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

[SouthernSurgeon]

+1 This is actually very interesting.

So then the way a particular team/ hospital logs and enforces their hours can have an impact on the quality of training you receive (or atleast perceive to)? That's what I gathered from your comment to not care about hour restrictions as a chief but log them as compliant.

There are a couple of things at play here.

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The first is the regulations themselves. Right now, in brief summary, the regulations are as follows:
1. 80 hr/week maximum, averaged over 4 weeks
2. 1 day off in 7 (*some specialties allow this to be averaged over 4 weeks, others it is strictly per week. Also is technically defined as a 24 hour continuous period off, rather than a calendar day. More on that in a second)
3. Maximum shift length of 16 hrs for interns, 24 hrs for PGY2 and up
4. 8 hour required/10 hour recommended period between shifts
5. For interns, if on night float, no more than 6 consecutive night shifts in a row

So as you can see, those are a lot of restrictions that can make life very inflexible. The 8 hr break period, and the 16 hr shift limit in particular, and the 1 day off in 7 particularly if enforced week to week.

For the 1 day off in 7 --> This functionally means in a lot of programs you don't get weekends off, ever, on inpatient services. You get your one day off, and it is often a random tuesday or something. In the old system, if you could average your days off, you could swap with a colleague and get a full weekend off in exchange for working another weekend.

The lack of flexibility has also led to some programs defining the 24 hrs when you switch from nights to days or vice versa as your day off (i.e. you leave at 6am from your night shift, come back the next morning at 6am) - this is commonly called a DOMA (day off, my a**)

In summary - while the 80 hr limit in and of itself is probably reasonable, the additional regulations make it so inflexible on a day to day basis that it makes scheduling really difficult.

----
The second issue is reporting of hours.

The vast majority of residency programs rely on self-reporting of the duty hours. Bottom line...if your residents are happy, they are going to log hours that comply with the rules (regardless of their real hours), because they don't want to change anything.

When I am a chief, I believe (based on my experience with the program thus far), that on the whole my hours will be compliant or very close to it with the "spirit" of the 80 hour work week. But I have no interest in "tapping out" because some stupid rule says that if I'm not home by 8pm I won't meet my 8 hour break requirement. So I will just check the boxes and make sure my reported hours meet the rules, and no one in my program will care.

There are some hospitals that attempt more strict mechanisms for logging of hours such as a swipe in/swipe out system (NY hospitals if I recall). There have been studies looking at this and bottom line is residents find ways around this just as well as in a self-reported system.

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[somedumbDO]

Pretty sure you do that one to yourself. I don't know a single physician outside of the surgical subspecialties that clocks over 80 hours a week regularly as an attending because they have to. There's a few hospitalists that pick up extra hours and end up working 18-30 days straight sometimes, but that's really them doing it to themselves for the money, not because they're being forced to be their group.

Hmm so clueless. Residents, students the reality if you want to make more than 200k a year in modern medicine you will work >80 hours. I am non surgery and easily top 80 a week. Wife is academics and with all the admin/teaching EASILY works more than 80 hrs. This is life. If you don't like it drop out, or become a mid level.

 

[Mad Jack]

Hmm so clueless. Residents, students the reality if you want to make more than 200k a year in modern medicine you will work >80 hours. I am non surgery and easily top 80 a week. Wife is academics and with all the admin/teaching EASILY works more than 80 hrs. This is life. If you don't like it dro out, or become a mid level.

Except you're wrong. Academics may work long hours, but they did that to themselves by going into academics. You can find positions paying over 200k working less than 80 hours a week. I could post pages of IM hospitalist gigs that are 7 on/7 off with 12 hour shifts that pay 200k+ a year. FP you'd be hard pressed to even find a way to work 80 hours a week, given the schedules of most offices and patient preferences. EM, it just doesn't happen. Psych, PM&R, derm, and the like, 80 hours a week is certainly not normal lol. Just because you and your wife's lives suck doesn't mean you couldn't go online right now and find a gig working elsewhere that gave you less hours per week if you were willing to leave academia.

