Best residency Hours

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Originally posted by odoreater
So what programs out there have good hours/week for their residents?

Which do not?
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Depends on your definition of "good."
 
Emergency Medicine has pretty good hours. I heard Surgery is long hours.
 
Residency is difficult and the hours are long, no matter which way you slice it. Some programs work all 12 hr shifts and switch back and forth b/w days and nights... some programs work 8/10/12 hr shifts... some programs work on a progressive schedule where your shifts change on a circadian rhythm... overall theme... EVERYBODY WORKS - A LOT!

As Sessamoid said, what's your definition of good? Mine was circadian rhythm - I just think its easier on your body 😀
 
Originally posted by Scrubbs
As Sessamoid said, what's your definition of good? Mine was circadian rhythm - I just think its easier on your body 😀
Click to expand...

I actually prefer the "rhythm method."

Q, DO
 
Shortest hours: Albany, NY: they work 13-15 twelve hour shifts and have half the month off.
Wake Forest: 18-20 eight hour shifts
Christiana Care: a combination of 8, 9 and 12 hour shifts. Total of about 19 shifts.
UConn: 8s and 9s, about 19 of them

Longest hours: Carolinas: twenty something twelve hour shifts
Stanford: over twenty twelve hour shifts
Duke: over twenty twelve hour shifts
Harbor: lots of twelves also
Pitt: lots of twelves also
Case Western also works lots of hours
Buffalo: 19-20 twelves

Other programs: Christ: 18 10 hour shifts
Maricopa: 18 10 hour shifts
Madigan: 20 9 hour shifts
Regions: 24 8 hour shifts
Rochester: 20 9 hour shifts
Syracuse: 19 9 hour shifts
Mayo: 18-20 9s

While I was interviewing, I kept track and this and here are the numbers I gathered. I personally think the best schedule is 18 ten hour shifts because it seems the most balanced. These numbers may not be perfectly correct, but that's the info I gathered.
 
Here at USF as interns we will do 20 12 hour shifts... as second years, less, and third years even less. I beielve the # we were quoted for as third years was 50-56 hours a week.

We dont' have the exact hours yet, because, well, I'm in the first class and there are no second years or third years.

I won't mind working 20 12s. I love being in the ED and LOVE being the only intern on... I get to do everything and anything there (some cherry picking if I wanted, which I dont' do). My first shift I was running codes by myself! Lots of fun, I love the ED!

Q, DO
 
Correction to the Rochester hours:

R1: 18-20 shifts of 10 hours
R2: 18 shifts of 10 hours
R3: average of 40 hours per week with 8-hour shifts during the week and 12-hour shifts on weekends to guarantee that seniors get 2 weekends off per month

Another aspect of this discussion:

Conference on Thursdays from 7:30 am to 1:00 pm with protected time in the afternoon. Latest shift on Wednesday night ends at midnight. Earliest shift on Thursday begins at 8:30 pm. We are excused from all off-service rotations except when we are in the unit.
 
Figured I'd elaborate what we do with the rhythm method at Drexel...

R1: All 10hr shifts, 6 days on, 2 days off. We do 2 day shifts (7a-5p), 2 mid shifts (2p-12a) and then 2 overnights (9p-7a).

R2: All 12hr shifts, 6 days on, 4 days off... same progression of days, mids, nights.

R3: All 8hr shifts, 6 days on, 2 days off... again same rhythm.

I know Temple has an identical intern year, not sure beyond that. 😀
 
Originally posted by kickbackdude
Duke: over twenty twelve hour shifts
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Duke is 22 10 hour shifts per 28-day block - but people are intentionally scheduled during journal club and conference, so they aren't actually working (and are doing 60 hours/week, instead of 65, or 69 during journal club weeks).
 
Thought I'd elaborate on this topic with some background as well. As a resident I worked 8, 10 and 12. As an attending 8 hour shifts which usually runs to 9-10. My brother a full time ED pit doc in Arizona works primarily 12s and likes it.

