How many hours do resident REALLY work??

[medigull]

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Exactly! I'm so sick of hearing "it just isn't possible" by people who're obviously drunk on the Kool-Aid while some fields manage just fine. And again, I'm not referring to surgery.

Do you actually read people who have other arguments or do you just read your sides posts and just respond with KOOL AID (which is getting really annoying by the way.)

ER is shift work you treat quick problems and send them home or you manage the early problems and admit ones that need to stay to another team. This is by no means an easy task but once again as stated before you arent treating one single patient for long periods of time. Same thing for Rads.
Things like IM have patients that stay in the hospital and are under ones care for more then a couple hours. Therefore the reason for the 30 hour shift. Im not gonna get into surgery because you already understand that...I think.

This is a quick summary of posts that you chose to ignore.

 

[Law2Doc]

...
Unrelated to Tic's post: My question arises from fields that manage to adequately train their docs on the less than 80 hours/week average, like EM. How is it possible that they train their learners with even more restricted hours (I feel like there is a formal cap of 72 hours/week averaged but I may have made that up, but having talked to a couple of EM residents it seems like they work closer to 60 hours/week averaged on service) while other fields can not manage the same. Is it simple enough to say that there is more to know in the 'other' fields?...

It's not even really just hours, but years. To be a hospitalist, you have to complete 3 years of residency. For cardiologist, add another two years of training. To be a radiologist you need 5. To be a neurosurgeon it's going to be 7 years. etc It's not like every specialty is going to be the identical cookie cutter training. So too with hours. You will log more hours as a surgeon in residency than as a psychiatry resident, even though the former has several more years of residency to work within. It has a lot to do with the nature of the work, as well as how many times you have to do certain things before you will be proficient, not just the sheer quantity of knowledge you have to amass, although I'm sure that's a component as well. In surgery, you can only fit so many long hour cases into a given week, while in EM, where the average ER visit may be in the order of 3 hours, you can see a lot of different things in a 10 hour shift. Also some fields have lots of rounding -- time spent planning, discussing. Other fields it's more heavy on the procedures. Other fields it's going through enough imaging studies to be proficient.

So each specialty has to decide how many hours they need to get their worst resident to the level of proficiency that they will be comfortable sending that person out into the world as an attending. For most residencies, it ends up averaging somewhere between 60-80 hours/week through most of residency, maybe a little heavier initially during intern year until folks become more efficient. It takes a lot of hours to get the exposure and skillsets needed. So I don't know that you can say there is "more to know" in one field versus another, because honestly no resident is going to know everything in their specialty and will constantly be learning regardless of the field. But every program has it's own internal notion of what is necessary for them to put their seal of approval on someone who is going out into the world as an "X hospital trained" attending/practitioner. Few places are going to shrug their shoulders and knowingly let someone who is a cold steel brandishing menace out their doors. The best way to guard against this is to force people to have seen and done a lot during residency. And you don't accomplish this by letting them coast.

And since a lot of us start to realize as the years of residency start flying past at breakneck speed once you are in it that you have barely scraped the surface of what you need to learn before you get out there, hospitals aren't really having to "force" anyone to stay on for that extra experience. I think this is the big difference in perspective between residents and med students -- the residents start to realize that if they don't stay those extra hours to learn X, Y and Z while it's someone else's license on the line, they are truly f-ed, while the med students are still looking at it from a quality of life perspective. The closer you get to the steep waterfall, the more willing you are to start paddling instead of enjoying the scenery.

 

[Laryngophed]

Edited: L2D stuck his post in before this one and his post addressed all of the points I had here. Sorry for the redundancy.

 

[Laryngophed]

I think this is the big difference in perspective between residents and med students -- the residents start to realize that if they don't stay those extra hours to learn X, Y and Z while it's someone else's license on the line, they are truly f-ed, while the med students are still looking at it from a quality of life perspective. The closer you get to the steep waterfall, the more willing you are to start paddling instead of enjoying the scenery.

I hope my question didn't prompt this post to be directed at me. I'm scared ****less by what I don't know and how much there is to learn and I would tend to err on the side of more "protected" time learning than rushing out in to the world. I'd rather be proficient with a few more grays than a younger attending on my own sooner, but that's just me. I just saw a discrepancy that I thought needed reconciliation.

