Hours during residency

[vtucci]

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Hi all.

I was looking on FRIEDA at a number of ED programs and I noticed a maximum consecutive hours category in the information provided. In many cases, the max hours were 24 or 30. I was wondering how common it is to work 24 hours straight or worse 30 hours during residency? I am concerned about this-- when I start residency I will be in my mid-30s and I do not want to make a mistake with patient care because I am tired and will likely not respond to lack of sleep as well as my mid-20s counterparts.

For those of you who have, it that usually off-service like surgery? or OB/GYN?

How do beeper hours work? It seems some programs do not count that in hours worked etc.

Thanks.

 

[turtle md]

These 24h or 30h are ALL going to be off-service rotations. The longest shift in the ED will be 12h (plus sign out time can make it into a 13h shift). By work-hour rules, the longest consecutive time period you can work is 30h. Basically, a full day, a call night, and then out after rounds the next day.

I don't know about beeper hours, b/c all of our call months (only 7 total) are in-house. I am about the same age as you. I don't like call (who in EM does 😕 ), but can swing it with little problem.

 

[EctopicFetus]

Hi all.

I was looking on FRIEDA at a number of ED programs and I noticed a maximum consecutive hours category in the information provided. In many cases, the max hours were 24 or 30. I was wondering how common it is to work 24 hours straight or worse 30 hours during residency? I am concerned about this-- when I start residency I will be in my mid-30s and I do not want to make a mistake with patient care because I am tired and will likely not respond to lack of sleep as well as my mid-20s counterparts.

For those of you who have, it that usually off-service like surgery? or OB/GYN?

How do beeper hours work? It seems some programs do not count that in hours worked etc.

Thanks.

Think about Trauma Surg, medicine floors, and perhaps some of the ICU months..

 

[vtucci]

Thanks guys. That is about what I thought. Maybe its the lawyer in me... we did too much research on work hours being related to errors and malpractice- I know I would not want to be the patient of a surgeon post-call on his 29th hour.

 

[bartleby]

I wouldn't either. But the work hours have made call much more do-able, as the pain of sleep deprivation always seemed to increase exponentially after the 30th hour of call. By the 36th hour, your primary interest is in making the pain go away. Patients are just something between you and your pillow... not a safe situation. The work hour restrictions were long overdue.

I know I would not want to be the patient of a surgeon post-call on his 29th hour.

 

[dlung]

From everyone I know in Medicine, compliance with work-hour rules is pretty spotty... give it several more years of polite hand-slapping by ACGME and it should be better. But, even now, it's much much better than it was just 2 years ago.

 

[EctopicFetus]

dlung, i think this depends on the field and the location. I have heard from friends who turn in their time sheets and are then politely reminded that there must be a mistake (i.e. please change the number of hours you worked).

FWIW this isnt a problem in EM, but might be on the off service rotations. Just ask the EM residents they tend to be real real honest about the off service rotations.

 

[dlung]

dlung, i think this depends on the field and the location. I have heard from friends who turn in their time sheets and are then politely reminded that there must be a mistake (i.e. please change the number of hours you worked).

FWIW this isnt a problem in EM, but might be on the off service rotations. Just ask the EM residents they tend to be real real honest about the off service rotations.

😕 Ugg? I thought I just said something like that...

anyways, if I had to put a number on it (from my sample size of 4 programs), I'd say most IM residents still work 80-100 hours/week on average during their ward and ICU months. I don't know anybody in IM who doesn't both go over the 30 hours/work period rule and go under the 10 hours between shifts rule regularly. Still, per my sr residents, it appears that 80-100 hours/week is a huge improvement from 100-120 hours/week.

Okay, gotta go take Step 3 now...

 

[Dr.Evil1]

I feel that your productivity goes WAY down after about 18 hours on your feet. If you come in at 7am this makes it about 1 AM when you start to feel really crappy if you don't get a good sit down.

As a resident it is really your obligation not to violate work hour rules. This of course depends on the attending that you are rounding with but you need to have things wrapped up enough in order to go home by noon or 1pm post call. If you cant get it done then you have to sign it out. I know that most programs have made this a priority or they soon will make it a priority if someone anonymously calls Chicago on them (or 2 seperate residents like at my hospital's surgery program). Through my intern year I have only violated duty hours 1 time and that was my first call when I didn't know any better

If you have an attending that is constantly keeping you late or is not respectful of duty hours you MUST take it to the chief resident of whatever program that you are working at. If they are not receptive then you bring it to your chief resident or program director. Remember when you are on an off service rotation you are not getting THEIR program in trouble by working too many hours you are getting YOUR program in trouble.

Have fun when you get to residency

 

[mikecwru]

Thanks guys. That is about what I thought. Maybe its the lawyer in me... we did too much research on work hours being related to errors and malpractice- I know I would not want to be the patient of a surgeon post-call on his 29th hour.

I would be cautious about the expected improvements with the work hr rules. What you save in compliance with extra sleep regarding errors, you'll probably make up for by increasing sign out and cross coverage. From my experience, an ED/unit resident that's well rested and is picking up sign out is more dangerous than a sleep deprived resident that knows the patients. I have heard these results have been born out in the data but haven't done the searches yet myself.

mike

 

[EctopicFetus]

perhaps my reading comp sux.. i wasnt trying to ruin your post.. my sincere apologies 🙂

 

[GeneralVeers]

I would be cautious about the expected improvements with the work hr rules. What you save in compliance with extra sleep regarding errors, you'll probably make up for by increasing sign out and cross coverage. From my experience, an ED/unit resident that's well rested and is picking up sign out is more dangerous than a sleep deprived resident that knows the patients. I have heard these results have been born out in the data but haven't done the searches yet myself.

mike

Possibly true, however if it's illegal for the government to use "sleep deprivation torture" on terrorist prisoners, then it should be illegal for hospitals and residency programs to do the same to residents.

 

[EM_Rebuilder]

What year are you in the game? I am a third year student and during surgery we were Q5 and routinely was up and at them for 33-36ish hours. Granted, no laws apply to us since technically we made no decisions. The worst week I had so far as a student was 114 hours while I was on Urology.

I think people already mentioned it who are more experienced in the matter than I, but the heavier hours will come from ICUs and surgery months.

Hi all.

I was looking on FRIEDA at a number of ED programs and I noticed a maximum consecutive hours category in the information provided. In many cases, the max hours were 24 or 30. I was wondering how common it is to work 24 hours straight or worse 30 hours during residency? I am concerned about this-- when I start residency I will be in my mid-30s and I do not want to make a mistake with patient care because I am tired and will likely not respond to lack of sleep as well as my mid-20s counterparts.

For those of you who have, it that usually off-service like surgery? or OB/GYN?

How do beeper hours work? It seems some programs do not count that in hours worked etc.

Thanks.

 

[turtle md]

I am in the MICU now. We average just under 80/week, with 1 24h period off per 7 days. It was a little less time committment for the floor month and in the CICU. Trauma was just under 80 as well. Luckily, all of our off-service rotations are compliant.

 

[8744]

On every service where I have rotated at Duke they move heaven and earth to comply with the duty hour rules. Here, at least in my experience, if you are going over then it is self-inflicted (the Martyr Syndrome).

I have gone over eighty hours but it has always averaged less over three weeks.