Status
Not open for further replies.

America's Anchorman

Membership Revoked
Removed
Account on Hold
Dec 10, 2018
13
7
I've wondered this for a while, but now that I have adequate residency experience, I feel I have some decent perspective.

My curiosity is genuine, not trying to start a war.

Question: Why does EM get by with a 60 hour work week cap while every other special is 80?

Emergency medicine is undoubtedly very stressful, but that is no different than most other specialties. Having done general surgery and orthopedics I cannot understand the logic behind this. Surgery was much much exhausting than EM. Surgery at my institution is routinely 80-100 hours per week although the official counting stops at 80, I know, how convenient. EM on the other hand, after their ten hour shift, sign out patients and go home. Most weeks they have four shifts, about one-third of the time they have five shifts per week during years two and three. I've heard others state the reasoning for these rules is because of the erratic schedule of EM. That argument doesn't hold water because surgery works those same times of the day, the only difference is they don't have all the free time in between....they're either sleeping or wish they were. Surgery hours are like EM except they don't have their time sliced into nice shifts.

Again, I'm not trying to start a war, just curious about the reason for these rules. If anything, shouldn't surgery have the 60 hour rule? Do you really want a surgery resident operating on your family when they are on hour 95 for the tenth consecutive week? Maybe EM should be condensed to two years. At my program EM could put their third year hours into years one and two an still work less than every specialty except maybe dermatology and psychiatry although they probably would still be a little less.
 

Raryn

Infernal Internist / Enigmatic Endocrinologist
10+ Year Member
Apr 25, 2008
8,307
7,839
Status
Attending Physician
I've wondered this for a while, but now that I have adequate residency experience, I feel I have some decent perspective.

My curiosity is genuine, not trying to start a war.

Question: Why does EM get by with a 60 hour work week cap while every other special is 80?

Emergency medicine is undoubtedly very stressful, but that is no different than most other specialties. Having done general surgery and orthopedics I cannot understand the logic behind this. Surgery was much much exhausting than EM. Surgery at my institution is routinely 80-100 hours per week although the official counting stops at 80, I know, how convenient. EM on the other hand, after their ten hour shift, sign out patients and go home. Most weeks they have four shifts, about one-third of the time they have five shifts per week during years two and three. I've heard others state the reasoning for these rules is because of the erratic schedule of EM. That argument doesn't hold water because surgery works those same times of the day, the only difference is they don't have all the free time in between....they're either sleeping or wish they were. Surgery hours are like EM except they don't have their time sliced into nice shifts.

Again, I'm not trying to start a war, just curious about the reason for these rules. If anything, shouldn't surgery have the 60 hour rule? Do you really want a surgery resident operating on your family when they are on hour 95 for the tenth consecutive week? Maybe EM should be condensed to two years. At my program EM could put their third year hours into years one and two an still work less than every specialty except maybe dermatology and psychiatry although they probably would still be a little less.
The ACGME common requirements are universal caps (ignoring the fact that some neurosurgical programs have exemptions to the 80 hour cap to make it 88 hours). The individual RRCs can make rules that are more strict if they want.

What the EM RRC has done is said that they do not want an EM resident on an EM rotation to work more than 60 hours a week. It doesn't apply to EM residents on off-service rotations and it typically doesn't apply to off-service residents on EM rotations.

Why was this done? Well, anyone can guess, but the argument you'll often see is EM shifts typically have very little downtime. Most other fields there's a period of a lull - but it often isn't the case for an EM shift. In addition, EM residents are more likely to have circadian rhythm changes within the same week - which can make getting up to 80 hrs much more difficult. Regardless though, this was a decision made by the EM RRC for EM residents. The general surgery RRC doesn't feel the same for general surgery residents. Neither does the ortho one, etc.

Why didn't other committees set stricter caps? Because they weren't thought to be necessary. You won't find many derm residents working 80 hour weeks (or 70, 60, 50, and in some programs even 40) with or without a cap - so the derm RRC just left it at the default. The EM RRC thought that the default was a problem for their own field.
 
  • Like
Reactions: res1cue and Gurby
Status
Not open for further replies.
About the Ads