Are MGH's new hours for real (Or, was I smoking crack on interview day)

[Burt Bachrach]

I had my MGH interivew last week and couldn't believe what I heard about the way interns hours will work next year. Did I misunderstand something or is MGH (aka "Man's Greatest Hospital") really changing their call schedule so that interns actually get decent sleep? How exactly is it going to work? From what I understood, on one service, call days will start at noon and residents are expected to go home the next day at the same time, and are not even expected to attend noon conference. On the other service, there will be a night float that takes over at 10pm, and interns are expected to go home and get some sleep before rounds the next day. So, interns should never be in the hospital for more than 24 hours straight, and for most of the year, they won't even have real overnight call. Plus, there are golden weekends, 6 weeks of outpatient, a month of elective, a month of ER, a month of vacation, a month in a cush community hospital, and two weeks in an awesome research seminar.

Was I smoking crack or something, or does this sound like a pretty awesome intern year. Of course, when you are on the floors at MGH, you'll be working your butt off. But, you'll get amazing teaching, be in a great city, and actually have a somewhat normal sleep schedule for most of the year. What gives? Is anyone else shocked at the surprisingly humane schedule MGH has put together, (or can any applicants or current resicdents let me know what's really going on?)

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[fuzzyerin]

Considering all the physician work hour and sleep surveys are done at Harvard, I wouldn't be all that surprised to see MGH actually change the schedule based on their research. Otherwise, it'd be pretty hypocritical ~ they did the research but still kept everyone sleep deprived.

 

[med1234]

actually, those studies were done by folks at BWH, but yea, i heard them reference those studies at mgh when talking about the new hours.

Considering all the physician work hour and sleep surveys are done at Harvard, I wouldn't be all that surprised to see MGH actually change the schedule based on their research. Otherwise, it'd be pretty hypocritical ~ they did the research but still kept everyone sleep deprived.

 

[ak1978]

The only thing is that this would make it less of a front loaded program, shifting work to JARs and SARs, and thus making those years less pleasant for you. At MGH & Hopkins, the general feeling I got was that internship was the time to learn & practice solid medicine and that your role changes when you become a JAR or SAR (reading, teaching, becoming leader of the team...)

 

[Burt Bachrach]

Come on, more people have to have opinions regarding the new work hours at MGH. (And, by the way, is the Brigham changing its schedule at all in light of the new sleep research studies that came out of rheir[/I own program]).

Of course, I am asking this for more than just academic curiosity. Like many of you out there, I am trying to pick which program I want to go to next year, and for me, it's important to find a program where I'll be happy--and a big part of that is having a somewhat physiologic sleep pattern. Before my interviews, everyone told me that the Brigham is so concerned with making sure that its residents are well taken care of, while MGH tends to be more hardcore/hardass. However, based on these new schedule changes and the overall vibe at each place, I get the sense that MGH is much less malignant than most other top programs. Basically, can I have my cake and eat it, too? Also, can anyone out there give me their sense of how the Brigham and MGH compare in the areas that are not directly related to academics (since both programs are solid in this regard.)

Good luck to everyone else out their. BTW, I've probably bumped into a couple of you this year on the interivew trail, and for the most part, you guys rock!!

 

[dak2006]

I was also really surprised when I heard about the schedule at MGH.. truth be told it sounds pretty great. However, I did talk to a first year cardiology fellow who rotated through there and he implied that the culture still exists that interns don't page the senior resident for help, so instead they page the fellow.. for whatever that is worth.

As far as BGW, I talked to a few people who seemed to think they liked the old system of overnight call better. Despite the fact that call ends at 10:00 p.m. , most people are tying up loose ends until 2 or 3am and still have to work a full day the next day, so they wind up working well beyond the 80 hour work week. Anyway, let me know if you have any great revelations as I too am trying to decide between these programs as well as others. Either way it is probably a small price to pay for such great training and the career opportunities that will exist afterward.

(also have to agree that most people on the interview trail have been very cool)

 

[pretzel]

Dak, it's good to hear that you heard the same thing as me at BWH. Several interns there told me that call technically ends at 10 pm, but they said that for a good 6 months, until they learned how to work up their patients more efficiently, they were typically working until 2 or 3 am, and sometimes even until 5 am (!) their call day, because it was not uncommon that multiple patients were admitted at around 10 pm, and admitting and writing orders took several hours.