 

[IL Pre Med]

Except you're wrong. Academics may work long hours, but they did that to themselves by going into academics. You can find positions paying over 200k working less than 80 hours a week. I could post pages of IM hospitalist gigs that are 7 on/7 off with 12 hour shifts that pay 200k+ a year. FP you'd be hard pressed to even find a way to work 80 hours a week, given the schedules of most offices and patient preferences. EM, it just doesn't happen. Psych, PM&R, derm, and the like, 80 hours a week is certainly not normal lol. Just because you and your wife's lives suck doesn't mean you couldn't go online right now and find a gig working elsewhere that gave you less hours per week if you were willing to leave academia.

Just out of curiosity, are the salary figures above accurate? Those numbers are much lower than has been reported on other sites. I don't know where to go to find accurate numbers for salary.

 

[Mad Jack]

Just out of curiosity, are the salary figures above accurate? Those numbers are muh lower than has been reported in other sites.

It's data from several years back, but so far as I know there hasn't been some drastic increase in physician work hours since the research was conducted. I could look up specialty figures individually, but this is the only table I know of with a compiled specialty hours worked list.

 

[somedumbDO]

Except you're wrong. Academics may work long hours, but they did that to themselves by going into academics. You can find positions paying over 200k working less than 80 hours a week. I could post pages of IM hospitalist gigs that are 7 on/7 off with 12 hour shifts that pay 200k+ a year. FP you'd be hard pressed to even find a way to work 80 hours a week, given the schedules of most offices and patient preferences. EM, it just doesn't happen. Psych, PM&R, derm, and the like, 80 hours a week is certainly not normal lol. Just because you and your wife's lives suck doesn't mean you couldn't go online right now and find a gig working elsewhere that gave you less hours per week if you were willing to leave academia.

I can post random stats from a non disclosed book as well. Believe what you will, but you are deluded. Do you think in private practice your job ends when you go home? Nope.... Adm meetings, committees, payroll, accounting, billing magically doesn't do itself because "a stat i once read in a book told me so". You younger generation want all the money and don't want to work for it. Cry about 80 hrs all you want when you are in pp you will remember all the free time you had in residency. Lastly, I love my life and job. Between research, clinical medicine, and administrative responsibilities i find it very rewarding. What I find annoying is people who have busted there ass to get to residency and now complaining that they have to work.

 

[Mad Jack]

I can post random stats from a non disclosed book as well. Believe what you will, but you are deluded. Do you think in private practice your job ends when you go home? Nope.... Adm meetings, committees, payroll, accounting, billing magically doesn't do itself because "a stat i once read in a book told me so". You younger generation want all the money and don't want to work for it. Cry about 80 hrs all you want when you are in pp you will remember all the free time you had in residency. Lastly, I love my life and job. Between research, clinical medicine, and administrative responsibilities i find it very rewarding. What I find annoying is people who have busted there ass to get to residency and now complaining that they have to work.

Dorsey. JAMA, Vol 290(9).Sept 3, 2003.1174.

 

[somedumbDO]

By the way i posted private practice. You want to be a slave for the hospital.... Go for it. Some administrator is not taking the revenue I GENERATE.

 

[Mad Jack]

I can post random stats from a non disclosed book as well. Believe what you will, but you are deluded. Do you think in private practice your job ends when you go home? Nope.... Adm meetings, committees, payroll, accounting, billing magically doesn't do itself because "a stat i once read in a book told me so". You younger generation want all the money and don't want to work for it. Cry about 80 hrs all you want when you are in pp you will remember all the free time you had in residency. Lastly, I love my life and job. Between research, clinical medicine, and administrative responsibilities i find it very rewarding. What I find annoying is people who have busted there ass to get to residency and now complaining that they have to work.

You do research, administration, teaching, and clinical medicine. Of course you work 80 hours a week. If you're just a clinician, you don't do research, you don't teach, and you're not an administrator, you will not work 80 hours a week. You are working that many hours because you have chosen to, because that is the sort of job you wanted. You have to work that many hours to be an academic physician+researcher+administrator, but if you just want to be an outpatient FP doc, a guy in community EM, a PP psychiatrist, a guy working in derm, etc, you won't have to work every waking hour of the day. That you claim every physician works so much is blatantly false. It is only normal in academia.

 

[somedumbDO]

Every private practice doc re read my post. You want to be an employee different animal.

