How many hours is sustainable?

[katmandu]

How many hours a month do you work? How many hours are you required to work? My current employer is considering offering 1-2 weeks of PTO in exchange for increasing the minimum required hours by about 15 into the 140s? Do you think that's sustainable long term? Would that be a worthwhile trade for you?

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[RustedFox]

No. Reject that bargain, real quick.

EDIT: Contracted minimum hours/month is 120. 130 is do-able long term. I have worked months of 140-150, and they are categorically unstable for me.

 

[Mad Jack]

I'm not even in the field, but you're working an extra 165 hours a year in exchange for 40-80 hours of PTO...

 

[tkim]

So, really it's making more money per hour but requiring you to work more. Hmmm.

Where I work, there's really no "PTO", although that's how it was explained to me, it's a reduction of yearly required hours for the same pay, which in effect is the same thing you are talking about, except you are increasing your hours in the process.

You should figure out dollar-per-hour wise and total hours/year wise, whether this is a good thing or not.

 

[shoal]

First job out for me and I'm pulling 135hrs which is near my limit. Would love to cut back to 120ish

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[emergentmd]

The MOST I have ever done in 15 yrs on avg was 135hr/mo. Short months maybe hit 150 for short periods of time. I am requesting 120/mo and happier.

I do know of docs who are pulling 280hrs/mo and have been doing this for years but are making over 1 mil/yr

 

[BoardingDoc]

I do know of docs who are pulling 280hrs/mo and have been doing this for years but are making over 1 mil/yr

What? That's 6 12 hr shifts a week. That's worse than residency. Unless they're doing it somewhere super low acuity where they're sleeping a bunch during those shifts, AND they have literally nothing else in their life, I don't see how this is feasible.

 

[Makati2008]

What? That's 6 12 hr shifts a week. That's worse than residency. Unless they're doing it somewhere super low acuity where they're sleeping a bunch during those shifts, AND they have literally nothing else in their life, I don't see how this is feasible.

I know someone that did the same thing for a year, paid off student loans, house and now does Locums. Said person is single/young and trained in a very high acuity program.

 

[Old_Mil]

How many hours a month do you work? How many hours are you required to work? My current employer is considering offering 1-2 weeks of PTO in exchange for increasing the minimum required hours by about 15 into the 140s? Do you think that's sustainable long term? Would that be a worthwhile trade for you?

No I don't. They are trying to get the coverage they need without hiring a new warm body. Reject that deal.

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[emergentmd]

What? That's 6 12 hr shifts a week. That's worse than residency. Unless they're doing it somewhere super low acuity where they're sleeping a bunch during those shifts, AND they have literally nothing else in their life, I don't see how this is feasible.

Thats right. 24 shifts a month at 12 shifts a pop. Level 1 trauma center. Busy, sick pts, complicated pts.

When I was in residency, I worked 22 shifts, 12 hr shifts as a resident. Add on 1 hr after for rounds. Add on meetings. Add on other residency junk.

I would say 24 shifts/12 hrs is less time than above.

If I got out of residency, no family, focused on a retirement goal... I would at 28 do this for 5 yrs. Bank 3 Mil after taxes/living expense. Set for life living a reasonable life working 6 locums a mo

 

[deleted77919]

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[The White Coat Investor]

I think the most that is sustainable is twelve 12s. That's 144. That's too many for me. I'm currently doing 120 and by this time next year will be under 100. But I've got another job and lots of hobbies.

I think 160-180 is NOT sustainable and would recommend that most young docs plan their finances on no more than 120 hours a month for the long term.

 

[katmandu]

Thanks for all the feedback. As a group, we have been doing this pseudo-voluntarily in short term d/t staffing issues. But, being required to do this long term seems much less sustainable.

 

[Greenbbs]

I just worked 81 hours in 10 days (4 on, 1 off, 5 on) so that I can take some time off at the end of the month when #3 arrives. They were all 3p-12a shifts. On a normal month, I do 14 9's, but had to front load this one with a bit extra since my time off encompasses an entire pay period.

I'm a miserable a****** currently (or so my wife says). I work in a very busy, very sick shop with great coverage and it's still hard. I come home, can't sleep immediately, and have 2 kids to prep for school in the morning so my very pregnant wife doesn't have to bust her ass as much.

I don't feel bad for people who kill themselves at work like that. If it works for them, great.....I just can't sustain that kind of schedule for that long and still be useful to my family or myself.

