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I feel like I'm missing something - long hours in residency

Discussion in 'Pre-Medical - MD' started by kristieb1, Dec 15, 2008.

  1. kristieb1

    kristieb1 Starting Over
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    Why do residents have to work these crazy 90 hr weeks? I don't understand why its allowed? I just don't understand why its not regulated like all the other jobs out there where you work 40 hrs a week (unusual shifts happen sure) with over time (I know getting a salary changes the rules from getting paid by the hour), but why was it originally allowed and perceived as ok for residents to work 80-110 hrs a week?
     
  2. Excelsius

    Excelsius Carpe Noctem
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    Residents are not necessarily "employees." They are basically in training and receiving education. The salary is sometimes thought of as stipend. Since you are not a regular employee, you don't fall under 40hr limit per week.
     
  3. shiftingmirage

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    Why is it like that? Tradition. That's how it has been, that's how it will be. Previous generations of docs have done it, and futer generations will.

    I believe there was a law passed limiting the number of hours a resident could work to 80...but my bet is most residents will say they exceed that number all the time.
     
  4. Excelsius

    Excelsius Carpe Noctem
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    Before around 2003 or so, residents worked 110 hours or more. The law that passed limited the hours to 80. But no, most residents don't really go over 80 - it's specialty dependent. There are many specialties out there where you average 60 hours or less. Then there are others that you go close to 100 (surgical specialties, hours unreported). I think the 80 hour limit also works as an average. So it might be ok to work 100 hours one week if you are going to work 60 the next week. But I'm not sure about the veracity of this.
     
  5. DrMom

    DrMom Official Mom of SDN
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    The rule is 80 hours/week averaged over 4 weeks, so, yes you can work more if you have a lighter week in the same time period.
     
  6. Perrotfish

    Perrotfish Has an MD in Horribleness
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    1) They don't need to pay you overtime because you're a salaried employee. Once you're salaried they don't need to pay you overtime. That's in all jobs from CEO to McDonald's assistant manager.

    2) Issues of patient welfare aside, they don't need to consider your desire to sleep (beyond the mandatory hour limits set by the accrediting organization) because during residency hospitals basically function as a trust. You can't bargain because you basically can't leave and even if you could no one else would be willing to make you a better offer. Once you get past residency you're in more of a free market enviornment, and you can either bargain for a great salary, or 40 hour weeks and a good salary (hospitalists). In countries where medicine is socialized and doctors have been forced to bargain collectively (because that's how you have to negotiate with a government/monopoly/trust) residency pay went up and residency hours went down. We can't get unions together, though, because physicians are basically looking ahead to when they're through residency and can earn a great salary.

    3) Though I think the residency hours should be much better then they are, you're kidding yourself if you think your average lawyer/business person/engineer works 40 hours a week at the start of their career. 60 hours is more normal. However they definitely don't work 30 hour shifts in an abusive enviornment.

    I get the impression that residents go over 80 hours like people go over the limit: a little is something everyone does, a lot is really bad and you don't see a lot of it. If a program has residents working 110 hour weeks they're at real risk of losing accreditation.
     
  7. DrYoda

    DrYoda Space Cowboy
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    1. To make the hospital money.
    2. To learn stuff.
     
  8. gujuDoc

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    Traditionally residency was 120 hours per week. Think about that for a minute.

    There are 168 hours in a week, 120 working means 48 aka 2 days of off time only. Why??? Because residents are basically like hospital servants. The resident needs training. The doc wants sleep and off time so uses the resident. Someone needs to look over the patient at all times and its not like nursing that there are shifts unless in EM. So who is easiest to use?? The residents because docs can use them since they want to learn. Some docs will argue that it is so they can learn as much as possible in the few years of residency before going on but I don't buy into that argument.

    They've changed it now to 80 hours per week but there are still places out there that do abuse the system.

    some residents on here have stated that way back in the day there were not as many patients as we see now and the idea of residency started with having the residents as in staff members for the hospital but were able to actually get sleep on call because there were far less patients. However, with each year patient basis is increasing and ever growing number of people needing medical care is increasing making it more tough to do such. Or at least that's what I got from a post from a long time ago.
     
  9. 236116

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    That, and they're sicker.
     
  10. gujuDoc

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    True that. More people with chronic illnesses and what not.
     
  11. njbmd

    njbmd Guest
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    I was one of those residents who trained before the 80-hour rule came in. Essentially, while I might have been in the hospital, I wasn't working break-neck for 120 hours. Many times, I would be working in the laparoscopic lab or journal reading or dictating charts. I was also operating and gaining valuable experience too. I had loads of "down-time" not at home but in the hospital. There was nothing "crazy" about my hours or my residency program.

