Is the "80 hour work week" for medical residents really true or just a rumor?

[JoyKim456]

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[giantswing]

I found it was enforced third year and went out the window fourth year.

 

[POW16]

There is no hour limit for med students.

 

[Raryn]

The LCME simply requires that schools have a policy, but no specifics. My school did have an 80 hour/week (as averaged over rotation) policy but did not have a specific shift limit or anything. So we frequently worked 24 hr shifts on rotations like ob/gyn.

 

[JoyKim456]

I said RESIDENTS

 

[Raryn]

I said RESIDENTS

With the exception of some Neurosurgery programs that allow up to 88 hrs/week, every other ACGME accredited program caps their residents at 80hrs/week as averaged over four weeks. So you can work 85 hours one week but then it has to be less than that later on, to bring you to no more than 320 hours in any 4 week rotation. There's certain circumstances where it is fewer: emergency medicine residents on emergency medicine rotations get capped at 60 hours/week.

There's a number of other limits on work hours: Interns in every field (except those at a small handful of IM/GS programs currently going through a trial) are capped at 16 continuous hours. PGY2 and above residents are capped at 28 continuous hours. You must have an 8 hour interval (and should generally have a 10 hour interval) in between shifts to reset that clock. (Once again, EM residents on EM rotations have much, much stricter duty hour caps. Maximum 12 hours continuous and your time off between shifts must be equal to or greater than the length of the entire shift).

You must also have 1 day off every 7 days, as averaged over a rotation. So basically a typical 28 day rotation, you must have 4 days off.

That's most of the duty hour rules. There's a lot of other specialty specific ones regarding how many nights you can have and such.

Are they always followed? No. But, at this point, the majority of the time in the majority of programs, they are followed pretty strictly. I've gone over a small handful of times, most notably as a senior resident in the ICU, but my program and the others I'm familiar with do everything possible to keep you below the limits. The majority of the time my work hours are in the high 50s and low 60s weekly.

Surgery programs and surgical subspecialties have the general reputation of being much longer hours, but even so, most of the time these days it's that they keep you right at 80 rather than breaking restrictions all that often. There's exceptions of course, but programs can't be too blatant regarding it anymore. It actually sucks sometimes for the surgical residents, because they want to stay and finish that case or whatever but they end up getting sent home.

 

[Law2Doc]

Agree with Raryn but would suggest that more times than not the duty hour rules are as much a hindrance as a help. For instance a lot of residents like to trade days off to block them to attend various family and friend events and the requirement of 1 day off in seven can hinder that. Or maybe you are on call overnight and do get in a cat nap and aren't very tired and want to go hear a cool speaker at grand rounds the next morning but that would technically put you over the overnight hours. And in surgery obviously the goal is to scrub in on as many interesting cases as you can and inevitably the one you desperately want will come in at the time you are supposed to be leaving. And then there are logistical issues -- you my be ready to sign out and leave, and a Patient chooses that moment to code, forcing you and the resident you are signing out to to deal with that for an hour, which can put you over the top. Or the guy you are supposed to sign out to may have car trouble or be blocked by weather, etc. So hard and fast rules don't always work.

Then there's the issue of self reporting. A lot of people want to be that superstar resident, even if they have to come in early and leave late to do it. it's just worth it to spend a few extra hours to cultivate that reputation and good will -- you do this in any professional field, it makes your day to day life easier. And although your department won't let you violate the 80 hour rule if they know about it and will send you home if they hear about you risking going over hours, there will always be rumblings about how you are the only one who seems unable to finish his work on time. You don't want to be that guy. So not surprisingly many residents turn in time cards that reflect the duty hours not their actual hours, and the program is none the wiser. I'm not saying you should do this, I'm saying many people have decided that making themselves seem efficient trumps being sent home an hour earlier sometimes.

I'd say on average a program gives it's residents schedules that ought to be easily completed in 80 hours a week, and at most places you'll likely average somewhere in the 70s. But you will go over 80 at times. And I think there are lots of things that can be much bigger issues in choosing a residency than a few hours here or there, so (OP) I wouldn't focus on that so much.