 

[gravitywave]

Exactly! I'm so sick of hearing "it just isn't possible" by people who're obviously drunk on the Kool-Aid while some fields manage just fine. And again, I'm not referring to surgery.

different fields are different, hurr durr. i think somewhere along the line the ROAD residencies started being thought of as the $$forlesswork specialties, when in fact they were originally seen as desirable because of the light hours and reasonable workload, both in residency and as attendings. Rads, optho, and derm are pretty lifestyle-friendly residencies when compared to med or gen surg. less sure about gas....

this is entirely reasonable when you consider that work schedules aren't as intense for these folks as attendings, either. comparatively little call, comparatively few nights/weekends. specialties set their own training requirements much as guilds once did, and residency is meant to be an apprenticeship on your way to being a master craftsman.

so, becoming a neurosurgeon takes a long time: more years and more hours per year until you can reasonably be said to have attained minimum proficiency, as opposed to some other specialties. which is entirely appropriate to me - neurosurg residency is training you for your actual career, which could well include working at an isolated level One Trauma center where it's conceivable that you might be the only qualified professional within hundreds of miles that's capable of handling a particular emergency. not every specialty demands that of its attendings, and thus that's a reason why some residencies demand more time than others.

 

[EagerToBeMD]

Do you actually read people who have other arguments or do you just read your sides posts and just respond with KOOL AID (which is getting really annoying by the way.)

ER is shift work you treat quick problems and send them home or you manage the early problems and admit ones that need to stay to another team. This is by no means an easy task but once again as stated before you arent treating one single patient for long periods of time. Same thing for Rads.
Things like IM have patients that stay in the hospital and are under ones care for more then a couple hours. Therefore the reason for the 30 hour shift. Im not gonna get into surgery because you already understand that...I think.

This is a quick summary of posts that you chose to ignore.

Climb down off your high horse there, sparky. There's no SDN rule that states one has to read every single post in a thread. I only read a handful of these posts and it was more than enough for me to know what I wanted to say in response. Perhaps you're sitting at home, with nothing better to do than pouce on every post as it comes through, but some of us don't have that kind of time. Gabby replied to the post she saw. There's no rule that says she must wait and read everyone else's two cents before replying.

Furthermore, I agree with the Kool Aid line of reasoning and with whoever it was who said it's Stockholm Syndrome. There's no reason that someone has to work 30 hours straight to "learn" when the retention ratio goes down so dramatically long before that point.

 

[medigull]

Climb down off your high horse there, sparky. There's no SDN rule that states one has to read every single post in a thread. I only read a handful of these posts and it was more than enough for me to know what I wanted to say in response. Perhaps you're sitting at home, with nothing better to do than pouce on every post as it comes through, but some of us don't have that kind of time. Gabby replied to the post she saw. There's no rule that says she must wait and read everyone else's two cents before replying.

Furthermore, I agree with the Kool Aid line of reasoning and with whoever it was who said it's Stockholm Syndrome. There's no reason that someone has to work 30 hours straight to "learn" when the retention ratio goes down so dramatically long before that point.

Yeah I understand but the post was responded to 1 or 2 times afterwards and the kool aid line was worked in every other post. First time haha funny...next time....ok......the 6th 7th its time to put the kool aid thing to rest

 

[Perrotfish]

So each specialty has to decide how many hours they need to get their worst resident to the level of proficiency that they will be comfortable sending that person out into the world as an attending. For most residencies, it ends up averaging somewhere between 60-80 hours/week through most of residency,

Paralleling the argument that residents work too many hours is the argument that residents are overtrained. You, like many residents, seem to credit your residency programs with having taken a benevolent, scientitific, and disinterested approach to deciding how many hours of training a resident needs. The reality is that the number of years/hours we are required to sacrific to residency is determined by the same programs that make enormous profits off of their residents. The residents bill as physicians, work 80 hours a week, and the federal government picks up the tab for all of their salary and benifits (plus a little extra). I think that residency programs constantly expand their training, nominally for the sake of patient care, but really because they're making a mint and letting everyone go earlier would be a huge cost for upper management. Residents go along with it because they're over a barrel and, in any event, the things that the residencies are saying echo the same deep insecurities that every physician has before going into practice. After all, who in the world is going to feel ready to suddenly be the attending? You're basically going from the endlessly extended childhood of medical training to being the end all authority figure, and you do it all at once with no real transition. You need an truely extrodinary ego to not have even a twinge of fear thinking about that, no matter how well trained you are.

Basically I think we can work fewer hours, sleep every night, not extend residencies, and do just fine as physicians.

 

[gravitywave]

Climb down off your high horse there, sparky. There's no SDN rule that states one has to read every single post in a thread. I only read a handful of these posts and it was more than enough for me to know what I wanted to say in response. Perhaps you're sitting at home, with nothing better to do than pouce on every post as it comes through, but some of us don't have that kind of time. Gabby replied to the post she saw. There's no rule that says she must wait and read everyone else's two cents before replying.

Furthermore, I agree with the Kool Aid line of reasoning and with whoever it was who said it's Stockholm Syndrome. There's no reason that someone has to work 30 hours straight to "learn" when the retention ratio goes down so dramatically long before that point.

