Is Residency really that bad?

[Ibuprofen]

I keep hearing all these horror stories about residency and no free time and blah blah blah. But I know this is a dumb question...but is it really that bad?

I know you work a lot, and have 24 hour shifts and ect, but if you had a shift like that how much time would you have before your next shift?

Does it matter to what residency you go to too? Some might work you harder than others?

I don't know if it's 50% work and 50% studying for if it's all just work-studying...somebody enlighten me please?

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[DrBowtie]

It varies from residency to residency, with surgery being the worst and outpatient heavy specialties like Family Medicine being the best.

You can technically work up to 30 consecutive hours (Will be 28 with the new rules as a 2nd year resident). Basically for surgery 5-6 AM through 10-noon the following day then be back at 5-6 the next morning so maybe 16 hours off in between.

It is almost 100% work. The only dedicated study time is for resident conferences which are usually either early in the morning or noon, lasting ~1 hr. The rest of the studying is done on your very little own time.

 

[metallo]

I keep hearing all these horror stories about residency and no free time and blah blah blah. But I know this is a dumb question...but is it really that bad?

I know you work a lot, and have 24 hour shifts and ect, but if you had a shift like that how much time would you have before your next shift?

Does it matter to what residency you go to too? Some might work you harder than others?

I don't know if it's 50% work and 50% studying for if it's all just work-studying...somebody enlighten me please?

Just so you know, the current maximum for a shift per the ACGME is 30 hours. This is changing on July 1, so the new max will be 16 hours for interns (essentially meaning no overnight shifts, unless you're on a night float rotation) and, I believe, 28 hours for upper level residents. The maximum number of hours that can be worked on average during a week is 80 hours. Depending on the specialty and program you match into, you could be at or near that maximum. There are very few specialties where you would be anywhere near a standard 40 hour work week -- dermatology is probably the closest, but not just anybody can match into it (most people are the top 1-2% of med students in terms of grades and board scores). From what I know (I'm still a fourth-year med student), the majority of residency is work, and particularly during intern year, you generally have very little time to read. Assuming you go to a halfway decent residency program, you will have didactic lectures and conferences to help you in this regard.

Don't worry about the hours -- if you like medicine enough, you should go for it. If you're just going into it for the money, it probably isn't worth it, although the hour restrictions are likely to be even lower by the time you would be entering residency.

 

[fahimaz7]

It's more suck than most of of can comprehend, until we find ourselves facing it on July 1st.

 

[45408]

Yes.

 

[docB]

Not anymore. The work hour restrictions mean you really shouldn't worry about the horror stories you hear from docs who trained under the old rules (i.e no rules).

 

[Winged Scapula]

Not anymore. The work hour restrictions mean you really shouldn't worry about the horror stories you hear from docs who trained under the old rules (i.e no rules).

Of course you have us old docs who fret about the education these young'uns are getting and will therefore, spend hours torturing the kids with stories about the old days and complaining about the quality of residents these days.

That can be very painful. 😀

 

[Law2Doc]

I keep hearing all these horror stories about residency and no free time and blah blah blah. But I know this is a dumb question...but is it really that bad?

I know you work a lot, and have 24 hour shifts and ect, but if you had a shift like that how much time would you have before your next shift?

Does it matter to what residency you go to too? Some might work you harder than others?

I don't know if it's 50% work and 50% studying for if it's all just work-studying...somebody enlighten me please?

I think you don't want to equate long hours with "horror stories". A lot of those hours can be spent doing pretty cool things, learning a lot, and gathering experiences 99.999% of the US population will never get to experience.

24 hours isn't the maximum stretch most current residents have done by any means. The current years rules limited residents to 30 hours in a row (and even then not every program is in strict compliance - I certainly didn't get out earlier than 30 hours in most of those shifts), and a few years earlier that that, there was no limit. Now they will limit interns to 16 hours in a row, which is pretty short by comparison, although it probably means longer stretches of night float at a lot of programs, and probably means the second year residents are going to get hit with the brunt of long houred shifts from here on out.

Under the new rules, you get at least 8-10 hours out of the hospital between shifts. So theoretically you might be on for up to 16 hours and off for as little as 8 each 24 hour day, with a total of up to 80 hours/week averaged over a month. In reality, expect to work on average 6 days a week with some of those days longer than others.

