How many hours do resident REALLY work??

[Belleza156]

I know that there is an 80 hour work week cap, but how many residency programs actually adhere to this? I'm told that while on paper it appears as though you are only working these 80 hours, you are coming in a few hours earlier every day by your own volition to be prepped on pts before the attending arrives. That would easily add another 10 hours to your work week, right? Also do the the calls you get put on count towards the 80 hour work week? If anyone can give me some perspective into what a residency work week would look like, especially in emergency medicine, please do. Thanks!

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[Charles_Carmichael]

I know that there is an 80 hour work week cap, but how many residency programs actually adhere to this? I'm told that while on paper it appears as though you are only working these 80 hours, you are coming in a few hours earlier every day by your own volition to be prepped on pts before the attending arrives. That would easily add another 10 hours to your work week, right? Also do the the calls you get put on count towards the 80 hour work week? If anyone can give me some perspective into what a residency work week would look like, especially in emergency medicine, please do. Thanks!

From what I understand, it's not an 80-hr workweek cap. Rather, it's 80 hrs/week averaged over 4 weeks. So you could work 100 hrs/week for 3 weeks in a row and have a 20 hr week after that and still not break any rules.

Feel free to correct me if I'm wrong.

 

[MightyMoose]

From what I understand, it's not an 80-hr workweek cap. Rather, it's 80 hrs/week averaged over 4 weeks. So you could work 100 hrs/week for 3 weeks in a row and have a 20 hr week after that and still not break any rules.

Feel free to correct me if I'm wrong.

That's not correct. It's 80 per week.


To answer the op, it is very specialty dependent.

 

[Charles_Carmichael]

That's not correct. It's 80 per week.


To answer the op, it is very specialty dependent.

According to the ACGME website ( http://www.acgme.org/acWebsite/home/Common_Program_Requirements_07012011.pdf ):

"Duty hours must be limited to 80 hours per week, averaged over a four-week
period, inclusive of all in-house call activities and all moonlighting." (pg. 16)

 

[MightyMoose]

According to the ACGME website (http://www.acgme.org/acWebsite/home/Common_Program_Requirements_07012011.pdf):http://www.acgme.org/acWebsite/home/Common_Program_Requirements_07012011.pdf):

"Duty hours must be limited to 80 hours per week, averaged over a four-week
period, inclusive of all in-house call activities and all moonlighting." (pg. 16)

Hmmm, is that based on the new regulation change? Either way, I stand corrected.

 

[Charles_Carmichael]

Hmmm, is that based on the new regulation change? Either way, I stand corrected.

No, I believe it's been the same since the Libby Zion case resulted in the rule changes (based on older SDN discussions from a few years ago discussing this topic). Also, it looks like some programs can get an extension to 88 hrs/week averaged over 4-weeks, according to the ACGME document (I didn't know that latter part before).

 

[MightyMoose]

No, I believe it's been the same since the Libby Zion case resulted in the rule changes (based on older SDN discussions from a few years ago discussing this topic). Also, it looks like some programs can get an extension to 88 hrs/week averaged over 4-weeks, according to the ACGME document (I didn't know that latter part before).

I always wondered why neurosurg always discussed 88's. Good info.

 

[smq123]

I know that there is an 80 hour work week cap, but how many residency programs actually adhere to this? I'm told that while on paper it appears as though you are only working these 80 hours, you are coming in a few hours earlier every day by your own volition to be prepped on pts before the attending arrives. That would easily add another 10 hours to your work week, right? Also do the the calls you get put on count towards the 80 hour work week? If anyone can give me some perspective into what a residency work week would look like, especially in emergency medicine, please do. Thanks!

There's no set rule on when you "start the clock." The ACGME rules imply that the hours are meant to reflect any times that you were actually required to BE IN THE HOSPITAL, but keep in mind that you don't "clock in" and "clock out," or swipe your badge, or anything. When the ACGME asks you how many hours you're working, they're assuming that you're being honest, since there's no other way for them to verify how many hours you're ACTUALLY working. The whole work-hour rules thing is based on self-reporting.

If you are taking call inside the hospital, then yes, the hours count towards the 80 hours. If you are taking call from home, then the hours do not count. As above, the hours that you are required to be in the hospital in order to take care of patients are what count.