Several key issues I believe:
The 12 hour format makes scheduling easier for the program in general. These programs are honestly less likely to have scheduling conflicts in them when there is a simple am/pm shift set. The issues are that after a 12 hour shift you usually are spent. Now I know that we have all rotated in surgery, but remeber in EM you are "on all the time you are there"...at least in residency anyway, so there will be days, weeks or months where you are redlining your internal rpms nearly nonstop...just the world we live in man...but often a @$%!load of fun!

The drawback on the 8-hour, more shifts concept is more days logged in house and not at home (obviously). So who you are, family needs, hobbies, and how you learn makes a huge difference.

If you remember only one thing from this diatribe it should be this;
When interviewing, try your best to see each institution in the evening/night. Even though you may have just arrived late via train, plain etc. and are looking to dive into that hotel bed, make an effort to see how things flow in the ED at night. Remember that at minimum about 30-50% of your ED training will be in the evening or night. many institutions have some selected faculty also that work primarily nights and this may be the chance to meet these key players in your future education. Most institutions are usually well staffed during the day (The only time 60-80% of applicants see it). Night stalking the ED may help you decide if the work hour format that the residency is using for shift scheduled hours may be a positive or negative in your eyes. Remeber "the freaks come out at night" and you sure want to see how things run during those times.

Paul
 
Good advice Peski...

Its always nice to hear from people in stages further out than my whole three months of internship so far.

I don't mind working 12 hour shifts, and often I dont' realize my shift is almost over! I'll look at the clock and realize I only have two hours left... although I can't wait until I'm an upper level resident... I'll actually have people under me who I can actually teach (and it will also help me see more pathology as I'll see their patients and mine).

Q, DO
 
I remember a study published in Annals (I think?) some years ago about emergency physician productivity towards the end of 12 hours shifts. The basic conclusion was that you are much less productive and more likely to make mistakes at the end of a 12 hour than at the beginning. Don't know if they studied 8 or 10s...
 
I can't quote a study on this issue but from personal experience working with residents... during the last 2-3 hours of a 12 hour shift they become pretty inefficient and just drag... the quality of the work also seems to decline. When they get home they are clearly too tired to read or, perhaps more importantly, take part in any social activity with friends/family. In the real world one can expect to do predominantly 8-10 hours... 12s are only sustainable in small EDs of less than 20-25K volume, otherwise you can expect high burn out! Just my 2.25 cents.

SH
 
Originally posted by SHOX
I can't quote a study on this issue but from personal experience working with residents... during the last 2-3 hours of a 12 hour shift they become pretty inefficient and just drag... the quality of the work also seems to decline. When they get home they are clearly too tired to read or, perhaps more importantly, take part in any social activity with friends/family. In the real world one can expect to do predominantly 8-10 hours... 12s are only sustainable in small EDs of less than 20-25K volume, otherwise you can expect high burn out! Just my 2.25 cents.

SH
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Case Western works 20-21 12 hr shifts a month with conference time sometimes on your day off. Also, some of the days off are between the night and day shift which are mainly "sleeping days." The main ED at the county hospital is fairly busy with about 80k visits a year and the secondary ED at the WFCCF sees less patients but they are usually more complex medically and politically and take more of your time. It's definitely on the heavy end of the places I interviewed at.

mike
 
I love how we must refer to it as THE WFCCF (world famous!!! Cleveland Clinic Foundation)

Also to chip in my experience, UF-Jax has 20-22 shifts in the ED in Jax which are a mix of 8,11,12s with the overnights being the shorter shifts. They can last up to 15 though realistically. Seniors decrease in number and length of shifts each year.
2 months out of the first 2 years are in Gainesville's UF ED. Shifts there depend on the number of residents from other services rotating, but tend to be about 20 12s for interns and 15 12s for seniors.
 
I don't think things have changed too much in the 2 years since I left Denver Health at that time when on ED rotations you could have three different schedules. Either 4(or 3 if you were lucky) 12's per week, 5 8's per week, or 6 8's on followed by 2 days off. My personal opinion on 12's was that they completely blew. On 8's you could still do other things-I used to ski or bike before or after some shifts. On 12's you were really to tired to do anything other than work, eat, and sleep. A few days of 12's in a row and you were exhausted. All of our 12 hour shifts were during peak ER volumes so they were even more exhausting.
 