Residency is NOT 50% studying. It's work, with as much studying as you can squeezed in. You will have a number of lecture hours each week, in the form of morning meetings, grand rounds, lunchtime meetings. And you will have periodic tests -- inservice exams, etc. And presentations. But 90% of your time at the hospital during residency will be spent doing work. Patient care, scut, procedures, etc. So at the end of your day, you may still have patients to read up on, presentations to prepare, and may try to squeeze in studying for the in-service exam or Step 3, etc. But this is time on top of the 80 hours/week you are spending at the hospital, unless you are lucky enough to have a lot of down time. So yeah, if you are at a program which averages close to the 80 hour mark/week, and you have a decent amount of "homework" you are doing on top of that, pretty much all you are going to be doing is working and sleeping. For a lot of folks, intern year is like that. It's not necessarily horrible, because the work is kind of cool, the colleagues are kind of cool and in the same boat, and time flies really really fast when you are running 100 MPH all the time from 5am on every day.

And yes, some residencies work you harder than others. Surgery is probably the most time demanding, followed closely by things like IM and OB. Fields like derm, path, psych, rads, EM, neuro, rad onc are going to have much more manageable hours during residency, although some of them are "advanced" programs and require you to do an intern year in IM or surgery first.

But don't get too frightened. Everyone in residency is there because they chose a challenging path, and pretty much everyone knew what they were getting into. It's a lot of hours, but hopefully a lot of it is educational and interesting. There's really no good way to get the training you need to be a physician other than the dive in and spend a lot of hours learning your trade. Makes your outside life hard to maintain. Bills pile up, phone calls go unreturned. But that's still a far cry from horror.

 

[Geekchick921]

Of course you have us old docs who fret about the education these young'uns are getting and will therefore, spend hours torturing the kids with stories about the old days and complaining about the quality of residents these days.

That can be very painful. 😀

Did you have to walk 3 miles to and from the hospital?

In a foot of snow?

Uphill?

Both ways?

😉

 

[Terpskins99]

And yes, some residencies work you harder than others. Surgery is probably the most time demanding, followed closely by things like IM and OB. Fields like derm, path, psych, rads, EM, neuro, rad onc are going to have much more manageable hours during residency, although some of them are "advanced" programs and require you to do an intern year in IM or surgery first.

Umm, not quite.

PGY2 neurology (aka first year neurology resident) = medicine internship on steroids. Each month is effectively a combined ICU/inpatient ward/consult service all rolled in one. Our calls (each of which are 30 hour in-house shifts) can get insane since one person is handling all consults, all admissions (including stroke codes; our equivalent of a rapid response) and routine inpatient night-float responsibilities. In no way would I consider it less demanding than PGY2 medicine. Surgery/OB, yes certainly. But not medicine.

Did you have to walk 3 miles to and from the hospital?

In a foot of snow?

Uphill?

Both ways?

😉

Probably not, but ask Winged if she's ever eclipsed the "120 work hours in one week" mark. Yikes.

 

[avatarftw]

...

 

[Winged Scapula]

Did you have to walk 3 miles to and from the hospital?

In a foot of snow?

Uphill?

Both ways?

😉

I lived 7 miles from the hospital.

Never walked the whole way, but once, after a particularly horrible snow and I couldn't get my car out, I started walking to the hospital (after my Chief resident informed me HE had walked 3 miles to get there) but was blessedly picked up by a 4 wheel drive from the hospital.

Probably not, but ask Winged if she's ever eclipsed the "120 work hours in one week" mark. Yikes.

The OP probably doesn't want to know but yes. More than once. Those q2s add up pretty fast as does staying 3 days straight as Chief on Vascular with loads of Trauma.

 

[Cornell IM]

I keep hearing all these horror stories about residency and no free time and blah blah blah. But I know this is a dumb question...but is it really that bad?

I know you work a lot, and have 24 hour shifts and ect, but if you had a shift like that how much time would you have before your next shift?

Does it matter to what residency you go to too? Some might work you harder than others?