Stockholm Syndrome was mine, and i was using it to contradict one of L2D's more extreme statements. but otherwise i'm fairly certain that we stand on opposite sides of this issue 😛

Paralleling the argument that residents work too many hours is the argument that residents are overtrained. You, like many residents, seem to credit your residency programs with having taken a benevolent, scientitific, and disinterested approach to deciding how many hours of training a resident needs. The reality is that the number of years/hours we are required to sacrific to residency is determined by the same programs that make enormous profits off of their residents. The residents bill as physicians, work 80 hours a week, and the federal government picks up the tab for all of their salary and benifits (plus a little extra). I think that residency programs constantly expand their training, nominally for the sake of patient care, but really because they're making a mint and letting everyone go earlier would be a huge cost for upper management. Residents go along with it because they're over a barrel and, in any event, the things that the residencies are saying echo the same deep insecurities that every physician has before going into practice. After all, who in the world is going to feel ready to suddenly be the attending? You're basically going from the endlessly extended childhood of medical training to being the end all authority figure, and you do it all at once with no real transition. You need an truely extrodinary ego to not have even a twinge of fear thinking about that, no matter how well trained you are.

Basically I think we can work fewer hours, sleep every night, not extend residencies, and do just fine as physicians.

you're going to have a hard time making this argument, i think, simply because if you want to dismantle the residency-government payment system, the academic attendings who do the training would revolt at the cuts to their own pay (rightfully so, IMO.)

a better argument for you to make would be based on whether the work hour restrictions in Europe (much more stringent even than here) have had any impact on the quality of care there. Oddly, no one in Europe seems interested in doing such a study....

 

[Droopy Snoopy]

Then they'd have to get rid of the one-day-off-in-seven rule too and I don't see that happening.

No they wouldn't, did you even read my post that you quoted? You don't get 1-day-off-in-seven. 24 hours free of clinical duties, THAT'S the rule. Get off post-call at 8am, come back at 8am the next day, there's your 24-hours off. Doesn't matter that you left an hour late and arrived back an hour early because you had to signout/sign-in and finish your work/catch up on the plan. Doesn't matter that you spent 15 of your actual 22 hours 'off' asleep. Doesn't matter that you missed post-call staff rounds and thus didn't have the opportunity to learn how to care for your patients from your attending (or you missed out on acually operating on the dude you just scutted around on all night).

It's not hard to set up a schedule such that you work every day of the week, every week of the month (and like I said more months out of the year due to a necessary decrease in elective time) in this manner. Every day would be between 8 and 16 hours long, and your schedule would conform to every ACGME work hours rule on the books. You can also see that the shift in schedule might very well trade away some 'learning' hours for 'scut' hours.

And at the end of the day you're still going to be held accountable for proficiency. Nobody's extending residency or hiring extra residents into unfunded spots anytime soon, because all that would cost the hospital millions of dollars. Easier to let you suck it up and let you flunk your boards. Again, be careful what you wish for.

 

[EagerToBeMD]

Yeah I understand but the post was responded to 1 or 2 times afterwards and the kool aid line was worked in every other post. First time haha funny...next time....ok......the 6th 7th its time to put the kool aid thing to rest

Nothing on SDN has ever been posted multiple times...

Stockholm Syndrome was mine, and i was using it to contradict one of L2D's more extreme statements. but otherwise i'm fairly certain that we stand on opposite sides of this issue

Yes, I'm well aware.

No they wouldn't, did you even read my post that you quoted? You don't get 1-day-off-in-seven. 24 hours free of clinical duties, THAT'S the rule.

We still have 24 hours in a day, right?

 

[mrjohndaniels]

Climb down off your high horse there, sparky. There's no SDN rule that states one has to read every single post in a thread. I only read a handful of these posts and it was more than enough for me to know what I wanted to say in response. Perhaps you're sitting at home, with nothing better to do than pouce on every post as it comes through, but some of us don't have that kind of time. Gabby replied to the post she saw. There's no rule that says she must wait and read everyone else's two cents before replying.

Furthermore, I agree with the Kool Aid line of reasoning and with whoever it was who said it's Stockholm Syndrome. There's no reason that someone has to work 30 hours straight to "learn" when the retention ratio goes down so dramatically long before that point.

That's because you're missing the point. This isn't a 30 hour study marathon. When you try to read books or notes for 30 hours, your retention goes way down after a while. 30 hour call is designed to allow you to follow a patient for the first 12 hours in which they are admitted to the hospital, during which time the most critical decisions and events will tend to happen. If you are going home at night and miss out on overnight events for your patients admitted during the day, you lose that experience. You also miss out on all the patients who come in the middle of the night very sick and don't learn how to manage them from the start. This kind of learning is not the same as just studying. You actually will retain more from answering the pager in the middle of the night and from those late-night admits than you realize, especially when that process recurs every fourth night for a significant portion of your first year of training. It leaves you able to make independent decisions starting during your second year. The way things are changing, second year residents will still have this learning to accomplish, and they will struggle more leading interns.

