always need at least seven hours of sleep a night and never really had to stay up all night (except during my party days) for anything before. Is it really doable? I just don't get it. And also to do that for four years straight seem really impossible even though I like doing things that are impossible, sleep ain't' one.

How do you guys all do it?

Im still in Med School, but I'd imagine its all about the SAID principle (Specific Adaptation to Imposed Demands).

Basically your body will adapt to what you put it through (within normal limits). Its probably tough at first, but then you just get used to it.

I used to not be able to function on less than 8-10 hours of sleep, but now with boards, school, work and going to the gym I barely get 5-6 hours in a day. It starts off hard but your body adapts over time.

Plus if I'm not mistaken, most residents will find some place to sleep during their long shifts. It might only be a small nap, but anything helps when you're pushing 30 hours straight.

Originally Posted by Ronin786

Im still in Med School, but I'd imagine its all about the SAID principle (Specific Adaptation to Imposed Demands).

Better described as "Suck it up Buttercup."

The short answer is that you get used to it because you have to. It never stops sucking though.

but would it be ridiculous to make it as one of the reason not to pursue medicine?

Originally Posted by zoner

but would it be ridiculous to make it as one of the reason not to pursue medicine?

There are a million other good reasons not to pursue medicine. This is somewhere in the top 450,000 of them.

Originally Posted by zoner

but would it be ridiculous to make it as one of the reason not to pursue medicine?

Laziness? Prolly a good reason to not pursue medicine.

i hardly call not getting a proper sleep essential for good health and well being as being lazy

sorry, for that, just that I am extremely health conscious and just doesn't make sense that I have to sacrifice my health for the the health of others.

which makes me think, is it really that bad?

Originally Posted by zoner

i hardly call not getting a proper sleep essential for good health and well being as being lazy

sorry, for that, just that I am extremely health conscious and just doesn't make sense that I have to sacrifice my health for the the health of others.

which makes me think, is it really that bad?

If you are planning to go into trauma surgery, then yea Id tell you to SUCK IT UP PANSY. Most people aren't planning to go into such demanding surgical specialties. More importantly, there is really no reason to quit medicine just because you need normal amount of zzz to function. Pick a specialty that provides regular hours. For most specialties, its only ****ty during first couple yrs or residency. You can join a big group after u finish residency to spread out the calls. It's up to how u want to practice after you are done. You might get paid less but you still have options.

so not every specialty residency requires you to work 80 hrs a week and sometimes 30 hours shift?

Originally Posted by zoner

so not every specialty residency requires you to work 80 hrs a week and sometimes 30 hours shift?

psych is usually less than that

Originally Posted by zoner

i hardly call not getting a proper sleep essential for good health and well being as being lazy
sorry, for that, just that I am extremely health conscious and just doesn't make sense that I have to sacrifice my health for the the health of others.

I do think that it is sometimes tough to maintain a healthy lifestyle in med school and residency. Even in "easier" residencies, you will most likely have times where you have to work long hours/overnight and have trouble getting enough sleep (it just probably won't be as frequent as in some of the harder residencies). You most likely will be so busy on some rotations that you may not be able to eat healthy well balanced meals. The stress level in med school and residency can take a toll on you. I definitely felt like my health was not its best at times during med school and early residency
I am in psychiatry, which tends to be a more humane residency than most, and it IS better now that I am a senior resident, but I still have overnight calls and night float - just not as much.

I don't think it's lazy to say that you don't want to live that kind of life. It isn't for everyone.
Basically, you have to try to decide if you love medicine enough that it's worth it to you. The best way to figure that out is probably to shadow as much as you can.

Originally Posted by zoner

Hi everyone

Thanks for reading this. I am about to attend medical school and one thing that has been really bugging me is the 80hrs work load for the residents with 30hrs of continuous work shift. What i don't get is how is anyone capable of staying awake for 30 hrs straight, yet people do it all the time since there are residents becoming and attending. Someone enlighten me on this? Would I be able to make it since I always need at least seven hours of sleep a night and never really had to stay up all night (except during my party days) for anything before. Is it really doable? I just don't get it. And also to do that for four years straight seem really impossible even though I like doing things that are impossible, sleep ain't' one.

How do you guys all do it?

These are the old (2003) rules. 80 hours/week averaged over 4 weeks, maximum of 30 hours per call (24 hours for call + 6 hours for transition of car)e. 1 day off a week averaged over 4 weeks. 10 hours off between shifts.

