is path really a lifestyle specialty?

[Chrismander]

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I know LADoc and others are always saying that path is a lifestyle specialty. is that just the career afterwards or is the residency chiller too? cause when you're on a surg path rotation, don't you pretty much have to keep surgeon-hours, minus the 30 hours of call? On scutwork.com it seems like a lot of the programs have 12-14 hour days--are these the outliers, or is this what's considered "lifestyle" these days?

 

[deschutes]

Yes. Just remember, it could always be worse.

 

[LADoc00]

I know LADoc and others are always saying that path is a lifestyle specialty. is that just the career afterwards or is the residency chiller too? cause when you're on a surg path rotation, don't you pretty much have to keep surgeon-hours, minus the 30 hours of call? On scutwork.com it seems like a lot of the programs have 12-14 hour days--are these the outliers, or is this what's considered "lifestyle" these days?

Come ON, look at me. I have what? 10+ posts/day. I got a nice lil Rum and pineapple juice next to me too. Going to hit up the steam room soon, probably jog a bit. Then grill some ribs tonight. Drink some beer...rough really rough.

 

[deschutes]

Come ON, look at me. I have what? 10+ posts/day. I got a nice lil Rum and pineapple juice next to me too. Going to hit up the steam room soon, probably jog a bit. Then grill some ribs tonight. Drink some beer...rough really rough.

...while his residents skip dinner and continue to preview late into the night for tomorrow's AM signout.

Oh wait - you're in private practice.

 

[DruidDoc]

To be honest, if I could work 12 hrs a day and have most weekends off, then yes, I would consider that to be a good lifestyle for a physician. And yes it could be much much much worse.

 

[CameronFrye]

I know LADoc and others are always saying that path is a lifestyle specialty. is that just the career afterwards or is the residency chiller too? cause when you're on a surg path rotation, don't you pretty much have to keep surgeon-hours, minus the 30 hours of call? On scutwork.com it seems like a lot of the programs have 12-14 hour days--are these the outliers, or is this what's considered "lifestyle" these days?

For most practicing pathologists, I think you can call it a lifestyle specialty.

As for residency, it depends on your perspective. As a new intern on surg path, I'm currently working 12-15 hours a day, but I take call from home (I've gotten paged at home, but I haven't had to come back in for a frozen yet, usually I just end up staying late until all the OR's are clear) and my weekends have been pretty free so far. Once you are more experienced and more efficient, your hours get even shorter. The upper levels have much easier grossing days and preview nights than I do.

And of course the above only refers to surg path (which is only 5 months of my first year). When I was on cytology, I worked 40 hours a week. When on a slow week of autopsy, I struggled to hit 40 (rare, but it did happen).

 

[juddson]

...while his residents skip dinner and continue to preview late into the night for tomorrow's AM signout.

Oh wait - you're in private practice.

Wait, is LADoc in private practice? I thought he was a resident.

Judd

 

[deschutes]

I only know what he tells on here - and from that I understood that he wasn't a resident. I might be wrong.

 

[trent05]

LADOC is in private practice. From what I gather he is somewhere in the middle of nowhere making sick bank and apparently not clocking too many hours 😎 .

 

[yaah]

Schedules vary greatly. When I am on surg path I can work 14+ hour days on occasion. That is uncommon though for me, although some people do get there - there isn't really a reason to work that long if you are efficient and budget your time well. Even on busy surg path days you usually don't have to work much more than 12 hours.

CP rotations are 8-5pm at most.

 

[pathstudent]

Schedules vary greatly. When I am on surg path I can work 14+ hour days on occasion.

.

You should be careful not to work over 14 hours. The ACGME can put your program on probation/close your program for doing that. You put your program at risk by doing so. They take that stuff very seriously these days. Something like almost 90 training programs have been shut down do to work-hour violations (so I heard on NPR a couple weeks ago).

We are never to work over 14 hours per day (all residents are required to have 10 hours off duty between shifts) and never more than 80 hours per week.

 

[yaah]

You can work more than 14 hours and then come in later the next day.

 

[pathstudent]

You can work more than 14 hours and then come in later the next day.

I'm not sure about that.

What if there are conferences the next morning? Are you supposed to skip them? Does your program document that you are coming in later the next day?

Someone affiliated with the ACGME could be browsing this site and see that residents at U Mich Pathology are claiming to work more than 14 hours a day. I would be careful broadcasting that. From what I heard on NPR, they are really cracking down right now. You don't want to get your program in trouble. All in all we have it really chill in path. For every month where you might work close to 80 hours a week, there is another month where you closer to 30 (unless you are AP only).

 

[yaah]

Like I said, we are told to come in late the next day, and people do, if it means missing conferences, so be it. If you are here until 10pm, don't come in until 8am. If you are here until midnight, don't come in until 10am. It isn't that hard to understand nor is it hard to implement. Someone can cover if necessary.

Personally, I only had one shift over 14 hours, and that was when I had the next day off anyway. Like I said, I am rarely here over 12 hours.