 

[PharmaTope]

How's that Kool-aid?

lol no kidding he is swimming in it

 

[EagerToBeMD]

That's because you're missing the point. This isn't a 30 hour study marathon. When you try to read books or notes for 30 hours, your retention goes way down after a while. 30 hour call is designed to allow you to follow a patient for the first 12 hours in which they are admitted to the hospital, during which time the most critical decisions and events will tend to happen. If you are going home at night and miss out on overnight events for your patients admitted during the day, you lose that experience. You also miss out on all the patients who come in the middle of the night very sick and don't learn how to manage them from the start. This kind of learning is not the same as just studying. You actually will retain more from answering the pager in the middle of the night and from those late-night admits than you realize, especially when that process recurs every fourth night for a significant portion of your first year of training. It leaves you able to make independent decisions starting during your second year. The way things are changing, second year residents will still have this learning to accomplish, and they will struggle more leading interns.

Thanks, but I'm finishing third year and am aware of what a 30-hour shift is like. Therefore, your entire post is irrelevant to my experience. I stand by what I said, and believe me, it's not because I "missed the point."

 

[Law2Doc]

... This isn't a 30 hour study marathon. When you try to read books or notes for 30 hours, your retention goes way down after a while. 30 hour call is designed to allow you to follow a patient for the first 12 hours in which they are admitted to the hospital, during which time the most critical decisions and events will tend to happen. If you are going home at night and miss out on overnight events for your patients admitted during the day, you lose that experience. You also miss out on all the patients who come in the middle of the night very sick and don't learn how to manage them from the start. This kind of learning is not the same as just studying. You actually will retain more from answering the pager in the middle of the night and from those late-night admits than you realize, especially when that process recurs every fourth night for a significant portion of your first year of training. It leaves you able to make independent decisions starting during your second year. The way things are changing, second year residents will still have this learning to accomplish, and they will struggle more leading interns.

Precisely.

 

[Law2Doc]

Paralleling the argument that residents work too many hours is the argument that residents are overtrained. You, like many residents, seem to credit your residency programs with having taken a benevolent, scientitific, and disinterested approach to deciding how many hours of training a resident needs. The reality is that the number of years/hours we are required to sacrific to residency is determined by the same programs that make enormous profits off of their residents. The residents bill as physicians, work 80 hours a week, and the federal government picks up the tab for all of their salary and benifits (plus a little extra). I think that residency programs constantly expand their training, nominally for the sake of patient care, but really because they're making a mint and letting everyone go earlier would be a huge cost for upper management. Residents go along with it because they're over a barrel and, in any event, the things that the residencies are saying echo the same deep insecurities that every physician has before going into practice. After all, who in the world is going to feel ready to suddenly be the attending? You're basically going from the endlessly extended childhood of medical training to being the end all authority figure, and you do it all at once with no real transition. You need an truely extrodinary ego to not have even a twinge of fear thinking about that, no matter how well trained you are.

Basically I think we can work fewer hours, sleep every night, not extend residencies, and do just fine as physicians.

I think this is a very hard argument to make if you aren't a senior resident or junior attending. It's easy to say "you'll never really be ready" so you probably are no worse off with less training. But in fact most of the time it's not that residents have "drunk the Koolaid" or are just getting sucked in by their securities. The closer you get to that point, the crisper the reality of what you are going to be expected to do becomes. As a med student, you get small windows into what attendings do, are responsible for, are expected to know. As residents, the windows get bigger. As senior residents, you start getting talked to as peers, start shouldering more of the responsibility, start getting more "here's what I wish I knew before I became an attending" kind of insight. So yeah, you do have a lot more insight into what's expected, what you wish you had spent more time working on during your training, how unprepared you are. It's really easy as a med student to say, "I can work fewer hours, sleep every night and do fine as a physician-- it doesn't matter I'm still going to be insecure about becoming an attending and more hours won't fix that". But you don't really have the perspective at that end of the spectrum to credibly make that statement, I think.

 

[KeyzerSoze]

No they wouldn't, did you even read my post that you quoted? You don't get 1-day-off-in-seven. 24 hours free of clinical duties, THAT'S the rule. Get off post-call at 8am, come back at 8am the next day, there's your 24-hours off. D

That's not exactly true.