I don't know if it's 50% work and 50% studying for if it's all just work-studying...somebody enlighten me please?

Residency is hard. 80 hour work weeks with one day off per eek averaged over a month (that means I can work 12 days straight, but get two days off in seven sometimes). There's no time you study, but you attend conferences and 'study on the job'. It's an intense period of training, but it's only for a short time. My advice: take one day at a time, and enjoy the journey rather than the destination. I am four months away from finishing residency. It seems like it was yesterday when I was 15 and worrying about whether I could handle this kind of stress one day. Could luck!

 

[Venko]

I loved my EM residency! I think the experience is a combination of the people you are with, the fit of the specialty to you, and your overall outlook on the career. Those that are surrounded with great colleagues, in a specialty that you love, and in general view what you do as fun and not work will really love the experience of residency.

To be honest, if it was an additional two or three years i wouldn't mind....

TL

 

[Doctor Positive]

It's all really up to you and your attitude going into all of it and I say that for a couple of reasons. Sometimes I get the feeling that some just convince themselves that Residency is going to be hell on earth and this decision ultimately ruins what could have been an enjoyable few years, if they gave it a chance. Come in with an open and positive mind? No it won't give your colleagues an eclipse of a heart per say but it could still make a hellish residency into at least a tolerable one. Lastly? Take a look at all the attending physicians and chiefs on this planet right this second. If Residency was impossible or absolute hell on earth, why would've any of them kept on going? If you love your job, you shouldn't hate Residency! You should love it, you're on your way to an attending and you're getting to fulfill your dream. So if you truly adore the profession known as medicine and you have a mind with open arms stuffed inside that noggin of yours, it won't be half as bad as people describe!

 

[docB]

Not anymore. The work hour restrictions mean you really shouldn't worry about the horror stories you hear from docs who trained under the old rules (i.e no rules).

Of course you have us old docs who fret about the education these young'uns are getting and will therefore, spend hours torturing the kids with stories about the old days and complaining about the quality of residents these days.

That can be very painful. 😀

See, I went out of my way not to go there and you called me out.

Yeah, I can't even conceive of how a residency works with hour restrictions. I'm sure it's even harder coming from a surgical perspective. I know I spend a lot of my teaching time saying things like "If you were going to be here in a few hours when this patient's work gets done these are the issues we would be considering..."

 

[MossPoh]

See, I went out of my way not to go there and you called me out.

Yeah, I can't even conceive of how a residency works with hour restrictions. I'm sure it's even harder coming from a surgical perspective. I know I spend a lot of my teaching time saying things like "If you were going to be here in a few hours when this patient's work gets done these are the issues we would be considering..."

I'm pretty sure every generation plays the "you have it so much easier than we did" card with the next generation. For the most part, it is true. I remember my dad talking about how residents have it so much easier now before the work hour restrictions were even in place. He did residency in the mid 60s and made 200-300 dollars a month while living in NYC. He talked about how he had is wife at the time bring my brother and sister to the hospital so he could see them that week every now and then.

I love looking back at how much stuff has changed in a 50 year span even.

 

[Law2Doc]

I'm pretty sure every generation plays the "you have it so much easier than we did" card with the next generation. For the most part, it is true. I remember my dad talking about how residents have it so much easier now before the work hour restrictions were even in place. He did residency in the mid 60s and made 200-300 dollars a month while living in NYC. He talked about how he had is wife at the time bring my brother and sister to the hospital so he could see them that week every now and then.

I love looking back at how much stuff has changed in a 50 year span even.

Well it's one thing to say it as a component of faulty memory, and it's another to say it based on the fact that there have been two very real hour restriction rule changes in the last decade. The folks in residency today DO have it easier than the folks a decade ago, in terms of hours based simply on the fact that there are rules in place. The folks doing internship next year will have it easier than the folks doing internship now (although folks will likely get more of a beat down in their second/third years thanks to the new rules). In terms of money, residents do a lot better now than just a decade ago. The salaries have jumped from about $30k average to around $45k (even higher in high cost of living places). And this is an increase at the time the hours were decreased so it's a nice bump.

