PowderHound

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Hey guys,

I'm two weeks into my first 3rd year rotation (OB-GYN) and at least once per day, a fellow or attending will make it a point to comment on the 80-hours-per-week limit and how s/he thinks we're all going to be bad doctors (in so many words), that we're lazy and don't really have to take responsibility for our patients because we just sign them out to the next team at night.

I don't really know how to respond to this, because we didn't make the rules. I don't doubt that the more you work, the more you learn, but I think they make the 80 hour cap because mistakes were being made and people were getting hurt. What I really want to say is, "Yeah, you worked 120+ for four years, and look what a DELIGHTFUL person you became." But of course I don't say that.

I was just wondering if other students were having this experience where docs that were ushered into medicine at 120 hours per week are giving you a hard time about it, (or if it's just the nasty OBs at my school) and what people think about the potential for it to REALLY affect their ability to care for people long-term. Is anyone worried about not learning what you need to learn during your residency, or do you think these docs are just bitter/trying to scare students?
 

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PowderHound said:
I was just wondering if other students were having this experience where docs that were ushered into medicine at 120 hours per week are giving you a hard time about it, (or if it's just the nasty OBs at my school)
It's probably the rotation. OBs are just nasty. ;)

Seriously, though...the 80-hour work week has resulted in more work for attendings, and some of them are bitter about it. That's pretty much it, in a nutshell. Eventually, they'll get over it, or die, or something.

Then again, it could be that OBs are just nasty. ;)
 

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I think there is a lot of deeply ingrained thought in the medical community that if you don't sacrifice everything--and I mean everything---for your job and your patients, that you are a bad doctor.

Hospitals have benefitted from this--they are more than happy to have physician slave labor at what amounts to $4-5 per hour, and meanwhile we continue to feed the machine that somehow makes it right (and noble) to work when you are exhausted.

OBs have a lot of this, and so do surgeons. (Although, on a side note--on my OB rotation, I worked with some OB residents who were fun, well-adjusted, really great people (and extremely competent docs), as were most of the attendings, so I have to differ with your statement Kent, though I know it was tongue-in-cheek :) )

It's clear that overworked residents are a danger to patients, themselves, and after work, other motorists.

The people who think you have to suffer to be great will just have to suck it up because if anything, there will be more restrictions on the workweek and working conditions of residents in the future, rather than less.
 

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PowderHound said:
Hey guys,

I'm two weeks into my first 3rd year rotation (OB-GYN) and at least once per day, a fellow or attending will make it a point to comment on the 80-hours-per-week limit and how s/he thinks we're all going to be bad doctors (in so many words), that we're lazy and don't really have to take responsibility for our patients because we just sign them out to the next team at night.

I don't really know how to respond to this, because we didn't make the rules. I don't doubt that the more you work, the more you learn, but I think they make the 80 hour cap because mistakes were being made and people were getting hurt. What I really want to say is, "Yeah, you worked 120+ for four years, and look what a DELIGHTFUL person you became." But of course I don't say that.

I was just wondering if other students were having this experience where docs that were ushered into medicine at 120 hours per week are giving you a hard time about it, (or if it's just the nasty OBs at my school) and what people think about the potential for it to REALLY affect their ability to care for people long-term. Is anyone worried about not learning what you need to learn during your residency, or do you think these docs are just bitter/trying to scare students?
Hi there,
As a medical student, it's not your job to answer your fellow or attending in terms of the 80-hour work week. The rules are there (from the RRC) and like it or not, everyone has to adjust or be in danger of being shut down or placed on probation. No amount of bitching and moaning to medical students is going to rescend the rules. In terms of most things in medicine, bitching and moaning only prolongs your agony and gets nothing accomplished.

What you CAN do, is re-direct the conversation focus to something that has learning value and let the rest fall on deaf ears. Try having a case or a question ready when the conversation starts to stray to useless stuff.

After four years of residency on the new system (post-80-hour work week rule) and one year (my intern year) pre-80-hour work week, the bitching and moaning is old news and counterproductive to good learning. In short, these folks have to "Get over it" because it is done and the world hasn't come to an end. Another good re-direct is is pointedly ask how you can improve signout and patient care so that good continuity remains and the patients do well.