Bolding mine:

Question: The common duty hour standards state that residents must be provided with one day in seven free from all responsibilities, with one day defined as one continuous 24-hour period. How should programs interpret this standard if the “day off” occurs after a resident’s on-call day?
Answer: The common duty hour standards call for a 24-hour day off. Many Review Committees have recommended that this day off should ideally be a “calendar day,” e.g., the resident wakes up in his or her home and has a whole day available. Review Committees have also noted that it is not permissible to have the day off regularly or frequently scheduled on a resident’s post-call day, but understand that in smaller programs it may occasionally be necessary to have the day off fall on the post-call day. Note that in this case, a resident would need to leave the hospital post-call early enough to allow for 24 hours off of duty. For example, if the resident is expected to return to the hospital at 7:00 a.m. the following day, he/she would need to leave the hospital at 7:00 a.m. on the on-call session day. Because call from home does not require a rest period, the day after a pager call may be used as a day off.

 

[mvenus929]

Programs are capped with their number of residency positions. There is a set amount of work that needs to be done and a set amount of 'learnin' that needs to be accomplished, approximately 80 hours/week of it per resident. A program is going to get that 80 hours one way or another, so instead of having q3/q4 call and a day or two off during the week the program is going to call the post-call day the 'off day'. Thus you could find yourself working 12-hour+ days, every day of the week, for months on end - in complete compliance with ACGME regs. AND you'll see a cutback on electives in order to provide more coverage for the wards/OR/clinic/unit. There has already been a trend toward this in response to the 16-hour intern cap change.

This is the point I was attempting to make above. I've been in a situation where I've practically had to work every day due to shorter shifts (though not quite to the extent of residents). I had to get up insanely early and was always tired and never had enough time to recuperate on my days off. We switched to longer shifts and fewer days (and I switched shifts from morning to night, which helped) and I felt so much more rested and prepared.

I'd much rather work longer hours and actually enjoy my days off, rather than work more days and shorter hours.

Have you ever heard anything about extending residency (don't kill me😱)?

The peds attendings at my hospital say there are whisperings of extending residency length to make up for the shorter hours. Dunno at what level that's happening, or if it's even true, but there you go.

 

[45408]

Thanks, but I'm finishing third year and am aware of what a 30-hour shift is like. Therefore, your entire post is irrelevant to my experience. I stand by what I said, and believe me, it's not because I "missed the point."

How many times have you done a 30 hour shift?

 

[EagerToBeMD]

How many times have you done a 30 hour shift?

I didn't count. I did 8 weeks of surgery and 8 weeks of IM where we were expected to take call, but not every single one our intern took. Granted, I wasn't making decisions. Everyone should be thankful for that because I was delirious after 22ish hours.

 

[mrjohndaniels]

I didn't count. I did 8 weeks of surgery and 8 weeks of IM where we were expected to take call, but not every single one our intern took. Granted, I wasn't making decisions. Everyone should be thankful for that because I was delirious after 22ish hours.

It's a lot different when you are doing the admitting, order writing, answering floor pager, etc. You still get tired, but you stay focused on your task, and you do learn. Wait until you finish your sub-I before saying that there is no value in a 30 hour call.

The other thing to keep in mind is that the next morning you will be rounding with an attending, who will be calling the shots from that point on. Once your call is over after 24 hours, you aren't making anymore critical decisions. You should also have a rested upper-level resident coming back at that point to help out with any new issues that are coming into play.

 

[45408]

It's a lot different when you are doing the admitting, order writing, answering floor pager, etc. You still get tired, but you stay focused on your task, and you do learn.

Agreed. You get a shot of adrenaline when the nurse calls you and tells you that your patient's O2 sat is in the 70s.

 

[DoctwoB]

It's a lot different when you are doing the admitting, order writing, answering floor pager, etc. You still get tired, but you stay focused on your task, and you do learn. Wait until you finish your sub-I before saying that there is no value in a 30 hour call.

I sure hope so. I find that often when I'm shadowing I'll get exhausted after 3 hours just from boredom (depending on how involved the doc actually lets me get).

 

[45408]

I sure hope so. I find that often when I'm shadowing I'll get exhausted after 3 hours just from boredom (depending on how involved the doc actually lets me get).

Shadowing is HORRIBLY boring. I hate it.

 

[EagerToBeMD]

It's a lot different when you are doing the admitting, order writing, answering floor pager, etc. You still get tired, but you stay focused on your task, and you do learn. Wait until you finish your sub-I before saying that there is no value in a 30 hour call.

The other thing to keep in mind is that the next morning you will be rounding with an attending, who will be calling the shots from that point on. Once your call is over after 24 hours, you aren't making anymore critical decisions. You should also have a rested upper-level resident coming back at that point to help out with any new issues that are coming into play.