 

[CameronFrye]

I find the 10 hour off rule to be completely ridiculous. Residents are on call 30 hours at a time all the time, but I can't work 15 hours, go home and sleep for 7 hours, and then go back to the hospital? Kind of absurd.

 

[b&ierstiefel]

I find the 10 hour off rule to be completely ridiculous. Residents are on call 30 hours at a time all the time, but I can't work 15 hours, go home and sleep for 7 hours, and then go back to the hospital? Kind of absurd.

I totally agree. I really didn't understand that discrepancy...residents in medicine and surgery can stay overnight in the hospital (and in-house call counts towards work hours) and that's not a violation?

The 80 hours/week is averaged over a 4 week period.

The 10 hour off rule should be also averaged over a finite period of time (e.g., every 7 days) instead of having one instance of working more than 14 hours in a day counting as a strike or a violation.

Look, some days will be long and some days will be easy. You really can't predict what a certain day will bring. But it should even out! (cuz if it doesn't, then you got a problem). One day might be really hard and you have 8 hours off between shifts...but the next day could be better (i.e., you work 8-5 pm and then you have 13 hours between shifts).

Yes, all these rules can be quite absurd when they don't allow for flexibility. But overall, I certainly think the work hour rules are a boon to residents.

That being said, I haven't violated any work hour rules since early first year when I logged in 81 or 82 hours but that's because I was new and slow. And that only happened once. And I usually get out between 5-8 pm on any given day.

 

[Cabbage Head]

I find the 10 hour off rule to be completely ridiculous. Residents are on call 30 hours at a time all the time, but I can't work 15 hours, go home and sleep for 7 hours, and then go back to the hospital? Kind of absurd.

They shouldn't be doing this, according to the work hour rules. If they are on for 30 hours, that would mean that they are getting out in the afternoon at some point. Unless they are coming back in at midnight, they are going to have more than 10 hours off.

So, technically, if you stayed in the hospital previewing all night, then stayed all the next day and left at 5, that wouldn't violate the work hours rule. As long as "previewing" is considered "duty", which I'm not really sure about.

Don't let any program directors read that.

 

[djmd]

They shouldn't be doing this, according to the work hour rules. If they are on for 30 hours, that would mean that they are getting out in the afternoon at some point. Unless they are coming back in at midnight, they are going to have more than 10 hours off.

So, technically, if you stayed in the hospital previewing all night, then stayed all the next day and left at 5, that wouldn't violate the work hours rule. As long as "previewing" is considered "duty", which I'm not really sure about.

Don't let any program directors read that.

The 10 hours off and 30 hours in house included research or any other in house hospital duties, so previewing would count against the 30, and yes in theory overnight previewing would be legal provided you dont exceed 30hours which means you would have to leave by 1-2 pm depending on what time you started the day before.

That would be a crazy way of running pathology.

I have heard plenty ot pathologist warn against looking at slides when you are tired, so not much benefit to that system.

 

[LADoc00]

I want to dispel some myths: Residency hours does not translate into how many hours you may work in the real world. Almost ANY speciality can be lifestyle, if you are peds doc working mega-shifts in residency and fellowship, you can easily find a gig that is 20 hours/week once you get out.


This may sound totally CrAzY BUT, once you leave residency and get a real job and have a family, you wanna work <40 hours a week, trust me. I dont care if you are the JP Morgan of medicine while in training with ambitions to take over the world, you mellow ALOT once you hit your 30s.

Although income and job satisfication are important, LIFESTYLE is the end goal of everyone, everywhere. Even your hardcore orthopod buddy who does crank to stay awake and bangs strippers after a night of binge drinking dreams of the day when he will wake up in his bed with his wife, 2 kids and goes off to his 30 hour work week.

The whole Cats in the Cradle thing!

My point is that dont pick path because of the la dolce vita lifestyle, pick something you love to do and do it with la dolce vita-style!

 

[DocKodak]

I'm currently a 4th year. Did a few years of a clinical residency prior to path. before I pulled my head out and got a clue. Back then we didn't have the residency work hour limitations. It SUCKED.

Yes, hours can be bad on preview day (been up till 3:00 a.m.), but beats the heck out of seeing patients anyday in my book. Although I dislike the fact that in order to have everything previewed and dictated, I am forced to work well beyond the hour that I mentally hit the wall. I will never sign out cases in such a state when I'm out of residency.

What is interesting, and opposite of most clinical residencies, is that hours spent on surg. path. rotations are worse for 3rd-4th years than 1st-2nd years. I'm a heck of a lot more efficient now but there's the pressure not to miss something or misdiagnose, whereas in the earlier years with a tough case you could just throw up your hands and write "??????" on the sheet of paper.

On an SP signout, our program caps us at 50 cases - but one case can have parts A-M or worse potentially. How about you from other programs - how many cases are you seeing on a signout?

 

[uhoh!]

Our PD made it really clear that the work-hours strictly mean the hours we spend doing assigned work, not the studying we do, which, technically, is on our own time.