Internship/residency is still a lot of hours, and is meant to be, and needs to be. You otherwise have a "license to kill" in most specialties. (Forget James Bond -- inexperienced residents kill far more people each July). You go through the gruel because it's really the best way we've come up with to give you a lot of experience in a reasonably short period of time. There may be better ways to tweak things, but this is the tried and true method -- you live in the hospital (which is why you are called a "resident") for a few years, and then you will be comparatively ready to go out and practice.

 

[45408]

The OP probably doesn't want to know but yes. More than once. Those q2s add up pretty fast as does staying 3 days straight as Chief on Vascular with loads of Trauma.

Here's what I want to know - if so many people were on Q2, doesn't that mean a lot more people were on call every night? We're Q4 now, so that means twice as many people must have been on call, doesn't it?

 

[Winged Scapula]

Here's what I want to know - if so many people were on Q2, doesn't that mean a lot more people were on call every night? We're Q4 now, so that means twice as many people must have been on call, doesn't it?

On some rotations yes but others were simply restructed.

For example, let's say you were the resident on Vascular Surgery and taking q2 call. When you could no longer take q2 in house, they had the Chief take q2 home call (but you were expected to come in for admits and other problems, regardless of who was in house).

On CT Surgery, they hired a PA who would take call in house with the fellow so the residents went to q3. No change in number of residents but there was one more person in the call pool.

Other rotations simply took residents from the lab and had them fill in the call schedule.

In general what happened, at least at my program, was that there was more cross-coverage and fewer residents in house every night. Cross coverage is very painful, IMHO.

 

[45408]

I wouldn't worry if you match into a residency in the US, even the most malignant ones can't be even close to an average residency in Mexico.

There's tons of slots down here where you will still see the inhumane Q1 call where the night of your post call will probably let you go home at around 8 pm. If you showed up the morning of your call at let's say 6 am, you would have worked a whopping total of 38 hours!

You do realize that if you're Q1 call, every day is post-call, but you still don't go home, right?

 

[Maybeknot]

One thing that does bother me about residency is that "one day off a week" means any 24-hour stretch. So, if I round on my patients on Saturday morning from 6-9am, my "weekend" is until Sunday when I round from 9am-12pm.

Other than that.... residency is not nearly the nightmare I had imagined when I started med school. It's a lot of learning while doing, a lot of doing while learning nothing, but there are definitely bright spots. Live for those bright spots.

 

[MedicineMan99]

No one likes to admit it but I just would like to point out that I have seen residencies, first hand, that are super easy on the hours. For instance, I personally know residents at US programs in Family Medicine or IM who work about 50 hours per week intern year. They work about a weekend (Saturday or Sunday) every 2 months and no overnights except for nightfloat for 4 weeks. They work less than 40 hours per week 2nd and 3rd years. This certainly is not the majority of residencies but they DO exist.

It is possible to go to an easy residency and get bare minimum training. Not ethical in my opinion, but it is possible to do.

 

[Law2Doc]

No one likes to admit it but I just would like to point out that I have seen residencies, first hand, that are super easy on the hours. For instance, I personally know residents at US programs in Family Medicine or IM who work about 50 hours per week intern year. They work about a weekend (Saturday or Sunday) every 2 months and no overnights except for nightfloat for 4 weeks. They work less than 40 hours per week 2nd and 3rd years. This certainly is not the majority of residencies but they DO exist.

It is possible to go to an easy residency and get bare minimum training. Not ethical in my opinion, but it is possible to do.

There are plenty of people who work 50 hours/week with infrequent call during specific rotations in those fields. Certainly outpatient stuff can be super cush. But you have to realize that there are a lot of inpatient and ICU months with the other extreme in there as well. Don't get fooled by the resident's on those rotations who seem to be living life -- it's just a respite from the more intense things. You aren't going to find many folks who get away with this for a whole year or even most of the year.

 

[Law2Doc]

One thing that does bother me about residency is that "one day off a week" means any 24-hour stretch. So, if I round on my patients on Saturday morning from 6-9am, my "weekend" is until Sunday when I round from 9am-12pm.
...