Well, I wasn't exactly shadowing. I was doing admits and H&Ps and consults in the ER, etc. I'm not saying I was doing nearly as much as my intern, but I wasn't just standing around being bored either. And I don't see how doing more is going to keep me from losing cognitive ability from lack of sleep, frankly. Maybe some of you can go all night without sleep and still be on top of your game, but your mistake is in thinking that everyone else can too. Even in undergrad, I couldn't pull all-nighters. I'm a lot older now and trust me when I say, I'm at 30% without sleep. The patients deserve better.

 

[Slack3r]

http://www.medicalnewstoday.com/articles/221369.php

 

[medigull]

http://www.medicalnewstoday.com/articles/221369.php

Not surprising this kinda study would come from Europe. Buncha slackers. Also this does nothing as there is absolutely no way we will go to/under 11 hours. If we do the wusses will have finally taken over america (if it hasnt already happened.)

 

[gravitywave]

http://www.medicalnewstoday.com/articles/221369.php

<scoffs> this study doesn't say what you wish it said. they didn't stratify by fitness-related issues that i can see (did this people have MIs because they worked hard, or because they ate McDonalds eight times a week?) Not to mention the fact that they didn't get any follow-up data on the work hours, just a snapshot taken once, based on a questionnaire. i could have used some person/hour/years.

the language they use to describe their conclusions is remarkably weak. these data don't have much to add to this already murky issue.

 

[MCAT guy]

Yet another reason to work 30+ hours at a time.

http://www.webmd.com/heart-disease/news/20110405/working-long-hours-linked-to-heart-disease-risk

Working Long Hours Linked to Heart Disease Risk

Study Shows a Higher Risk of Heart Disease for People Who Work 11 Hours a Day
By Bill Hendrick
WebMD Health News
Reviewed by Laura J. Martin, MD

April 5, 2011 -- People who work 11 hours or more on a daily basis may be at increased risk of developing coronary heart disease, a British study indicates.


The researchers note that doctors often use information from the Framingham Risk Score, which identifies common factors of heart disease, to predict a patient's 10-year risk of developing coronary heart disease.
This score includes risk factors such as age, sex, cholesterol levels, blood pressure, and smoking habits, but not psychosocial factors such as daily work hours.

Edit: Lol, looks like someone beat me to it.

 

[45408]

An 8 hour work day would take me to just after 1pm, because I start around 5:15am.

 

[Sammich117]

I won't lie, I only read the first 2 pages of this, but this thread scares me...

I have no idea how I'm supposed to get used to 30 hours straight. I'm only just finishing first year so I've got some time, but oh man. The hours are definitely daunting.

(I'm going to hold back from joining the should we/should we not work that much argument)

 

[bomgd3]

I won't lie, I only read the first 2 pages of this, but this thread scares me...

I have no idea how I'm supposed to get used to 30 hours straight. I'm only just finishing first year so I've got some time, but oh man. The hours are definitely daunting.

(I'm going to hold back from joining the should we/should we not work that much argument)

I feel the exact same way. I shadowed a couple days ago and the resident was at the end of a busy 30 hour shift--she was practically passing out. Scary to have that in my future!

 

[mrjohndaniels]

Yet another reason to work 30+ hours at a time.

http://www.webmd.com/heart-disease/news/20110405/working-long-hours-linked-to-heart-disease-risk



Edit: Lol, looks like someone beat me to it.

I guess we should tell everyone with occupational hazards that they shouldn't do them anymore because it's bad for their health.

 

[KeyzerSoze]

I guess we should tell everyone with occupational hazards that they shouldn't do them anymore because it's bad for their health.

OFFS.

People in this thread have claimed that "sleep is overrated." The first thing to do about occupational hazards is to acknowledge them, not deny their existance.

 

[Just Joshin]

I guess we should tell everyone with occupational hazards that they shouldn't do them anymore because it's bad for their health.

What's hazardous for doctors is hazardous for patients. There's a reason pilots have a strict limitation on hours. Think about it.

 

[Law2Doc]

OFFS.

People in this thread have claimed that "sleep is overrated." The first thing to do about occupational hazards is to acknowledge them, not deny their existance.

I said that, and I basically meant that most of the people who jump on here and claim that 30 hours is impossible and fear they are going to drop dead after a month of q4 30 hour shifts are going to actually find that it's not nearly as bad as it sounds before you get there. You won't be pushing the limits the human body was designed to handle. You won't end up with rapidly deteriorating health or lose your mental faculties. You will be fine. That's what I meant by saying this fear of loss of sleep was overrated. There are posters on here who simply don't believe they can manage it. Yet even the weakest in the profession throughout history have gotten through it up to now.

 

[Law2Doc]

What's hazardous for doctors is hazardous for patients. There's a reason pilots have a strict limitation on hours. Think about it.

