Hours in Family Medicine Residency?

[singalongblog]

Can any of you give me an average of your hours that you work per week per year? Are 100 hour workweeks common in FM residencies? Also, how easy is it for a family medicine resident to date?

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[cabinbuilder]

Not sure what your definition of "easy" is??? Every residency is different so you will get many different views, opinions. My residency was relatively easy and most week I put in about 50 hours a week. The exception for us was "medicine" went we did inpatient service and had to round later in the evening when the attendings were done with clinic. That month was about a 60-70 hour week. No one does 100 hour weeks anymore with the new rules.

 

[VA Hopeful Dr]

Expect 80 hour work weeks on inpatient months (medicine, peds, and OB). Then somewhere around 50 hour weeks for everything else.

You may also take a few hits from continuity OB patients. I once stayed in the hospital for 72 hours straight taking care of 3 continuity deliveries that came in one after another. Now that was unusual and mainly due to the fact that I lived 30 minutes from the hospital. Had a lived closer, likely wouldn't have done that.

 

[galactus]

Intern year was mostly hospital for me, so it was pretty much close 80 hrs/week. During 2nd and 3rd year, during inpatient months and OB it was around 80 hrs/week, but on clinic rotations I was honestly doing 40-50. Occasionally when a continuity OB (or call) came along I'd stay in the hospital longer of course, but generally 2rd and 3rd year was easier on time.

 

[MedicineMan99]

You are limited to 80 hours/week and will I did exactly that during all my inpatient months. Outpatient months vary from 40-60 hours/week. Also remember for continuity OB deliveries, "duty hour limits" legally go out the window, so you can easily stay at the hospital for a few days in a row.

 

[NurWollen]

Expect 80 hour work weeks on inpatient months (medicine, peds, and OB). Then somewhere around 50 hour weeks for everything else.

You may also take a few hits from continuity OB patients. I once stayed in the hospital for 72 hours straight taking care of 3 continuity deliveries that came in one after another. Now that was unusual and mainly due to the fact that I lived 30 minutes from the hospital. Had a lived closer, likely wouldn't have done that.

Was there somewhere like a residents' lounge where you could at least get some sleep for a few hours here and there?

 

[NurWollen]

Expect 80 hour work weeks on inpatient months (medicine, peds, and OB). Then somewhere around 50 hour weeks for everything else.

You may also take a few hits from continuity OB patients. I once stayed in the hospital for 72 hours straight taking care of 3 continuity deliveries that came in one after another. Now that was unusual and mainly due to the fact that I lived 30 minutes from the hospital. Had a lived closer, likely wouldn't have done that.

Was there somewhere like a residents' lounge where you could at least get some sleep for a few hours here and there?

 

[VA Hopeful Dr]

Was there somewhere like a residents' lounge where you could at least get some sleep for a few hours here and there?

Resident call room. I actually got a decent bit of sleep, just didn't leave. I wasn't awake for that whole stretch.

 

[brianmartin]

Highly variable. Inpatient months are 80 -90 hours. Outpatient are around 40 ish. Overall pretty good and I feel like I have more free time than I expected. The biggest complaint I have is that when you are in a hospital for 80 hours a week, you have to eat mostly hospital food! It's just not healthy...

 

[CutterSpindell]

As I understand it PGY1 is brutal no matter what residency your land? That is unless your are in a cushy transitional year program. Has it been most people's experience that PGY2 and PGY3 of family medicine are fairly lifestyle friendly? Do the 3 years of a FM residency fly by?

I'll be a MS1 this fall and one of the few that is very interested in family medicine. The opportunity to open a DPC practice sounds amazing!

 

[drcrispmd]

Our 3rd year was great. Only 5 weekend calls, all done before Christmas. It really depends on the program. Each programs does their rotations, calls, coverage, etc differently. I know some 3rd years doing 80 weeks (I never had 80 hour week the entire residency).

I thought 3 years of residency flew by.