At UNC,
interns work 19 12 hour shifts a month at UNC Hospital.
2nd years work 18 10 hour shifts.
3rd years work 18 shifts, mainly 8 hour shifts but some 12 hour teaching shifts.

We also work about half our shifts at our community affiliate, WakeMed in Raleigh, NC, where we work ~ 18 10 hour shifts.
 
I agree with ERMudPhud in that 12s blow. With 8-10 hour shifts you still have time to go out afterwards or get something done before. With 12s you just hit the sack. Plus, programs with 12s frequently have a day shift and a night shift, no swings. For me a swing shift is like another day shift, I don't have to change my sleep schedule, I just work the second half of my awake period, rather than the first.

Another important thing to check on with programs is what time the residents actually leave. 2 hours after shift=bad, occasionally before end of shift=good. An easy sign-out culture makes life blissful. For example, at my program we work 9s. We stop picking up patients at 7.5 and we demand that our colleagues sign out to us as soon as they have a plan for the patient. It makes everyone's life easier. My $0.02. I chose between my number one and number two based on this.
 
Originally posted by Desperado
Another important thing to check on with programs is what time the residents actually leave. 2 hours after shift=bad, occasionally before end of shift=good. An easy sign-out culture makes life blissful. For example, at my program we work 9s. We stop picking up patients at 7.5 and we demand that our colleagues sign out to us as soon as they have a plan for the patient. It makes everyone's life easier. My $0.02. I chose between my number one and number two based on this. [/B]
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This is important. This is also something that people may lie or exaggerate about during the interview/tour. This is one very good reason that you should actually spend a shift or two in any ER you want to go to. We worked 12-hour shifts in my residency and we left ON TIME, almost without exception. Those who hung around long after their shifts were told to go home, and one especially gung ho intern I had to personally escort out of the department one time I caught him in the dept almost two hours after his shift ended. 🙂
 
I thought I'd ressurect this thread hoping that people would have more info by now. I interviewed at Uconn a few days ago and was told by an intern that the most recent statistics indicate that they had the second shortest working hours. Don't know who's first. Any info on Baystate?
 
UF-Jax at the request of the residents has made some serious changes in hours to prevent people from staying long after shift changes, and conference time is now protected. A largely resident-run program, our concerns are heard and addressed...couldn't ask for a better place to be.
 
MLK Drew 14 12s
UIC 15 12s first year, then 17-18 10s

Those were the best schedules I ran into.

Lincoln 21-21 12s all three years

That was the worst.

Don't forget that three year programs have intrinsically less shifts you work as an underpaidoverworked er scutmonkey.
 
Scrubbs said:
Residency is difficult and the hours are long, no matter which way you slice it. Some programs work all 12 hr shifts and switch back and forth b/w days and nights... some programs work 8/10/12 hr shifts... some programs work on a progressive schedule where your shifts change on a circadian rhythm... overall theme... EVERYBODY WORKS - A LOT!

As Sessamoid said, what's your definition of good? Mine was circadian rhythm - I just think its easier on your body 😀
Click to expand...

Is it possible to get a list of which institutions use the circadian/progressive schedule? Or, is there a resource for determining this information?
 
The program I'm going to has the interns do 20 8 hour shifts, so that doesn't seem too bad compared to what people have posted above, huh?
 
DrEastWest said:
Is it possible to get a list of which institutions use the circadian/progressive schedule? Or, is there a resource for determining this information?
Click to expand...

The only one I ran across using circadian is Indiana University.

I'm going somewhere that does 20 x 12's per calendar month. Yikes.
 
Think of it this way: total hours per month.

3 divisions:
Less than 180 - that's low
180-220 - most programs and right down the middle
220 or more - that's high and old school, mostly programs that do 12hr shifts and often 4 year programs or inner city programs.

The logic of why a program would do more, like 225+, is rather obvious and I"ll leave that to your imagination or typical debates.

In the end, like all things in life, the extremes on either side are bad.

Also, loving your work and working alot, is more desirable than having no interest in your work and working a smaller amount of hours.

"Be happy in your work!"
 