It would be hard to tell you what an average week looks like. Not just because it is specialty dependent, but even within that specialty, it is rotation dependent. Especially as an intern, you still have to rotate through different departments, and each department will be different.

I can't personally speak for EM, but I THINK that they are limited to 72 hours per week while on an EM rotation, just due to the nature of how long their average shifts are (8 hours or 12 hours). That being said, as EM residents, they have to rotate through IM, ICU, OB, etc., and on those rotations they may work MUCH more than those 72 hours.

That's not correct. It's 80 per week.

Nope, it's an average of 80 per week.

Hmmm, is that based on the new regulation change?

It's always been that way. In most specialties, there may be times when you will have to go way over 80, but you usually make up for it at some point that month.

 

[a winner is you]

About 60 for radiology on average, obviously somewhat program-dependent.

 

[Law2Doc]

I know that there is an 80 hour work week cap, but how many residency programs actually adhere to this? I'm told that while on paper it appears as though you are only working these 80 hours, you are coming in a few hours earlier every day by your own volition to be prepped on pts before the attending arrives. That would easily add another 10 hours to your work week, right? Also do the the calls you get put on count towards the 80 hour work week? If anyone can give me some perspective into what a residency work week would look like, especially in emergency medicine, please do. Thanks!

Most places will schedule your sign ins/sign outs (including call) to at least on paper enable you to theoretically be within the duty hour requirements. What happens in practice varies from program to program. There will inevitably be things that happen at the end of the day that make it difficult to leave on time (Codes can happen during sign out, things asked of you by attendings at the end of the day that you aren't comfortable signing out, etc. that will throw off your schedule, the person who you are signing out to may not show up on time, etc). There will certainly be people who don't feel comfortable showing up blind and will get there a bit earlier than required to get themselves up to speed. And as mentioned, there will be "homework" consisting of presentations, things attendings asked you to read up on, home call duties, calling up nurses from home to check on patients, etc that don't count toward the duty hours but may be a substantial amount of time. The duty hours are limited to 80 (or in some case 88 hours, averaged over 4 weeks, so you absolutely may have crazy 100 hour weeks mixed in with lighter weeks.
While every program is either in compliance or claims compliance, there are plenty of stories on SDN about programs that ask residents to "rethink" and resubmit time cards that seem in excess of 80 hours/week rule. Realistically though, you will probably find yourself within the ballpark of the duty hours rule most of the year for most specialties. It's a lot of work, but most folks don't have real grounds to complain.

 

[Law2Doc]

About 60 for radiology on average, obviously somewhat program-dependent.

Like all the advanced residency paths, there's a prelim or traditional year first which may push the hours.

 

[SouthernSurgeon]

I am a general surgery intern at a major academic center. I log my hours honestly, with the occasional exception being that I forget to log them for a week and then have to make up the approximate time when I left at the end of the day (bc I can't remember a week later).

I have logged several individual weeks in the 90-100 hr range, but I have never averaged more than 80 over four week period. I have had a couple of violations for staying past 30 hrs on a post-call day. My overall average for the year is 72 hrs/wk (our logging system keeps a running total).

 

[Law2Doc]

...I have had a couple of violations for staying past 30 hrs on a post-call day. ...

Right -- the 30 hour is the duty hour limit many programs seem to have a bigger struggle with than the 80 hour limit, because it's not an average. It's often tough to finish rounding and finish up whatever you have to do at the end of a long shift without getting sidetracked. It will be curious to see what happens now that the intern limit is 16 hour shifts.

 

[swamprat]

I am a general surgery intern at a major academic center. I log my hours honestly, with the occasional exception being that I forget to log them for a week and then have to make up the approximate time when I left at the end of the day (bc I can't remember a week later).

I have logged several individual weeks in the 90-100 hr range, but I have never averaged more than 80 over four week period. I have had a couple of violations for staying past 30 hrs on a post-call day. My overall average for the year is 72 hrs/wk (our logging system keeps a running total).

How do you work 30 hours in a row? It doesn't seem physically possible lol

 

[smq123]

How do you work 30 hours in a row? It doesn't seem physically possible lol

- Get there at 6 AM on Monday morning to start seeing your patients.