 

[NinerNiner999]

This is a question solely dependent on the number of patients you see, the efficiency of the hospital, the ease of charting, and the other coverage you have. 120 hours in one department can feel like 180 hours in another.

Also, why are so many of us working so few hours without hitting their limit? I'm a medical director, department chairman, and work 130-140 clinical hours per month - have done so for over 8 years and have no desire to slow down.

 

[sum dude]

How many hours a month do you work? How many hours are you required to work? My current employer is considering offering 1-2 weeks of PTO in exchange for increasing the minimum required hours by about 15 into the 140s? Do you think that's sustainable long term? Would that be a worthwhile trade for you?

Depends on place, 140-150 is probably max you want to do. I've worked up to 180-190 hours in month, busy community, and that sucks, and is not sustainable. A wise doc once told me that every doctor only has so many hours in them over a career, so you don't want to over-work yourself to avoid burn out (kind of like NFL RB's only have "so many carries", w/ some much more than others). Also consider if you want to do admin time--you'll want to have even less hours then.

I will warn everyone here--"attending" hours are much harder than Resident hours. There's much more pressure to see patients faster, and $$ is often the bottom line at most hospitals. You're expected to see 2-3 patients per hour on average (which means you'll see 6-7/hr during busy times). Disposition is king. There will be metric, press-Gaineyesque goals people shove down your throat, and that's before you even talk about worrying about having responsibility over patients. You usually get a lot more comfortable and not nervous about your clinical choices after 6 months to 2 years, after that, it's more of a mental grind of having to work.

Highly recommend moonlighting if it is allowed at your shop--it'll show you that you still have a lot to learn, and will help with your speed in disposition (though GME rules I hear make that tough, if your into "reporting hours" accurately.)

 

[goodoldalky]

Also, why are so many of us working so few hours without hitting their limit? I'm a medical director, department chairman, and work 130-140 clinical hours per month - have done so for over 8 years and have no desire to slow down.

I am just guessing that you do not work a full slate of nights. The day to night transition is the biggest hurdle to increasing hours worked, in my opinion. If 1/3 to 1/2 of your shifts are nights then not sure how you do that, but I doubt it.

The answer if you work in a high acuity 2.5+ pph shop and you work a full night load is about 120 hours a month for most people, give or take 10. If you are working more than that there should be a hefty financial incentive, IMO.

 

[GeneralVeers]

I would reject any contract that FORCES you to work more than 120 hours. I've seen a few that had a minimum of 140 hours with a clause that they could force you to work more. Definitely a reject.

I have worked 180 hours in the past, and it was tough. It's certaily doable for 1 month, but not long term. Right now as I travel I have to schedule blocks of 4-5 for efficiently. I currently do 12-15 shifts for month in blocks of 4-5 depending on need. That equates to between 120-160 hours which is definitely sustainable.

 

[Lord Humongus]

Thats right. 24 shifts a month at 12 shifts a pop. Level 1 trauma center. Busy, sick pts, complicated pts.

When I was in residency, I worked 22 shifts, 12 hr shifts as a resident. Add on 1 hr after for rounds. Add on meetings. Add on other residency junk.

I would say 24 shifts/12 hrs is less time than above.

If I got out of residency, no family, focused on a retirement goal... I would at 28 do this for 5 yrs. Bank 3 Mil after taxes/living expense. Set for life living a reasonable life working 6 locums a mo

Pure curiosity here: at what age does maintaining this kind of schedule become untenable? I am asking from a purely physical standpoint: assume you are a lifelong bachelor with excellent exercise habits and few outside commitments. A lean mean EM machine. Is there noticeable slippage that occurs even between late 20's and early 40's that would prevent you from biologically tolerating such a grueling schedule.

Asking because I will become an attending in my early 30's, which makes it all the more crucial for me to make hay while the sun shines versus someone who finished training in his late 20's. But it would suck if at that point my body already began to betray me. I'd be curious to hear from attendings who have already traversed that age range on when you guys started to notice a decreased tolerance for intense schedules. (Again with the caveat that this decreased tolerance resulted from age rather than family, commitments, etc)

 

[Greenbbs]

Pure curiosity here: at what age does maintaining this kind of schedule become untenable? I am asking from a purely physical standpoint: assume you are a lifelong bachelor with excellent exercise habits and few outside commitments. A lean mean EM machine. Is there noticeable slippage that occurs even between late 20's and early 40's that would prevent you from biologically tolerating such a grueling schedule.