Of the places I interviewed, Geisinger has circadian scheduling (11 day cycle with 2 days, an 11a-11p, a day off, 3 swing-ish shifts, an overnight, then 3 days off). Einstein does a block that is semi-circadian with 3 days, 3 swings, 3 overnights, 3 off.
 
Keep in mind, the defined "circadian" schedules usually don't permit requests to modify the pattern, whereas many of the other programs that don't have such rigid scheduling rules, will permit you to request certain days or times off that may suit your unique needs in that month. As with everything, it's a tradeoff you must decide upon...
 
Before residency, I received advice I've found helpful: "You'll never wish you had worked less or seen fewer patients when you finish residency."
This is your chance to see as much as possible while still having the chance to learn, grow, find your style, and even make mistakes. Although everyone has something different they would like to get out of residency, taking it easy shouldn't be one of them.
I agree that the circadian schedule is the way to go. It helps you adjust to the shifting sleep patterns, and also gives a great perspective on how the department flows at different times of day.
By the way, as a small correction--at Pitt we work mainly 10's, with 8's and 9's for overnights. No 12's for any ED shifts. Interns work 22/mo, 2nd years work about 21/mo, and 3rd years 20/mo.
Hope this helps!
 
Muscletoe said:
Before residency, I received advice I've found helpful: "You'll never wish you had worked less or seen fewer patients when you finish residency."
This is your chance to see as much as possible while still having the chance to learn, grow, find your style, and even make mistakes. Although everyone has something different they would like to get out of residency, taking it easy shouldn't be one of them.
Click to expand...

Amen.
 
Muscletoe said:
Before residency, I received advice I've found helpful: "You'll never wish you had worked less or seen fewer patients when you finish residency."
!
Click to expand...

I don't know, the residents I've met from the New York programs where they work 20 12s a month looked like they could have used a few less hours working.

As others have said in other threads, it's not just hours, it's patients per shift. So there are places where you work 12s but spend a lot of time spinning your wheels trying to get nurses to give meds you've ordered, trying to get the patient admitted etc. There are places were you'll see more new patients in a 9 hour shift than having a list full of borders for 12 hours.
 
At Carolinas- no one does 12 hour shifts.
R1- 20, 10 hour shifts
R2- 18, 8 and 10 hour shifts
R3- 17, 8, 9, and 10 hour shifts

At Pitt- no one does 12 hour shifts.
R1- 22, mostly 10s
R2- 21, mostly 10s
R3- 20, mostly 10s

At Duke- also no 12 hour shifts.
All years- 22, 10 hour shifts

... be careful putting too much weight into these numbers. A few hours one way or the other isn't going to make or break your residency.

kickbackdude said:
Shortest hours: Albany, NY: they work 13-15 twelve hour shifts and have half the month off.
Wake Forest: 18-20 eight hour shifts
Christiana Care: a combination of 8, 9 and 12 hour shifts. Total of about 19 shifts.
UConn: 8s and 9s, about 19 of them

Longest hours: Carolinas: twenty something twelve hour shifts
Stanford: over twenty twelve hour shifts
Duke: over twenty twelve hour shifts
Harbor: lots of twelves also
Pitt: lots of twelves also
Case Western also works lots of hours
Buffalo: 19-20 twelves

Other programs: Christ: 18 10 hour shifts
Maricopa: 18 10 hour shifts
Madigan: 20 9 hour shifts
Regions: 24 8 hour shifts
Rochester: 20 9 hour shifts
Syracuse: 19 9 hour shifts
Mayo: 18-20 9s

While I was interviewing, I kept track and this and here are the numbers I gathered. I personally think the best schedule is 18 ten hour shifts because it seems the most balanced. These numbers may not be perfectly correct, but that's the info I gathered.
Click to expand...
 
Last edited:
at tampa, interns work

15 12's hr shifts
5 8's
1 10's
with circadian schedule (1 wk nights)
it decreases 1-2 days for R2-3
I agree with the previous post: if you don't see the patients, you don't learn. it's a lot of hours but overall its' not too bad
 
It's also important to note if you're schedules are for the full month or are a 4wk block b/c a block will usually result in a 1 shift reduction

Ohio state on a 4 week block system
intern- 20 tens
2nd year- 19 tens
3rd year- 19 nines(with 1 hour overlap so more like an 8)
 
jbar said:
I don't know, the residents I've met from the New York programs where they work 20 12s a month looked like they could have used a few less hours working.

