How can this be possible?

[Wanna B a Doc]

I read these posts about residents that have 100+ hour weeks for 3-7 years. I just wanted to know how this was even possible, and why this even happens. I know that spots in residencies are competitive, so why wouldn't they split the number of hours in half in order to make room for two times as many residents? I don't see how anyone can work 20 hour days for 5 days strait. It sure doesn't seem like it puts the patient's health first. (which is why we are all supposed to be doing this in the first place) I sure wouldn't be comfortable being operated on by a surgeon that has slept less than 20 hours in five days. And for any residents that may be reading this post, how do you keep that kind of schedule? I can't imagine doing it. And it is beginning to scare me. I know that surgical residents have some of the longest hours during residencies, but I don't understand why. Wouldn't surgeons that perform invasive procedures be the doctors that should have the most rest? Besides surgery I was wondering what the typical residents schedule is for different specialties (how many hours standing up at the hospital) or where I can find this information. Thanks for any help.

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[PMPMD]

If someone worked 12 hours a day, 5 days a week, plus was on call 3 nights that week, that would be 5*12 + 3*12 = 60 + 36 = 96 hours/week. I think a lot of programs are trying to get away from having anyone work that many hours a week, but I'm sure it still exists somewhere. I think it's counterproductive to have anyone stay awake that long; I can't imagine that they would be doing anyone any good in that state. At all of the schools I interviewed at, Q4 was the most call anyone had to pull in years 3& 4 (as opposed to Q2 in the example I gave). Residency could be worse than this, but I would think it depends on the number of residents. However, the system is in place to provide cheap labor, so I wouldn't be surprised if it wasn't always fair. I'll be starting med school next fall, so I'm probably not the most informed person on this topic.

 

[Kiki2004]

Good post! I am a second-year med student right now and I am already worrying about the hours when going on rotations, let alone residency...personally, I am getting a little freaked out! <img border="0" title="" alt="[Eek!]" src="eek.gif" />

I suggest posting this thread in the Rotations and Residencies Forum. I bet you could get more input. Hopefully a lot of the residents on that forum can put our minds at ease a little! <img border="0" title="" alt="[Frown]" src="frown.gif" />

 

[med student]

In doing the calculations for the number of hours worked per week people keep talking about working five days a week but I always thought residents worked more than this.

 

[ghostcow]

The surgery residents I know would love a 5 day week but usually it is 1-2 days completely off per month, call often every 3rd night and on some every other night (not supposed to happen per laws but it does). Yes it is insane. They do have some months which are less intense but they are few. You find a lot of ex-surgery people now doing residency in radiology, anesthesiology, etc. Go figure. There are so many flaws to the medical education process and this is just another.
Peace

 

[Whisker Barrel Cortex]

I am the last person to endorse these hours, as I am planning on going into radiology. I wanted to make three points.

First of all, at most programs you do not do Q2 (every other day call = 3-4 calls per week) in house call for the whole year. Usually it is a handful or less, which makes it better. The rest of the time you are Q3-Q5.

The second point is that on a good portion of general surgery calls, depending on which service you are rotating on, you can sleep 3-5 hours with occasional interruption.

Here is where people might disagree with me. I see a lot of the usefulness of these kinds of hours during residency. There is an incredible amount of knowledge that needs to be gained and skills to be perfected. If hours are shortened, the residency needs to be lengthened by 1-2 years. Once surgeons get out of residency, they are often on call frequently and work 12 hour days or more every weekday. They will need to make life and death decisions on very little if any sleep many times during their career. By having residents have that much experience in this state of sleep deprivation will get them to feel confident at these times and think more clearly.

That's just my take on it. Then again, I'm going into a field where Q5 call for a year is considered a bad call schedule.

 

[Dr. Dad]

I feel for you, I am having a similar problem. You see I am going for pathology and they work M-F 8-5, 40 hours a week with no call nights during residency. So you see my problem is what to do with all that free time. Maybe I should take up cross-stitching or something....oh well.

PS. Please excuse the sarcasm, and if it makes you feel any better, you sugeons will be making a gazillion times more money than me.

 

[NuMD97]

This ol' chestnut again, huh? OK. I remember in the early 1970s when the residents were on strike in NY asking for an 80-hour week. Imagine, an 80-hour work week, when "regular" folk at the time were working a 40-hour week. It took Libby Zion's death in the late 1980's for the law to finally change in NY State in the summer of 1989 with the new crop of incoming residents. And, I strongly suspect, it wouldn't have come to light as a court case, if her father, Sidney Zion, were not a famous journalist. You probably know about this change in NY law as the Bell Commission. But as far as I know, it's the only state on record that mandates by law, how much a resident is allowed to work. Yet, it is also to my understanding that even in NY abuse continues.

In the first month of my internship year, I counted the hours I was working, and it was 96. I wondered why I was even going home, just to turn around and do it again four hours later.