- Stay on call overnight Monday into Tuesday morning.

- Leave at noon on Tuesday.

30 hours in a row!

I think my personal record as an intern was 38 hours in a row. I went to work at 6 AM, finished the day at 6 PM, but one of my OB patients came to the hospital in labor at around 7. Stayed at the hospital overnight until she finally delivered at around 5 AM - didn't get any sleep because her labor course was pretty abnormal. Since I was supposed to be back at work at 6 AM, I just stayed. Since it was the day before a major holiday, we were getting SLAMMED - it was just me an attending, but we were getting at least 2 admissions/consults every hour. Finally went home at 8 PM the next day. I was tired, but it's physically possible to do it.

Good times, good times.

 

[Law2Doc]

How do you work 30 hours in a row? It doesn't seem physically possible lol

As smq suggests a lot of us were thrilled if we actually got out of the hospital after "just" 30 hours. You show up in the morning one day, leave in the afternoon the next day after rounding on your patients with the team and tying up loose ends. Not physically impossible -- in fact most interns survive this without being unusual physical specimens. The only tough part for many is driving home afterwards, which is why living a relatively short shot from the hospital is key. Coffee, energy drinks and a loud stereo also help.

The need for regular, daily sleep is overplayed.

 

[Hopefulone09]

The ER residency at my home school does 80 hour average over 2 weeks. So you could potentially work 100 hours the first week and 60 the next.

 

[45408]

I am a general surgery intern at a major academic center. I log my hours honestly, with the occasional exception being that I forget to log them for a week and then have to make up the approximate time when I left at the end of the day (bc I can't remember a week later).

I have logged several individual weeks in the 90-100 hr range, but I have never averaged more than 80 over four week period. I have had a couple of violations for staying past 30 hrs on a post-call day. My overall average for the year is 72 hrs/wk (our logging system keeps a running total).

Likewise. I'm a general surgery intern as well, but not at a major academic center. We can only take our vacation weeks when we're on service (the elective rotations don't like it when you cut your rotation with them down by 25%), so that averages a week of 0 hours into the rest of a few months. I think the highest I've averaged was 75 hours or so. As for going over the 30 hours, it's been fairly minimal. I don't think I've really gone more than an hour past it, and it's rare for me to get less than 2 hours of total sleep on call, so I've never been really extremely sleep-deprived by the end.

The <1 mile drive home is pretty nice though.

 

[Law2Doc]

The ER residency at my home school does 80 hour average over 2 weeks. So you could potentially work 100 hours the first week and 60 the next.

Individual programs can tweak the rules as long as they stay within the ACGME rules, which are that the duty hours have to average out to 80 or less over a 4 week period. (Two 2 week averages thus still fits this pattern).

 

[Alvarez13]

How do you work 30 hours in a row? It doesn't seem physically possible lol

I can't imagine working that long and then having to study on top of it. Residency scares the **** out of me

 

[KeyzerSoze]

Likewise. I'm a general surgery intern as well, but not at a major academic center. We can only take our vacation weeks when we're on service (the elective rotations don't like it when you cut your rotation with them down by 25%), so that averages a week of 0 hours into the rest of a few months. I think the highest I've averaged was 75 hours or so. As for going over the 30 hours, it's been fairly minimal. I don't think I've really gone more than an hour past it, and it's rare for me to get less than 2 hours of total sleep on call, so I've never been really extremely sleep-deprived by the end.

The <1 mile drive home is pretty nice though.

No it doesn't. You can't count vacation weeks when calculating the 80 hour average.

 

[TexasPhysician]

I average under 60.

 

[45408]

No it doesn't. You can't count vacation weeks when calculating the 80 hour average.

Good to know.


Either way, months with or without vacation, I haven't averaged >80.

 

[Gabby]

The need for regular, daily sleep is overplayed.

Only if you drink the Kool-aid.

 

[Law2Doc]

Only if you drink the Kool-aid.

Nah, has nothing to do with "the Kool-aid", I'm not rallying around long hours here. (If anything, I'm the Jim Jones here, not a follower on this point).