 

[Winged Scapula]

Moving to Pre Allo

 

[JoyKim456]

This has nothing to do with Pre-Allo

 

[CrimsonKing]

This has nothing to do with Pre-Allo

No but you are a pre-med asking a question that has no relevance to you to people for whom the hours per week of rotations are the least of their concerns.

 

[mimelim]

80 hour work weeks hurt education. It also pushes handoffs which hurts patients.

 

[Psai]

80 hour work weeks are bad. who thought of it?
you go in early, get home late, you waste time "signing out" two times a day, you barely have time to take care of yourself by making dinner or whatnot, there's little time for studying or having leisure activities
barely enough time to write those stupid notes that no one reads because they're full of useless crap and no time for teaching. these restrictive hour mandates from nonphysicians are hurting morale and damaging medical education

 

[Winged Scapula]

This has nothing to do with Pre-Allo

It had nothing to do with medical school either since you posted it in the Allo forum and insisted you were talking about residency.

SDN policy is that posts should be of interest to the audience.

Since you are a pre-med student asking about residency work hours, the question is best placed in this forum where those with an interest can answer it appropriately.

 

[Lamel]

80 hour work weeks hurt education. It also pushes handoffs which hurts patients.

Can you expand on this? Does the long length of the shifts + lack of sleep not affect education?

 

[KnuxNole]

I like that there is a limit....after all, residents do have lives and don't wish to be in the hospital for insane amounts of times.

 

[Mr.Happy]

how long do emergency medicine residents work per week? I know emergency medicine attending physicians can get away with working 30-40 hours per week (though some will be night and weekend shifts) as long as they are willing to earn say $200k gross rather than 300k gross.

 

[helpabrotherout]

Can someone explain to me how these 80 hour shifts are supposed to work? Are you really doing 80 hr. of hard work every week? Also, wouldn't this system be detrimental to the health of the residents in both the short and long term, and this also to the health of the patients being treated by tired residents?

 

[DrBowtie]

Can someone explain to me how these 80 hour shifts are supposed to work? Are you really doing 80 hr. of hard work every week? Also, wouldn't this system be detrimental to the health of the residents in both the short and long term, and this also to the health of the patients being treated by tired residents?

Lots of 13 hr shifts x 6 days a week. Or some days 16 hours and some 10 hrs for interns at least.

The 80 hour week was created out of patient safety issue, there used to be no cap.

 

[Mr.Happy]

Lots of 13 hr shifts x 6 days a week. Or some days 16 hours and some 10 hrs for interns at least.

The 80 hour week was created out of patient safety issue, there used to be no cap.

That still sounds very unhealthy. Why not 8 hours a day, 5 days a week? or four 12 hour shifts per week?

 

[DrBowtie]

That still sounds very unhealthy. Why not 8 hours a day, 5 days a week? or four 12 hour shifts per week?

Sure if you want to add years onto training.

 

[Mr.Happy]

Sure if you want to add years onto training.

looks like it will be very difficult to be married or in a relationship while in medical school or residency. The spouse will either divorce you or start cheating on you if you do 6 13 hour shifts a week and then sleep all day on your 1 day off.

 

[Eppur Si Muove]

80 hour work weeks hurt education. It also pushes handoffs which hurts patients.

My father shares this view. When he was a resident he never went under 100hrs/week. He feels today's physicians don't work enough hours and need more training coming out

 

[DrBowtie]

looks like it will be very difficult to be married or in a relationship while in medical school or residency. The spouse will either divorce you or start cheating on you if you do 6 13 hour shifts a week and then sleep all day on your 1 day off.

Solid username for this post.

 

[Mr.Happy]

My father shares this view. When he was a resident he never went under 100hrs/week. He feels today's physicians don't work enough hours and need more training coming out

how can someone work 100 hours or more per week and still have a decent standard of life? If the number of training hours are that important, then I think it's better to extend the number of years of residency then work in such inhumane unhealthy conditions.

 

[sinombre]

looks like it will be very difficult to be married or in a relationship while in medical school or residency. The spouse will either divorce you or start cheating on you if you do 6 13 hour shifts a week and then sleep all day on your 1 day off.

Yep, your partner has to understand the demands of what it is you're doing and be supportive of it, otherwise it will end badly. I wouldn't say it is "very" difficult to be in a relationship in medical school (obviously I can't speak to how challenging it is in residency). It is challenging though. But would you really want to marry someone who couldn't handle a challenging period, or who wasn't able to cope with the life you chose for yourself?

