General Surgery Residency Work hour/schedule structure at different programs

[Medee]

I'm finishing up my 3rd year of medical school, enjoyed my GS rotation and am strongly considering a residency in GS. I do have some concerns I was hoping some residents/attendings on SDN might be able to help clarify.

So during my GS rotation the 80hr work week was enforced for the residents and the call schedule was every 3rd night. The residents/students were guaranteed one 24 hr period free from clinical duty each week. An off day was always schedule during a you were post call. For example, if you were on call on Friday and you left the hospital at 8AM Saturday morning, you were not expected to return to work until Sunday morning at 8AM. To me this seemed like a typical post-call day, except instead of being back in the hospital at 5:00-5:30AM you arrived a little later. This hardly seems much different than a post call day where I found myself spending a good chunk of it recovering and sleeping. I found this type of schedule managable during my rotation however the thought of burn out during residency with such a schedule does concern me somewhat.

Is this strictly 24hr free-of-duty type schedule the typical format for most GS programs throughout most rotations during the year?

Are there programs where say if youre to have a Thursday off, that you would leave work Wednesday in the evening, be off Thursday and return for work Friday morning?

If anyone would be willing to share what their typical GS residency schedule is/was I'd greatly appreciate it.

Additionally, if anyone could share some insite on what the typical workload/schedule is like s/p intern year, it would also be a big help.
Thanks!

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[traumachick]

I'm a fourth year resident and have never had a rotation where the day off was considered the same as your post-call day (thank goodness!). Generally we get our days off per month frm a golden weekend and then a sat off and a different Sun off...HTH!

 

[dynx]

I'm finishing up my 3rd year of medical school, enjoyed my GS rotation and am strongly considering a residency in GS. I do have some concerns I was hoping some residents/attendings on SDN might be able to help clarify.

So during my GS rotation the 80hr work week was enforced for the residents and the call schedule was every 3rd night. The residents/students were guaranteed one 24 hr period free from clinical duty each week. An off day was always schedule during a you were post call. For example, if you were on call on Friday and you left the hospital at 8AM Saturday morning, you were not expected to return to work until Sunday morning at 8AM. To me this seemed like a typical post-call day, except instead of being back in the hospital at 5:00-5:30AM you arrived a little later. This hardly seems much different than a post call day where I found myself spending a good chunk of it recovering and sleeping. I found this type of schedule managable during my rotation however the thought of burn out during residency with such a schedule does concern me somewhat.

Is this strictly 24hr free-of-duty type schedule the typical format for most GS programs throughout most rotations during the year?

Are there programs where say if youre to have a Thursday off, that you would leave work Wednesday in the evening, be off Thursday and return for work Friday morning?

If anyone would be willing to share what their typical GS residency schedule is/was I'd greatly appreciate it.

Additionally, if anyone could share some insite on what the typical workload/schedule is like s/p intern year, it would also be a big help.
Thanks!

It varies a lot.

My intern year the schedule was mostly Q4. One full day off a week, as in leave friday post call and come back on sunday. And for the most part 80 hours a week. But, some times you're Q3 (or even Q2 on the rare occasion) and I had 2 periods of a month straight without a day off and 110 hour weeks.
Intern year sucks no matter what and you're going to feel burnout.

 

[Medee]

Thanks dynx & traumachick for your input!
I'm happy to hear there are programs out there like the ones both of you are at. By any chance if you can remember back when you were interviewing for residency did you find other programs to have similar work structures as the ones you are currently in?

 

[Winged Scapula]

I'm confused what the OP's question really is. Are you asking if there are programs where you don't get any days off? Here are the work hour guidelines.

If a program is going to adhere to the guidelines, you have to have a full 24 hour period off once a week. Some will give you 1 day of per week, many will try and combine two of those days into a "golden weekend", etc. Some *will* make your day off a post-call day, and some will not.

FYI: I haven't seen many programs where the day off is a weekday (as in your example of being off on Thursday), but I suppose it could happen.

Notwithstanding programs that don't adhere to RRC guidelines and certain circumstances like dynx mentioned where you are q2 or don't get *any* days off for a full month or more, most programs are going to have somewhat similar set ups where they try and adhere to the guidelines.

The most common hours violations is not the days off but rather the 10 hour rest period between shifts.

 

[Medee]

I'm confused what the OP's question really is.