I'm simply stating that most people, like doxycycline above, come into residency saying "oh my gosh, there's no way I can stay up for 30 hours". And yet everybody manages it, nobody finds this an insurmountable hurdle, and most of us actually do quite fine for extended periods of time on only about 5 hours a night average and still are able to pull the long overnight shifts. It's a lot fewer hours than what was imposed before the duty hour limits, and even then nobody died from long shifts or q2 call. It's no fun, but it's certainly doable for an extended period of time. Thus yes, most of us come to the conclusion based on personal experience that the perceived need for a daily good night's sleep is overplayed. Get it when you can, but don't kid yourself that you lack the physicality to survive a long shift.

 

[HankReardon]

The ER residency at my home school does 80 hour average over 2 weeks. So you could potentially work 100 hours the first week and 60 the next.

I'd be interested to hear whether that was in the ED or off-service. I applied to 30ish EM programs and none of them averaged over 60h/wk in their own department. The program I matched at works 19-21 ten hour shifts per 28d block depending on your seniority and responsibilities. That was pretty typical at the places I interviewed.

Of course, when you are on another service, you work their hours.

 

[KeyzerSoze]

Only if you drink the Kool-aid.

If you've been around here for long enough, you realize that L2D has not only drunk the Kool-aid, he's ladling it to all... as indicated by his post above.

 

[MCAT guy]

OH YEAH!!!

Working 40 hrs straight is easy and fun!!!!

OH YEAH!

 

[Charles_Carmichael]

Eh, at least in my experience, nearly every attending/resident I've interacted with has said the same thing L2D has been saying. Who knows? Maybe the physicians I'm interacting with are lying to my face. Or maybe people on SDN are exaggerating how horribly horrible long shifts are.

Guess I'll find out for myself in 4 years.

 

[KeyzerSoze]

Eh, at least in my experience, nearly every attending/resident I've interacted with has said the same thing L2D has been saying. Who knows? Maybe the physicians I'm interacting with are lying to my face. Or maybe people on SDN are exaggerating how horribly horrible long shifts are.

Guess I'll find out for myself in 4 years.

What's the longest you've been awake without sleeping?

 

[Gabby]

Eh, at least in my experience, nearly every attending/resident I've interacted with has said the same thing L2D has been saying. Who knows? Maybe the physicians I'm interacting with are lying to my face. Or maybe people on SDN are exaggerating how horribly horrible long shifts are.

Guess I'll find out for myself in 4 years.

How many critical decisions have you made after being awake for 30 hours straight? Perhaps the reason every resident and attending has told you that is that they, too, have been drinking the Kool-aid. Do they do it? Yes. They're forced to. Is the need for sleep on a daily basis overplayed? No.

 

[smq123]

Thus yes, most of us come to the conclusion based on personal experience that the perceived need for a daily good night's sleep is overplayed. Get it when you can, but don't kid yourself that you lack the physicality to survive a long shift.

Well, I think that it's physically do-able. I don't think that it's optimal, and I don't want to do have to do it on a regular basis for several years.

I wouldn't say that a daily good night's sleep is overrated. I observe that I DO function better when I get a decent amount of sleep regularly. Not everyone needs 8 hours, but getting a consistent amount on a regular basis is important, at least for me.

 

[DOCTORSAIB]

40-45 hours/week during residency. Most weekends off.

Not every residency is a nightmare.

 

[Charles_Carmichael]

What's the longest you've been awake without sleeping?

I've been up for 30+ hours on a few occasions (mainly during finals weeks where I've been unlucky enough to have a ridiculous number of exams in a very short time-span). Obviously, it's not comparable to residents being up for that long since studying for exams =/= taking care of patients.

How many critical decisions have you made after being awake for 30 hours straight? Perhaps the reason every resident and attending has told you that is that they, too, have been drinking the Kool-aid. Do they do it? Yes. They're forced to. Is the need for sleep on a daily basis overplayed? No.

I just took MCQ/essay exams, so they're definitely nowhere as critical as the decisions you'd make as a resident. Genuine question here: do med students during the clinical years follow the same schedule as the interns (in general)? And how often do med students make critical decisions, particularly after being awake for many hours?