 

[CutterSpindell]

Our 3rd year was great. Only 5 weekend calls, all done before Christmas. It really depends on the program. Each programs does their rotations, calls, coverage, etc differently. I know some 3rd years doing 80 weeks (I never had 80 hour week the entire residency).

I thought 3 years of residency flew by.

Do you think your experience of hours worked was typical of atypical? Do nonacademic programs typically have more forgiving hours?

 

[drcrispmd]

It is program specific. I cannot say if it is typically or not. You need to expect to put in many hours in residency, especially intern year. If you are looking for an easy residency with "forgiving" hours you will have a difficult time. Residency is the time you need to put in the hours to learn everything you can.

 

[Bacchus]

Extremely variable with inpatient experiences at 60-80 hours a week. I've had outpatient weeks where I've worked 25 hours. The hardest thing from 1st to 2nd year has been managing all of the outpatient hooplah after going from 1/2 day a week of office hours to four half days a week. The rotations where you spend most of your time inpatient tend to have longer hours, but this time often goes by quickly because you're constantly moving unless you're on L&D where its "hurry up and wait."

 

[Yadster101]

Not sure what your definition of "easy" is??? Every residency is different so you will get many different views, opinions. My residency was relatively easy and most week I put in about 50 hours a week. The exception for us was "medicine" went we did inpatient service and had to round later in the evening when the attendings were done with clinic. That month was about a 60-70 hour week. No one does 100 hour weeks anymore with the new rules.

So during a "typical" 50 hour week, how many hours did you also spend studying outside? Do FM boards and other residency exams require studying similar to Step 1?

 

[FrustratedFamDoc]

Studying during intern year usually comes in the form of mini presentations before rounds, looking stuff up as you go along or formal presentations that you'll give a few times during the morning/noon conferences. As 3rd year comes around, you're usually afforded more time to get back to real studying again for the FM boards.

My program was pretty rough and I'm grateful for it. On inpatient rotations, weeks were usually about 80 hours but the consecutive days of work is what got to me. If your 4 days off for the month were all in the beginning of one month, there's no guarantee that the next month would give you early reprieve. My longest stint was 27 straight days at least 12-14 hours each day. Days 10-17 were the hardest then full on autopilot zombie mode kicks in and you're ok.

 

[cabinbuilder]

So during a "typical" 50 hour week, how many hours did you also spend studying outside? Do FM boards and other residency exams require studying similar to Step 1?

Most of the FM boards was stuff you do day to day in clinic. I studied for the board cert exam in the evenings doing questions for about 4 weeks.

 

[JustPlainBill]

Agree with most of the above with one caveat --- in our program, if you went over the expected norm or hours restrictions, you got to visit with the PD to discuss why it took you so much longer than the "other" residents and it was always your fault --- many of my colleagues, with the full knowledge and advice of the upper levels, sandbagged their hours by doing a lot of work off the clock to avoid this little talking to and to stay below the radar --- we all commiserated that it was never the programs fault or the systems fault, always the interns when in fact it just was not physically possible, given our situation, to get everything done in the time allocated --

 

[Relentlessrook18]

Did you guys get very many weekends off during intern year or how did that work?

 

[FrustratedFamDoc]

Weekends off during intern year?

ACGME requires 4 days off a month for each rotation. These are typically weekend days but no guarantees. Our program had a night float that covered inpatient nights mon-thurs. The rest of the weekends were divided among the interns and second years. we would usually get 2 sat/sun off a month but they could come at any time.

 

[VA Hopeful Dr]

Prior to the newest work hour rules, during service months we would get 1 weekend/month. With the new rules prohibiting intern 30 hour calls, those "Golden Weekends" have pretty much vanished.

 

[Natividad Resident]

We have a call schedule for weekends, which covers all services, and is set at the beginning of the year. On average a resident covers 1-2 weekend calls shifts per month. Night float is a separate rotation and covers all nights except Saturday. Then we have a weekend rounding schedule for each inpatient service, which the residents divide up among ourselves, usually with 2 residents on the rotation. Most of the time if a resident has weekend day call they also cover rounding for that day. So let's say I want a golden weekend on an inpatient service. First I'd better be looking 1-2 months ahead. Then I trade call if I have call. Then I negotiate with the other resident on the service to have them cover rounding for that weekend. Maybe I do a little math on ACGME rules, with # hours between shifts and the 4 week average for working hours and days off. I generally "pay" for my golden weekend with a long streak of working days with no weekend days off at another time during the rotation. There are a few rotations where there's no negotiation, you just take your day off when you're scheduled. And there are a few rotations with no call or rounding at all so every weekend is golden.