Asking because I will become an attending in my early 30's, which makes it all the more crucial for me to make hay while the sun shines versus someone who finished training in his late 20's. But it would suck if at that point my body already began to betray me. I'd be curious to hear from attendings who have already traversed that age range on when you guys started to notice a decreased tolerance for intense schedules. (Again with the caveat that this decreased tolerance resulted from age rather than family, commitments, etc)

Birth.

Seriously. No amount of want or desire could make me sacrifice my time with my family and outside interests to work that kind of schedule.

Everyone's different.

 

[Lord Humongus]

^^Sure, but juggling a family is a salient issue regardless of whether you're 28 or 58 assuming you have a family. I was asking specifically about at what point age related physical decline begins to manifest itself in a markedly decreased tolerance for grueling schedules.

 

[The White Coat Investor]

^^Sure, but juggling a family is a salient issue regardless of whether you're 28 or 58 assuming you have a family. I was asking specifically about at what point age related physical decline begins to manifest itself in a markedly decreased tolerance for grueling schedules.

Interesting question, and I don't know. I guess if all someone lived for was practicing EM they could work a ton and be happy. But in my experience, there are very few people like that. Most of the people working that much are doing it for financial reasons. If you set your financial life up right, you don't have to do that. And if you don't have to, why would you want to?

 

[Lord Humongus]

Interesting question, and I don't know. I guess if all someone lived for was practicing EM they could work a ton and be happy. But in my experience, there are very few people like that. Most of the people working that much are doing it for financial reasons. If you set your financial life up right, you don't have to do that. And if you don't have to, why would you want to?

Of course. I only ask because I will start collecting paychecks relatively late, and so will need to make up for lost time in the early part of my career as an attending. My concern was whether I'd still "have it in me" in my thirties precisely to "set my financial life up right" by my early 40's.

 

[GeneralVeers]

Of course. I only ask because I will start collecting paychecks relatively late, and so will need to make up for lost time in the early part of my career as an attending. My concern was whether I'd still "have it in me" in my thirties precisely to "set my financial life up right" by my early 40's.

I'm 36 and now on year 8 of practice. I haven't noticed a physical slow down. Some keys to longevity:

1. Take frequent vacations
2. Recognize signs of burnout, and change your schedule to let you recover.
3. Don't get fat. Seriously, this job is not for the out of shape, especially as you get older. Taking care of your health will give you better career longevity.

 

[The White Coat Investor]

Of course. I only ask because I will start collecting paychecks relatively late, and so will need to make up for lost time in the early part of my career as an attending. My concern was whether I'd still "have it in me" in my thirties precisely to "set my financial life up right" by my early 40's.

Since when is an emergency doc in his thirties old? I came out of residency at 31. My entire career has been in my thirties. If you can't work nights in your 30s when can you work nights? I mean, even if you go straight through college, med school, and residency, how are you out of training before 29 at the earliest?

 

[emergentmd]

I think longevity in EM and many field has 1 big Factor. A supporting spouse.

Most have kids and having a spouse that can deal with the household with a smile while you are doing crazy hours, weekend hours, holiday hours is very helpful. Said spouse has to be able to juggle the family, change plans quickly, be ready to deal with all of the kids/activities during times when most have their spouse to help. This relieves alot of stress from said doctor and I will tell you it helps me out alot.

If you have a spouse that complains all of the time b/c they have to deal with the kids by themselves, then it wears on you.

Make your Job the priority in the household and have that ingrained. So when you are coming home from a night shift, they all know that sleep is a priority and spouse has to take care of the family. When you are working a holiday, spouse knows that she has to take the kids to both sides of the family by herself with a smile.

 

[Hercules]

I think longevity in EM and many field has 1 big Factor. A supporting spouse.

Most have kids and having a spouse that can deal with the household with a smile while you are doing crazy hours, weekend hours, holiday hours is very helpful. Said spouse has to be able to juggle the family, change plans quickly, be ready to deal with all of the kids/activities during times when most have their spouse to help. This relieves alot of stress from said doctor and I will tell you it helps me out alot.

If you have a spouse that complains all of the time b/c they have to deal with the kids by themselves, then it wears on you.