 

[Eppur Si Muove]

how can someone work 100 hours or more per week and still have a decent standard of life? If the number of training hours are that important, then I think it's better to extend the number of years of residency then work in such inhumane unhealthy conditions.

He missed the birth of my brother and I, but many old school physicians considered the hours as a right of passage and necessary for training. He said since resident hours changed he and others he has spoken with have noticed a difference in the preparedness of new physicians.

 

[helpabrotherout]

Lots of 13 hr shifts x 6 days a week. Or some days 16 hours and some 10 hrs for interns at least.

The 80 hour week was created out of patient safety issue, there used to be no cap.

But that's what I'm saying. Maybe it's because I'm inexperienced, but how can someone be expected to give a high quality of care if they've been running around doing stuff for the last 16 hours? And this isn't even a very small group of people that it's being asked of, but what seems like every medical resident.

 

[DrBowtie]

But that's what I'm saying. Maybe it's because I'm inexperienced, but how can someone be expected to give a high quality of care if they've been running around doing stuff for the last 16 hours? And this isn't even a very small group of people that it's being asked of, but what seems like every medical resident.

16 hours isn't that long. Interns are capped at that. Residents at 24-30 hours. The thing about high quality care is debatable as some would argue the guy who has been with the patient and admitted them on hour 20 is better than the night float guy who may have gotten a 30 sec history on the guy during signout and is "fresher".

 

[Baron Samedi]

16 hours isn't that long. Interns are capped at that. Residents at 24-30 hours. The thing about high quality care is debatable as some would argue the guy who has been with the patient and admitted them on hour 20 is better than the night float guy who may have gotten a 30 sec history on the guy during signout and is "fresher".

30 secs is a pretty good sign out. Standard is like 5, lol.

 

[gettheleadout]

So what's worse for patients, residents falling asleep and functionally drunk from sleep deprivation treating them or more handoffs between residents who are in appropriate shape to treat them?

Also, why should patients' interests be considered alone? What's humane for residents and enables them to best learn, develop competent practice habits, and maintain their health (in all forms)?

 

[NickNaylor]

But that's what I'm saying. Maybe it's because I'm inexperienced, but how can someone be expected to give a high quality of care if they've been running around doing stuff for the last 16 hours? And this isn't even a very small group of people that it's being asked of, but what seems like every medical resident.

You are failing to take into account the problems with 1) handing off patients (including a failure to provide all pertinent information about a patient to the new team) and 2) the frank difference in a new person seeing a patient for the first time. Obviously it's not possible for the same resident/physician to always be caring for a patient, but there's something to be said for the same person following a patient's clinical course with their own eyes. They might be able to notice subtle changes in a patient's status that a new team may not be so privy to.

 

[DrBowtie]

So what's worse for patients, residents falling asleep and functionally drunk from sleep deprivation treating them or more handoffs between residents who are in appropriate shape to treat them?

Also, why should patients' interests be considered alone? What's humane for residents and enables them to best learn, develop competent practice habits, and maintain their health (in all forms)?

Like I said someone who knows the patient well vs someone cross covering?

Some would argue that better learning happens when you can see a pathology evolve/resolve over time. This sometimes takes longer than 16 hours.

 

[Baron Samedi]

To be honest I'd rather do my 80 hours with a few 30-hr shifts rather than a bunch of 16s.

 

[Instatewaiter]

looks like it will be very difficult to be married or in a relationship while in medical school or residency. The spouse will either divorce you or start cheating on you if you do 6 13 hour shifts a week and then sleep all day on your 1 day off.

It's not. I had a few long term relationships in med school. Dated. Got married in residency. Kids in fellowship.

13 hour days really aren't that long. In by 6, out by 7. Leaves hours for you and that significant other. If you're expecting hours and hours of free time everyday, go work a menial 40h per week job.

Pretty much every high powered job ( lawyer, doctor, finance, engineer) are going to work well over 40 hours per week.

 

[Instatewaiter]

To be honest I'd rather do my 80 hours with a few 30-hr shifts rather than a bunch of 16s.