Prior to that, there were no rules nationally. Look up the Libby Zion case if you're interested in the history of medical residency duty hours reglations. Anyway, residents in surgical and OB programs would often work >100 hours a week and well over 30 hours in a row. For example, my dad as an intern in the 60's was q2 - on call every other night for 36+ hours. Not fun.

Starting last summer, the ACGME adopted new rules that limit call for interns to 16 hours. For PGY-2 and above, the max is 28 hours (24h + 4 for handoff).

ACGME Program Requirements (duty hour info starts on p. 16)

Originally Posted by zoner

Hi everyone

Thanks for reading this. I am about to attend medical school and one thing that has been really bugging me is the 80hrs work load for the residents with 30hrs of continuous work shift. What i don't get is how is anyone capable of staying awake for 30 hrs straight, yet people do it all the time since there are residents becoming and attending. Someone enlighten me on this? Would I be able to make it since I always need at least seven hours of sleep a night and never really had to stay up all night (except during my party days) for anything before. Is it really doable? I just don't get it. And also to do that for four years straight seem really impossible even though I like doing things that are impossible, sleep ain't' one.

How do you guys all do it?

To the heart of your question, it sucks being up all night. Intern year, I had 8 months of q4 call (every 4th night). This was after the 30/80 hour rules but before the newer 16 hour limit for interns. Most nights, I would get an hour or two of sleep somewhere, but when I was truly up all night, it felt terrible. Usually I would "hit the wall" about 0400-0500. Then around 0600-0700 the day crew would come in and it would wake me up because I would tell them about what went down overnight. I found caffeine to be counterproductive late at night.

For most fields, the life as an attending is much different than as a resident. However, some fields will still keep you up all night even after residency. I hear it's much harder to come back from overnight call later in life. There are also subspecialties that can offer less night call even if the primary specialty is more call-heavy.

Originally Posted by PMPMD

.... I hear it's much harder to come back from overnight call later in life...

I think this statement is likely BS. You require less sleep when you are older. And it's never the 35+ year olds claiming they can't function in less than 8 hours per night, it's always the yunguns who never pushed the envelope.


Truth of the matter is that those of us who lived the 30 hour rule loved it because it didn't take many 30 hour shifts to get to an 80 hour week, and a post call day is awesome compared to endless night float. Also very few people drop dead after a 30 hour shift, believe it or not.

does 30 hr shift mean you have to stay awake and work for the whole entire 30 hours? or is there some kind of nap time or do you get into trouble for napping?

Originally Posted by zoner

does 30 hr shift mean you have to stay awake and work for the whole entire 30 hours? or is there some kind of nap time or do you get into trouble for napping?

If you have down time you can sleep. But there will be many shifts where this never happens. You are carrying multiple pagers and covering enough patients that someone is always trying to reach you.

Originally Posted by Law2Doc

I think this statement is likely BS. You require less sleep when you are older. And it's never the 35+ year olds claiming they can't function in less than 8 hours per night, it's always the yunguns who never pushed the envelope.


Truth of the matter is that those of us who lived the 30 hour rule loved it because it didn't take many 30 hour shifts to get to an 80 hour week, and a post call day is awesome compared to endless night float. Also very few people drop dead after a 30 hour shift, believe it or not.

Just what I've heard from old timers.

Originally Posted by PMPMD

Just what I've heard from old timers.

Don't buy it.

Originally Posted by Law2Doc

Don't buy it.

Yeah maybe they were trying to make us feel bad so we'd take their calls

Originally Posted by Law2Doc

If you have down time you can sleep. But there will be many shifts where this never happens. You are carrying multiple pagers and covering enough patients that someone is always trying to reach you.

um.. i am sorry, i'd love to practice med but i think i rather kill myself than having to stay up for 30 hours straight and on top of that work!

Originally Posted by Law2Doc

Truth of the matter is that those of us who lived the 30 hour rule loved it because it didn't take many 30 hour shifts to get to an 80 hour week, and a post call day is awesome compared to endless night float. Also very few people drop dead after a 30 hour shift, believe it or not.

Not everyone feels this way. I've done multiple consecutive months of Q4 call during my core courses, and multiple consecutive months of 13 hr/day 6 day/week shift work during my sub-Is. Even though my cores were a half-assed version of call (med students almost always get 2-4 hours of sleep) and my sub-Is were true 13 hour+ sign out shifts, I STILL preferred shift work. I felt like during Q4 every call day made me a little bit sicker in a way the post call day never helped me recover from, so that at the end of a few months I was phsyically quite sick and mentally quite depressed. On the other hand at the end of a few months of sub-Is I was more or less healthy and happy. I think a year of true q4 call might have caused me to either quit or lose my mind, but I think I can do the 12 hour shifts for years, if not forever.

