How many hours do resident REALLY work??

[Just Joshin]

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Okay, what's the average number of hours residents work when not on call in a given day?

This is entirely dependent on specialty, program, and hospital.

 

[Charles_Carmichael]

That's a cop-out. It's a reasonable analogy, regardless. And as for the patient errors not going down, as others have said, if it doesn't affect patient errors, then why not let residents sleep every night, like their bodies were intended to do? I really do think an earlier poster hit the nail on the head -- bragging rights and nothing more.

But you don't know that cutting resident hours down even more won't affect patient errors though. When the work hour rules were first put in place, people expected errors to go down. Better rested residents = less mistakes, right? Well, things didn't turn out that way. Mistakes due to something else in the system increased instead and kept the patient errors the same as the pre-reform era.

Now, if you cut down on resident hours even further, you don't know how much other things in the system, like hand-offs, will increase errors. Will residents making fewer mistakes due to sleeping 8 hrs/night every night offset the increase in errors due to other things? And will the decrease in hours spent in the hospital cut down on scut time or education time? There doesn't seem to be any data regarding this. The smarter thing to do would be to do a pilot study at one or a few institutions before making further changes rather than making changes based purely on sleep studies without considering other variables.

I'm not trying to argue one way or another. I'd just rather see some evidence supporting a change before the change is implemented rather than people just saying that "it's a no-brainer" that the change is for the better. Lots of things that seem like no-brainers turn out to be wrong.

 

[Mattchiavelli]

for any MS1-2s or premeds checking this, I went in to clinical years ready to be drained after a call night but it wasn't as bad as I'd thought- however I was noticeably deprived at the end, as were the residents on call with me, but neither I nor my residents were making split second life altering decisions the next morning. I'm not at a malignant school so I'm sure there are horror stories about residents being rode hard and hung up wet but I think those programs deliver bad patient results too. Do you think a program that treats residents like trash treat their patients much better? I doubt it. I'm interested to see how night float goes in my internship next year.

Anyway I'm glad formal training on transfer of patient care and information is coming into the residency training experience- arguing that longer work hours reduce transfers and therefore errors is sticking one's head in the proverbial sand IMO. I think medicine is trending away from the old days of following your patients into the hospital from outpatient and more to hospitalist based care. There are also more specialists we are sending patients to or having referred to us if we are specialists, and having good patient transfer skills. I see that as the price we pay for having more advanced, specialized medicine. 20 years ago I could follow a stroke patient in 30 hours because they'd either died or stopped stroking out at that point and were discharged. Nowadays I could stay up for 72+ hours following a stroke patient through tpa-->ICH-->NICU [or interventional neuroradiology, or emergent neurosurgery, etc] and still be presented with clinical experience of educational value as I become delirious from sleep deprivation.

It's really all about patient care in the end. I see the work hours as a cultural change to adapt to the differences in medical practice we are seeing evolve d/t its advancements. Adapt, change, survive, roll with the punches- it's what we do. Residencies will get longer anyway because biomedical information increases at an exponential rate and will mean more stuff to learn and put into practice.

 

[raynor123456]

For health reasons, I did actually experience very long term sleep deprivation (and fatigue) in the past. My learning, judgement, cognitive prowess and reactions were all greatly impaired. I didn't realize how bad it was until I started getting some sleep again. I fear residency.

 

[Incho]

I am resident in the UK and here we do not work more then 12hrs/day. This does not mean we do not get any experience of nights etc. On the contrary, we do nights and we are responsible for a large number of patients. It is so easy to plan and make decisions on patients that you know, it is much more difficult for young doc to make decision for patients they dont know. It gives you an opportunity to learn. Working for more then 12hrs per day means you are putting patient at risk big time. 30 hrs I am no even going to comment on that. I would never ever be feeling safe if I am treated by a doctor who has not had slept for 24hrs, let alone surgeon.
Also it seems that in USA you get no senior support which again put you in position of making decisions above your competency which may be useful for you but definitely not right for the patient.
I am not surprised that so many mistakes are done by doctors in the US.

 

[DOFOSHO]

its actually pretty simple: you may not LOG more than 80 hours per week

 

[mvenus929]

I am resident in the UK and here we do not work more then 12hrs/day. This does not mean we do not get any experience of nights etc. On the contrary, we do nights and we are responsible for a large number of patients. It is so easy to plan and make decisions on patients that you know, it is much more difficult for young doc to make decision for patients they dont know. It gives you an opportunity to learn. Working for more then 12hrs per day means you are putting patient at risk big time. 30 hrs I am no even going to comment on that. I would never ever be feeling safe if I am treated by a doctor who has not had slept for 24hrs, let alone surgeon.
Also it seems that in USA you get no senior support which again put you in position of making decisions above your competency which may be useful for you but definitely not right for the patient.
I am not surprised that so many mistakes are done by doctors in the US.

As an attending, I do 24 hour shifts all the time. I frequently get 6 hours of sleep when I’m on. Just because you’re working a long stretch doesn’t mean that you don’t get any sleep.

And there is plenty of senior support for residents. I went to my senior resident frequently as an intern and called my attendings not infrequently at night. I still call other attendings to run plans by them.

 

[68PGunner]

As an attending, I do 24 hour shifts all the time. I frequently get 6 hours of sleep when I’m on. Just because you’re working a long stretch doesn’t mean that you don’t get any sleep.

And there is plenty of senior support for residents. I went to my senior resident frequently as an intern and called my attendings not infrequently at night. I still call other attendings to run plans by them.

How's the bedding in those hospital beds? Are they sanitized?

 

[The Physician Philosopher]

But you don't know that cutting resident hours down even more won't affect patient errors though. When the work hour rules were first put in place, people expected errors to go down. Better rested residents = less mistakes, right? Well, things didn't turn out that way. Mistakes due to something else in the system increased instead and kept the patient errors the same as the pre-reform era.

This is exactly right. Transitions in care from different places (ED to the floor; floor to ICU; PACU to floor) are a large hole in most systems that are supposed to be filled by excellent hand offs and transitions of care that may or may not happen depending on where you work. Standardizing these handoffs has been shown to be beneficial, but is rarely done in most places.

I will say that one item missing from this discussion (though, admittedly, I didn't read all five pages) is work hours and how that leads to burnout and exhaustion. Now physician burnout has been shown to negatively affect care directly. This can lead to major burnout, depression, and much worse. It is also costly to both the individual and the institution, even in academic medicine.

I know people can work 24 hour calls, I just finished four years of it and still do home call (though I get good sleep most nights on call) for 24 hour stretches. The question is, why do this if it isn't necessary? Can't we fix the transitions in care to provide optimal patient care and provide the optimal amount of hours for physicians to work? I don't think these ideas are mutually exclusive.