The only thing I have to go by is what I've been told by residents/attendings and what I read on SDN. What I've been told is that while the hours are rough, you get used to it fairly quickly (because you have to). Like I said though, this is just what I've been told. I personally won't know how true this is for me until several years from now. So, please don't take my posts as trying to stir up trouble or anything like that. I'm genuinely oblivious, like most premeds are I'd imagine, regarding the hours involved in the clinical years of med school/residency.

 

[MCAT guy]

It is a stupid practice to have people awake for 30 hours making decisions that affect people's health.

Saying, "oh, we have to" is an excuse for lack of planning/resources.

Just like staying awake for 30 hours before taking an exam. You planned poorly the last however many months if you are pulling cramming sessions that long.

There are doctors in other countries that are not forced to work 30+ hours. There is research out there showing that decision making is much worse and errors increase after staying awake that long. But hey, it's doable! And we train much better mistake prone physicians. Education first.

 

[smq123]

Genuine question here: do med students during the clinical years follow the same schedule as the interns (in general)?

Not really. We usually got sent home before the interns did, we had less work to do during the day, and fewer responsibilities. This is school dependent, but generally, it's a SIMILAR schedule, but not exactly the same.

And how often do med students make critical decisions, particularly after being awake for many hours?

Thankfully, very infrequently. Pretty much never.

What I've been told is that while the hours are rough, you get used to it fairly quickly (because you have to).

You do get used to it, and yes, it's because you have to.

It's funny, though. Chronic sleep deprivation is sort of like chronic undiagnosed hypertension - a lot of patients who have had high blood pressure that was undiagnosed, once you put them on meds, come in saying that they didn't realize how bad they were feeling until they finally got their BP under control. You don't realize how crappy you're actually feeling until you get "treated" by a week of restful, adequate sleep.

 

[Mace1370]

I've done several all-nighters in my life and they were pretty terrible.

1) Once in high school for a band fundraising event. They called it the "Play-A-Thon." I was so miserable the next morning I resolved never to do it again.

2) In college during my freshman year I stayed up night studying for a classics test. I almost failed the exam because during the actual thing I was falling in and out of consciousness and couldn't remember anything I actually studied.

3) During a training event last summer we had to be up the entire night. It was miserable, but I think that was more because we had literally nothing to do and were forced to just stand there being awake all night with nothing to keep up occupied.

I think staying up for 30 hours would be easier if you had something to occupy you (walking around, talking to people, etc). I dunno, I guess I'll see when I get there.

 

[Gabby]

40-45 hours/week during residency. Most weekends off.

Not every residency is a nightmare.

What specialty? Is this an AOA residency or ACGME?

 

[Droopy Snoopy]

I think staying up for 30 hours would be easier if you had something to occupy you...

Sorry, it's just that having "something to occupy you" is a bit of an understatement when it comes to intern overnight call.

 

[Mace1370]

Sorry, it's just that having "something to occupy you" is a bit of an understatement when it comes to intern overnight call.

I wasn't speculating on an intern's workload to be like. I was referring to one of our training exercises where we were told to stand in the middle of a field for 24 hours and "don't move, don't sleep."

 

[Geekchick921]

It's funny, though. Chronic sleep deprivation is sort of like chronic undiagnosed hypertension - a lot of patients who have had high blood pressure that was undiagnosed, once you put them on meds, come in saying that they didn't realize how bad they were feeling until they finally got their BP under control. You don't realize how crappy you're actually feeling until you get "treated" by a week of restful, adequate sleep.

I learned this after I graduated undergrad. I started getting ~8 hours of sleep a night instead of 5. I was like, "How in the hell did I SURVIVE?!

 

[medigull]

It is a stupid practice to have people awake for 30 hours making decisions that affect people's health.

Saying, "oh, we have to" is an excuse for lack of planning/resources.

Just like staying awake for 30 hours before taking an exam. You planned poorly the last however many months if you are pulling cramming sessions that long.

There are doctors in other countries that are not forced to work 30+ hours. There is research out there showing that decision making is much worse and errors increase after staying awake that long. But hey, it's doable! And we train much better mistake prone physicians. Education first.