Agree whole heartedly

 

[Winged Scapula]

If the number of training hours are that important, then I think it's better to extend the number of years of residency then work in such inhumane unhealthy conditions.

The majority of US resident physicians would disagree with you. When asked if they would prefer a "European type" residency with shorter hours, but more years, the majority chose the American model.

 

[Mad Jack]

To be honest I'd rather do my 80 hours with a few 30-hr shifts rather than a bunch of 16s.

After you pass 12 hours you just kind of stop caring. It's like you get kind of numb to it. The difference between 8 and 12 is huge, 8 and 16 massive, but between 12 and 24? My whole day's already gone, why not. Hell is 80 hour weeks split over 12 hour shifts.

 

[Winged Scapula]

That still sounds very unhealthy. Why not 8 hours a day, 5 days a week? or four 12 hour shifts per week?

Sure if you want to add years onto training.

In addition to the issue of length of training and cross coverage, just who's going to cover those shifts? If each resident only worked 40 hours per week, I'd need approximately 4.2 times the currents number of residents to cover the shifts.

Its not like patients don't need care before 8 am or after 5 pm (notice I allowed for a leisurely 1 hour lunch for that 8 hour work day).

 

[somedumbDO]

This is hilarious, just wait till your a private practice physician and work ( pager call, home call and actual hospital call) greater than 80 hrs/ week consistently! THERE IS NO FREE LUNCH.

 

[Doctor Bob]

This is hilarious, just wait till your a private practice physician and work ( pager call, home call and actual hospital call) greater than 80 hrs/ week consistently! THERE IS NO FREE LUNCH.

There's always EM... work 36 hours a week. And oftentimes the hospital provides a free lunch.

 

[mimelim]

Can you expand on this? Does the long length of the shifts + lack of sleep not affect education?

Residents sleep less with an 80 hour cap. You have MORE to do because you are expected to keep up with your reading, presentations etc. on 'your own time'. Does lack of sleep affect education? Yes.

I like that there is a limit....after all, residents do have lives and don't wish to be in the hospital for insane amounts of times.

My role is a resident is to learn to be a physician. My training program is 7 years. I honestly feel, half way through, that there isn't enough time to learn everything that I need to. This is most likely not true, given the level of competency that we produce. If there is something going on, you have to kick me out of the hospital.

Can someone explain to me how these 80 hour shifts are supposed to work? Are you really doing 80 hr. of hard work every week? Also, wouldn't this system be detrimental to the health of the residents in both the short and long term, and this also to the health of the patients being treated by tired residents?

We work 80 hours/week. I don't know of any direct data linking long work hours and physical health. Patients are worse off with shorter shifts than with tired residents.

That still sounds very unhealthy. Why not 8 hours a day, 5 days a week? or four 12 hour shifts per week?

Who are you expecting to take care of the patients the OTHER 16 hours a day? The patients nor the work disappear just because it is 5pm. Education is part of residency. Service is the other part.

So what's worse for patients, residents falling asleep and functionally drunk from sleep deprivation treating them or more handoffs between residents who are in appropriate shape to treat them?

Also, why should patients' interests be considered alone? What's humane for residents and enables them to best learn, develop competent practice habits, and maintain their health (in all forms)?

I am in appropriate shape after 26 hours in to take care of the vast majority of patients that roll in the door. No, I am not as good as in hour 6, but... Handoffs are deadly and costly. And it isn't even close. Medical training requires a LOT of hands on time. You simply can't do it 9-5 every day. People complain about scut work and paperwork. They are a part of the day for physicians. You either have to do it or hire and train someone to do it for you. At the end of the day, you need to be able to do it and do it well. And then, you need to learn how to be a physician.

There are plenty of residents that clock in, clock out. Other residents dislike them because they are dumping more work on the others and not pulling their own weight. They are also sacrificing their education. You are the sum total of your experiences. For residents, that means time in the hospital dealing with floor calls, seeing consults, being in clinic, the OR, etc. Every minute that you give up is one less minute of education.

 

[Spinach Dip]

So what's worse for patients, residents falling asleep and functionally drunk from sleep deprivation treating them or more handoffs between residents who are in appropriate shape to treat them?

Also, why should patients' interests be considered alone? What's humane for residents and enables them to best learn, develop competent practice habits, and maintain their health (in all forms)?