If the pilots had to swap in and out of the planes mid-air when they got tired (the equivalent of hand-offs in residency), that would be a reasonable analogy. Otherwise you are ignoring the fact that there's not just a single risk factor in the system. You can fix one source of errors and another will take hold. This is why patient errors didn't go down when they capped the duty hours at an average of 80/week.

 

[Perrotfish]

Yet even the weakest in the profession throughout history have gotten through it up to now.

The weakest in the profession have traditionally quit their jobs, or screwed up so badly due to exhaustion that they were fired, or died in car wrecks when they fell asleep on the way home, or comitted suicide.

The next weakest group merely developed problems with depression, or with substance abuse, or watched their families disintigrate around them. They made it to the finish line but they left part of themselves on the course.

Not everyone has 'gotten through it'.

 

[mvenus929]

What's hazardous for doctors is hazardous for patients. There's a reason pilots have a strict limitation on hours. Think about it.

Last I checked, pilots didn't have a multitude of backups (it's them and the copilot). Interns are backed up by residents, who are backed up by attendings. If something makes it past them, the nurses are there looking out for the patients as well, as is much of the ancillary staff (I called more than a couple docs questioning orders in my time working in the lab). If the flight attendants could also fly the plane, your argument might work.

And really, I don't understand what limiting the workday to 16 hours is going to do to improve sleep quality. You'll probably get more sleep in 48 hours working a 30 hour shift than you will working two 16 hour shifts (I would, anyway), and yet that's what the new regulations require. What good is it to have shorter shifts if you're more chronically sleep deprived?

 

[Just Joshin]

I said that, and I basically meant that most of the people who jump on here and claim that 30 hours is impossible and fear they are going to drop dead after a month of q4 30 hour shifts are going to actually find that it's not nearly as bad as it sounds before you get there.

The fact that you exaggerate to such depths squashes your whole argument. No one claimed it was impossible and no claimed they'd drop dead. Don't twist the argument into something more than it is so that you can defend your side.

You won't be pushing the limits the human body was designed to handle. You won't end up with rapidly deteriorating health or lose your mental faculties. You will be fine. That's what I meant by saying this fear of loss of sleep was overrated.

So all those studies about the consequences of sleep deprivation on the body are unfounded?

There are posters on here who simply don't believe they can manage it. Yet even the weakest in the profession throughout history have gotten through it up to now.

Well, hey, a lot of people have also managed to drive drunk without crashing. Should we all do that too?

 

[Just Joshin]

If the pilots had to swap in and out of the planes mid-air when they got tired (the equivalent of hand-offs in residency), that would be a reasonable analogy. Otherwise you are ignoring the fact that there's not just a single risk factor in the system. You can fix one source of errors and another will take hold. This is why patient errors didn't go down when they capped the duty hours at an average of 80/week.

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.

 

[Just Joshin]

Last I checked, pilots didn't have a multitude of backups (it's them and the copilot). Interns are backed up by residents, who are backed up by attendings. If something makes it past them, the nurses are there looking out for the patients as well, as is much of the ancillary staff (I called more than a couple docs questioning orders in my time working in the lab). If the flight attendants could also fly the plane, your argument might work.

LOL, I don't know what hospital you work at, but at my hospital, if the intern's on call, the intern is responsible for the patients. It's not like the intern is just there to shadow. Same for the resident. It's not like they're shadowing the attending all night.

And really, I don't understand what limiting the workday to 16 hours is going to do to improve sleep quality. You'll probably get more sleep in 48 hours working a 30 hour shift than you will working two 16 hour shifts (I would, anyway), and yet that's what the new regulations require. What good is it to have shorter shifts if you're more chronically sleep deprived?

Why would you be more sleep deprived working 16 hours? That's 8 hours out of the hospital every single day. Most people are just fine with 6 hours of sleep every night and for me, it's A LOT better than working 30 hours every 3rd or 4th night.

 

[gravitywave]

Why would you be more sleep deprived working 16 hours? That's 8 hours out of the hospital every single day. Most people are just fine with 6 hours of sleep every night and for me, it's A LOT better than working 30 hours every 3rd or 4th night.

have you ever actually worked either of these schedules? I have (not as a doctor, but that's not germane to this point) - both of them - and mvenus is right. you're going to get better rest overall in the 48 with the 30 than you will with the two 16s.

as you keep stacking these posts up, i'm increasingly suspicious that you haven't taken the trouble to familiarize yourself with the various running arguments in the thread before coming on here and shooting your mouth off.

 

[Just Joshin]

have you ever actually worked either of these schedules?

Yes, as a matter of fact. In a hospital.

and mvenus is right. you're going to get better rest overall in the 48 with the 30 than you will with the two 16s.