Make your Job the priority in the household and have that ingrained. So when you are coming home from a night shift, they all know that sleep is a priority and spouse has to take care of the family. When you are working a holiday, spouse knows that she has to take the kids to both sides of the family by herself with a smile.

Can't agree enough with this post. Work is hard. If home is not a happy place and your spouse is stressed and angry every time you come home that equals instant burnout.

 

[hundreddaysoff]

I think longevity in EM and many field has 1 big Factor. A supporting spouse.

Most have kids and having a spouse that can deal with the household with a smile while you are doing crazy hours, weekend hours, holiday hours is very helpful. Said spouse has to be able to juggle the family, change plans quickly, be ready to deal with all of the kids/activities during times when most have their spouse to help. This relieves alot of stress from said doctor and I will tell you it helps me out alot.

If you have a spouse that complains all of the time b/c they have to deal with the kids by themselves, then it wears on you.

Make your Job the priority in the household and have that ingrained. So when you are coming home from a night shift, they all know that sleep is a priority and spouse has to take care of the family. When you are working a holiday, spouse knows that she has to take the kids to both sides of the family by herself with a smile.

I like it in theory. In practice, isn't this quite a lot to ask of a modern professional tentative spouse with current career aspirations and non-family-related dreams of his or her own?

Or is the key to strike "professional" from the above? Or is the key that when I've found the right one, I won't even need to ask?

 

[emergentmd]

I like it in theory. In practice, isn't this quite a lot to ask of a modern professional tentative spouse with current career aspirations and non-family-related dreams of his or her own?

Or is the key to strike "professional" from the above? Or is the key that when I've found the right one, I won't even need to ask?

I think everyone has to pick what is important to them when they pick a mate. You CANT have everything. If having your wife at home to take care of the kids, then marry someone willing to give up her career. If you marry someone that has a full time career, they can't put your job at the top of their list.


I chose a person that was willing to sacrifice her career to be home with the kids.

If My wife wanted to have her own career, then either we have a full time nanny (BIG no no for me), or we would have to have opposite schedules to be home with the kids. Either choice would be very stressful.

 

[The White Coat Investor]

I think everyone has to pick what is important to them when they pick a mate. You CANT have everything. If having your wife at home to take care of the kids, then marry someone willing to give up her career. If you marry someone that has a full time career, they can't put your job at the top of their list.


I chose a person that was willing to sacrifice her career to be home with the kids.

If My wife wanted to have her own career, then either we have a full time nanny (BIG no no for me), or we would have to have opposite schedules to be home with the kids. Either choice would be very stressful.

Just bringing stuff like this up gets you labeled as sexist, but it's a reality of life. It is also a reality of life that it generally works out better if the person staying home is the female, both biologically and culturally/socially. There is a reason that this is the "traditional" set-up. Doesn't mean other set-ups don't work, but of the female emergency docs I know who are working and have kids, they have one of the following things going:

1) Nanny
2) Working very part-time
3) Kids with serious issues that perhaps could have been prevented with a stay at home parent
4) House husband

I have a partner, a male, whose wife is a doc who works many more hours than him. How do they do it? Well, they very much prioritize time with the kids (he'll turn down a shift switch just because his kids need someone to pick them up at school.) Oh yea, and he works 12 shifts a month, and only works the 11am-7pm shift so he can get the kids off to school and his wife can pick them up/be with them in the evenings on the days he works. Not a lot of groups offering that as an option, and you can bet he takes a pretty good financial hit for that schedule.

Serious issue to deal with if you want a consuming career like medicine and kids. Luckily emergency docs make enough that they can either pay a nanny or support the family on just their income.

 

[emergentmd]

I am no PC. I try to be upfront on issues and sometimes to my detriment. I have these discussions with my wife all of the time and she agrees with me.

Bottom line is you can't have it all. Everyone makes sacrifices. If my wife kept her career, she would be making over 100k/yr. We could easily hire a live in Nanny just on her Salary and have easy lives. Just let the Nanny do it......

But for me, why have kids if you are going to let someone raise them? I am sure I will get lampooned on this b/c people with nannies will tell me that they are there for their kids. Sure you are there some of the time but the Nanny is there 80% of the time.

I am completely confident if we hired a nanny, life would have been easier.

Go to work, come home at 6pm after the Nanny has bathed/fed them. Play/Deal with kids for 2 hrs and they are asleep until the nanny comes in the am to take over after they awaken.