 

[RogueUnicorn]

Do you guys not get 1 day off in 7?

depends on the service but some will give you goldens to flank the 4 weeks which averages out to 1/7

 

[Mad Jack]

Every private practice doc re read my post. You want to be an employee different animal.

PP psych, PP IM hospitalist groups, EM groups, PP derm... I could go on and on with examples of fields where you don't have to work 80 hours in PP.

 

[Mad Jack]

Every private practice doc re read my post. You want to be an employee different animal.

http://archinte.jamanetwork.com/Mobile/article.aspx?articleid=1105820#ild15019f1

The high end of the interquartile range was just over 2900 hours per year, which correlates to 56.5 hours a week. You are a couple standard deviations above the mean at 80 hours per week.

 

[RogueUnicorn]

arguing against attendings often ends up poorly on the part of the medical student...

 

[TooMuchResearch]

It's data from several years back, but so far as I know there hasn't been some drastic increase in physician work hours since the research was conducted. I could look up specialty figures individually, but this is the only table I know of with a compiled specialty hours worked list.

Looking just at the EM numbers above, $ is too low and hours are too high. Also saw anesthesiology since it was on the top...$ too low.

 

[DarknightX]

So I think the larger point that's been lost in the more recent squabbling posts isn't the inherent issue of questioning institutionalized beliefs and whether you need adequate exposure to the institution to have a right to question it.

The larger point was that you're getting several posts from residents/graduates explaining what the realities of training are (i.e. the hours, the calls, the lack of time off, etc), and several posts from residents demonstrating the most common attitude toward that reality (i.e. once you start training you will realize how precious little time you have to learn what you need to learn, and more commonly residents are clambering for MORE not LESS and feel frustrated by external limitations being imposed on responsible adult learners).

If, as a pre-med, you:
(a) find the realities of the hours depressing/horrifying/unimaginable/etc - then you should get out now while you still can.
(b) find the attitudes of residents regarding the work hours and their learning a major cognitive disconnect to your own attitude, you should consider whether your attitude is either uninformed or not conducive to happiness in residency.

This is spot on. There isn't enough time in residency to learn everything you need to learn to be a safe physician if you play by the 80 hour a week rules. This is my point.

Maybe I'm not that smart and some people learn faster than me. That's fine and I really don't care. I know that I need more exposure than 80 hours a week to learn everything I need to be a safe and effective surgeon.

And yes, my specialty is general surgery. Again, if working 80 hours a week scares you, then you have no business going into medicine.

 

[Mad Jack]

Looking just at the EM numbers above, $ is too low and hours are too high. Also saw anesthesiology since it was on the top...$ too low.

That was published in 2003, using data from 2001-2002. The salaries are thus over a decade old.

 

[Cyberdyne 101]

So what are the pros and cons of night-float?
Again, we appreciate the feedback from residents and attendings.

 

[gettheleadout]

And yes, my specialty is general surgery. Again, if working 80 hours a week scares you, then you have no business going into medicine.

I truly don't mean any offense, but I can't take this seriously given the number of fields where you don't have to approach that number either in residency or after, and I'm going by numbers other residents have posted elsewhere on SDN.


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[DarknightX]

I truly don't mean any offense, but I can't take this seriously given the number of fields where you don't have to approach that number either in residency or after, and I'm going by numbers other residents have posted elsewhere on SDN.


Sent from my neural implant using SDN Mobile

No offense taken.

I can't speak for other specialties, but surgical specialties are different, no doubt. In general, residency is a time to learn and to train. It's not a job. A job is a place where you clock in, spent a certain amount of required time, get your work done, and get out. Some residents have this mentality, but it's the wrong mentality to have. It is YOUR training and YOUR education. It is much different than undergrad, medical school, or any other type of learning environment. This isn't college, where you take an exam and then you've made it through. Nobody is going to care about your grades, AOA, medical school or the amount of letters behind your name if you don't know what you're doing. I might sound a bit paranoid or over the top, but there are many bad surgeons out there who have no idea what they are doing, and I'll be damned if I end up being one of them.

