A week in the life of an EM resident?

[PossibleEMapplicant]

Hey I hope there are some EM residents on this forum. What does a weekly schedule look like for you? At the hospital everyday or just 3-4 days a week ? Consistent hourly schedule throughout the week?

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[Apollyon]

Just about everyone in this forum is or was a resident.

It depends. For example, when I was a resident, we did 8s during the week, and 12s on weekends. If your scheduler sucks, or hates you, you can still get screwed, even with 3 shifts a week (like Monday overnight, Wednesday day, then Thursday overnight). EM residents are limited to 60 hours a week, clinical, by the RRC. Some places, like St. John's in Detroit, do (or did) 20 12 hour shifts across all 3 years.

Some places graduate the schedule to help you, like 2 days, 2 afternoons, 2 overnights, then 2 days off. Lather, rinse, repeat.

 

[InternistDO]

Many residency programs will have a schedule on their website, even if its as vague as "18 twelve hour shifts a month as an intern, dropping by one shift a year".

 

[bearstanley]

it depends.

this week is dope for me. i was off last weekend, worked days MWF, and i'm off this weekend. next week is pretty chill too, then i switch to a run of four or five night shifts.

much better than my medical and surgical colleagues. worse than my real life friends with regular adult jobs. but very manageable, generally speaking.

 

[gamerEMdoc]

It's going to vary depending on where you go. Its very important when you apply to ask how many shifts a month the residents work and how many hours those shifts are. 19 12 hr shifts is a lot more work than 20 8 hour shifts. Figure out the weekly average hours. You can work 60 hrs clinically in the ED every week per ACGME rules. Many programs are nowhere near that. Some are. If you are working 12's, that's 5/week. That is a lot. 12's are tough. At my institution, everyone works 9's. Our interns work about 42-45 hrs/week in the ED clinically. Seniors less obviously. But scheduling is something that is highly variable depending on the program, so it's just something you'll have to weigh and ask about during the application situation.

As for an average week, its going to be all over the place for the most part. In EM, for the rest of your career, your schedule is very likely to be unpredictable. Some days, some nights, a lot of afternoons, weekends, etc. Its unpredictable, and you'll never be scheduled the same days every week. There's definitely positives and negatives to the varying shift work.

 

[dadaddadaBATMAN]

Hey I hope there are some EM residents on this forum. What does a weekly schedule look like for you? At the hospital everyday or just 3-4 days a week ? Consistent hourly schedule throughout the week?

The answer to this is pretty variable as outlined above, and there can be dramatic differences between years.

Three programs I am familiar with through myself/friends at others

Program 1
23/28 12s 1st yr
22 2nd yr
21 3rd

Program 2
18 8s with two education shifts
20 8s 2nd yr
18 8s 3rd yr

Program 3
23/28 tens and twelves (overnights 12)
20 8s 2nd yr, 12s weekends
18 8s and 12s as above

Also, it’s important to recognize these schedules only matter when you’re in the ed. Most ed residencies have between 6-9 months of icu time. Icu schedules generally blow. Other off service months can be difficult as well, at least in terms of hours.

Another thing to consider is the content of hours. While I objectively worked more hours in the micu and the trauma icu, the pace of those hours was much slower. I generally find ed months more exhausting than icu months, even when I have less hours scheduled. There were also less circadian rhythm shifts as a general rule, though this was not always true.

Although I don’t know why you’re asking this question, I would be cautious about choosing ed based on the number of hours worked as an attending or resident. It’s a more challenging field than it first appears to be, and has a wider range of knowledge required than you realize at first glance. Rotate through the specialty, see if you can tolerate the type of work and the patient population.

Good luck

 

[RainbowOtterz]

As an EM2 I work 19/28 days, 9 hr shifts. Our shift reduction goes 20/19/18 with 2 shifts as "resuscitation shifts" senior year where we don't pick up patients and our job is to help with procedures, sick patients, and flow. We spend ~70% of our time as our university site and 30% at our county site. Each month we have about 2-3 peds shifts. We work about 1/3 days/eves/nights but given the way scheduling works it seems like we work a higher proportion of eves. One day a week we have conference for about 4-5 hrs and yes, some days our conference days is considered our day off.

 

[GonnaBeADoc2222]

Another important question to ask is if everyone is excused from clinical shifts for conference. Where I trained, everyone was except 1 poor pgy4 who had to staff the critical care side with a usually disaffected attending and 1 or 2 useless offservice junior resisents.

 

[DO3]

Another important question to ask is if everyone is excused from clinical shifts for conference. Where I trained, everyone was except 1 poor pgy4 who had to staff the critical care side with a usually disaffected attending and 1 or 2 useless offservice junior resisents.

That’s funny. Where I was, we had attendings request the conference shifts when everyone was in conference, because it meant they got to do something...chest tubes, intubations, lines, etc..