The above should be pretty similar to what you'll find at unopposed programs and/or where residents "run the hospital." The more flexibility in the schedule, the less responsibility you carry, and arguably the less rigorous the training.

If you're interviewing right now, and this stuff matters to you, stay out of the weeds. Just ask if there's a process by which a resident can get a golden weekend. If the residents answer that question with some confidence, you're good. If the residents aren't sure if there's a process, or they don't know what the process is, that's bad. On your ranking differential this should go under a category like "Lord of the Flies / Soviet Union continuum" where the extremes are to be avoided.

 

[JustPlainBill]

Did you guys get very many weekends off during intern year or how did that work?

If you mean as an FM intern -- yes -- I took perverse please in the fact that I was in the lazy river at the local waterpark on 4th of July with my family while my colleagues from other specialties were possibly at work -- especially after the trash talking they had done after the match.

If you mean during the wards month -- we used to try to give the interns a golden weekend if possible -- everyone had one weekend day off.

 

[futuredrdo]

Curious, how often did you usually get the so called "golden weekend" during each year PGY1,2,3? (I know it depends on the service your on, but in general how often i.e. once a month as PGY1, every other as PGY2, every weekend PGY3)?

 

[Natividad Resident]

We have 5 week rotation blocks. During intern year we have 3 outpatient rotations; one is split. One of those includes 3 night calls. The other 2 outpatient rotations have no call at all. So that's 2 5-week blocks of golden weekends, plus 2 2.5 week blocks of golden weekends.

During an inpatient rotation, 70% of intern year, to get a golden weekend, as I describe above, you have to (a) deal with call, if you're scheduled, which requires negotiating with another intern for a trade, and then (b) deal with rounding, which requires negotiating with the other residents on your service. So for 2/3 of the year, by default, you're working 6 day weeks with the opportunity to trade for a weekend off. No opportunities while on night float; night float is 2.5 weeks at a time, twice a year.

During R2 and R3 there is more outpatient, but more call responsibility, including during outpatient rotations, and it takes a bit more work to get a weekend off if you're scheduled to take call. But since there's more outpatient during R2 and R3, there are more built-in weekends off, less consecutive.

In other words, at Natividad we'll go 5 weeks straight with all golden weekends, then a 5-10-15 week stretch of at *most* 1 golden weekend per month.

But: our inpatient rotations include some vacation time, and generally it's straightforward to get the weekend attached to vacation days off.

 

[Natividad Resident]

Oh: another way to think about how a program like Natividad allocates weekend duties: 10 residents per class, 50 weeks in 10 scheduled blocks, each resident has responsibility for 5 of each type of weekend call. This year I'll work 5 Friday nights, 5 Saturday days, 5 Saturday nights, 5 Sunday days, 5 Sunday nights. (The other 2 weeks are a separate entity at the end of the year: rising interns cover the whole hospital to prepare for being R2s while the incoming interns are in orientation.)

On an inpatient rotation, every weekend day has to be covered by one of 2-3 residents for rounding, which is about a 6 hour shift. If I'm on call that day, I round 6-noon and do admits noon-6. If I negotiate for a weekend off, on the previous and following weekends, I'm probably rounding Sat/Sun, possibly also doing call one of those Sat/Sun.

 

[cabinbuilder]

So during a "typical" 50 hour week, how many hours did you also spend studying outside? Do FM boards and other residency exams require studying similar to Step 1?

I only studied for boards for 4 weeks before in the evenings. Boards is not like Step I. I looked up things I needed to know on a day by day basis. I didn't study extra at home since I spent time with my kids. Work stayed at work.