Keep in mind the 30 (now 28) hour limit only applies to residency/fellowship. As an attending, there are no rules limiting duty hours. While you might be less likely to be up all night, you're also less likely to be guaranteed the post-call day off.

Originally Posted by PMPMD

Keep in mind the 30 (now 28) hour limit only applies to residency/fellowship. As an attending, there are no rules limiting duty hours. While you might be less likely to be up all night, you're also less likely to be guaranteed the post-call day off.

i mean, i am so sorry to keep posting, but is it just me or that 30 or 28 hours shift without sleep is like one of the worst thing that can be put upon a human being to endure?

i understand they do this during the war with soldiers using speed to stay awake, but they don't do ti four year every week. how can this be normal and still many many go through with it every year? there gotta be some sort of trick that people use to do this

Originally Posted by Perrotfish

Not everyone feels this way. I've done multiple consecutive months of Q4 call during my core courses, and multiple consecutive months of 13 hr/day 6 day/week shift work during my sub-Is. Even though my cores were a half-assed version of call (med students almost always get 2-4 hours of sleep) and my sub-Is were true 13 hour+ sign out shifts, I STILL preferred shift work. I felt like during Q4 every call day made me a little bit sicker in a way the post call day never helped me recover from, so that at the end of a few months I was phsyically quite sick and mentally quite depressed. On the other hand at the end of a few months of sub-Is I was more or less healthy and happy. I think a year of true q4 call might have caused me to either quit or lose my mind, but I think I can do the 12 hour shifts for years, if not forever.

It's very different as a med student. You aren't really "responsible" for anything, so you tend to be more focused on the sleep you aren't getting.

Night float as an intern grinds you down a lot more. And it's not usually 12 hour shifts, it's usually 13-14, for six days in a row each week.

Originally Posted by zoner

i mean, i am so sorry to keep posting, but is it just me or that 30 or 28 hours shift without sleep is like one of the worst thing that can be put upon a human being to endure?

I promise you most of your patients are enduring far worse than missing a night of sleep.

You need some perspective. 30 hours isn't such a big deal, once you've done it once. Nobody dies from it. It doesn't make people sick. It's totally doable. The prior generation did even longer shifts than that. If you think that's the worst thing a human could be forced to endure you need to get out more. This isn't even in the top 1000,000,000,000.

Originally Posted by Law2Doc

I promise you most of your patients are enduring far worse than missing a night of sleep.

You need some perspective. 30 hours isn't such a big deal, once you've done it once. Nobody dies from it. It doesn't make people sick. It's totally doable. The prior generation did even longer shifts than that. If you think that's the worst thing a human could be forced to endure you need to get out more. This isn't even in the top 1000,000,000,000.

Well, maybe not the worst, but sleep deprivation is a form of torture used for interrogation.

Anyways, it doesn't sound right to me that just because the patient is going through something worse, the docs have to do the same. There gotta be a better system where you aren't putting the health of the Doc in such jeopardy. Maybe not death but certain, pathology of some sort.

I used to work as a casino dealer doing graveyard shift and I only lasted a month! I got sick, depressed and cranky as hell. This is kinda making me think medicine isn't really for me, I just don't think I can endure that kind of time from not sleeping continuously for four years.

Originally Posted by zoner

Well, maybe not the worst, but sleep deprivation is a form of torture used for interrogation.

Anyways, it doesn't sound right to me that just because the patient is going through something worse, the docs have to do the same. There gotta be a better system where you aren't putting the health of the Doc in such jeopardy. Maybe not death but certain, pathology of some sort.

I used to work as a casino dealer doing graveyard shift and I only lasted a month! I got sick, depressed and cranky as hell. This is kinda making me think medicine isn't really for me, I just don't think I can endure that kind of time from not sleeping continuously for four years.

Overnight call isn't fun but it's a far cry from torture. It's just like working late, then a little later, then a little more, then it's almost morning, then you're done.

Originally Posted by zoner

i mean, i am so sorry to keep posting, but is it just me or that 30 or 28 hours shift without sleep is like one of the worst thing that can be put upon a human being to endure?

Originally Posted by zoner

Well, maybe not the worst, but sleep deprivation is a form of torture used for interrogation.

Anyways, it doesn't sound right to me that just because the patient is going through something worse, the docs have to do the same. There gotta be a better system where you aren't putting the health of the Doc in such jeopardy. Maybe not death but certain, pathology of some sort.