Obviously limiting residents to 80 hrs/wk cuts into the fullness of their education. Clearly a 164 hour workweek would have no effect on patient care. I mean, it's not like mental exhaustion is bad, right?

 

[TooMuchResearch]

There is no hour limit for med students.

/thread

 

[Lucca]

What's the history behind the 80 hr week? Who changed it, when, and why? Is the general consensus in the medical community that it was a bad change?

 

[TooMuchResearch]

What's the history behind the 80 hr week? Who changed it, when, and why? Is the general consensus in the medical community that it was a bad change?

Libby Zion.

 

[Winged Scapula]

What's the history behind the 80 hr week? Who changed it, when, and why? Is the general consensus in the medical community that it was a bad change?

It all started with Libby Zion and the Bell Commission.

Short story: young drug addict dies in New York City hospital in 1984 without being honest about her recent drug usage. Her well-connected, well-to-do father blames work hours as the cause of her death. Investigation ensues, the state of New York institutes work hour restrictions and despite no evidence that it reduces errors and increases patient safety, in 2003 the rest of the country followed suit.

The most vociferous voices against the change are non physicians, premeds, med students, and physicians in specialties that traditionally work low hours. Most physicians start to realize once they get into training how much there is to learn such little time

 

[Lucca]

It all started with Libby Zion and the Bell Commission.

Short story: young drug addict dies in New York City hospital in 1984 without being honest about her recent drug usage. Her well-connected, well-to-do father blames work hours as the cause of her death. Investigation ensues, the state of New York institutes work hour restrictions and despite no evidence that it reduces errors and increases patient safety, in 2003 the rest of the country followed suit.

The most vociferous voices against the change are non physicians, premeds, med students, and physicians in specialties that traditionally work low hours. Most physicians start to realize once they get into training how much there is to learn such little time

Are we stuck with this change now? Is there an effort to have it reversed or is the status quo cemented at this point? It has only been about a decade or so.

 

[NickNaylor]

Are we stuck with this change now? Is there an effort to have it reversed or is the status quo cemented at this point? It has only been about a decade or so.

There is no public interest to reverse the change. The adage of the tired doctor making all kinds of crazy mistakes has been engrained in the public consciousness. I have yet to meet one academic physician or program director that thinks the work hour restrictions are a great idea, but the argument is a difficult one to make to the lay public who unquestionably equate fatigue with danger.

 

[Mr.Happy]

Since EM attending physicians can get away with working 30-40 hours per week, can EM residents also get away with working the same number of hours per week? I'm assuming IM residents and residents of other fields have to do close to the full 80?

I still don't think 80+ hour weeks (or 100+ hour weeks as the old school residents did it) is healthy. Why can't residents work less hours and other attending physicians and residents take up the rest of the hours? I don't find this line of reasoning to be very logical. It's like going up to someone who works at a 24/7 IHOP and telling them "hey you, you better start working hundred hours a week because who will work here when you're not here?" The person's reply "anyone else who's trained to work here"
If there's not enough money to pay additional residents and attending physicians, then simply don't provide the medical care. Let patients not receive care and the resulting public outcry will force the government to give more money towards residency training programs.

Even if the "majority" of residents disagree with me, I still feel residents should have the option to extend the number of years of their residency so that their working hours are more reasonable.

 

[VisionaryTics]

As a medical student, I never liked work hour restrictions, and as an intern, I freaking hate them.

Interns are mandated to only work 16 hour shifts, so there is a complicated system of night float and cross cover where there is an intern who only comes in at night and covers a lot of patients.

As a matter of fact, I'm doing the switch right now. I worked yesterday during the day, and tonight I start nights. I should probably be sleeping to let my body adjust, but I can't, so I'll feel like crap 26 hours from now when I'm in the hospital. Then I'll feel like crap when I switch back a few days from now.

And with regards to cross cover, there is nothing more terrifying that getting a stat page to a room, and walking in to a jaundiced, tachypneic patient on BiPAP and CRRT who is tachy and hypotensive. I have no idea what the hell is happening with this patient after getting my crap signout. Are they septic? Are they in liver failure? What are they post-op from? No idea. Dangerous, dangerous, dangerous.