Just to clarify for the non-residents on here, the rule is you need to get 4 days off a month, not one a week. You can definitely go a couple of weeks without a day off. Most programs give those days on weekends, but not necessarily. The traditional model is you get one black weekend (no weekend days off), one golden weekend (both weekend days off) and two split weekends each month. But I've seen plenty of places that work weekdays into the mix such that you might never get a weekend. In a way that's fine, because you can get errands done during the week that you couldn't do on the weekends. But it makes social lives harder since family/friends tend to be at work during the week.

 

[MedicineMan99]

There are plenty of people who work 50 hours/week with infrequent call during specific rotations in those fields. Certainly outpatient stuff can be super cush. But you have to realize that there are a lot of inpatient and ICU months with the other extreme in there as well. Don't get fooled by the resident's on those rotations who seem to be living life -- it's just a respite from the more intense things. You aren't going to find many folks who get away with this for a whole year or even most of the year.

I beg to differ. There are some residencies at small community hospitals where their idea of an ICU rotation is a 4 bed ICU with no patients. Whenever a patient is complicated, they are shipped off immediately to another hospital. There are residencies that are just plain pathetic in terms of what experience they offer residents. There are residencies where you do not work longer than 50 hours/week for the entire 3 years. I know because I've rotated through them as a student where all the residents on outpatient as well as inpatient rotations all had the same cush experience. In fact, they looked forward to the weeks they only had to work 25 hours. They thought working 50 hours a week was murder on some rotations.

 

[45408]

Just to clarify for the non-residents on here, the rule is you need to get 4 days off a month, not one a week. You can definitely go a couple of weeks without a day off. Most programs give those days on weekends, but not necessarily. The traditional model is you get one black weekend (no weekend days off), one golden weekend (both weekend days off) and two split weekends each month. But I've seen plenty of places that work weekdays into the mix such that you might never get a weekend. In a way that's fine, because you can get errands done during the week that you couldn't do on the weekends. But it makes social lives harder since family/friends tend to be at work during the week.

I actually have to take a weekday off this month because I got put on call three weekends in a row, and I'd violate the 4 days in 4 weeks rule.

In med school, I did a medicine sub-I at the VA that picked random days throughout the month for people's days off. It was usually a weekday for me.

I beg to differ. There are some residencies at small community hospitals where their idea of an ICU rotation is a 4 bed ICU with no patients. Whenever a patient is complicated, they are shipped off immediately to another hospital. There are residencies that are just plain pathetic in terms of what experience they offer residents. There are residencies where you do not work longer than 50 hours/week for the entire 3 years. I know because I've rotated through them as a student where all the residents on outpatient as well as inpatient rotations all had the same cush experience. In fact, they looked forward to the weeks they only had to work 25 hours. They thought working 50 hours a week was murder on some rotations.

I would be terrified that I would hit the "real world" and have no idea what I was doing. I'm pretty confident that by the end of my residency, I will have dealt with patients who are about as sick as they get, at all hours of the night.

 

[Law2Doc]

...There are residencies that are just plain pathetic in terms of what experience they offer residents....

I promise you this comes back to bite any such people.

I also would suggest that what you perceived as a med student and the reality as a resident are often not the same. Not saying that's the story in your case, just that there's a lot of downplay of how bad the hours are when the med students are around. There's a ton of time when the med students are not in the hospital and they don't really appreciate that when you tell them to go ahead and take off at the end of a 12 hour day, you aren't heading out the door right after them.

 

[Maybeknot]

Just to clarify for the non-residents on here, the rule is you need to get 4 days off a month, not one a week. You can definitely go a couple of weeks without a day off. Most programs give those days on weekends, but not necessarily. The traditional model is you get one black weekend (no weekend days off), one golden weekend (both weekend days off) and two split weekends each month. But I've seen plenty of places that work weekdays into the mix such that you might never get a weekend. In a way that's fine, because you can get errands done during the week that you couldn't do on the weekends. But it makes social lives harder since family/friends tend to be at work during the week.

This is true, although in New York State, the rule is 1 day off per week. If you're on a black weekend (call on Saturday), then you leave Sunday post-call at 9 and you don't report on Monday until 9am... hence, your day off.

Rules differ for home call... and are exceedingly vague.

 

[MedicineMan99]

I promise you this comes back to bite any such people.