What the question is is how good of a doctor do you want to be? Do you want to go into practice knowing that you will have seen 99.9% of the illnesses that will come up in 100 different ways? Do you want to know that you have treated a patient for the duration of their illness? Do you want to go into practice knowing that you have done the procedure so many times in so many different ways that nothing can surprise you? Do you want to be used to doing that surgery after hour 24 of a 30+ hour shift so when you get called out for the 3am gunshot wound its nothing?

The only way to get this type of volume to train a good physician is a. long work hours or b. long residency. Id rather the hours myself. Believe me Im all for having my "self/family" time. Finding a specialty with a decent attending lifestyle is important to me. However residency is temporary and Id rather put the hours in now to be the best doctor I can be. Deal with it itll put hair on your chest....Unless you're a woman then I would hope for your sake you dont get the hair. Theres a reason why its been done this way forever. It works. Don't compare us to other countries. They have a completely different set up. Yes there needs to be some sort of limits however I worry for the future the more and more the bureaucrats try to dictate the training of medical professionals.

 

[KeyzerSoze]

What the question is is how good of a doctor do you want to be? Do you want to go into practice knowing that you will have seen 99.9% of the illnesses that will come up in 100 different ways? Do you want to know that you have treated a patient for the duration of their illness? Do you want to go into practice knowing that you have done the procedure so many times in so many different ways that nothing can surprise you? Do you want to be used to doing that surgery after hour 24 of a 30+ hour shift so when you get called out for the 3am gunshot wound its nothing?

The only way to get this type of volume to train a good physician is a. long work hours or b. long residency. Id rather the hours myself. Believe me Im all for having my "self/family" time. Finding a specialty with a decent attending lifestyle is important to me. However residency is temporary and Id rather put the hours in now to be the best doctor I can be. Deal with it itll put hair on your chest....Unless you're a woman then I would hope for your sake you dont get the hair. Theres a reason why its been done this way forever. It works. Don't compare us to other countries. They have a completely different set up. Yes there needs to be some sort of limits however I worry for the future the more and more the bureaucrats try to dictate the training of medical professionals.

Cite for any of the multiple unfounded assertions and implications in your post, please?

 

[medigull]

Cite for any of the multiple unfounded assertions and implications in your post, please?

Its common sense...more time in the hospital=more patients seen=more diseases/alternate presentations=more procedures.....The more time you spend doing training the more training you are going to get....its not a hard thing to follow and you dont need a study to back it up. Now can you get "adequate training" in less time, probably so, but did the docs who used to work well over 80 hours see more patients? Did the surgeons who worked well over 80 hours do/assist in more surgeries? The answer is obviously yes.

 

[KeyzerSoze]

Its common sense...more time in the hospital=more patients seen=more diseases/alternate presentations=more procedures.....The more time you spend doing training the more training you are going to get....its not a hard thing to follow and you dont need a study to back it up. Now can you get "adequate training" in less time, probably so, but did the docs who used to work well over 80 hours see more patients? Did the surgeons who worked well over 80 hours do/assist in more surgeries? The answer is obviously yes.

No, it's not at all common sense that extra training when you are extremely sleep deprived is effective. To me, it seems obvious that you have drastically diminished returns.

 

[Gabby]

What the question is is how good of a doctor do you want to be? Do you want to go into practice knowing that you will have seen 99.9% of the illnesses that will come up in 100 different ways? Do you want to know that you have treated a patient for the duration of their illness? Do you want to go into practice knowing that you have done the procedure so many times in so many different ways that nothing can surprise you? Do you want to be used to doing that surgery after hour 24 of a 30+ hour shift so when you get called out for the 3am gunshot wound its nothing?

The only way to get this type of volume to train a good physician is a. long work hours or b. long residency. Id rather the hours myself. Believe me Im all for having my "self/family" time. Finding a specialty with a decent attending lifestyle is important to me. However residency is temporary and Id rather put the hours in now to be the best doctor I can be. Deal with it itll put hair on your chest....Unless you're a woman then I would hope for your sake you dont get the hair. Theres a reason why its been done this way forever. It works. Don't compare us to other countries. They have a completely different set up. Yes there needs to be some sort of limits however I worry for the future the more and more the bureaucrats try to dictate the training of medical professionals.

How's that Kool-aid?