I used to work as a casino dealer doing graveyard shift and I only lasted a month! I got sick, depressed and cranky as hell. This is kinda making me think medicine isn't really for me, I just don't think I can endure that kind of time from not sleeping continuously for four years.

When sleep deprivation is used as a form of torture, it's usually in fairly bleak circumstances, for DAYS at a time. Not sitting in the call room or in the ER, chugging a cup of coffee.

Sorry, but equating torture by sleep deprivation to overnight call is just a teensy bit melodramatic. They're not the same thing at all.

That being said, if you really don't do well with irregular work hours, either consider a) not becoming a doctor, or b) choosing a specialty with 9-5 hours and minimal call. PM&R and pathology come to mind.

Originally Posted by smq123

...
That being said, if you really don't do well with irregular work hours, either consider a) not becoming a doctor, or b) choosing a specialty with 9-5 hours and minimal call. PM&R and pathology come to mind.

the PM&R folks all do an intern year. And honestly if the prior poster thinks long hours and overnight call are equivalent to torture I'm not sure I see him/her making it through the third year of med school to even get to a path residency. Because of the need for prerounding, i surpassed the 80 hour work week several times as a med student, and there are no national duty hour rules protecting them. There are plenty of non physician careers that don't require overnight work, so it's silly to whine about torture when it's clear the right road for you is probably elsewhere. Nobody is forcing you to pick a career with overnight call. But if you do pick such, you pretty much have to endure a call shift or two before you earn the cred to call it the worst torture known to man.

I think it's telling that it's always the premeds (or folks outside of the US healthcare system) making these statements, rarely those actually in US residencies. Long houred calls are no fun. They are even scary to those that have never done one. But no, they aren't equivalent to torture, nobody dies or gets sick because of them, and many of us who have lived under both systems see the overnight call with post-call day as hugely advantageous and much less tiring than a never ending night float system. They are totally doable, and most residents have done many. Bottom line is a lot happens overnight, and with little supervision that's when you really learn to be a doctor.

Originally Posted by zoner

i hardly call not getting a proper sleep essential for good health and well being as being lazy

sorry, for that, just that I am extremely health conscious and just doesn't make sense that I have to sacrifice my health for the the health of others.

which makes me think, is it really that bad?

You dont have the proper mindset for medicine. Please do us all a favor and do something else. You "lifestyle" types are ruining the profession.

The profession involves a great deal of sacrifice, and your precious sleep is the least of them.

Originally Posted by HondoCrouch

...
The profession involves a great deal of sacrifice, and your precious sleep is the least of them.

yeah, I would say there are a lot of things that make intern year a very hard and initially scary year, but staying up a lot of hours in a row isn't really even close to the biggest hurdle in that year. In fact it's the one hurdle virtually everyone makes without much difficulty.

Originally Posted by zoner

i mean, i am so sorry to keep posting, but is it just me or that 30 or 28 hours shift without sleep is like one of the worst thing that can be put upon a human being to endure?

Drama queen much? Torture? SRSLY?!

Have you considered law school? Or perhaps barista school? If this is your biggest concern about med school and residency (which is frankly a tiny little problem), the actual important stuff is just going to crush you down the road.

i understand they do this during the war with soldiers using speed to stay awake, but they don't do ti four year every week. how can this be normal and still many many go through with it every year? there gotta be some sort of trick that people use to do this

There is a trick, and I already posted it...Suck It Up! You do it because you don't have a choice.

Originally Posted by Law2Doc

I think this statement is likely BS. You require less sleep when you are older. And it's never the 35+ year olds claiming they can't function in less than 8 hours per night, it's always the yunguns who never pushed the envelope.


Truth of the matter is that those of us who lived the 30 hour rule loved it because it didn't take many 30 hour shifts to get to an 80 hour week, and a post call day is awesome compared to endless night float. Also very few people drop dead after a 30 hour shift, believe it or not.

As one of the "35+/old timer" crowd, I'm going to respectfully disagree.

Sure, I regularly function on 5-6 hours of sleep a night when all is going well, that's not a problem. 8 hours for me is a massive luxury and I consider it sleeping in (I got 7 1/2 hours of sleep last night and I feel amazing).

But the overnights have gotten more and more brutal as I've gotten older. Part of it is probably that since after I finish one up I generally go back to work (in the lab) for another full day so even though I routinely get 2-3 hours of sleep a night (not consecutively of course), my days wind up being 36+ hours. But...if I have a busy, no sleep night, I bail out first thing in the morning and go home and sleep...I find it a lot harder to power through than I did 5 or 6 years ago.

