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How can this be possible?

Discussion in 'Clinical Rotations' started by Wanna B a Doc, Feb 16, 2002.

  1. Wanna B a Doc

    Wanna B a Doc Junior Member

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    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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  3. PMPMD

    PMPMD 4G MD
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    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.
     
  4. Kiki2004

    Kiki2004 princessa!
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    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" />
     
  5. med student

    med student Senior Member
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    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.
     
  6. ghostcow

    ghostcow Member
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    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
     
  7. Whisker Barrel Cortex

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    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.
     
  8. Dr. Dad

    Dr. Dad Senior Member
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    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.
    :D :D :D :D :D :D :D :D
    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.
     
  9. NuMD97

    NuMD97 Senior Member
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    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
     
  10. tulanestudent

    tulanestudent Member
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    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.
     
  11. hosskp1

    hosskp1 Senior Member
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    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.
     
  12. Medic171

    Medic171 Senior Member
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    write yourself a Rx for adderrall, ritalin, phentermine, or some other stimulant.

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

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    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.
     
  14. Whisker Barrel Cortex

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    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?
     
  15. Winged Scapula

    Winged Scapula Cougariffic!
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    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. :p )
     
  16. Sabreman

    Sabreman Member
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    I find it extremely disappointing that poor UF's IM program got put on probation by the RRC for not keeping their residents under 80 hrs/week and not giving them one day off/week, when 90% of IM programs as well as EVERY SINGLE surgery program in the country works at least as long or longer. UF was just stupid enough to admit it and got hosed as an example to others.

    Interestingly, 2 days after UF got probation I received an email from Emory stating that in-house call had moved from q4 to q12 (really just a new night float system but still an improvement). I hope this trend continues throughout the country, but I would like to see a surgery program get dinged too in the interest of fairness.

    Kimberli, can you honestly say you work under 80 hrs or always get 1 day off each week?
     
  17. HairlessHeart

    HairlessHeart Member
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif"> (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. ) </font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">q2 call!! That sounds positively miserable. I rather naively didn't know that existed for any sustained period of time.
     
  18. MacGyver

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    There are 168 hours in a week.

    Why dont ALL residencies go to 140 hour work weeks? After all, you could learn even more right?
     
  19. Winged Scapula

    Winged Scapula Cougariffic!
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by HighpowerdMed:
    <strong>
    Kimberli, can you honestly say you work under 80 hrs or always get 1 day off each week?</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I think I've been quite honest in this regard. The answer to both your questions is "no". There are some easier rotations which have q4 call and generally 12 hour days, but when you include call hours, (and the few hours on the weekends, even if I'm not on call) it exceeds 80 hours per week. We get 1 weekend a month off and on most rotations they've at least tried to give us an extra day - but to be honest, there have been a couple of rotations where I worked 7 days a week. If you are the only junior resident on service, guess who has to come in every day and see the patients, write the notes and the orders? If the Chief is there, so are you.
     
  20. Winged Scapula

    Winged Scapula Cougariffic!
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by HairlessHeart:
    <strong> </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif"> (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. ) </font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">q2 call!! That sounds positively miserable. I rather naively didn't know that existed for any sustained period of time.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">The longest we've done here is 2 weeks of q2 (it apparently used to go for months several years ago). We try not to do it, but if others take vacations, the service has to be covered and it falls to you and other residents left behind to take that call. After a week of q2 I'm totally wiped out...it wouldn't be so bad if you could go home post-call, but staying all day the next day is PAINFUL, to say the least.
     
  21. ghostcow

    ghostcow Member
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    I know one surgery intern who was forced to do q2 call for 2months in a row. He was trying to plan his wedding at the time and couldn't find time to get his blood tests done. Tough guy, always in good mood and ready to teach in what little free time he had. Yes the way out was that "on average" for the year it was q3.5 call or something stupid like that. <img border="0" alt="[Wowie]" title="" src="graemlins/wowie.gif" />
     
  22. hosskp1

    hosskp1 Senior Member
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    Just a thought. MAy be these screwy hours are part of an attempt to try and weed people out after they started residency or before they even apply. Maybe they just want to see how much you can take. But who really knows?
     
  23. MacGyver

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    Kimberli,

    Do you really think you got so much more out of the Q2 calls that it was justified? Did you really learn so much more on these shifts to make it worthwhile?

    You say that your experience during this period was "painful" but any surgery attending would tell the public that you were perfectly capable of treating patients the best possible way. Isnt there an inherent contradiction here?

    hosskp,

    If that is what the surgery attendings and program directors are doing, then they need to be reminded that this is the TAXPAYER'S FUNDING which is being used to provide for these residents' services. Such a petty and childish reasoning for these kinds of schedules is not only dubious at best, but in my opinion, unethical.
     