 

[Gabby]

Its common sense...more time in the hospital=more patients seen=more diseases/alternate presentations=more procedures.....The more time you spend doing training the more training you are going to get....its not a hard thing to follow and you dont need a study to back it up. Now can you get "adequate training" in less time, probably so, but did the docs who used to work well over 80 hours see more patients? Did the surgeons who worked well over 80 hours do/assist in more surgeries? The answer is obviously yes.

Actually, what's common sense is that after a certain number of hours without sleep, your focus decreases, you learn less, and you retain less. Oh, and you're more prone to mistakes. What's funny is that I think we all agree interns driving home after a 30-hour call shift are more prone to traffic accidents. Yet, so many are willing to let them make life and death decisions in the name of medicine. Let's just call it what it is -- a rite of passage. That's why so many are fine with it.

 

[medigull]

One of the reasons people want to do residencies at large university hospitals is because the wide range of pathology-why is there a wide range? 1. payer base 2. huge hospitals. Emory's hospital is like 1000+. If you have more people you have more chances that rare condition comes in. The same applies to volume of people seen/time spent. If you are at the hospital more you are going to see more patients its inevitable. Personally Id rather have seen a disease and treated a disease rather than take the easy way out and get a couple more hours of sleep hoping when it comes up that I read it in a text book. For example: if Im a surgeon resident I hope Ive operated in training on a patient with situs inversus (just something random I thought of Im sure there are rarer things out there) before I come up on one in practice. Anyone is more comfortable doing something the'yve done before. Id rather see it in residency with someone watching me then in practice with no one. Its just common sense you cant see as much with less hours. If you want quality sleep and see as much you have to extend the years.

 

[Gabby]

One of the reasons people want to do residencies at large university hospitals is because the wide range of pathology-why is there a wide range? 1. payer base 2. huge hospitals. Emory's hospital is like 1000+. If you have more people you have more chances that rare condition comes in. The same applies to volume of people seen/time spent. If you are at the hospital more you are going to see more patients its inevitable. Personally Id rather have seen a disease and treated a disease rather than take the easy way out and get a couple more hours of sleep hoping when it comes up that I read it in a text book. For example: if Im a surgeon resident I hope Ive operated in training on a patient with situs inversus (just something random I thought of Im sure there are rarer things out there) before I come up on one in practice. Anyone is more comfortable doing something the'yve done before. Id rather see it in residency with someone watching me then in practice with no one. Its just common sense you cant see as much with less hours. If you want quality sleep and see as much you have to extend the years.

You think wanting to sleep a few hours every night is taking the easy way out?

 

[JacobSilge]

What the question is is how good of a doctor do you want to be? Do you want to go into practice knowing that you will have seen 99.9% of the illnesses that will come up in 100 different ways? Do you want to know that you have treated a patient for the duration of their illness? Do you want to go into practice knowing that you have done the procedure so many times in so many different ways that nothing can surprise you? Do you want to be used to doing that surgery after hour 24 of a 30+ hour shift so when you get called out for the 3am gunshot wound its nothing?

The only way to get this type of volume to train a good physician is a. long work hours or b. long residency. Id rather the hours myself. Believe me Im all for having my "self/family" time. Finding a specialty with a decent attending lifestyle is important to me. However residency is temporary and Id rather put the hours in now to be the best doctor I can be. Deal with it itll put hair on your chest....Unless you're a woman then I would hope for your sake you dont get the hair. Theres a reason why its been done this way forever. It works. Don't compare us to other countries. They have a completely different set up. Yes there needs to be some sort of limits however I worry for the future the more and more the bureaucrats try to dictate the training of medical professionals.

Creating the idea that either you take super frequent call or don't get enough exposure to patients to be a good doctor is a false dichotomy.

Compare these two schedules (I've had both of them):
a) q3 call - 7a-1p the next day, 7a-1p the other day with one non-call day off per week - 78 hours/week
b) Day/night float system - 7a-~8p 6 days /week with some weeks of 7p-8a - 78 hours/week

The hours are the same, the number of patients seen is roughly the same (probably more with the float schedule). But one of those schedules gives you daily sleep and the other makes you barely able to function every 3rd night.