They said the rough part of this is that their 2 am day was technically over at 10 pm, so they are expected to be in at their normal time the next morning (they said they usually get in by 6-7 am depending on patient load), and work a full day until 5-6 pm.

Yikes. They told me that for that reason, even though call night is done by 10 pm technically, they usually sleep in the hospital overnight, because it isn't worth wasting the 15 min home and 15 min back when they are only going to get 3 hours sleep.

They said that they and their fellow interns do definitely log well over 80 hours, but then by the end of intern year, they are learning to be more efficient, so they only log several hours over 80 hours/week. They also said that they don't need much sleep, so they really like working like that. One said that it sounds bad, but he can find time to read journals despite the schedule.

I think attendings will expect that kind of work ethic out of all interns. I think you just have to be the kind of person who lives and breathes medicine. The interns I spoke with were all single, so they said it works out very well for them because they don't have outside obligations.

I have read some rank list threads where some applicants (who are obviously much more together than me) have already finalized their lists. 🙂 I'm trying to figure out what to rank from 1-5. 🙂

 

[pretzel]

About MGH, interns told me that working right around 80 hours/week was the norm, because they have normal overnight call, and then they leave promptly at noon the next day. I asked if noon was actually enforced, or if it was just "technically" noon, and they said that not only do they leave by noon, but attendings and residents will actually ask you to please wrap up your work or if you are overwhelmed with work, to please hand it off to the day interns if it is getting near noon.

Two interns said that they usually leave by 10 am to noon the next morning, because the interns who weren't on call the night before try to take work from the night interns as fast as possible, so they will get the same treatment when they are on call. The interns I talked to said that they usually get home, nap for a few hours, then they have the day and a full 8-10 hour night of sleep.

The MGH interns said that a lot of the top programs "expect" their interns to work way over 80 hours, and the problem is that most interns do work way over 80 hours, so if you don't, you're sort of lazy in comparison. They said that an important thing to understand is that MGH attendings and residents are the opposite, that an intern will not get an ounce more "credit" if he stays beyond 80 hours, because he is breaking the pattern of the team-based approach, where everyone helps each other on the team, and don't try to "one-up" each other by trying to out-work your fellow interns.

I didn't catch which service this was, but MGH is starting night float on some service, and the interns said that this should make the work load even easier.

Several MGH interns said that they were looking at both MGH and Brigham when they were ranking programs, and they said that they ranked MGH first (obviously). Their reasons: The work schedule is more humane at MGH, you get more autonomy at MGH.

They said at BWH, you admit together with a JAR, so the JAR ends up sort of being the main doctor (of course it's your patient) and the fellows or attendings relay things to the JAR, who will relay them to you. They said the difference at MGH is that you admit on your own and then discuss it with a JAR, and the fellows and attendings contact you directly, so instead, you relay things to the JAR.

One of the chief residents at MGH said that when he was an intern, he was a little confused the first time a cards attending called him to discuss how a cath went and what happened when the patient was on the table, until he realized that the cards attending was calling him and not the JAR, because MGH attendings regard interns as the main doctor. He said he wasn't so surprised the next time another attending paged him to discuss a patient. 🙂 He emphasized that interns are never left alone, and JARs are immediately available for help.

I have read the other responses in this thread, and I had heard the same reputation about MGH, that it was malignant and made you work until you couldn't see straight. I also heard the same reputation about BWH, that it was concerned that its residents are very well taken care of.

I don't know where these reputations came from, because my experiences were the opposite as far as work hours and autonomy are concerned. The housestaff at both programs were so nice, and they seemed genuinely happy at both places. I think BWH interns work far more hours, and they like it that way. I think that's great if you're that type -- I couldn't find any difference in fellowship matches between programs, so the extra work doesn't translate into any different fellowship result.

Did I just have a really strange experience? I would really appreciate anyone else's experiences or comments.