I also would suggest that what you perceived as a med student and the reality as a resident are often not the same. Not saying that's the story in your case, just that there's a lot of downplay of how bad the hours are when the med students are around. There's a ton of time when the med students are not in the hospital and they don't really appreciate that when you tell them to go ahead and take off at the end of a 12 hour day, you aren't heading out the door right after them.

Oh I know the residents are not doing themselves any favors. I was just stating that those residencies do exist. Not all residencies are hard.

I'm sorry but this was not a perception issue. At the particular program I am talking about, I was good friends with many of the residents (all years). I hung out with them at the hospital and outside the hospital. I knew their schedules. It was cush. Even when they were in the hospital they hardly did anything. Maybe signing off on a few H&Ps and SOAP notes the students did and relaying a few orders the attending called in. They hardly even had to come up with an assessment or plan by themselves. I saw it myself and they bragged about it endlessly when we were outside of the hospital. (Many of them justified it by saying it was an "independent residency" that gave them plenty of time to read for themselves). Of course this is the extreme, extreme minority of residencies. But the fact is that these residencies do exist in America. Residency can be easy.

 

[Signifier]

The question is whether such time and brutality is truly required to produce good physicians. Doctors trained under these conditions/expectations of course will usually defend them. So it becomes a difficult, slowly changing system defined more by tradition than best practice... I'd be interested to see large scale studies of physician effectiveness versus "residency intensity" or something like that. I bet a lot of old school docs would claim that the relationship is monotonically increasing 🙂

 

[Chirurgia magna]

Interns only work 16 hours? Wow, that's C-U-S-H. I personally think it's too short, 24 hours sounds more reasonable. Guess the philosophy of American programs is to not tire their resident too much that they are incapable of learning. If only things were slightly close to that nice in Mexico. We put up with it because we're used to being treated horribly bad and accept our ill fate.

You realize that working 16 hours ever day means you never get a chance to see your kids, wife/husband, family, never get a chance to see your doctor or dentist, you never get a chance to have a decent meal or do normal things like work out or watch a movie? You would have exactly 8 hours in between shifts and if you are lucky get 4-5 hours of sleep in between. Working 24 hours/day would mean that you will get no sleep at all, so you would work 5-6 days straight with no sleep and with one day off. There is something wrong with that math.

As a fourth year med student I have worked up to 96 hours. It's not hard, especially if you love what you do. Hours fly by if you are busy, only to realize that you felt like using the restroom 8 hours ago. The toll on the family is brutal. It's pathological to work non stop and neglect your family. It's not right for them as well. It's not fair to the kids to never see their parent and is not fair to the spouse to see their husband/wife once a week. It's highly irregular.

To me (and this is only my opinion), you don't need 120hrs to train a good physician as proven by studies that have come out of Europe and Australia. They average 50-60hrs/week and the quality of the physician is the same. Now with midlevel practitioner to handle scut one could train a very good physician with 60hrs of quality work every week. I believe this to be the biggest fallacy in resident training and I strongly believe it stems from the hospitals wanting the residents to do everything under the sun for as long as possible for as little money as possible.

 

[Winged Scapula]

To me (and this is only my opinion), you don't need 120hrs to train a good physician as proven by studies that have come out of Europe and Australia. They average 50-60hrs/week and the quality of the physician is the same.

You do realize that they train for several more YEARS than US residents?

In addition, having trained in Australia, I can tell you that registrars/RMOs often work more than 50-60 hours; they are paid overtime and are therefore, "encouraged" to report less hours. I am not implying that they work nearly as many hours as US residents, but you can't use the UK/Oz example of how you can do training in less hours. Less hours per week perhaps, but for a much longer period. Several polls have shown that US medical students and residents would rather work longer hours for a shorter period rather than follow the European model of 2 or more Foundation Years, followed by RMO and registrar and then entry into specialist training.

 

[VA Hopeful Dr]

You realize that working 16 hours ever day means you never get a chance to see your kids, wife/husband, family, never get a chance to see your doctor or dentist, you never get a chance to have a decent meal or do normal things like work out or watch a movie? You would have exactly 8 hours in between shifts and if you are lucky get 4-5 hours of sleep in between. Working 24 hours/day would mean that you will get no sleep at all, so you would work 5-6 days straight with no sleep and with one day off. There is something wrong with that math.