On good thing that the 80-hour work week had helped with, it is that there is little time to waste. You have to be efficient and effective in those 80 hours. Do whatever you can to get the most learning out of this experience and let the rest go. Sometimes you have to be proactive about your learning experrience but do so because you are paying loads of cash for it.

njbmd :)
 

pillowhead

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PowderHound said:
Hey guys,

I'm two weeks into my first 3rd year rotation (OB-GYN) and at least once per day, a fellow or attending will make it a point to comment on the 80-hours-per-week limit and how s/he thinks we're all going to be bad doctors (in so many words), that we're lazy and don't really have to take responsibility for our patients because we just sign them out to the next team at night.

I don't really know how to respond to this, because we didn't make the rules. I don't doubt that the more you work, the more you learn, but I think they make the 80 hour cap because mistakes were being made and people were getting hurt. What I really want to say is, "Yeah, you worked 120+ for four years, and look what a DELIGHTFUL person you became." But of course I don't say that.

I was just wondering if other students were having this experience where docs that were ushered into medicine at 120 hours per week are giving you a hard time about it, (or if it's just the nasty OBs at my school) and what people think about the potential for it to REALLY affect their ability to care for people long-term. Is anyone worried about not learning what you need to learn during your residency, or do you think these docs are just bitter/trying to scare students?
The bottom line is that you don't respond to it and you certainy don't disagree with an attending to their face. You kind of nod and shrug your shoulders like "that's an interesting thought" and move on. I am in no way worried that my medical education will be compromised by working 80 hours a week instead of 100. I've just come of a >80 hour work week with two 30 hour calls and my brain is fried. It's not like I'm learning anything at that point anyway.
 

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pillowhead said:
The bottom line is that you don't respond to it and you certainy don't disagree with an attending to their face. You kind of nod and shrug your shoulders like "that's an interesting thought" and move on. I am in no way worried that my medical education will be compromised by working 80 hours a week instead of 100. I've just come of a >80 hour work week with two 30 hour calls and my brain is fried. It's not like I'm learning anything at that point anyway.
My med school takes the attitude that med students can work >>80 hours because we're students and not technically responsible for anything. Anyone else get this load of s***???
 

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Or, if you have a decent rapport with the person, you could say (VERY jokingly) "but you're such an excellent teacher, I'm sure that 80 hours a week working with you is all that anyone would need." It's kind of a more lighthearted way to redirect the conversation.

You definitely have to gauge the atmosphere with your attending and team, and you probably couldn't get away with it at this point in third year. But later in the year when everyone's a bit more chill it can work well.
 
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njbmd said:
Hi there,
As a medical student, it's not your job to answer your fellow or attending in terms of the 80-hour work week. The rules are there (from the RRC) and like it or not, everyone has to adjust or be in danger of being shut down or placed on probation. No amount of bitching and moaning to medical students is going to rescend the rules. In terms of most things in medicine, bitching and moaning only prolongs your agony and gets nothing accomplished.

What you CAN do, is re-direct the conversation focus to something that has learning value and let the rest fall on deaf ears. Try having a case or a question ready when the conversation starts to stray to useless stuff.

After four years of residency on the new system (post-80-hour work week rule) and one year (my intern year) pre-80-hour work week, the bitching and moaning is old news and counterproductive to good learning. In short, these folks have to "Get over it" because it is done and the world hasn't come to an end. Another good re-direct is is pointedly ask how you can improve signout and patient care so that good continuity remains and the patients do well.

On good thing that the 80-hour work week had helped with, it is that there is little time to waste. You have to be efficient and effective in those 80 hours. Do whatever you can to get the most learning out of this experience and let the rest go. Sometimes you have to be proactive about your learning experrience but do so because you are paying loads of cash for it.

njbmd :)

Thanks, njbmd, for always being a voice of reason and full of helpful advice :)
 

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SurgeryChef said:
My med school takes the attitude that med students can work >>80 hours because we're students and not technically responsible for anything. Anyone else get this load of s***???
YES. Although officially the school is against it, everybody at the hospital absolutely does this to the med students. Only last Thursday at surgery Grand Rounds while the surgery department was getting a medical education lecture did a hospital administrator mention that the 80-hour workweek also applied to med students.
A collective "yeah right" went up through the whole audience.
 