 

[cyanide12345678]

Every program is different. Like the above posters said, it's a good interview questions for residents to know what you're getting into.

My program does 20 10 hour shifts in a 4 week period intern year, 18 shifts 2nd and 3rd year.

We're usually on a block schedule where we are either days or nights. So we don't shift around schedule on a day to day basis. For example, if I'm the 6 a - 4 p resident, that's the shift I'll most likely have all block (with some minimal variation). But next block may be all nights.

 

[TooMuchResearch]

Oh man, I haven't thought about my residency schedule since the day I finished. I definitely worked more than now, and I'm working quite a few hours.

 

[Perrin]

Sometimes the schedulers will work with you, if you make it worth their while. Our Peds ED scheduler worked for the peds group that covered the Peds ED. I would email her a month or two in advance and offer to work night shift the whole month if she would schedule me off for certain times. It made her life easier and I got the schedule I wanted. I let our senior residents who made our main EDs schedules know that I preferred nights when I was a 2nd and 3rd year. They would throw a few extra night shifts at me and group them together. So when I was off, it was sometimes 3-4 day blocks. I was single with no kids. The married and/or with kids fellow residents did fewer nights and I got a schedule I liked.

 

[gamerEMdoc]

Also, the block vs monthly schedules matter, remember to ask that. 20 shifts a month is different than 20 shifts in a 31 day period. That's another 3 days off a month in a 31 day month.

Our residency is based on monthly schedule. All shifts are 9's. 20/19/18.

 

[OneTwoThreeFour]

I work overnight tonight, 3-11pm on Wednesday, Saturday, Sunday 7am-7pm. Those are my next 7 days (with conference in there somewhere)

EDIT: So that comes to 44 hours this week. A little below typical for us PGY1 (tends to be about 50/wk).

 

[Buckeye1992]

We do 18 10s all three years(in 28 day blocks).

 

[Rekt]

The answer to this is pretty variable as outlined above, and there can be dramatic differences between years.

Three programs I am familiar with through myself/friends at others

Program 1
23/28 12s 1st yr
22 2nd yr
21 3rd

Program 2
18 8s with two education shifts
20 8s 2nd yr
18 8s 3rd yr

Program 3
23/28 tens and twelves (overnights 12)
20 8s 2nd yr, 12s weekends
18 8s and 12s as above

Also, it’s important to recognize these schedules only matter when you’re in the ed. Most ed residencies have between 6-9 months of icu time. Icu schedules generally blow. Other off service months can be difficult as well, at least in terms of hours.

Another thing to consider is the content of hours. While I objectively worked more hours in the micu and the trauma icu, the pace of those hours was much slower. I generally find ed months more exhausting than icu months, even when I have less hours scheduled. There were also less circadian rhythm shifts as a general rule, though this was not always true.

Although I don’t know why you’re asking this question, I would be cautious about choosing ed based on the number of hours worked as an attending or resident. It’s a more challenging field than it first appears to be, and has a wider range of knowledge required than you realize at first glance. Rotate through the specialty, see if you can tolerate the type of work and the patient population.

Good luck

Wow Jesus no one should ever go to program one. That's just stupid.

Also, the block vs monthly schedules matter, remember to ask that. 20 shifts a month is different than 20 shifts in a 31 day period. That's another 3 days off a month in a 31 day month.

Our residency is based on monthly schedule. All shifts are 9's. 20/19/18.

That's a nice set up. Probably one of the best schedules I've seen. I agree heavily. 31 vs 28 was a large factor in my rank list.

 

[gamerEMdoc]

Wow Jesus no one should ever go to program one. That's just stupid.



That's a nice set up. Probably one of the best schedules I've seen. I agree heavily. 31 vs 28 was a large factor in my rank list.

Thanks! We designed it so residents have plenty of time to read. Our conference and didactics lean heavily on asynchronous learning with small group sessions to reinforce the readings. Its a great educational model imo, but does require residents to prepare for conference each week. So our goal has always been to give the residents enough time to actually stick to the didactic work.

 

[CajunMedic]

Program 1
23/28 12s 1st yr
22 2nd yr
21 3rd

Sounds like a program I rotated at and one of my friends matched at. On top of a similar schedule, residents can't use Dragon, residents literally couldn't sit until last year (they finally gave them chairs). Interns are expected to see the lion's share of the patients, to include physically snatching charts out of auditioning student's hands.

Ours are based on the calendar month. My ED months, I do 17-18 10's with the expectation of an extra 2 hours minimum to finish charting. Shifts are shortened on Tuesday and Wed to ensure adequate rest for didactics. Didactics are protected time on Wednesdays from 0700-1200. July is "intern bootcamp", classroom from 9-12 M,T, Th,F. Categorical interns work 3 10's, EM tracked TY's work 2 10's.