As others have said in other threads, it's not just hours, it's patients per shift. So there are places where you work 12s but spend a lot of time spinning your wheels trying to get nurses to give meds you've ordered, trying to get the patient admitted etc. There are places were you'll see more new patients in a 9 hour shift than having a list full of borders for 12 hours.
Click to expand...

You are certainly correct that one hour at one place is not the same as an hour at another. a place that boards patients for many hours can have very few new patients in a shift which offers limited experience making critical EM decisions in the same time that another place that is more efficient with throughput may transition two or three times as many new patients in your care.

The point this person is making is that if you are trying to figure out which place has the fewest hours, it is not necessarily the right attitude when deciding a place to train.
 
13770 said:
Think of it this way: total hours per month.

3 divisions:
Less than 180 - that's low
180-220 - most programs and right down the middle
220 or more - that's high and old school, mostly programs that do 12hr shifts and often 4 year programs or inner city programs.

The logic of why a program would do more, like 225+, is rather obvious and I"ll leave that to your imagination or typical debates.

In the end, like all things in life, the extremes on either side are bad.

Also, loving your work and working alot, is more desirable than having no interest in your work and working a smaller amount of hours.

"Be happy in your work!"
Click to expand...

The 180-220 hours a month is equivalent to only 45-55 hours a week. Are residencies in emergency medicine really only as time consuming as any other full time job?

How much time do residents spend working outside of their shifts (i.e. conferences or outside studying)? Or is it really only 45-55 hours a week, and the rest of the time is for yourself/family?

There must be something I'm not taking into account, can someone please enlighten me on the true time commitment (i.e. average hours per week for all tasks required during residency)? Thanks.
 
Turkelton said:
The 180-220 hours a month is equivalent to only 45-55 hours a week. Are residencies in emergency medicine really only as time consuming as any other full time job?

How much time do residents spend working outside of their shifts (i.e. conferences or outside studying)? Or is it really only 45-55 hours a week, and the rest of the time is for yourself/family?

There must be something I'm not taking into account, can someone please enlighten me on the true time commitment (i.e. average hours per week for all tasks required during residency)? Thanks.
Click to expand...

I come from a residency where we work 8 hour shifts -- 22 as interns, 20 as 2nd yrs, and 18 as 3rd years.

truthfully, despite the fact that you are scheduled for the above, on average i spend about 1.5-2 hours at the end of each shift dictating and tying up loose ends. this adds about an extra 8-10 hrs/week.

i'm currently a third year, and can't speak much to the number of hours i worked as a 1st and 2nd year in the ED, but I'd say I'm working about 45-50 hours a week in the ED as a third year. however, we have 5 hours of didactics every week, plus journal club, plus time preparing lectures, etc etc etc... i'd say it's about a 50-60 hour weekly commitment as a third year in my average ED month. off service months cap at 80 hours/week.

keep in mind that duty hours in the ED are more limited by the ACGME than they are on the wards. this may be because you rarely have time to eat, much less urinate, on a busy ER shift. risk of bladder rupture and renal insufficiency and such, i suppose.
 
Turkelton said:
The 180-220 hours a month is equivalent to only 45-55 hours a week. Are residencies in emergency medicine really only as time consuming as any other full time job?

How much time do residents spend working outside of their shifts (i.e. conferences or outside studying)? Or is it really only 45-55 hours a week, and the rest of the time is for yourself/family?

There must be something I'm not taking into account, can someone please enlighten me on the true time commitment (i.e. average hours per week for all tasks required during residency)? Thanks.
Click to expand...


Trust me... after you put in 50 hrs a week in a busy ED you'll wish that you were doing 80 on the floor. In the ED, you go a whole day so balls-to-the-wall busy that you realize when you get home that you haven't urinated nor eaten. I look forward to my off-service rotations where I can go eat lunch while the OR is turning over or mentally check out during rounds.
 
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