Nope, mvenus is wrong. I feel refreshed every morning after 6 hours of sleep. How are you going to get better rest overall if you skip sleeping one night just to sleep 12 hours the next day?

as you keep stacking these posts up, i'm increasingly suspicious that you haven't taken the trouble to familiarize yourself with the various running arguments in the thread before coming on here and shooting your mouth off.

Oh, believe me, I have. That's why you don't see me replying to anything from page one. And by the way, I don't give a flying fig about your suspicions.

 

[MCAT guy]

I said that, and I basically meant that most of the people who jump on here and claim that 30 hours is impossible and fear they are going to drop dead after a month of q4 30 hour shifts are going to actually find that it's not nearly as bad as it sounds before you get there. You won't be pushing the limits the human body was designed to handle. You won't end up with rapidly deteriorating health or lose your mental faculties. You will be fine. That's what I meant by saying this fear of loss of sleep was overrated. There are posters on here who simply don't believe they can manage it. Yet even the weakest in the profession throughout history have gotten through it up to now.

Agreed with previous poster. Lame arguments here, especially for a lawyer.

"Drop dead?"

And you won't have "rapidly deteriorating health or LOSE your mental faculties?"

How about your health WILL deteriorate and you will not be mentally sharp putting yourself and your patients in danger.

Can we manage it? Yeah. But it's stupid. Bad for our health. Risky for our patients. Bad for our family/social life. And error rates are the same.

It's funny when you want to just work 60-80 hours a week, you are all the sudden a sissy that yearns for a lifestyle specialty.

 

[Slack3r]

Last I checked, pilots didn't have a multitude of backups (it's them and the copilot). Interns are backed up by residents, who are backed up by attendings. If something makes it past them, the nurses are there looking out for the patients as well, as is much of the ancillary staff (I called more than a couple docs questioning orders in my time working in the lab). If the flight attendants could also fly the plane, your argument might work.

Most planes can fly themselves nowadays. So you've got the pilot, co-pilot, and the auto-pilot.

 

[mvenus929]

LOL, I don't know what hospital you work at, but at my hospital, if the intern's on call, the intern is responsible for the patients. It's not like the intern is just there to shadow. Same for the resident. It's not like they're shadowing the attending all night.

Of course not, but if you're out of your depth, there's going to be someone there to help you out. And if you screw up, the chances someone will catch it are relatively good. I've heard plenty of stories of nurses suggesting medication changes because the intern isn't as familiar with them. Maybe I'm wrong, and the analogy to a pilot actually holds.

[/quote]Why would you be more sleep deprived working 16 hours? That's 8 hours out of the hospital every single day. Most people are just fine with 6 hours of sleep every night and for me, it's A LOT better than working 30 hours every 3rd or 4th night.[/QUOTE]

That's only 8 hours outside the hospital, every day (or most days, anyway). You basically have time to go home and sleep. Most people aren't able to chronically function on less than 5-6 hours of sleep each night. Most people are able to pull off a night every once and a while with very little sleep, provided they are able to catch back up later.

I haven't worked the extreme of resident hours, so maybe I'm completely off my mark, but in my experience, working longer shifts with more off time when you're actually off is so much more resting than working shorter shifts with less time off between shifts. It's not so much one week to the next, but just how you feel when you've been doing it for a month or two.

 

[unsung]

Shadowing is HORRIBLY boring. I hate it.

OMG, I'm so glad someone admits this! Especially when it's something like... outpatient peds.

 

[Just Joshin]

Of course not, but if you're out of your depth, there's going to be someone there to help you out. And if you screw up, the chances someone will catch it are relatively good. I've heard plenty of stories of nurses suggesting medication changes because the intern isn't as familiar with them. Maybe I'm wrong, and the analogy to a pilot actually holds.

If that was true, there wouldn't have been as many errors made due to lack of sleep on the residents' part.

That's only 8 hours outside the hospital, every day (or most days, anyway). You basically have time to go home and sleep. Most people aren't able to chronically function on less than 5-6 hours of sleep each night. Most people are able to pull off a night every once and a while with very little sleep, provided they are able to catch back up later.

We're not talking every once in a while. We're talking q3 or q4 call. That's a big difference.

I haven't worked the extreme of resident hours, so maybe I'm completely off my mark, but in my experience, working longer shifts with more off time when you're actually off is so much more resting than working shorter shifts with less time off between shifts. It's not so much one week to the next, but just how you feel when you've been doing it for a month or two.

Ask around and find out how much time off residents get. Working q4 call, they still only get one full day off in every seven. That wouldn't change with 16-hour shifts. No one's taking off the 1-day-off-in-7 rule for next year's interns.

 

[mvenus929]

Ask around and find out how much time off residents get. Working q4 call, they still only get one full day off in every seven. That wouldn't change with 16-hour shifts. No one's taking off the 1-day-off-in-7 rule for next year's interns.

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