When I was a pre-med or a med student, I couldn't understand this concept. Heck, even when I was an intern, I didn't really get it. Now that I'm a senior resident and getting closer to finishing, every single moment I spend in the operating room is GOLD. It's valuable protected time that I will never get again for the rest of my life. I get to practice, make mistakes, and I have protection and guidance. I don't give a crap about how many hours I work per week, nor do I keep track. Some arbitrary number that some suits make up means nothing to me. I'm sure I'll have even more insight once I'm done with residency and am an attending.

So again, if working 80 hours a week scares you, then medicine is not for you, regardless of the specialty. I'm sorry if this is offensive, but outsiders have no right to comment on how many hours a resident works. You'll come to this realization once you start taking care of very sick patients and realize how little you actually know.

 

[KnuxNole]

You do research, administration, teaching, and clinical medicine. Of course you work 80 hours a week. If you're just a clinician, you don't do research, you don't teach, and you're not an administrator, you will not work 80 hours a week. You are working that many hours because you have chosen to, because that is the sort of job you wanted. You have to work that many hours to be an academic physician+researcher+administrator, but if you just want to be an outpatient FP doc, a guy in community EM, a PP psychiatrist, a guy working in derm, etc, you won't have to work every waking hour of the day. That you claim every physician works so much is blatantly false. It is only normal in academia.

Exactly. I turn my head the other way at research, academics, admin work...I simply want to do clinical medicine. And working 5 days a week, I won't hit 80 hours lol...and that's with finishing paperwork.

 

[NickNaylor]

No offense taken.

I can't speak for other specialties, but surgical specialties are different, no doubt. In general, residency is a time to learn and to train. It's not a job. A job is a place where you clock in, spent a certain amount of required time, get your work done, and get out. Some residents have this mentality, but it's the wrong mentality to have. It is YOUR training and YOUR education. It is much different than undergrad, medical school, or any other type of learning environment. This isn't college, where you take an exam and then you've made it through. Nobody is going to care about your grades, AOA, medical school or the amount of letters behind your name if you don't know what you're doing. I might sound a bit paranoid or over the top, but there are many bad surgeons out there who have no idea what they are doing, and I'll be damned if I end up being one of them.

When I was a pre-med or a med student, I couldn't understand this concept. Heck, even when I was an intern, I didn't really get it. Now that I'm a senior resident and getting closer to finishing, every single moment I spend in the operating room is GOLD. It's valuable protected time that I will never get again for the rest of my life. I get to practice, make mistakes, and I have protection and guidance. I don't give a crap about how many hours I work per week, nor do I keep track. Some arbitrary number that some suits make up means nothing to me. I'm sure I'll have even more insight once I'm done with residency and am an attending.

So again, if working 80 hours a week scares you, then medicine is not for you, regardless of the specialty. I'm sorry if this is offensive, but outsiders have no right to comment on how many hours a resident works. You'll come to this realization once you start taking care of very sick patients and realize how little you actually know.

This sort of mentality was something I became acutely aware of even approaching the end of the MS3. As residency looms, I've developed a new-found motivation to learn as much as I can before "really" doing stuff. I can imagine this feeling is even more amplified in a procedure-based field and as one approaches the time of being truly dependent as an attending.

 

[DrBowtie]

http://archinte.jamanetwork.com/Mobile/article.aspx?articleid=1105820#ild15019f1

The high end of the interquartile range was just over 2900 hours per year, which correlates to 56.5 hours a week. You are a couple standard deviations above the mean at 80 hours per week.

What was your denominator for weeks? Gotta figure 4-8 weeks vacation. Some up to 12-16 weeks.

 

[primadonna22274]

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.

No, your spouse develops a healthy sense of independence and doesn't need you around very much. Or at least mine doesn't--but we have been married 8 years, lived half of those apart, sometimes states apart. We don't have children and don't plan to. Finances are easier now that we only have one household and he at least sees me on an almost daily basis so for us it's an improvement

 

[Lucca]

No, your spouse develops a healthy sense of independence and doesn't need you around very much. Or at least mine doesn't--but we have been married 8 years, lived half of those apart, sometimes states apart. We don't have children and don't plan to. Finances are easier now that we only have one household and he at least sees me on an almost daily basis so for us it's an improvement

Good to hear that it worked out. This is honestly the only part of pursuing medicine that very seriously frightens me.