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njbmd said:
Hi there,
As a medical student, it's not your job to answer your fellow or attending in terms of the 80-hour work week.
Exactly
 

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PowderHound said:
I'm two weeks into my first 3rd year rotation (OB-GYN) and at least once per day, a fellow or attending will make it a point to comment on the 80-hours-per-week limit and how s/he thinks we're all going to be bad doctors..
Well..take this in context of the rotation you are currently on. Basically those young OB attendings worked 120 hr wks as residents in the goal of having a light workload as an attending - yet now they are stuck towing the line for the work that the residents don't do. Sympathesize with them and move on..happily to another non-Ob rotation.
As another poster mentioned, there will probably be more working restrictions in the future, not less.
 

DadofDr2B

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PowderHound said:
Hey guys,

I'm two weeks into my first 3rd year rotation (OB-GYN) and at least once per day, a fellow or attending will make it a point to comment on the 80-hours-per-week limit and how s/he thinks we're all going to be bad doctors (in so many words), that we're lazy and don't really have to take responsibility for our patients because we just sign them out to the next team at night.

I don't really know how to respond to this, because we didn't make the rules. I don't doubt that the more you work, the more you learn, but I think they make the 80 hour cap because mistakes were being made and people were getting hurt. What I really want to say is, "Yeah, you worked 120+ for four years, and look what a DELIGHTFUL person you became." But of course I don't say that.

I was just wondering if other students were having this experience where docs that were ushered into medicine at 120 hours per week are giving you a hard time about it, (or if it's just the nasty OBs at my school) and what people think about the potential for it to REALLY affect their ability to care for people long-term. Is anyone worried about not learning what you need to learn during your residency, or do you think these docs are just bitter/trying to scare students?
==================================

The work week was changed because of a complaint made by resident who fell asleep after opening a woman for a C section. The resident was disciplined and no one questioned the fact he was somewhere at the end of a 150 hour work week. This included being lent out to another hospital for 40 hours of this time.

Ask the attending would he rather have the work week rules or have some of their patients to die to prove how tough his residents are? They were idiots and cowards for not complaining and stopping the overworking of residents years before. They wanted their attendings to love their hard work and did not care for patients. I took more guts to stand up to the establishment than it would take to tough out the long work hours. The gentlemen who complained and stopped this practice is a hero in my eyes.
 

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kaos said:
YES. Although officially the school is against it, everybody at the hospital absolutely does this to the med students. Only last Thursday at surgery Grand Rounds while the surgery department was getting a medical education lecture did a hospital administrator mention that the 80-hour workweek also applied to med students.
A collective "yeah right" went up through the whole audience.
That's because it's very very rare that a student is going to stay longer than the intern. And if they are, you should look at the reason they are (either wants to do that field very badly OR is a horrible gunner).
 

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DadofDr2B said:
The work week was changed because of a complaint made by resident who fell asleep after opening a woman for a C section. The resident was disciplined and no one questioned the fact he was somewhere at the end of a 150 hour work week. This included being lent out to another hospital for 40 hours of this time.
i was about to make a snide comment, but then i realized that it is indeed possible if not feasible to work 150 hours.
 

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Bubb Rubb said:
i was about to make a snide comment, but then i realized that it is indeed possible if not feasible to work 150 hours.
You must be one of those horrible gunners that fuzzyerin was talking about. :smuggrin: 150 hours straight is pure insanity. :mad:
 

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kashif said:
You must be one of those horrible gunners that fuzzyerin was talking about. :smuggrin: 150 hours straight is pure insanity. :mad:
That doesn't even describe the half of it.

At 150 hour/week, you get 18 hours of sleep a week. That's just about 2.5 hours a day.

So yea, insanity falls a little short.
 

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Xypathos said:
That doesn't even describe the half of it.

At 150 hour/week, you get 18 hours of sleep a week. That's just about 2.5 hours a day.

So yea, insanity falls a little short.
Not only is a 150 hour week insane, it is both unnecessary and dangerous. It is not possible for any human being to function safely working on that amount of sleep. Yes, this forum has seen lots of discussion regarding 80hr vs. 100-120 hour weeks. But 150 hours is well outside the limits of even that discussion.