As a fourth year med student I have worked up to 96 hours. It's not hard, especially if you love what you do. Hours fly by if you are busy, only to realize that you felt like using the restroom 8 hours ago. The toll on the family is brutal. It's pathological to work non stop and neglect your family. It's not right for them as well. It's not fair to the kids to never see their parent and is not fair to the spouse to see their husband/wife once a week. It's highly irregular.

To me (and this is only my opinion), you don't need 120hrs to train a good physician as proven by studies that have come out of Europe and Australia. They average 50-60hrs/week and the quality of the physician is the same. Now with midlevel practitioner to handle scut one could train a very good physician with 60hrs of quality work every week. I believe this to be the biggest fallacy in resident training and I strongly believe it stems from the hospitals wanting the residents to do everything under the sun for as long as possible for as little money as possible.

The 80 hour rule is still in place. You can't work 16 hours for 6 days with one day off. You max out your hours with 3 16 hour days, 3 10 hour days, and 1 day off per week.

Likewise, if you work 24-30 hours straight, you get the post-call day to run errands, catch up on sleep, have family time.

 

[Maybeknot]

To me (and this is only my opinion), you don't need 120hrs to train a good physician as proven by studies that have come out of Europe and Australia. They average 50-60hrs/week and the quality of the physician is the same. Now with midlevel practitioner to handle scut one could train a very good physician with 60hrs of quality work every week. I believe this to be the biggest fallacy in resident training and I strongly believe it stems from the hospitals wanting the residents to do everything under the sun for as long as possible for as little money as possible.

I heard from the grapevine that the ACGME has noticed that, since the 80 hour work week, more residents are going into fellowships. Now, one benevolent interpretation might be that since residency is less grueling, more trainees are willing to continue training a few more years. The more worrying interpretation is that residents do not feel as adequately trained as they once were, and are doing more fellowships to make up for the reduced training hours during residency.

And I've heard first hand from ENT residents in Europe that while their residency hours are much nicer, they don't operate nearly as much as ENT residents do in the US. They graduate with <10% of the number of cases that we do here. They become junior attendings and are universally expected to work with senior attendings and learn to operate from them... whereas in the US, we are supposed to be capable of handling cases on our own after graduation.

 

[45408]

Fellowships are extremely popular, but that may also be due to other market forces - people expect their physician to be a specialist, increasingly small niches at large tertiary centers, etc.

 

[Law2Doc]

The 80 hour rule is still in place. You can't work 16 hours for 6 days with one day off. You max out your hours with 3 16 hour days, 3 10 hour days, and 1 day off per week.

Likewise, if you work 24-30 hours straight, you get the post-call day to run errands, catch up on sleep, have family time.

The 80 hour limit is an AVERAGE over 4 weeks. Meaning you can go over 80 hours as long as another week that month is fewer than 80 hours. It's not uncommon to have a 90 hour week balanced out by a 70 hour week in some fields.

 

[Law2Doc]

...Now with midlevel practitioner to handle scut one could train a very good physician with 60hrs of quality work every week....

Well, midlevels are a mixed blessing, and IMHO aren't really a benefit to residents the way you describe. On the one hand, you are right that they can do a lot of the paperwork many consider "scut". But this benefit comes with a cost. You have to understand that midlevels (NPs, PAs) are longterm employees that are hired to work with the hospital/attendings for many years, while residents come and go after a fairly short tenure. Also midlevels stay put while residents go to various rotations. A good midlevel is hard to find and retain, while residents are in abundant supply. And midlevels after a few years are going to be more experienced than all new residents. Thus many have the attendings' ears and are considered by the higher ups as very valuable employees. They are not people you get to boss around. Many will evaluate you to the PD/attendings each year. Many will compete with you for the non-scut work, and in some cases can even scut you out. So I think you have to realize that although these are midlevels in terms of attendings, they are not midlevels to the junior residents. The physician assistants are not your assistants. They are simply another set of folks you need to navigate around. And so no, that doesn't always free you up from scut. You will see. It just gives you another "boss" hounding you on the behalf of the attendings for your missing "TPS report".