 

[Mad Jack]

What was your denominator for weeks? Gotta figure 4-8 weeks vacation. Some up to 12-16 weeks.

The kind of guy that's working long hours is generally the kind of guy that doesn't take much vacation. Assuming 4 weeks of vacation for our hypothetical workaholic, that'd put work weeks up to 61.2 hours, which correlates with the reported average of high hour specialties post-residency. And keep in mind, this is the high end. The average physician works a bit over 2400 hours, which either correlates to more weeks of vacation and still working 60ish hours a week, or shorter work hours, take your pick on how you want to read that. A 500 hour difference is enough to bump you up to 14 weeks of vacation at 61 hours per week lol. That's way more than we know most physicians take- the only physicians that commonly take over 4 weeks of vacation per year were anesthesiologists and radiologists. Most doctors average less than 4 weeks of vacation per year.

http://www.medscape.com/features/slideshow/lifestyle/2012/public

 

[cs24]

When I was a pre-med or a med student, I couldn't understand this concept. Heck, even when I was an intern, I didn't really get it. Now that I'm a senior resident and getting closer to finishing, every single moment I spend in the operating room is GOLD. It's valuable protected time that I will never get again for the rest of my life. I get to practice, make mistakes, and I have protection and guidance. I don't give a crap about how many hours I work per week, nor do I keep track. Some arbitrary number that some suits make up means nothing to me. I'm sure I'll have even more insight once I'm done with residency and am an attending.

So again, if working 80 hours a week scares you, then medicine is not for you, regardless of the specialty. I'm sorry if this is offensive, but outsiders have no right to comment on how many hours a resident works. You'll come to this realization once you start taking care of very sick patients and realize how little you actually know.

First of all, this has been a great thread, and I really appreciate all the attendings and residents that have chimed in. I learned a great deal. It is reassuring to hear how many of you are content to live a lifestyle where you work a ton of hours in residency. I imagine that beginning to truly study your career, the field you will try to master for the rest of your life, helps ease the hours a great deal. As an MS-2, I am used to our current life with ultimate flexibility and tons of free time (relatively). Comparing what I do now on a day-to-day basis to the schedule of residency certainly concerns me a little bit.

However I have one question regarding the bolded above (and this doesn't have to be directly specifically to DarkKnightX, as others have echoed his (her?) sentiments). If you couldn't understand the concept as a medical student, why does having concerns about the number of hours worked in residency, as a medical student (or a premed, as we are in pre-allo) mean that medicine is not for you, regardless of specialty? It certain seems like a valid concern to me, and I would venture to guess it is a very rare medical student who has had exposure to doing ANYTHING for 80+ hours a week, much less something as demanding as residency training. I have no idea how I will respond to that sort of environment.

I guess the TL;DR for this post is-
Residents/attendings- how was life in residency? We know the hours are long and the work is hard, but how did you hold up? Was it overall a positive experience? What would you change, if anything hours-wise? Were you concerned about lifestyle/hours prior to residency, and how did those fears compare to how the experience actually went?

Thanks for all your input.

 

[mimelim]

First of all, this has been a great thread, and I really appreciate all the attendings and residents that have chimed in. I learned a great deal. It is reassuring to hear how many of you are content to live a lifestyle where you work a ton of hours in residency. I imagine that beginning to truly study your career, the field you will try to master for the rest of your life, helps ease the hours a great deal. As an MS-2, I am used to our current life with ultimate flexibility and tons of free time (relatively). Comparing what I do now on a day-to-day basis to the schedule of residency certainly concerns me a little bit.

However I have one question regarding the bolded above (and this doesn't have to be directly specifically to DarkKnightX, as others have echoed his (her?) sentiments). If you couldn't understand the concept as a medical student, why does having concerns about the number of hours worked in residency, as a medical student (or a premed, as we are in pre-allo) mean that medicine is not for you, regardless of specialty? It certain seems like a valid concern to me, and I would venture to guess it is a very rare medical student who has had exposure to doing ANYTHING for 80+ hours a week, much less something as demanding as residency training. I have no idea how I will respond to that sort of environment.

I guess the TL;DR for this post is-
Residents/attendings- how was life in residency? We know the hours are long and the work is hard, but how did you hold up? Was it overall a positive experience? What would you change, if anything hours-wise? Were you concerned about lifestyle/hours prior to residency, and how did those fears compare to how the experience actually went?