    I actually hated the fact that some "arbitrary" hours-limit would mean that I couldn't scrub that trauma that just came in or that ruptured AAA that I had helped work up in the Emergency Department. In short, learning high quality medicine/surgery is not "shift-work". When the patient care is done, that's when I would leave not because I HAD to leave but because there was nothing else to do.

    Some programs abused the resident staff but mine was not in that category. We were presented with learning opportunities as opposed to scut. The learning was outstanding and the attendings were very supportive and teaching us at the same time. If I was in the hospital operating, my attending was there too. In short, we were not "slave labor" for the staff but people that were being taught the craft of excellent surgery.

    In surgery, you can't sit at home and study a book to learn your craft. You have to be operating. Those operations don't always end when your 80-hour work week ends either. At times, the days were long but I can't ever say that I was so tired that I needed to be "hauled out". We had ample rest and plenty of relaxation as needed both in the hospital and at home.

    When you look at hours, you need to look at how those hours are spent. You can have 40 hours were you are non-stop or 60 hours where you have plenty of time to learn and get your work completed. I choose the later.
     
  12. 236116

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    i got a kit from qvc that lets me do just that. :)
     
  13. Excelsius

    Excelsius Carpe Noctem
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    Are you attending a top school? Could tell how can a student find out which school takes good care of their students in terms scutwork during residency? Would it be correct to assume that top school usually = less scutwork?
     
  14. stooges287

    stooges287 Thread Killer
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    Doubt it, "top school" usually means lots of research $$$, and has nothing to do with clinical stuff. That being said, there are certainly schools among the top who take good care of their students.
     
  15. LizzyM

    LizzyM the evil queen of numbers
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    Keep in mind that the word resident is a hold over from the days (60-80 years ago) when new medical graduates were "in residence" at the hospital. Unless you were married (frowned upon), you lived in the hospital, took your meals there, sent your clothing through the hospital laundry and rarely sent foot outside of the buidling. You were a RESIDENT.

    One of the benefits was continuity of care, you were there all the time and saw the patient from admission to discharge. Residents did a lot that is no longer expected (all your own chemistries and CBC -- there was a little lab right on the ward), but the pace was often less hectic as patients were there for weeks and the convalenscent patients took up space but demanded little of the resident's time.
     
  16. diosa428

    diosa428 SDN Angel
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    No. I can think of at least a few "top" residency programs (esp in general surgery) that are malignant... but there are variations on that, ranging from lots of scut to being treated poorly, etc. The pros and cons of each program are different and you will find that the way residents are treated at each hospital will vary by department. In addition, some places that appear to have great learning opportunities will still have unhappy residents. Once you figure out what you want to specialize in, you will have to talk to a lot of people (your program director, attendings, other residents at various programs, etc) to figure out where you want to be.
     
  17. mbe36

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    So the treatment procedures become second nature.
     
  18. dannyboy1

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    sounds like you just lived in the hospital. thats great if you are single but, increasingly, residents are older and many have families.
     
  19. njbmd

    njbmd Guest
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    I am an attending (finished residency & fellowship). It's not the medical school that determines the amount of scut but the residency program. Fortunately for me, my program was great. When residency application time comes around, the amount of "scutwork" is a good question for the current residents.
     
  20. 236116

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    Well, duh, Tired. Get with the program. It's aaaaaaaaaaaaaaaaaaaaaaaaaall about lifestyle.

    The hell with that, I don't want to see my kids until they're 15. My husband -or the nanny if the babydaddy's in the field- can raise.
     
  21. eagledriver

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    Are there some specialties (i.e. Pediatrics, Family Practice, etc) that work normal hours during residency? Do they still have to do 80+/- hour weeks? 30 hour shifts?
     
  22. 236116

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    No, you still have to be a resident. Even in Peds and FP.

    That's why it's residency, and not shiftwork. If you don't want to put in the hours, and the blood, and tears, and sweat, and missing birthdays and anniversaries and going through wanting to quit and burn everything at least once, DO SOMETHING ELSE.
     
  23. :thumbup:

    This is all that really needs to be said. Case closed.
     
  24. 236116

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    you tell them, cheetos!
     
  25. 236116

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    Dammit, Tired. You can cuddle with little ones all you want. "Little" is the last adjective I'm looking to apply to want I want to cuddle.
     