TL;DR - As I've gotten older, yes, I can function on less sleep each night. But the 24+ hour shifts are a lot harder on me now.

Originally Posted by Law2Doc

I think it's telling that it's always the premeds (or folks outside of the US healthcare system) making these statements, rarely those actually in US residencies. Long houred calls are no fun. They are even scary to those that have never done one. But no, they aren't equivalent to torture, nobody dies or gets sick because of them, and many of us who have lived under both systems see the overnight call with post-call day as hugely advantageous and much less tiring than a never ending night float system. They are totally doable, and most residents have done many. Bottom line is a lot happens overnight, and with little supervision that's when you really learn to be a doctor.

Bingo to the last point.

Originally Posted by zoner

I used to work as a casino dealer doing graveyard shift and I only lasted a month! I got sick, depressed and cranky as hell. This is kinda making me think medicine isn't really for me, I just don't think I can endure that kind of time from not sleeping continuously for four years.

There is individual variation in how well people are able to function with sleep deprivation.
This has apparently been shown in research according to a presentation that my residency made us go to about sleep deprivation. It's possible that you are more sensitive to sleep deprivation than some of the people who are saying overnight call is not a big deal.

When you say four years, are you talking about med school? Keep in mind that you won't be doing any overnight calls the first two years of med school. While many med students do find it hard to get enough sleep just because of the amount of studying to do...however it is possible that if you budgeted your time wisely you could stay with a decent sleep schedule during those years.
If you think that getting through overnight/long hours work 3rd year/4th year and residency is not something you can picture yourself doing, then maybe you would be happier in a different area of health care. It really depends on how much you are attached to the idea of being a doctor in particular.

Originally Posted by zoner

does 30 hr shift mean you have to stay awake and work for the whole entire 30 hours? or is there some kind of nap time or do you get into trouble for napping?

No, you do not have to stay up for 30 hours. You just have to be "on duty" and in the building usually. I had a very nice residency where we did one weekend day call a month and usually 2 weekday nights a month. I never stayed up for the 30 hours straight. Usually on the worst nights I struck a deal with the ER so I could at least lay down from midnight to 4:30 then I would do any other admits needed and get ready for my morning report presentation at 7:30 (we had to present 3 patients from the night before). Our total shifts then were from 7:30am through 1pm the next day. We went home after the noon lecture.

I found that having newborn children prior to medical school really helped me as I thought being on call was way easier than doing the mom thing. Also, I found it helpful to go home after clinic at 5pm and take a shower and get freshened up before going back at 7pm.

I will say I never worked an 80 hour week in residency. The most I put in was 55-60 and that was on medicine/hospitalist service because the attendings rounded late and we had to be present for that.

Yeah, i guess i was being bit of a drama queen, and I also didn't realize that 28 hours shift only occurs once in a while and not everyday kinda thing which I think can definitely be doable. The whole residency work is still kinda unclear to me, but I guess it will get clear once I get to that place. Just trying to find out from people who are currently experiencing it since hundred of residences go through with it every year. As a premed, you get bombarded with things like how sucky it is blah blah blah, so I just wanted to find out for sure if it really is that sucky or just sucky once in a while. Working as a graveyard casino dealer was everyday thing, so I never really got a good sleep , ever during the day for that month i was working the graveyard shift, but since over night is only once in a while, it probably is fine,,, i think.

Originally Posted by zoner

Yeah, i guess i was being bit of a drama queen, and I also didn't realize that 28 hours shift only occurs once in a while and not everyday kinda thing which I think can definitely be doable. The whole residency work is still kinda unclear to me, but I guess it will get clear once I get to that place. Just trying to find out from people who are currently experiencing it since hundred of residences go through with it every year. As a premed, you get bombarded with things like how sucky it is blah blah blah, so I just wanted to find out for sure if it really is that sucky or just sucky once in a while. Working as a graveyard casino dealer was everyday thing, so I never really got a good sleep , ever during the day for that month i was working the graveyard shift, but since over night is only once in a while, it probably is fine,,, i think.

What's your definition of "once in awhile"?

I've never done NF but would remind you that some residency programs and rotations have a system which would be akin to your casino job (i.e., every day, overnight - albeit not 28 hours).