Thanks for all your input.

Life in residency sucks. You have little to no control over your schedule. You are in a system that is hierarchical by nature and have to start from the bottom. There is never enough time to do the work, learn what you need to, keep everyone happy and have a life. From a comparison perspective, it is hard to imagine many jobs that compare, much less are worse.

Positive? Yes. You are learning to be a physician. Is it fun? You better derive some sort of pleasure from it or you are in the wrong field, but it isn't 'fun' for the most part.

For me, you need a lot of hours to learn what you need to. But, that doesn't mean that we are always very efficient with our education. At some point, most people learn to do the scut really well and it ceases to be of education value. For us, PAs/NPs will do most of it at that point, but that is definitely NOT true everywhere. I honestly don't think that you need more than 80 hours a week to train even the most hardcore surgeons. You should be able to get your training in in that time. Maybe not if the service load at your hospital is immense, but it should be doable. At the same time, all of the micromanaging rules need to go. Nobody should be forced to leave the hospital if they are learning. That is just stupid.

I wasn't personally concerned about the lifestyle/hours. I don't sleep much, which clearly helps a lot. I also enjoy what I do every day. I am genuinely smiling when I walked into the hospital every day. I get to be a badass every day. An overworked, underpaid badass, but whatever. Patients entrust their health to me to the point of letting me draw on them with a sharpie and then assault them with a knife in an attempt to make them better. For me, that means a lot and makes most of the bull**** matter a whole lot less.

 

[cs24]

Life in residency sucks. You have little to no control over your schedule. You are in a system that is hierarchical by nature and have to start from the bottom. There is never enough time to do the work, learn what you need to, keep everyone happy and have a life. From a comparison perspective, it is hard to imagine many jobs that compare, much less are worse.

Positive? Yes. You are learning to be a physician. Is it fun? You better derive some sort of pleasure from it or you are in the wrong field, but it isn't 'fun' for the most part.

For me, you need a lot of hours to learn what you need to. But, that doesn't mean that we are always very efficient with our education. At some point, most people learn to do the scut really well and it ceases to be of education value. For us, PAs/NPs will do most of it at that point, but that is definitely NOT true everywhere. I honestly don't think that you need more than 80 hours a week to train even the most hardcore surgeons. You should be able to get your training in in that time. Maybe not if the service load at your hospital is immense, but it should be doable. At the same time, all of the micromanaging rules need to go. Nobody should be forced to leave the hospital if they are learning. That is just stupid.

I wasn't personally concerned about the lifestyle/hours. I don't sleep much, which clearly helps a lot. I also enjoy what I do every day. I am genuinely smiling when I walked into the hospital every day. I get to be a badass every day. An overworked, underpaid badass, but whatever. Patients entrust their health to me to the point of letting me draw on them with a sharpie and then assault them with a knife in an attempt to make them better. For me, that means a lot and makes most of the bull**** matter a whole lot less.

Thanks mimelim, I was hoping you'd see this post. I know you've talked in the past how you are in a rather intense residency (vascular), yet you have time to rock climb, have a significant other (if I recall correctly), etc so I was curious as to your take. I also have a sport outside of medicine that I hope to be able to dedicate time to in residency, and I will be in residency at the same time as my SO (which is really the biggest driver of my hours concerns). I also recently discovered some interest in some of the fields with more time-intensive residencies, which my SO doesn't love the sound of, obviously (not that it's a deal-breaker, they support me fully and what me to do what makes me happy, but of course I am worried about making choices that will have excessively detrimental effects on our relationship).

You said you weren't worried about hours prior to residency, why? Was is because you don't need sleep and had a passion for vascular surgery? Maybe experiences in 3rd year and during sub-Is going well despite the hours and stress? I'm sure doing a surgery clerkship 3rd year will give me a better idea of how I would react to the stresses of residency hours as well.

I also enjoy what I do every day.

I think this is really what I'm worried about. Thanks for the advice.