  24. hosskp1

    hosskp1 Senior Member
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by MacGyver:
    <strong>Kimberli,

    Do you really think you got so much more out of the Q2 calls that it was justified? Did you really learn so much more on these shifts to make it worthwhile?

    You say that your experience during this period was "painful" but any surgery attending would tell the public that you were perfectly capable of treating patients the best possible way. Isnt there an inherent contradiction here?

    hosskp,

    If that is what the surgery attendings and program directors are doing, then they need to be reminded that this is the TAXPAYER'S FUNDING which is being used to provide for these residents' services. Such a petty and childish reasoning for these kinds of schedules is not only dubious at best, but in my opinion, unethical.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I really do not agree with what they are doing. I am just a medical student who wants to and has always wanted to become a surgeon. I just want to get a shot at a decent place. For that to happen, I can not complain (or even question really). I better not rock the boat right now.
     
  25. Winged Scapula

    Winged Scapula Cougariffic!
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by MacGyver:
    <strong>Kimberli,

    Do you really think you got so much more out of the Q2 calls that it was justified? Did you really learn so much more on these shifts to make it worthwhile?

    You say that your experience during this period was "painful" but any surgery attending would tell the public that you were perfectly capable of treating patients the best possible way. Isnt there an inherent contradiction here?
    </strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Justified? I don't any other alternatives except to hire more residents. The fact is that someone has to be on call, and if there are only 2 of you then it works out to be q2. its hard to say whether or not I get more out of more frequent call - at my level I rarely make independent decisions, so learning is generally by watching rather than doing (although there is some of the latter as well). I'm sure I do benefit from it - after all the more you're here, the more patient interaction you have, the more clinical scenarios you see, the more orders you write and the more you learn. Do I learn significantly more to make q2 justified? I'm not sure.

    I can tell you that I am well aware that my mental prowess falters when I do a stretch of q2, especially when I am not going home early post-call (which you generally don't). I have to hunt for words when I'm speaking and have to stop and collect my thoughts much more often. But I am just starting out - perhaps once I gain a larger fundamental knowledge and practice base, those decisions will come easier and I will not find it so hard. After all, my body is getting used to the hours, shouldn't my mind as well?

    I agree that the argument that it makes you better is a slippery slope and I don't care for the idea that 'I suffered so should you" (I fought this argument in my college sorority as well over hazing). But I haven' t a solution as to where the funds for more residents would come from - and can't answer the question as to whether I would get the training I need (including case numbers) if there are x number of more residents.
     
  26. jvarga

    jvarga Member
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    Well, it seems that most of you have ignored practically the busiest residents in medicine...the OB/Gyns (although Surgery residents definately are a close second). I would say that an average week for them is around 100+ hours. Of course, as all specialties, there are the easy months that lower the average and there are the killer q2 call months that will make any one a walking zombie. After interviewing and site-visiting this year, I have come to the conclusion that almost all of the programs are intimidating when considering the work load. But hey, this is what we need to do to finally become the doctors that we had hoped to become when we first applied to med school.
    However, I definately agree that the number of hours is excessive and is compromising patient care. I do believe in the movement that wishes to limit the allowed number of work hours for a resident and hope that it takes flight some day soon and I also agree that more residents would help alleviate this problem. Where would the money come from you ask? How about eliminating many of jobs held by the unnecessary, non-MD, multi-six figure income, obstacle-creating hospital administrators? This would surely free up enough money to pay for more residents and, not to mention, make things flow a hell of a lot smoother in the hospitals.
     
  27. droliver

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    jvarga,

    I don't know where you got the misconception of OBGYN as the busiest of all residents. Outside of L&D months, it is an elective specialty with pretty regular hours and few emergencies
     
  28. jvarga

    jvarga Member
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    Since you ask droliver, I, like everyone else (yes this includes you), am able to obtain my opinions with the following complex formula (now let me know if I lose you somewhere):
    (My personal experience + Other people's experience) + Sophisticated analysis = My Opinion
    I hope that helps clear up your confusion as to how my opinion came to be.
    Now to address the question of the "pretty regular" months. If I could direct your attention to the fourth line in my original post, you can notice (through intense observation) that I have already allowed for said "regular" months. However, as we all know, these "regular" months tend to be on the scarce side and are usually preceded and then followed by your "harder than regular" months. Still with me? Good! It is because of the fact that there are more of these "harder" months that one can arrive at the AVERAGE that I have quoted in the original post. That, droliver, is how that so called "misconception" came to be. By the way, if you argue that surgeons have a tougher schedule, let us not forget that OB/Gyns are surgeons too!
     
  29. Sabreman

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    Sarcasm aside, I must agree with jvarga. The OB/GYNs at my school average at least 100 hrs/week all four years (actual numbers added up and discussed with residents).

    I think that surgery is just such a malignant field that is SEEMS like you're there forever! Sorry, couldn't resist that. :)
     

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