Originally Posted by zoner

Yeah, i guess i was being bit of a drama queen, and I also didn't realize that 28 hours shift only occurs once in a while and not everyday kinda thing which I think can definitely be doable. The whole residency work is still kinda unclear to me, but I guess it will get clear once I get to that place. Just trying to find out from people who are currently experiencing it since hundred of residences go through with it every year. As a premed, you get bombarded with things like how sucky it is blah blah blah, so I just wanted to find out for sure if it really is that sucky or just sucky once in a while. Working as a graveyard casino dealer was everyday thing, so I never really got a good sleep , ever during the day for that month i was working the graveyard shift, but since over night is only once in a while, it probably is fine,,, i think.

Every once in a while for me is usually q4-5. Although sometimes is can be as frequent as q3, and occasionally there will be a week of every other night (although the next week then would be just 1 call). But it does suck. staying up all night is hard. You are very tired at the end. If you dont think this is something you can handle, dont go into medicine. its not for everyone.

Originally Posted by zoner

Well, maybe not the worst, but sleep deprivation is a form of torture used for interrogation.

Anyways, it doesn't sound right to me that just because the patient is going through something worse, the docs have to do the same. There gotta be a better system where you aren't putting the health of the Doc in such jeopardy. Maybe not death but certain, pathology of some sort.

I used to work as a casino dealer doing graveyard shift and I only lasted a month! I got sick, depressed and cranky as hell. This is kinda making me think medicine isn't really for me, I just don't think I can endure that kind of time from not sleeping continuously for four years.

U looking too much ahead.
I think u will be fine. When u get there u will cross the bridge. ..its not the worst thing to happen. When I was a pre med...I thought it was insane. But going to a foreign Med school that I had to take crazy calls...I got used to it.I took 2 years off to do research(which is less rigorous than residency)...and surprisingly I sleep 4-5 hours a day. I dont have the obligation to stay very late ...but at a point in life I just felt that it is waste of my mind to sleep before 1am. I will start my intern year in June. U will also be fine....if Medicine is what u want...u will do OK just like every single one of us....

Originally Posted by zoner

Yeah, i guess i was being bit of a drama queen, and I also didn't realize that 28 hours shift only occurs once in a while and not everyday kinda thing which I think can definitely be doable....

when I was an intern we did 30 hour shifts about twice a week, followed by a post call day. You get 1 day off in 7 averaged, so you don't always get a weekend day off each week, so the post call days were huge, even if you slept through half of them. Since we did a lot of cross-covering (covering other teams patients), you would be responsible for multiple pagers, and as many as 40 patients in the hospital, so your pager was always going off and RARELY did you get more than an hour of quiet to nod off unless the hospital census was really low (eg the Xmas to New Years week was often quiet). I'd say in less than a third of my calls did I even bother going to the on call room. Obviously quieter services or hospitals with more residents on overnight call or no cross coverage might allow more nap time, but dont bank on it.

I also experienced night float on certain intern rotations, where you were up every night for 13+ hours a night, six nights a week for a month. They didn't even bother giving you access to an on call room because the expectation was that you would sleep in the daytime and treat it like shift work, and they actually left you work to finish up for the team overnight ( as opposed to overnight call where if you handled the new admissions and kept the existing folks alive they were generally happy). My experience was that night float was far more tiring and disruptive to sleep cycle than the isolated biweekly 30 hour shift. Part of the problem was the 7th day (Saturday), where you inevitably tried to switch back to a normal day-night cycle for a day. Part was that you never got as good a sleep during the day.

Medicine is not for everyone, and long hard hours are part of the training. I think you really need to walk the walk before you go spouting off about torture and unreasonableness. These days senior residents can only be in the hospital 28 hours, and interns 16. It's hard to make a straight faced argument that that's undoable when most of the residents and older on here worked longer hours than this.

Originally Posted by Perrotfish

Not everyone feels this way. I've done multiple consecutive months of Q4 call during my core courses, and multiple consecutive months of 13 hr/day 6 day/week shift work during my sub-Is. Even though my cores were a half-assed version of call (med students almost always get 2-4 hours of sleep) and my sub-Is were true 13 hour+ sign out shifts, I STILL preferred shift work. I felt like during Q4 every call day made me a little bit sicker in a way the post call day never helped me recover from, so that at the end of a few months I was phsyically quite sick and mentally quite depressed. On the other hand at the end of a few months of sub-Is I was more or less healthy and happy. I think a year of true q4 call might have caused me to either quit or lose my mind, but I think I can do the 12 hour shifts for years, if not forever.

If you want to see your kids, call is a much better way. Rolling in at 6-7pm means that you're just in time for bedtime. Mowing your lawn at 7pm sucks too.