For me as a first year, though I'm quite slow at grossing & dictating, I usually get off latest by 8-9pm on Surg. Our morning conferences begin at 8am, so its 10 off. It must be really difficult to crack the 80 hours if you have almost every weekend off. Though I like to be the early bird, and get in by 7am, to do some reading/ease into the day, that time does not count in our work-hours as I'm not doing any assigned work...Atleast it wasn't overtly assigned, though we are expected to read up and know about our cases..

Is it ok to gloss over those occasional days where we might go a bit over the 10-hours-between-duty? I haven't gone over yet, but I imagine it must be a whole lot easier to make it exactly 10 hours off (to get the point across that you are working your butt off) rather than face the ire of the PD/ACGME...

 

[DarksideAllstar]

What I dont get and that which hasn't been addressed is, how will ANYONE other than yourself know what time you come in/or leave? Its not like you are punching in and out for chrissakes. Stay late if you want or leave early and make it to happy hour (now that's what I'm talkin' bout).

 

[djmd]

What I dont get and that which hasn't been addressed is, how will ANYONE other than yourself know what time you come in/or leave? Its not like you are punching in and out for chrissakes. Stay late if you want or leave early and make it to happy hour (now that's what I'm talkin' bout).

That is exactly the direction programs are going... they want residents to punch in and punch out so the have accurate proof of the lack of violations.

 

[pathstudent]

That is exactly the direction programs are going... they want residents to punch in and punch out so the have accurate proof of the lack of violations.

Right. THe ACGME isn't just taking the PDs word for it that residents don't work 80 hours a week or 14+hours a day. They want documentation of work hours.

If your program isn't keeping track now of when residents come and go, it will be soon enough.

 

[yaah]

We don't punch in and out but we have to log in every week to a local site and enter in our duty hours for each day - i.e. when we came in, when we left. Then it adds them all up, does calculations, and if you have any violations it asks you to explain them or account for them. It only came up once with a violation on me, and that was a computer error because I worked 55 hours that week and it said I worked 85. My explanation was "This adds up to 55 hours."

 

[SLUsagar]

We don't punch in and out but we have to log in every week to a local site and enter in our duty hours for each day - i.e. when we came in, when we left. Then it adds them all up, does calculations, and if you have any violations it asks you to explain them or account for them. It only came up once with a violation on me, and that was a computer error because I worked 55 hours that week and it said I worked 85. My explanation was "This adds up to 55 hours."

regarding hours, I've been wondering if anyone has truly gotten to 80 hrs/wk, and excluding staying late and just reading up on crap unrelated to cases (i.e. NOT a "previewing" day/evening)? I've had to come in both days of weekends, and have come close but not broken 80...although I often avg over 70.

 

[djmd]

regarding hours, I've been wondering if anyone has truly gotten to 80 hrs/wk, and excluding staying late and just reading up on crap unrelated to cases (i.e. NOT a "previewing" day/evening)? I've had to come in both days of weekends, and have come close but not broken 80...although I often avg over 70.

I heard that U Pitt pathology got a violation or was in trouble for routinely exceeding the 80hr/week rule. But that was second hand and a number of years ago.

 

[DarksideAllstar]

Sorry about the seemingly ******ed statement (in retrospect) I made. Last year I never saw any residents putting hours in a computer and such, when did this start happening? this academic year?

 

[djmd]

Sorry about the seemingly ******ed statement (in retrospect) I made. Last year I never saw any residents putting hours in a computer and such, when did this start happening? this academic year?

Don't worry about it.
Different hospitals are going different routes with it. And most aren't there yet, but they are all headed towards daily reporting of hours (if not swiping in and out). I just know about it from some committees and discussions of upcoming tracking about ACGME time rules.

 

[cytoborg]

Sorry about the seemingly ******ed statement (in retrospect) I made. Last year I never saw any residents putting hours in a computer and such, when did this start happening? this academic year?

One dept I've seen has been logging hours for a few years now, since before the 80-hr workweek took effect. We started recently.

It's an honor system where you write down what time you came in and what time you left, for 1 week out of the month. So it primarily addresses hours per week, and the 10-hr rule - it doesn't show how many days off you're getting per month (supposed to average 1 in 7, over 4 wks).

I've only reached 80 a few times...it's definitely not as big an issue in path without q3 in-house call. But in my 1st year I had to come in both days of the weekend several times, which lead to working quite a few days in a row without any day off. That burns me out fast. I learned to bust my ass on Saturdays so I can get a full day off on Sunday.

Overall we have it pretty sweet in path, though. The 10 hour rule is utterly ridiculous in our situation - it was designed for residents working 30 hrs in a row (and if it weren't for the rule, would have to work much longer than that). If I work 12, 14, even 18 hrs, I'm still on a normal day/night routine, get to sleep in my own bed, and know what day of the week it is. (On the other hand, when we really could use the 10 hour rule, say after a busy night of call when we have to come back to the hospital for several frozen sections in the middle of the night and get no sleep, then we have to work an entire full day the next day - for some reason that doesn't count. Bah.)