How do you residents manage to pull off continuous 36 hour shifts?

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misplacedshadow

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Hey guys,

I know residents, especially those in surgery, have continuous 36 hour shifts. I am just curious to know how you guys are able to pull it off? I hear many residents drink a lot of coffee. But how many cups can you possibly drink to pull off being awake and working for 36 hours straight? Do you guys have naps inbetween the 36 hours? Are there any alternatives to coffee?
 
We don't anymore. Go to the attending forum...
 
So its the attendings that pull 36 hour shifts?

If the program is ACGME compliant, 36 hour shifts should not exist for residents. Clinical duties should not exceed 24 hours straight.

How did I deal with 36 hour shifts when they existed? Caffeine, naps when possible, and lots of "sucking it up".

For attendings, anything goes. There are no duty hour restrictions. Welcome to the real world.
 
Two points:

1) Whether its 36 hours straight or 28 hours straight, the OP's original question is still valid. Its not like 28 is some reasonable amount of time (at least in the public eye).

2) I have yet to meet this mythical attending everyone talks about that runs around like crazy getting paged Q5 minutes for 36 hours straight...
 
I have read a lot of posts about how attendings work so much harder than residents. I have to say that this is complete nonsense with respect to academic attendings who have residents to buffer them.

Life as an attending with residents is way easier than life as a resident. Any academic attending who cries about work hours either is incredibly lazy, or had an easy residency.

Now as a private practice attending, things may be much different, though I couldn't say.
 
I was referring to PP attendings. I think one of the big differences would be the lack of the post-call day off. And you don't need to be paged q5 min to have a terrible night.
 
Even though I'm a student, I've still done some 30+ hr shifts. You just go. If it was sitting at a desk, you'd be toast. It's hard to fall asleep while walking. If you sit down, you'll fall asleep (check-out was always rough for me). Basically stay moving. If you're not moving, then you probably could sleep. Caffeiene helps, as does small meals. Big meals and then you just get sleepier.
 
Two points:

1) Whether its 36 hours straight or 28 hours straight, the OP's original question is still valid. Its not like 28 is some reasonable amount of time (at least in the public eye).

2) I have yet to meet this mythical attending everyone talks about that runs around like crazy getting paged Q5 minutes for 36 hours straight...

All my attendings work 36 hours straight like that, and walk uphill in the snow both ways and what not. All you have to do is ask, they would be more than happy to tell you all about it.
 
Even though I'm a student, I've still done some 30+ hr shifts. You just go. If it was sitting at a desk, you'd be toast. It's hard to fall asleep while walking. If you sit down, you'll fall asleep (check-out was always rough for me). Basically stay moving. If you're not moving, then you probably could sleep. Caffeiene helps, as does small meals. Big meals and then you just get sleepier.

What school do you go to where they make you do 30+ hour shifts?
 
I have read a lot of posts about how attendings work so much harder than residents. I have to say that this is complete nonsense with respect to academic attendings who have residents to buffer them.

Life as an attending with residents is way easier than life as a resident. Any academic attending who cries about work hours either is incredibly lazy, or had an easy residency.

Now as a private practice attending, things may be much different, though I couldn't say.

As PMPDM mentioned, things are much different on the private side, and some surgeons do work insane hours with very little breaks in-between. I do agree with TM, however, that it's less common on the academic side.

Most "barefoot in the snow uphill both ways" surgeons are very audible/histrionic with any extra work they have to do without resident help, so this tends to amplify things a little.

Some of the reasons that attendings can have worse hours than residents:

1. Income is production based.
2. It's difficult and dangerous to tell a consultant "no," even if you're tired and beat down.
3. Unlike residency, the show can not go on without you. If you have a couple long nights, you'll still have clinics and elective cases that need to be done, and they can't be skipped or moved very easily.
 
What school do you go to where they make you do 30+ hour shifts?

I had a couple surgical rotations in med school where the mantra was "there's no such thing as post call when you're a med student/sub-i/etc". Was always offered the "you can go lie down for a while if you want" line, but if there were things going on I'd tough it out. Sucked sometimes, but I saw a lot of interesting/cool/educational stuff, so I can't complain.
 
As PMPDM mentioned, things are much different on the private side, and some surgeons do work insane hours with very little breaks in-between. I do agree with TM, however, that it's less common on the academic side.

Most "barefoot in the snow uphill both ways" surgeons are very audible/histrionic with any extra work they have to do without resident help, so this tends to amplify things a little.

Some of the reasons that attendings can have worse hours than residents:

1. Income is production based.
2. It's difficult and dangerous to tell a consultant "no," even if you're tired and beat down.
3. Unlike residency, the show can not go on without you. If you have a couple long nights, you'll still have clinics and elective cases that need to be done, and they can't be skipped or moved very easily.

Income is production based in almost every job out there. You actually can tell a consultant no (another myth of academia) although there are tactful ways to do it. True that the show will always go on, and we all have some tough stretches, but overall "the show must go on" analogy is way overblown.

What I observed in residency was that unhappy and "overworked" attendings had the following characteristics:

1. Slow in clinic. They could spend all morning seeing 15 patients even with residents seeing them first and teeing everything up.

2. Slow in the OR. How many times were you waiting around for an attending to come and time out? Or how about the simple case that took 3 times longer than it should because the attending was inefficient and slow?

3. Poorly organized overall. These attendings were always late to a meeting, a case, or something else. Consequently everything took longer than necessary.

4. Attendings who relied so much on resident labor that they claimed they didn't know how to use the EMR so they wouldn't do a single note or documentation/consent themselves.

5. Attendings who could not do anything without having a resident by their side.

6. Attendings who insisted rounds be done before the first case.

Granted, most of these things occured in my general surgery years. General surgeons in my albeit very limited experience are the poster children for "my life is so hard" complex. However in academia, the above occur all the time in all specialties. Residents can learn bad habits too, and may be shocked to discover that life as an attending no longer has to be the inefficient mess that it can be as a resident.

My advice is to make your practice what you want it to be, and don't feel obligated to ape the bad habits of inefficient (and usually unhappy) attendings you knew in residency.
 
Income is production based in almost every job out there. You actually can tell a consultant no (another myth of academia) although there are tactful ways to do it.

I would opine that it's easier to say no in an academic setting than in private practice. You're not as worried about pleasing the consulting physician, and there aren't as many surgeons competing for the same patient population.
 
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