It's also quite different as a resident.

Originally Posted by Law2Doc

the PM&R folks all do an intern year. And honestly if the prior poster thinks long hours and overnight call are equivalent to torture I'm not sure I see him/her making it through the third year of med school to even get to a path residency. Because of the need for prerounding, i surpassed the 80 hour work week several times as a med student, and there are no national duty hour rules protecting them. There are plenty of non physician careers that don't require overnight work, so it's silly to whine about torture when it's clear the right road for you is probably elsewhere. Nobody is forcing you to pick a career with overnight call. But if you do pick such, you pretty much have to endure a call shift or two before you earn the cred to call it the worst torture known to man.

Of course, that no longer entails overnight call.

Originally Posted by zoner

i mean, i am so sorry to keep posting, but is it just me or that 30 or 28 hours shift without sleep is like one of the worst thing that can be put upon a human being to endure?

i understand they do this during the war with soldiers using speed to stay awake, but they don't do ti four year every week. how can this be normal and still many many go through with it every year? there gotta be some sort of trick that people use to do this

No tricks. It just sucks. Get used to that, or don't bother with this.

Originally Posted by zoner

Yeah, i guess i was being bit of a drama queen, and I also didn't realize that 28 hours shift only occurs once in a while and not everyday kinda thing which I think can definitely be doable. The whole residency work is still kinda unclear to me, but I guess it will get clear once I get to that place. Just trying to find out from people who are currently experiencing it since hundred of residences go through with it every year. As a premed, you get bombarded with things like how sucky it is blah blah blah, so I just wanted to find out for sure if it really is that sucky or just sucky once in a while. Working as a graveyard casino dealer was everyday thing, so I never really got a good sleep , ever during the day for that month i was working the graveyard shift, but since over night is only once in a while, it probably is fine,,, i think.

For much of this year, I've been on call every third night for long stretches, usually on call 8-9 times/month.

Originally Posted by Law2Doc

when I was an intern we did 30 hour shifts about twice a week, followed by a post call day. You get 1 day off in 7 averaged, so you don't always get a weekend day off each week, so the post call days were huge, even if you slept through half of them. Since we did a lot of cross-covering (covering other teams patients), you would be responsible for multiple pagers, and as many as 40 patients in the hospital, so your pager was always going off and RARELY did you get more than an hour of quiet to nod off unless the hospital census was really low (eg the Xmas to New Years week was often quiet). I'd say in less than a third of my calls did I even bother going to the on call room. Obviously quieter services or hospitals with more residents on overnight call or no cross coverage might allow more nap time, but dont bank on it.

I also experienced night float on certain intern rotations, where you were up every night for 13+ hours a night, six nights a week for a month. They didn't even bother giving you access to an on call room because the expectation was that you would sleep in the daytime and treat it like shift work, and they actually left you work to finish up for the team overnight ( as opposed to overnight call where if you handled the new admissions and kept the existing folks alive they were generally happy). My experience was that night float was far more tiring and disruptive to sleep cycle than the isolated biweekly 30 hour shift. Part of the problem was the 7th day (Saturday), where you inevitably tried to switch back to a normal day-night cycle for a day. Part was that you never got as good a sleep during the day.

I agree with all of this. I don't know many PGY2-3 residents (i.e. the people most likely to have lived in both the traditional call systems and the new float systems) who feel differently.

I would also add that even when I'm not on the night float itself, I find the day shift (i.e. working 6 straight days of 14 hour days) more tiring. I've gone weeks at a time without seeing the sun. It's extremely draining.

Another thing the new rules have largely eliminated is the early day. It used to be (not frequently, but maybe a couple of times per month), we would get things all tucked in on our services and the cases/clinic for the day were done. So we would find the on-call intern and sign out early to him/her. Since they were going to be there all night anyways, they didn't care and knew they'd get the favor paid back in the future. This year with the rigid structure of night float, you are there until at least 6pm when the night person comes to relieve you.

not every nightfloat system is 6 on 1 off..... ours is 4 on/4 off where there is a pool of 8 (4 residents and 4 interns) and each night one intern and one resident cover half the crosscover/admissions

I too thought this would break me but it isn't as bad as I'd thought it would be. A lot of it will have to do with if you are training at a place where residents must do ALL of the hospital work vs places where there are non-teaching services to help with overflow and take some pressure of the teaching services. I have a friend in a TY with the former situation and it's awful, friend of mine got a massive dvt and needed a vascular procedure and part of a rib removed, the hospital acted like it was going to have to shut down because some people got called in for jeapordy....