 

[biplane]

Hi,
I am an intern at the Brigham, and I wanted to correct the impression left by the previous message. While it is true that the intern admits with the junior or senior resident, this setup does not mean that interns are welded to the hip of their resident and merely doing what the JAR tells them to do. In practice, most interns I know see the patient and start orders on the patient alone. The JAR/SAR the then runs back and forth between the two interns running over the admissions in groups as the night progresses. Obviously, if a patient is really sick--or for that matter if you need help with crashing cross cover patients, they show up to help immediately. So you can work efficiently and form your own impression while still delivering high quality patient care.

In terms of being treated as the "doctor", I think most hospitals I am familiar with treat the intern as the primary doctor, the one who enters the orders and knows the most about the patient. On cardiology, the interventional fellow always calls me to describe how the procedure went etc. For all consults and for all subspecialty services, the attendings/fellows always call me with their recommendations and to discuss the case. The same applies to primary outpatient attendings. I would think it works this way in most hospitals. The only instance where I know of things later is when my resident/attending bump into the consultants in the hallway. One area where I do routinely hear about things through my resident is dispo--the resident is usually the one handling the interaction with the care coordinator (thank god), except on onc and GMS5-8 when more responsibility falls to the intern. At the beginning of the year, the interns get more help and at the end of the year they need less help. However, the important thing is that you get all the help you need. At the Brigham, people will only be angry with you if you wait too long to call for help.

While many differences between the General and the Brigham are thrown around in chat rooms, I think they are often overblown. To me, the reason I ranked the Brigham higher was because the Brigham's atmosphere suits me better and because I dislike the Bigelow format for delivering care. I personally feel I deliver higher quality care when I have the "ownership" that comes with doing the admission for my patients and having the benefit of a strong relationship with the patient. I also have particular interests in cardiology and oncology--two areas where the Brigham provides more first year exposure (at least it was true when I applied).

I do happen to agree that working post-call has its drawbacks. However, many critical decisions are made on the post-call day. So it is important to be there when important diagnostic studies become available and to interface with the consultants.

In the end, I think you cannot go wrong with residency at either hospital. You should just see where you "click" the best and go there. I do not think the quality of the clinical training will differ substantially at the two places.

 

[pretzel]

Thanks a lot, biplane, for explaining the Brigham program. I absolutely did not mean to disparage the Brigham program in any way, so sorry if it came out that way. Both Brigham and MGH have such strengths that anyone would feel so lucky to match in either.

 

[Savard]

Like a lot of people out there, I really liked MGH and Brigham. Now that ranking time is just around the corner, I am having a tough time making my mind up as to which I should rank #1 and #2.

Personally, I thought I bombed both interviews. But my dean got a call from MGH last week, and the PD from Brigham mentioned my name (along with 2 or 3 others) when he called, as well. So the good news is that it looks like I have strong shot of ending up in Boston. My gut sense is that MGH might be a better fit. In general, I thought the people at MGH seemed a bit more down to earth, but I am not sure if that was just something about the day itself.

Since I am from the Midwest, I'd really appreciate hearing from people who have more experience with life at MGH. Both MGH and BWH have amazing reputations and will do a great job training me, but what I am looking for is the place where I'll be able to maintain the most sanity. (I am definitely not one of those martyr/gunner types. If my patients are tucked in for the day at 2pm, I have no problem signing them out and going to the park or gym).

So, a couple of specific questions about the culture at MGH.

1) What is call like now, and what will it be like next year? Is it expected that interns attend noon-conference post-call? (At my hospital, interns are now sent home after work rounds).

2) How does admitting patients work? Do the interns do all of the work-up (assuming the patient is not in extremis), or do they get to go over cases with the residents?

3) What’s the atmosphere with the attendings or at resident report? Is there any real pimping? Do residents ever feel an undercurrent of competition?

4) How does the Bigelow service work (or not work)?

5) How is the year broken up in terms of scheduled blocks and sites?

6) Do they place an inordinate amount of value on face-time. In other words, is it expected that you stay until 6 or 8 everyday, or if things are slow, is it OK to sign out at 2 or 3. (and are things ever slow??). Or , do they actively want to encourage interns and residents to have a life outside of the hospital (Go to the gym, go skiing, catch a movie, have a hot date, etc.)

 

[cubby]

Savard, I PM'd you. Thx.