Unnecessary, in that the hospital in question probably could have called upon another physician to fill in for at least 24 of those hours. Of course, the hospital would have had to pay for that privilege, which shows the real motiviation for endangering the life of both the resident and his/her patients.
 

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fuzzyerin said:
That's because it's very very rare that a student is going to stay longer than the intern. And if they are, you should look at the reason they are (either wants to do that field very badly OR is a horrible gunner).
All I can say is that there are definitely chief residents who make their students stay longer than any of the other residents. Granted, these are usually surgical rotations. But I know this for a fact.
 

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Its all about the cheap labor
 

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SurgeryChef said:
My med school takes the attitude that med students can work >>80 hours because we're students and not technically responsible for anything. Anyone else get this load of s***???
I worked/stood around for 308 hours (I was counting) during the 3 weeks of my GI surgery rotation compared to 250 hours during kidney transplant. GI was miserable and my feedback on the last day was "you did a good job."
 

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kashif said:
You must be one of those horrible gunners that fuzzyerin was talking about. :smuggrin: 150 hours straight is pure insanity. :mad:
no, you misunderstand: before i did the quick mental 24 x 7 calculation i didn't realize that there were 150 hours in the week in which one could possibly work. i do not endorse it in any way, shape, or form.

:cool:
 

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Do med students on rotations actually do this many hours as well!!? Or were these attending just taking it out on you that their RESIDENTS are doing less work. I didn't think 3rd years worked nearly that many hours (from what I have heard, I am only a second year).

BMW-


PowderHound said:
Hey guys,

I'm two weeks into my first 3rd year rotation (OB-GYN) and at least once per day, a fellow or attending will make it a point to comment on the 80-hours-per-week limit and how s/he thinks we're all going to be bad doctors (in so many words), that we're lazy and don't really have to take responsibility for our patients because we just sign them out to the next team at night.

I don't really know how to respond to this, because we didn't make the rules. I don't doubt that the more you work, the more you learn, but I think they make the 80 hour cap because mistakes were being made and people were getting hurt. What I really want to say is, "Yeah, you worked 120+ for four years, and look what a DELIGHTFUL person you became." But of course I don't say that.

I was just wondering if other students were having this experience where docs that were ushered into medicine at 120 hours per week are giving you a hard time about it, (or if it's just the nasty OBs at my school) and what people think about the potential for it to REALLY affect their ability to care for people long-term. Is anyone worried about not learning what you need to learn during your residency, or do you think these docs are just bitter/trying to scare students?
 

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BMW19 said:
Do med students on rotations actually do this many hours as well!!? Or were these attending just taking it out on you that their RESIDENTS are doing less work. I didn't think 3rd years worked nearly that many hours (from what I have heard, I am only a second year).

BMW-
The only rotation that med students were routinely going above 80 hrs a week at my school was trauma surgery. But during ob/gyn and other surgery months, and sometimes during medicine, you will definitely be working 70+ hours a week as med student. It's hard to take at the beginning of 3rd year, but like everyone who came before you, you will survive!
 

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Doctor Octopus said:
I worked/stood around for 308 hours (I was counting) during the 3 weeks of my GI surgery rotation compared to 250 hours during kidney transplant. GI was miserable and my feedback on the last day was "you did a good job."
Yep - those LARs are painful - they pretty much expect you to be a human piece of retractor metal for 5 hr stretches.
 

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BMW19 said:
I didn't think 3rd years worked nearly that many hours (from what I have heard, I am only a second year).
It must depend a lot on the school. There are a lot of horror stories floating around SDN; I wonder whether that's partially because overworked people need to vent more.

I've done two of the 'cushy' rotations and two of the 'harder' ones (neuro and IM). The cushy ones were mostly 8-5 with some variation.

Neuro was maybe 7-6, again with some variation. IM has been 8-6 most days. Call is q4 so you usually are in the hospital at least one weekend day, either to admit or to present, but the med students are not expected to stay overnight. Once you pick up your patient(s), you go home. (I think we only have one rotation that requires overnight call.)

Of course I haven't done the two killers yet (surgery and OB), and I'm sure I'll be whining when they happen. But if there are only ten weeks out of this whole year when I have to work >60 hours, I'll be pretty happy. So overall it's been pretty cush. Far easier than I expected from listening to people in classes ahead of me b1tch and moan.