I don't like nightfloat *or* 30 hour call; you're basically just exchanging one set of evils for another. But someone has to be in the hospital overnight, because the patients don't all go home at dinnertime. (Rude of them, isn't it???) Like the others said, you do it because you have to, and somehow most everyone survives.

What I think is the very worst is the constant switching back and forth that occurs on certain rotations. On my last ICU rotation, we would do a few days of days, then a few days of nights, then back to days, etc., with one day in between to "recover." That's tough. It takes me 2-3 days to get adjusted to the new hours, so I would start out every shift time change feeling like I was jetlagged. Then by the time I'd get more or less adjusted, bam, back to trying to readjust again. I would rather do two weeks straight of each, or better yet, an entire month of nights, than keep switching back and forth every few days like that.

At my hospital, many of the faculty who do night shifts are mainly nocturnists (meaning that they only work nights.) I'm so exhausted that I have no trouble sleeping all day when I'm on nights, and a good set of blackout curtains and earplugs help a lot. So I think if I have a job after residency that requires me to work nights, I'd prefer to be a nocturnist and just live in that reversed day/night schedule all the time. Being a nocturnist often has the added bonus of getting paid more, too.

I also agree that it gets harder to switch schedules the older you get. I started residency at 36, and like I said, I'm always dragging on rotations that make you constantly switch. Plus, research backs up the idea that people's circadian rhythms become more diurnal and less amenable to switching to nights as they get older.

Finally, it's interesting that you mentioned casino schedules. Casinos pioneered the so-called casino shift schedule, where everyone gets to sleep during some part of the "anchor sleep period" from 2-6 AM, when workers are the tiredest and most likely to make cognitive errors. In other words, the night shift schedule gets divided so that one shift ends around 4AM and the other shift starts around that time. For hospital shifts, a possible schedule might be something like noon-4 AM for the night shift and 3:30AM-5PM for days, which allows for a 30 minute nighttime signout overlap.

The reason why casino shifts came into being is that the casino industry found they were losing money during the graveyard shift due to increased dealer error. We hear all the time about how medicine should be like the airline industry, but I'd say that medicine could learn a lot from casinos, too.

The concept that doctors should be treating patients when sleep deprived or fatigued is ludicrous. It's dangerous, plain and simple.

There are many industries that require 24h shift coverage, yet almost none of them require one person to cover all 24 hours.

As more patients hear about this, lawsuits for mistakes made while on a long shift will skyrocket. We must stop it to protect ourselves. This is a liability and risk management issue.

We have 24h to cover. Why not three 8h shifts with an hour overlap each, making it really a 9h shift.

8a-5p
4p-1a
12a-8a

You stay on each shift for at least one month, or permanently if you prefer evening or night shifts. Done.

Be Safe. Stay Healthy.

Originally Posted by digitlnoize

The concept that doctors should be treating patients when sleep deprived or fatigued is ludicrous. It's dangerous, plain and simple.

There are many industries that require 24h shift coverage, yet almost none of them require one person to cover all 24 hours.

As more patients hear about this, lawsuits for mistakes made while on a long shift will skyrocket. We must stop it to protect ourselves. This is a liability and risk management issue.

We have 24h to cover. Why not three 8h shifts with an hour overlap each, making it really a 9h shift.

8a-5p
4p-1a
12a-8a

You stay on each shift for at least one month, or permanently if you prefer evening or night shifts. Done.

Be Safe. Stay Healthy.

Yes but the more shifts there are, the more handoffs are required, and this too has risk for error.

Originally Posted by digitlnoize

The concept that doctors should be treating patients when sleep deprived or fatigued is ludicrous. It's dangerous, plain and simple.

There are many industries that require 24h shift coverage, yet almost none of them require one person to cover all 24 hours.

As more patients hear about this, lawsuits for mistakes made while on a long shift will skyrocket. We must stop it to protect ourselves. This is a liability and risk management issue.

We have 24h to cover. Why not three 8h shifts with an hour overlap each, making it really a 9h shift.

8a-5p
4p-1a
12a-8a

You stay on each shift for at least one month, or permanently if you prefer evening or night shifts. Done.

Be Safe. Stay Healthy.

1. As long as you don't mind getting paid 1/3 of what you would have otherwise.
2. There is no evidence that decreased work hours (at least the 2003 30/80 rule) have improved outcomes.
3. FWIW, the fact that doctors (esp trainees) work a hojillion hours in a row isn't news to malpractice attorneys.