 

[gamerEMdoc]

Sounds like a program I rotated at and one of my friends matched at. On top of a similar schedule, residents can't use Dragon, residents literally couldn't sit until last year (they finally gave them chairs). Interns are expected to see the lion's share of the patients, to include physically snatching charts out of auditioning student's hands.

Amazing anyone would want to match there. They must have a good doximitry rating (for those that care) or be in a sweet city or near the beach. Because I dont know how anyone could rotate in that environment and still want to rank the place.

 

[CajunMedic]

Amazing anyone would want to match there. They must have a good doximitry rating (for those that care) or be in a sweet city or near the beach. Because I dont know how anyone could rotate in that environment and still want to rank the place.

None of the above.

I did until about 6 hours into my first shift, heck I loved it when I shadowed there between my OMS-1 and OMS-2 years. It's one of those places you either love or hate. My friends that are there absolutely love it, but they're about 15 years younger than I am too.

 

[cyanide12345678]

Amazing anyone would want to match there. They must have a good doximitry rating (for those that care) or be in a sweet city or near the beach. Because I dont know how anyone could rotate in that environment and still want to rank the place.

Cincinnati had it's interns doing 24-25 shifts a month as far as I remember on the interview trail. I could be wrong since it was a long time ago but I think it was ridiculous work load from what I remember. Plus 4 years instead of 3. A lot of high caliber people still want to go there.

 

[gamerEMdoc]

It’s just a matter of supply and demand. If you are in a good location, or have some perceived level of prestige, you can get away with being 4 years, working the residents more, or paying less than some programs. That’s just market dynamics. If a small town program tried to go the 4 year route, or worked their residents 25 shifts a month, or paid a below market salary, no one would ever ever ever go there. It’s not wrong that places do this, its simply the market. Student value different things. Some may value more money, or moonlighting opportunities, or low cost of living, while others may value a cool place to live, while others may value prestige, etc etc etc.

It’s definitely a frustration of mine coming from a smaller town program because a lot of these variables can be changed for a program, but the one that can’t is geography. We see a ton of bad pathology, my residents are very well trained, we pay well, the cost of living is low, and our schedule is very resident friendly. But at the end of the day, you can’t change geography, and that immediately puts you behind the eight ball when it comes to recruiting for a lot of candidates because many people just don’t want to live in rural small town America. It makes it difficult to recruit, but there’s always a small segment that either doesn’t care about living in a city or tropical area, or is actually looking to live in a more rural area. You just have to seek those people out when it comes to the application season.

 

[Buckeye1992]

I know it’s probably variable depending on a variety of factors, but how many patients are you guys seeing in your ED months? I usually see 1.5pph as an intern. Everyone else seeing similar?

 

[dadaddadaBATMAN]

I know it’s probably variable depending on a variety of factors, but how many patients are you guys seeing in your ED months? I usually see 1.5pph as an intern. Everyone else seeing similar?

Stated goal of the program is to have you be able to see one pph per year of residency. In reality most people see more than this, though certainly not seeing more than 3/hr on a consistent basis. 1.5-2.5/hr would not be unusual. More than 2.5 is a busy shift for us.

Unless it’s peds or fast track.

 

[OneTwoThreeFour]

I know it’s probably variable depending on a variety of factors, but how many patients are you guys seeing in your ED months? I usually see 1.5pph as an intern. Everyone else seeing similar?

I'm probably closer to 1 pph at this point. Though I at least like to blame some of it on the obscene boarding going on in our ER right now.

 

[AlvinKamara]

Stated goal of the program is to have you be able to see one pph per year of residency. In reality most people see more than this, though certainly not seeing more than 3/hr on a consistent basis. 1.5-2.5/hr would not be unusual. More than 2.5 is a busy shift for us.

Unless it’s peds or fast track.

Wow, 1.5pph in intern year?? I think I barely see 1pph at my residency. How do I increase throughput without getting totally screwed on documentation?

 

[gamerEMdoc]

Going to depend heavily on the documentation system used at a given site. When we were dictation with no physician order entry, our residents routinely saw 0.5 or more pph than they do now with epic. But a good rule of thumb is 1 as an intern, 1.5 as a pgy2, 2 as a pgy3. Some will be faster, some will be slower.

 

[CajunMedic]

I know it’s probably variable depending on a variety of factors, but how many patients are you guys seeing in your ED months? I usually see 1.5pph as an intern. Everyone else seeing similar?

Our goal is 1.2pph by the end of intern year. I average 1.0 to 1.1, but spend a ridiculous amount of off duty time charting

 

[dadaddadaBATMAN]

Wow, 1.5pph in intern year?? I think I barely see 1pph at my residency. How do I increase throughput without getting totally screwed on documentation?

Na, goal is at least 1pph by end of year. The 1.5-2.5 are from pgy2-3s, who are both scheduled for the same type of shifts.

We also have dictation software, and have a somewhat ****ty culture around documentation (routinely 1hr+ after shifts).