  26. Slowpoke

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    That's what she said.
     
  27. 236116

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    :D

    [​IMG]
     
  28. T12

    T12
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    I completely agree. In fact, applications to universities/medical schools/residency programs should automatically screen out anyone that is married and/or has children. Hell, if they've been in a relationship longer than a year....ever....they're out. You know what? If they even kind of look like they might want a family someday, let 'em burn. A lonely doc is a good doc, eh?

    See how I took one thing you said that might have a slight flaw in logic and brewed up a really pissy reply?

    ....I learned how to do that by reading your posts on this thread. Thanks for the cool new tricks!
     
  29. 236116

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    Nice try, chickiepoo.

    But that's not what he said and there wasn't a flaw in the logic.
     
  30. Livingapparatus

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    it seems like people who want to work and be the best are a dying breed
     
  31. 8744

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    Just a few general comments:

    1. There is no "blood, sweat, or tears" involved in residency. It is mostly just a job punctuated by frequent intervals of being tired and annoyed. Because residents, even with the 80 hour week, work for peanuts there in very little incentive for the hospital to become administratively efficient and you will therefore find much of your time spent wrestling with paperwork and other clerical duties which have absolutely nothing to do with the practice of medicine. Conservatively I would say that 30 percent of my time as a resident is completely and totally wasted, frittered away by a system that relies on brainwashed zealots to martyr themselves for the faith to save the hospital some money.

    2. To say that people should be willing to sacrifice their families for the sake of This Mother****er is ridiculous. Times have changed, medicine has changed, and the people who go to medical school have changed. At one time in those far away Golden Days for which you yearn medical school was the exclusive domain of young single men. If we're going to turn back the clock let's turn it back all the way and exclude not only the married but women as well.

    3. Consider the 72-hour week. That would be six 12-hour days with one day off a week. There is not one profession on the face of the earth that you could not master, and this includes brain surgery and rocket science, if you devoted 72 hours a week for five years to it. The idea that it takes 120 hours a week for five years to master anything is ludicrous. Medicine and Surgery are complicated but they're not that complicated. The fact that your hospital wants you to work 120 hours a week is a function of their desire to pad the bottom line, the cheap-by-the-hour labor of a couple hundred residents providing a comfortable cushion against the necessity to cover their services with well-paid professionals who, despite your belief in the altruistic nature of medicine, do not want to work for nothing.

    4. "Continuity of Care" is a myth. Just another tool of The Man to try to shame you into keeping your mouth shut. On several services where I rotated as an intern and a second year, my job on call (every third day for three weeks with a week of night float) was to admit as many patients as was physically possible and I spent every night in the Emergency department doing history and physicals and orders for boring chest pains, abdominal pains, and vague psychosomatic complaints which are the bread and butter of modern medicine. It would not be unusual to admit fifteen patients a night and if you think there was any continuity of care you are mistaken. If we worked more hours the only difference would have been that we would have admitted even more patients. In other words, the extra hours would not be devoted to lovingly following a small group of interesting patients from admission to discharge but only in ramming more raw material into the patient processing mill that is the modern hospital.

    Do you get that times have changed? My older attendings tell me that back in the day, they may have had a large census of patients on their service but as most were stable, long-term boarders (more like hotel guests than patients) their days and call nights proceeded at a more leisurely pace; it being one thing to have a couple of admissions a night onto a sleepy service full of patients for whom nothing much is being done but quite another to deal with ten or twelve admission a night onto a service full of what would have been considered critically ill patients twenty years ago but who are now extremely routine. Even our routine patients, you understand, would have been considered impossibly complex by the previous generation of physicans who lived at a time, not that long ago, when people routinely died of the first serious medical problem they encountered instead of living to accumulate a catalog of them as they do today.

    Residents in the Good Old Days spun their own urine and made their own slides because they had nothing but time. Remember that in the 1950s and 1960S, the standard therapy for a heart attack was three weeks of bed rest in the hospital. Today you are home the day after your heart cath. Appendectomy? Back then you might spend a few days in the hospital before the operation and a week post-op. Today, oftentimes a same-day procedure. Not to mention that back then, a 97-year-old woman who stopped eating and began to choke on her food would have signaled the need for a priest and funeral home. Today we admit the lady, diagnose her with a stroke, ram a feeding tube into her demented body, support her in the ICU for a few days, send her to the floor for a few more days, and then place her contracted, eighty-pound body in a pre-death warehouse until the next time.