Hey WS. I guess my original post was a bit drawn out. Basically I wanted to know if it is typical for most residency programs to ensure that one of your post-call days is 24hrs long for which they would count as your 1 day off/week (because technically it is 1 day off) or is it more common to see residency programs not make one of your post-call days your assigned day off?

Also is there a huge difference regarding this issue when it comes to community vs. university programs? Thanks.

 

[butterfly0660]

My program is set up like this:
Trauma/Acute care- q3 in house call, with one day off every week (not a post call day), often a week day unless you are a chief

All other services get their days off by essentially getting every other weekend off.

 

[Buzz Me]

I've been on services where the day off that week was on a post-call day (e.g. 7 am on Wednesday until 7 am on Thursday).

There have also been services when your day off has to be on a weekday so that you're always available to round on the weekend (these are usually the rotations when you're the only resident, and the fellows want occasional days off during the weekends).

 

[45408]

FYI: I haven't seen many programs where the day off is a weekday (as in your example of being off on Thursday), but I suppose it could happen.

The medicine residents I rotated with often had their days off in the middle of the week, since the day of the week was mostly irrelevant - they were either admitting or they weren't. It makes a lot more sense to take weekends off as a surgery resident, since they rarely schedule weekend cases, and some services would just come in, round, and leave after only a few hours.

 

[Smurfette]

My program generally considers a day off to be a calendar day rather than the 24 hour post-call example given above. Rarely, if there are manpower issues, we may do a "day off" as a 24 hour period rather than a calendar day.

We have issues with the 10 hour rule during the week as well as the 80 hour limit when we have weekend calls (often because it screws up the days off, and it's made up with a future golden weekend). When not on call over the weekend, we are generally out of the hospital by 11-12 at the latest (often quite a bit earlier), unless there are a lot of sick patients on the service.

 

[Winged Scapula]

Hey WS. I guess my original post was a bit drawn out. Basically I wanted to know if it is typical for most residency programs to ensure that one of your post-call days is 24hrs long for which they would count as your 1 day off/week (because technically it is 1 day off) or is it more common to see residency programs not make one of your post-call days your assigned day off?

I guess I'm still confused or perhaps just being passive-aggressive. Have you read the ACGME regulations? If you read the ACGME regulations, they are supposed to give you a 24 hour period off, but it is not required (although it is suggested) that it not be the post-call day. Therefore, programs can use/abuse this however they like or it may be a function of a particular Chief Resident. As long as they give you 24 hrs off, they are following the regulations, even if its a post-call day.

I suspect that nearly all of us have only trained at 1 programs, perhaps 2 if you include fellowship and might have a passing knowledge of a couple of others. There are over 150 general surgery residencies in the US. So no one here is going to know what *most* programs do.

This is NOT a factor you should use when choosing a residency program because as I noted above, the schedule is made by various people, various years, who may have a variable interpretation of the regulations. There may also be a difference depending on manpower and patient census.

Also is there a huge difference regarding this issue when it comes to community vs. university programs? Thanks.

No. It is not a function of type of program but as I noted above, "philosophy" of program, who is making the schedule, the census, the number of residents to cover, etc.

The medicine residents I rotated with often had their days off in the middle of the week, since the day of the week was mostly irrelevant - they were either admitting or they weren't. It makes a lot more sense to take weekends off as a surgery resident, since they rarely schedule weekend cases, and some services would just come in, round, and leave after only a few hours.

Well, yes but we aren't talking about IM residency, who often do take middle of the week days off. For surgical programs it does not make much sense to take days off in the middle of the week (although it can and does happen) for the reasons you state above. I recall getting 1 middle of the week day off because my Chief was interviewing every weekend for PRS and I literally did not have a day off for over 2 months and they couldn't figure out another way to get me one.🙄

 

[Winged Scapula]

We have issues with the 10 hour rule during the week as well as the 80 hour limit when we have weekend calls (often because it screws up the days off, and it's made up with a future golden weekend). When not on call over the weekend, we are generally out of the hospital by 11-12 at the latest (often quite a bit earlier), unless there are a lot of sick patients on the service.

80 hours is not a "limit" but an average. Therefore, if you have a weekend call and go over hours that week, you may be under for the following week. I'm sure that's what you meant but medical students read 80 hours as an absolute and don't read the regulations.