As another poster noted, it's cheap labor. By the time you take off for taxes and such, your actual take home pay, reflecting the reality of those hours, is roughly $2.65 an hour. You'd be making more if you went to Hamburger College. But before many start to say that that is not the reason they go to med school and then on to becoming physicians, you have to recognize that this is the reality and it will not change for a multitude of reasons. In my father's time, in the mid 1930's when he trained, he told me that residents did not even receive a "stipend" [I do so love that word for our salary! ], only room and board. So things have changed in that sense dramatically in the past 70 years or so. And all the arguments for "rights of passage" and being able to "think on your feet" just do not hold water after a certain number of hours of sleep deprivation. It's just part of human physiology. Thankfully, there are many checks and balances built into the system so that egregious errors rarely occur.

As far as you folks on the cusp of waiting on Match Day, at the risk of sounding paternalistic, just know that you will survive. It's probably the hardest part of a residency - the long hours. And most of you have one distinct advantage in your favor: your youth and physical conditioning. A friend of mine was correct in saying that "the hardest part of residency in your 40s is the call schedule primarily, and the hours in general". And most of us "older folk" have found that to be true, I believe.

Just one older person's perspective. I wish you all well as you wait on the results of the Match.

Nu

 

[tulanestudent]

I wondered how all these hours add up too...until I did my 3rd year surgery rotatoin and counted 117 hours worked in the first week, then I quit counting after that. That did sometimes include a few hours of sleep in the call room on our nights of q4 call. I only had one day off in the entire first month and my interns and residents did not have ANY days off that month. So, that's how it can add up.

That said, I have found most other specialties to be much eaiser. For instance, Internal Medicine also had q4 call, but on the non-call days most residents worked something like 7am-3pm, earlier if you were post-call and really tried to get the work done earlier and go home sooner. On psych the residents only have call a few days a month (or get paid for moonlighting if they choose to do more), and work a similar 7-3 type schedule usually, plus coming in for one weekend day for a few hours. Now these are all inpatient services - most residency programs in med, peds, neuro, psych, etc. will also have some months of only outpatient clinics or consult services, in which you can literally work maybe 5-6 hours a day 5d/week. So it's not like anyone (except, of course, surgeons an OB's) are really pulling 100hr weeks every week of the year.

The unfortunate outcome of all this, however, is that many people, like me, would love to be surgeons for the intrinsic nature of the job, but will not do it b/c we would like to try to have a personal life. I can't imagine living most of my 5 year residency without regular exercise, without being able to eat dinner with my spouse or family most nights, without being able to partake in many weekend events. Being a physicaian of any kind invovles some willingness to sacrifice the social life that many non-docs have, but within medicine this sacrifice of time varies greatly among specialties and among specific programs.

 

[hosskp1]

I agree with everybody on this topic. The hours are really long. I want to be a surgeon-- I will go into it. I will just have to make enough time to get to the gym and eat healthy-- and read. I am willing to not care about the rest of my life as long as I get to the gym regularly (except on nights when I am call). I know I won't have a life and I am willing to live with that.

 

[Medic171]

write yourself a Rx for adderrall, ritalin, phentermine, or some other stimulant.

And yes, I AM kidding. caffeine, however, is cheap and ethical.

 

[MacGyver]

Whisker cox,

The 100+ hour work weeks with 36 hour shifts are a far cry from the 12+ hour shifts of surgery attendings. Surgery attendings average do NOT work 36 hour shifts, they do NOT average 115 hours per week like residents. In fact, they are closer to 80 hours per week on average.

Even if it was 15 hour shifts, thats OK, but 36? Thats just too much. I once read a study where they tried to teach new surgical methods to residents after 30 straight hours on the job. The next day, they quizzed the students on the surgical procedures. Guess what, they retained only 10% of the required and necessary info they had been supposedly "learning"

The human brain CANNOT just accept endless data with no sleep and still retain the data in memory. A rested mind is essential for good learning. So all this crap about how sleep deprivation is necessary because theres too much to learn is bunk because although you may be EXPOSED to new info, its almost certain you are not really learning anything new after such long periods with no sleep.

 

[Whisker Barrel Cortex]

MacA**hole,

Looks like you had a little trouble typing my name correctly, maybe you should get some more sleep. Surgeons in practice are on call overnight. True, this is home call. However, if a surgeon works a full day in the OR and seeing patients, then gets a busy night of emergent surgeries or situations, they still have to work the next day, operate and see their patients. This amounts to a 36 hour shift. Admittedly, this is much less frequently than in residency. Who would you rather had operating on you, someone who had never operated under these conditions or someone who had had this experience a multitude of times during their residency?

 

[Winged Scapula]

Interestingly enough - even "normal" people (ie, not tired surgery residents) retain only 10% of what they learned 3 days after the teaching. So while the literature is correct in showing that sleep dep can negatively affect learning, is it significantly different than in the average joe without sleep dep?

On that note...moving to Rotations and Residencies...

(BTW, programs get "away" with some q2 call because they average it out. Some q4 calls mixed in, gives you an average of q3 and slips by RRC. )