Family member wanting reassurance

[rms]

Hello.. My brother recently started a surgical internship - I am a little concerned with the hours he is working; from what I understand, there are certain restrictions but it still means he is routinely getting less than 4 hours of sleep a night. Is this typical/normal? If yes, how is a schedule like that sustained for a whole year?? If not, what might he be able to do to ensure that he gets enough sleep?

Any advice would be greatly appreciated!!!

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[Elisabeth Kate]

He should be getting 8 hours off in between shifts, at the least, and he should be working no more than 80 hours a week, averaged over 4 weeks. Internship year sucks, especially in surgery. Interns all over the country are learning this to be true and family members are, no doubt, as concerned as you. Take heart, this too shall pass.

 

[Dermione Granger]

He should also be getting 1 day off every 7 days

 

[Siggy]

Hello.. My brother recently started a surgical internship - I am a little concerned with the hours he is working; from what I understand, there are certain restrictions but it still means he is routinely getting less than 4 hours of sleep a night. Is this typical/normal? If yes, how is a schedule like that sustained for a whole year?? If not, what might he be able to do to ensure that he gets enough sleep?

Any advice would be greatly appreciated!!!

It depends on a lot of things.

16 hours is the maximum amount of time for interns in a day. However, that remaining 8 hours includes eating, bathing, sleeping, laundry, and everything else (while not a surgery intern, I have to do 2 months of surgery for my internship program, and yes, there were days that I didn't eat while working 16 hours). If the commute isn't short, then the commute can eat a lot of that time up.

 

[DrZzZz]

There is an ACGME study going on this year, specific to surgery. The 16 hr shift limit has been lifted at many programs as part of this study. I am doing a CBY for my anesthesia program and since the surgery program here is part of the study, I will be working 24+ hr shifts during my surgery rotations. I've heard that the vast majority of programs ARE a part of the study, so it's a good chance he isn't restricted to 16 hour shifts. Still, what everyone else said about the 80 hr/wk avg, etc still applies.

 

[Law2Doc]

Hello.. My brother recently started a surgical internship - I am a little concerned with the hours he is working; from what I understand, there are certain restrictions but it still means he is routinely getting less than 4 hours of sleep a night. Is this typical/normal? If yes, how is a schedule like that sustained for a whole year?? If not, what might he be able to do to ensure that he gets enough sleep?

Any advice would be greatly appreciated!!!

Because the 80 per week cap is a rolling average, there will be weeks you go above this and yes there probably will be many many nights where 4 -5 hours of sleep a night is the norm. It may not sound sustainable, but thousands of doctors have endured this over the decades. In fact, you don't have to go back very many years to a Time when the 80 hour ceiling didn't even exist and 100+ hours of work a week was the norm. Attendings used to joke that Q2 call meant residents were missing half the good cases. Your brother will survive this.

 

[Law2Doc]

In terms of advice tell your brother to drink lots of coffee, sleep whenever he can, and stay off the roads.

 

[TooMuchResearch]

He should also be getting 1 day off every 7 days

Averaged per 4 weeks.

 

[Shikima]

Sleep when you can, eat when you can, and [bodily functions] when you can.

 

[Siggy]

Averaged per 4 weeks.

No. 80 hour weeks is averaged over 4 weeks. Regardless of that average, it's 24 hours every 7 days OR 48 continuous hours every 14 days. Days off is not subject to a running average like hours/week.

 

[Law2Doc]

No. 80 hour weeks is averaged over 4 weeks. Regardless of that average, it's 24 hours every 7 days OR 48 continuous hours every 14 days. Days off is not subject to a running average like hours/week.

Yep. But not every place follows the rules to a T, and bear in mind that the 24 hours when you transition from days to nights can technically count as your "day off" at some places such that you can work one day until 7 pm and be expected to come in the next night starting at 7pm (so you might be in the hospital every calendar day for multiple weeks). And although it's totally against the rules residents frequently trade days to get specific two day weekends and a lot of programs pretend they don't know about it.

 

[ketosisevangelist]

It's Saturday 6am I'm up. At hospital. Getting the breakfast.

 

[Siggy]

Yep. But not every place follows the rules to a T, and bear in mind that the 24 hours when you transition from days to nights can technically count as your "day off" at some places such that you can work one day until 7 pm and be expected to come in the next night starting at 7pm (so you might be in the hospital every calendar day for multiple weeks). And although it's totally against the rules residents frequently trade days to get specific two day weekends and a lot of programs pretend they don't know about it.

Agreed... I'm simply stating that the 24 hours off isn't an average.

 

[ohman]

Hello, I totally understand your situation. My son is also averaging 4 hours of sleep/night. He is working very hard because these are his first weeks on the floor of internal medicine. It is mostly a secretarial job and there is not much learning. His boss is a very critical man and puts a microscope to whatever he writes so that he will find a mistake and get a chance to blame him. I believe that the intern, resident and attending should work in a good team with the intent to make the young starting interns learn and not be terrorized that every small thing they forget can make them work 1 extra hour. He has lots of loans and these young men and women are working very hard and trying to save precious lives but putting their own lives at risk. I also want to add that it is because of such sweat shop conditions that two bright interns committed suicide in NYU and Cornell. Please pray that all interns are treated in a way that they will become good physicians

 

[SouthernSurgeon]

Agreed... I'm simply stating that the 24 hours off isn't an average.

The language from the ACGME:

VI.G.3. Residents must be scheduled for a minimum of one day free of
duty every week (when averaged over four weeks).

Would suggest otherwise.

In their Duty hours FAQ they specify that averaging the days off is acceptable, unless your specific program (internal medicine, emergency medicine) has program/RRC requirements above and beyond the ACGME duty hours. They explicitly state that its acceptable to lump days off to get entire weekends off, as long as the 1-in-7 rule and the Q3 call average are met over the four week period.

 

[bjb305]

and this is one of the main reasons i refused to even consider surgery. i knew surgeons would be working well over 80 hours a week and that is not a lifestyle i want

 

[Law2Doc]

and this is one of the main reasons i refused to even consider surgery. i knew surgeons would be working well over 80 hours a week and that is not a lifestyle i want

I think you have to keep in mind that the number of hours isn't really the whole story. Working 80 hours but having a blast is a whole lot less brutal than working 65 hours a week but feeling miserable every minute. Look at the guys working the longer hours -- they aren't often the most miserable creatures on the wards. In my experience too many people shy away from the longer houred fields and throw themselves into things they actually find tedious and mind numbing just to save a few weekends of call a month, and then complain that being a doctor isn't what they expected.

 

[bjb305]

I think you have to keep in mind that the number of hours isn't really the whole story. Working 80 hours but having a blast is a whole lot less brutal than working 65 hours a week but feeling miserable every minute. Look at the guys working the longer hours -- they aren't often the most miserable creatures on the wards. In my experience too many people shy away from the longer houred fields and throw themselves into things they actually find tedious and mind numbing just to save a few weekends of call a month, and then complain that being a doctor isn't what they expected.

this is certainly true... i guess i should elaborate on my previous statement.. i am the type of person that isn't going to love ANY job for 80 hours a week.. i enjoy too many things outside of work to do that