 

[blue2000]

We have all different versions of schedules. Some are every other weekend on with a golden in between, some are one day off a week. Rarely do we have just 24 hours off (7AM to 7AM), but that does happen occasionally. The only service that does mid-week days off is our trauma ICU, as we are more likely to have weekend than weekday admissions. We've also gone to almost entirely night float or home call system. Chiefs are more likely to work a weekend then have a weekend off; juniors are more likely to have one day off a week. Our issue too is with 10 hours off between shifts, especially as you get more senior and are more likely to operate late.

 

[Smurfette]

80 hours is not a "limit" but an average. Therefore, if you have a weekend call and go over hours that week, you may be under for the following week. I'm sure that's what you meant but medical students read 80 hours as an absolute and don't read the regulations.

Yes, I meant that it's an average so sometimes a future weekend off can make you compliant.

Although every year we get interns who think that the second they hit 80 hours during the week, they have to leave the hospital...

My med students today were all concerned about my work hours after realizing I haven't had a day off in a while and that they often think I'm on call every night (because I'm there so late every night). Kind of endearing actually that they care, but if only they knew...

 

[treehorsio]

My home institution has a "night float" system, which is becoming more and more common. Being on nights sucks (6 pm - 6 am Sun night to Sat am, a few more hours for conference - although it's still around 80, seems much much longer - especially to your family), but it is really nice to not have to see consults that roll in after 6. Sure, you may be in the OR until 10-11 (we also have a problem with the 10 hours off rule) but almost always get at least 5 hours of sleep a night. We are in the call pool for Sat (24 hours) and Sun (12 hours)...which averages roughly 2 times a month...not bad. Of course, the hours are long and you never get the option of a free (even if post-call) afternoon, but it's definitely worth it. Not all of our hospitals do this, but I think it's the best.

 

[opr8n]

So during my GS rotation the 80hr work week was enforced for the residents and the call schedule was every 3rd night. The residents/students were guaranteed one 24 hr period free from clinical duty each week. An off day was always schedule during a you were post call. For example, if you were on call on Friday and you left the hospital at 8AM Saturday morning, you were not expected to return to work until Sunday morning at 8AM. To me this seemed like a typical post-call day, except instead of being back in the hospital at 5:00-5:30AM you arrived a little later. This hardly seems much different than a post call day where I found myself spending a good chunk of it recovering and sleeping. I found this type of schedule managable during my rotation however the thought of burn out during residency with such a schedule does concern me somewhat.

Is this strictly 24hr free-of-duty type schedule the typical format for most GS programs throughout most rotations during the year?

Are there programs where say if youre to have a Thursday off, that you would leave work Wednesday in the evening, be off Thursday and return for work Friday morning?

If anyone would be willing to share what their typical GS residency schedule is/was I'd greatly appreciate it.

Additionally, if anyone could share some insite on what the typical workload/schedule is like s/p intern year, it would also be a big help.
Thanks!

this is impossible to do and stay under 80 hrs/wk
its also frowned upon by many residents as most people consider their day off" as one where they go to sleep and wake up in their own bed and dont go to work that day, ie no rounding, no nothing
sometimes you need to do this once in a while to provide coverage and its technically not illegial

 

[match]

I worked some weks up to 120 but I could not enter my exact hours in the system because it says must cosign with ur superviser. so it means say lie.😀

 

[glade]

80 hours is not a "limit" but an average. Therefore, if you have a weekend call and go over hours that week, you may be under for the following week. I'm sure that's what you meant but medical students read 80 hours as an absolute and don't read the regulations.

Amazingly, that means that the medical students are as up to speed about duty hours regulations as some programs. 👍 (Except the programs are illiterate the other way.)

 

[dpmd]

The 10 hr thing is a recommendation not a strict rule. If it were we would be in big trouble since a violation of it is inherent into the way we do weekend night float, as well as night float on our educational conference day (leave saturday around 10-11 am and return 6 pm, leave wednesday morn around 7:30 and are expected to attend conference at 3). We have never had a post call day turned into a day off. We get our days off as two full weekends off per month except for rare instances when things need get adjusted. We are a small program, so if someone is getting screwed while someone is getting over it won't go unnoticed.

 

[SLUser11]

The 10 hr thing is a recommendation not a strict rule.

This is what we've all been told, but having recently undergone our q5 year site review, I think the "10 hour thing" is more important than the ACGME is letting on.

From what I've been told by our PD, and by the site reviewer, the 10 hour rule is becoming increasingly important, and can be a "ding" against a program if it's violated.