7 on/7 off schedule Q

[throwaway0628]

Hey, MS2 here with little knowledge of attending hours. For an IM hospital internist, I've been seeing that they typically work 7 on/7 off as a schedule (correct me if I'm wrong?)

Are these 12-hour shifts? So that makes it an 84 hour work week?

This is kind of strange to me because I was an EM scribe and if an EM attending had 7 shifts in a row (10-hours) it was considered really brutal. Am I missing something? Is the 7 on/ 7 off really brutal or manageable because of a slower pace? Does this include call or it is straight up shift hours?

Thanks 🙂

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[NITRAS]

Different places practice differently.

My practice, I don't have to do admission, I see 15-16 patients, and cross cover takes the pager at 8pm. With the exceptions of the first day, it really isn't that bad. I usually work 14 on 14 off (with some moonlighting on my weeks off usually). Other places you have 20-30 patients, do admission, swing shift with some nights.

Some places, they will require you stay in house for your entire shift (mine does not). Some places you will cover ICU, work on getting people transferred out, doing procedures. You can usually find what you want. Pay will vary, but that is often geographical more than anything else.

Hope it helps.

I'm usually really tired ofter 14 days on.

 

[throwaway0628]

Thank you @NITRAS

 

[atomi]

7 10's is not "brutal". Its a "busy week" - then you have a whole week to do whatever you want - ie go to Bali.

A common criticism of this work schedule is that the 7 off days require a lot of physical and emotional recover from the previous 7 days and the rest are filled with dread of having to return, so the quality of those off days really isn't that great.

 

[mvenus929]

A common criticism of this work schedule is that the 7 off days require a lot of physical and emotional recover from the previous 7 days and the rest are filled with dread of having to return, so the quality of those off days really isn't that great.

I mean, nurses complain about having to do 3-4 12 hour shifts in a row. Everyone will complain about their work schedule, but depending on your outlook, having 7 days off every other week means a lot of time for traveling and pursuit of other hobbies.

 

[IMreshopeful]

7 10's is not "brutal". Its a "busy week" - then you have a whole week to do whatever you want - ie go to Bali.

It can absolutely be brutal. If you’re rounding on 15-20 patients a day, admitting some days, and dealing with decompensating patients in between all the paperwork and billing, it can be very tiring. The week off can often require a day or two of just rest and recuperation before anything normal can be done. It’s not something to blow off. EM arguably can be worse because there’s zero downtime - which is often why their stretch of workdays is 4-5 days instead of 7.

Also you lose three days just flying to Bali and back. That would be a very short vacation indeed lol.

 

[IMreshopeful]

I mean, nurses complain about having to do 3-4 12 hour shifts in a row. Everyone will complain about their work schedule, but depending on your outlook, having 7 days off every other week means a lot of time for traveling and pursuit of other hobbies.

Nursing shifts are a different type of labor intensive thing. Intensive care nursing can be exhausting - even taking care of just one or two patients. Hard to compare the two.

 

[atomi]

I mean, nurses complain about having to do 3-4 12 hour shifts in a row. Everyone will complain about their work schedule, but depending on your outlook, having 7 days off every other week means a lot of time for traveling and pursuit of other hobbies.

Perhaps some internists and IM residents can chime in, but I did do an IM prelim at an academic center, and my perspective was that these jobs (1) weren't that common (they were not offered at my institution), and (2) weren't all they were cracked up to be due to being severely overworked and psychologically screwed up on your downtime. I had one attending who told me about a previous night shift job where he was covering 45 (!) patients on his own. Jokingly, he said when he signed them out the next morning - well I think they're all alive, but I don't really know. Some really dangerous stuff can go on out in the community.

For me personally, I greatly prefer a steady 8-5 with weekends off and 6 weeks of vacation a year. I went into a specialty that offers this. I can still have hobbies and downtime even during the week -- can't really do that when you're literally either sleeping or at work, which is what that 7/7 life is like when you're on. The alternative lifestyles of EM and internists seemed worse, although still better than the surgeon lifestyle. The 8-5 M-F lifestyle is the only one I would call healthy and balanced and sustainable for life.

 

[aafisahar]

Cross covering 45 patients isn't that bad unless they are very sick or combined with the ICU. Vast majority of patients will just sleep.

 

[Basil246]

For me personally, I greatly prefer a steady 8-5 with weekends off and 6 weeks of vacation a year. I went into a specialty that offers this.

What speciality?

 

[mvenus929]

Perhaps some internists and IM residents can chime in, but I did do an IM prelim at an academic center, and my perspective was that these jobs (1) weren't that common (they were not offered at my institution), and (2) weren't all they were cracked up to be due to being severely overworked and psychologically screwed up on your downtime. I had one attending who told me about a previous night shift job where he was covering 45 (!) patients on his own. Jokingly, he said when he signed them out the next morning - well I think they're all alive, but I don't really know. Some really dangerous stuff can go on out in the community.

I'm not in IM, I'm in Peds. Our Hospitalists would work either 7 or 14 days in a row and most of the time were not required to be in house for 12 hours per day. When there were two hospitalist teams, they would trade of admit days, and during the summer when there was only one, they would be on for 7 days at a time. Our community hospital that doesn't have residents has an attending on call for 5 days straight, and is responsible for all the admissions and can be called in from the ED in cases of pediatric emergencies.