    5. Medicine is "shiftwork" nowadays whether you want to accept it or not. You will find yourself admitting patients at 3Am as if it were the middle of the day and there is, at least at academic medical centers, no respite from the onslaught of patients, all of whom believe their particular problem is an emergency that must be dealt with right away.
     
    #32 8744, Dec 16, 2008
    Last edited: Dec 16, 2008
  32. 8744

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    That's just you parroting The Man's propaganda. The only thing that is dying is willingness of people to sacrifice and suffer needlessly for a corrupt, highly inefficient system that is extremely resistant to change and zealously protects its right to abuse residents for the sake of the hospital's bottom line.

    And what's more, This Mother****er is so not worth the sacrifice and getting less worth it every year.
     
  33. Perrotfish

    Perrotfish Has an MD in Horribleness
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    Do you have any evidence that we're turning out the best doctors in the world? It seems like the UK is turning out a perfectly good quality of physician with reasonable residency hours and higher residency pay.
     
  34. tabrazinski

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    hooray! panda, will you marry me?
     
  35. bennnythejet

    bennnythejet once is nonce
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    a recent book by Malcolm Gladwell says that excellence at a complex task requires 10,000 hours of practice. according to panda bear, approximately 30% of his time as a resident was wasted on scut. that would mean, factoring in wasted time, a good residency program should total approximately 13,000 hours. a five year surgical residency program would achieve this with a 50-hour work week. you could shorten that to four years and 62.5 hours per week or three years and 83 hours per week to accomodate the longer hours it actually takes to turn over a surgical case. either way, if you buy the initial premise, the current system is a ridiculous waste of time.

    here's the literature: http://www.guardian.co.uk/books/2008/nov/15/malcolm-gladwell-outliers-extract
     
  36. bennnythejet

    bennnythejet once is nonce
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    edit: my math was wrong.

    14285 total hours.

    5 years, 54 hours a week
    4 years, 68 hours a week
    3 years, 91 hours a week.
     
  37. Perrotfish

    Perrotfish Has an MD in Horribleness
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    No offense, but when someone has an estimate that a power of 10, chances are they're not using the scientific method. Maybe this is the exception to the rule, though. 1/10,000 statistics that are a power of 10 are completely valid.
     
  38. diosa428

    diosa428 SDN Angel
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    Outliers was also noted to be a particularly poor book, with loads of Wikipedia references (hearsay, since I haven't read it, but with all the negative feedback, I'm not so inclined to use my limited time to do so).
     
  39. Livingapparatus

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    your right

    but I want to be the best.
     
  40. eagledriver

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    Of course I understand you still have to be a resident. But what about specialties that typically work 9-5? How do their residencies compare? Are, say, dermatologists working thru the weekend typically? Forgive my ignorance, that's why I'm here asking . . .
     
  41. GoldShadow

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    I want to be,
    the very best,
    that no one ever was.
    To admit them all,
    is my quest;
    To treat them is my cause!
    Medicine!

    [​IMG]
     
  42. poiuyt123

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    based on what I've read here, residents get one day off a week...correct? Do they get any break or time off during the year or do they continuously work 80 hour weeks throughout the entire year?
     
  43. vasca

    vasca En la era postpasambre
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    :laugh: Gotta learn it all! Would have been funnier if you used a Nurse Joy pic instead though. :smuggrin:

    ---

    As for the final question; if I, a mexican intern that is going to do internship in a public hospital (probably averaging 110 workweeks in a hospital flooded with patients) has the right to enjoy 2 10 day vacation periods and a certain amounts of sick leave days; I'm pretty sure residents that tend to have slightly better working hours get vacations too.

    The Ortho residents that worked a damn lot that I knew usually get 4 weeks off each year.
     
  44. Livingapparatus

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    kickin it old school of course
     
  45. Tiki

    Tiki Girl named after a Giant
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    Dermatology residents have to do an intern year first, either transitional or a preliminary medicine year. Either way, they will have months where they are working 80 hours. Once residency starts, they probably have better hours than most other specialities. But you can't assume you are going to match into dermatology. It is the toughest specialty to match in.

    And just for the record, I'm in a so-called "lifestyle" specialty (pathology) and while I never have to take overnight call (although I have been called in for 2 am frozen sections on transplants), on my surgical pathology months I hit 80 hours. My point in this? Don't go into medicine expecting 9-5 during residency, you'll be miserable.
     
  46. gujuDoc

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    YAY Panda came and posted. I was hoping you'd post panda bear MD!!! It was one of your old posts I alluded to in one of my posts wayy above yours.
     

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