One of my friends got a job out of residency as an oncologist hospitalist and worked 7 days in a row, and was required to be in house the full 12 hours. She's not doing the job this year, but I'm unclear if that's because she's burned out, or just decided that heme/onc isn't her jam anymore.

It's a nicer schedule than residency, so probably appeals more to people straight out of residency than others, but for the person that doesn't like office-based work, it's not a bad schedule.

 

[IMreshopeful]

Perhaps some internists and IM residents can chime in, but I did do an IM prelim at an academic center, and my perspective was that these jobs (1) weren't that common (they were not offered at my institution), and (2) weren't all they were cracked up to be due to being severely overworked and psychologically screwed up on your downtime. I had one attending who told me about a previous night shift job where he was covering 45 (!) patients on his own. Jokingly, he said when he signed them out the next morning - well I think they're all alive, but I don't really know. Some really dangerous stuff can go on out in the community.

For me personally, I greatly prefer a steady 8-5 with weekends off and 6 weeks of vacation a year. I went into a specialty that offers this. I can still have hobbies and downtime even during the week -- can't really do that when you're literally either sleeping or at work, which is what that 7/7 life is like when you're on. The alternative lifestyles of EM and internists seemed worse, although still better than the surgeon lifestyle. The 8-5 M-F lifestyle is the only one I would call healthy and balanced and sustainable for life.

7/7 is actually probably the most common type of hospitalist schedule there is for inpatient IM. Many variations of this exist of course - 15 shifts per month, 14 on/off, etc. if you’re in primary care of course then the schedule is usually pretty nice - 8-5 M-F with almost no call per se. The reason people choose one or the other is usually related to what they enjoy doing - outpatient vs inpatient medicine.

As a resident at our VA I routinely cross covered 50-80 patients depending on the team censuses. So 45 ain’t a big deal especially if patients stable tbh. If they’re all crashing and burning then that’s a different story.

 

[Ms Procrastinator]

What speciality?

I'm guessing derm

 

[jdh71]

Hey, MS2 here with little knowledge of attending hours. For an IM hospital internist, I've been seeing that they typically work 7 on/7 off as a schedule (correct me if I'm wrong?)

Are these 12-hour shifts? So that makes it an 84 hour work week?

This is kind of strange to me because I was an EM scribe and if an EM attending had 7 shifts in a row (10-hours) it was considered really brutal. Am I missing something? Is the 7 on/ 7 off really brutal or manageable because of a slower pace? Does this include call or it is straight up shift hours?

Thanks 🙂

Generally brutalish.

It's work hard play hard.

7 on 7 off. At least if they are twelves are a grind. Though there are different practice models based on this 7/7 and you may not spend every hour of a 12 hour shift at the hospital.

 

[throwaway0628]

Thank you all for the replies.

I have to say I have been fairly discouraged this summer learning about the reality of attending jobs in specialities I am considering.

Of course I have always known that residency would be a major grind, but I thought that attending life would be loads better- in most specialties, not just FM or derm or clinic-based fields. Am I misreading what 7 on /7off would feel like for a lifestyle? I know you get a week off and that's great but what about being miserable for 84 hrs the week before?

 

[mvenus929]

Thank you all for the replies.

I have to say I have been fairly discouraged this summer learning about the reality of attending jobs in specialities I am considering.

Of course I have always known that residency would be a major grind, but I thought that attending life would be loads better- in most specialties, not just FM or derm or clinic-based fields. Am I misreading what 7 on /7off would feel like for a lifestyle? I know you get a week off and that's great but what about being miserable for 84 hrs the week before?

You're not going to find a hospitalist job that is 8-5, because that is not the nature of hospitalist medicine. You can find hospitalist jobs that are 7-5, or noturnist jobs that are 5p-7a and don't have you work every night. You can find jobs that require you to stay in house for 12 hours a day and are busy the whole shift, or jobs where you're 'on call' after you round, and rounding takes 6 hours. Jobs where you work with residents are going to mean less paperwork for you, but more teaching in exchange.

People who do 7/7 style shifts are not necessarily miserable--it depends on the acuity, the season, the tendency of the nurses to take care of things for you before they call... there is a lot of variability in practice style. And whether or not you enjoy it. I did neonatal hospitalist last year, which meant that I was in house in case there were any deliveries that required peds attention. The shifts were 24 hours, but generally after I finished rounding (generally in the first 4-5 hours of the shift), doing my billing, and checking in with the moms, I had a ton of downtime and slept 7-8 hours almost every time I was on. The nurses would put in admission orders for me, and only call if there was something they were really concerned about, not every time the babies hiccuped. I still hated it, cause I don't like neonatal medicine in the least, but the job wasn't bad. It's all about mindset.

 

[sloop]

I'm guessing derm

My psych residency basically has this schedule. Well it's slightly worse: start of the day can be any time from like 7-9 and usually get out by like 6 unless you get really shafted with a late admission. Average of ~q14 call. Weekends and holidays off if not on call. This is also inpatient.