 

[anbuitachi]

my surgery residents said "hours" for the 80 hr standard only counts clinical hours. he told me he worked 100+ hr weeks very often because there was a lot of paperwork involved as well, and doing that doesn't count in the 80 hrs

 

[SouthernSurgeon]

my surgery residents said "hours" for the 80 hr standard only counts clinical hours. he told me he worked 100+ hr weeks very often because there was a lot of paperwork involved as well, and doing that doesn't count in the 80 hrs

By the rules, it counts.

All clinical work including paperwork/documentation/etc counts toward the 80 hrs limit.

Now does everyone accurately log this? Usually not

 

[SouthernSurgeon]

So what are the pros and cons of night-float?
Again, we appreciate the feedback from residents and attendings.

Pros:
Don't have to work 24+ hour shifts

Cons:
personal
Increased disruptions to circadian rhythm
Long stretches of time working at night
Loss of golden weekends
Little social contact while on night float
educational
Loss of educational opportunities at night:
Missed conference time
Missed teaching from attendings (little to no direct contact with attendings at night)
Realistically no time for reading while on night float
Less opportunity for procedures in a procedure related field
patient care
Increased handoffs
Decreased continuity

*I'm biased

 

[Cyberdyne 101]

Pros:
Don't have to work 24+ hour shifts

Cons:
personal
Increased disruptions to circadian rhythm
Long stretches of time working at night
Loss of golden weekends
Little social contact while on night float
educational
Loss of educational opportunities at night:
Missed conference time
Missed teaching from attendings (little to no direct contact with attendings at night)
Realistically no time for reading while on night float
Less opportunity for procedures in a procedure related field
patient care
Increased handoffs
Decreased continuity

*I'm biased

Thanks, @southernIM!!

 

[circulus vitios]

Hmm so clueless. Residents, students the reality if you want to make more than 200k a year in modern medicine you will work >80 hours. I am non surgery and easily top 80 a week. Wife is academics and with all the admin/teaching EASILY works more than 80 hrs. This is life. If you don't like it drop out, or become a mid level.

Bitching about work hours when she willingly went into the ****tiest mode of practice when it comes to $/hr.

If I ever find myself in the position of necessarily working 80 hours a week as an attending, I'm going to jump in front of a train. What a god damn waste of a life.

 

[NickNaylor]

First of all, this has been a great thread, and I really appreciate all the attendings and residents that have chimed in. I learned a great deal. It is reassuring to hear how many of you are content to live a lifestyle where you work a ton of hours in residency. I imagine that beginning to truly study your career, the field you will try to master for the rest of your life, helps ease the hours a great deal. As an MS-2, I am used to our current life with ultimate flexibility and tons of free time (relatively). Comparing what I do now on a day-to-day basis to the schedule of residency certainly concerns me a little bit.

However I have one question regarding the bolded above (and this doesn't have to be directly specifically to DarkKnightX, as others have echoed his (her?) sentiments). If you couldn't understand the concept as a medical student, why does having concerns about the number of hours worked in residency, as a medical student (or a premed, as we are in pre-allo) mean that medicine is not for you, regardless of specialty? It certain seems like a valid concern to me, and I would venture to guess it is a very rare medical student who has had exposure to doing ANYTHING for 80+ hours a week, much less something as demanding as residency training. I have no idea how I will respond to that sort of environment.

I guess the TL;DR for this post is-
Residents/attendings- how was life in residency? We know the hours are long and the work is hard, but how did you hold up? Was it overall a positive experience? What would you change, if anything hours-wise? Were you concerned about lifestyle/hours prior to residency, and how did those fears compare to how the experience actually went?

Thanks for all your input.

I disagree with the notion that caring about lifestyle is nonstarter for pursuing medicine with some caveats:

-Residency will be time demanding REGARDLESS of the field you go into. This isn't 100% true, but this should be your expectation. At the very least, intern year will be a bear, and it will get better or worse as you move through your training depending on the field.

-If lifestyle is one of the most important factors for you, understand that this will severely limit your options. Many surgical fields will be a no-go. The traditional specialties will be difficult during residency but get better in practice, though even this isn't a guarantee. The point here is that you won't have as much freedom to choose your field if lifestyle is important. That makes some people uncomfortable.

-Above all, make sure you find something that you intrinsically enjoy. Hopefully the residents beat that idea hard enough in this thread. That really is critical to happiness. The reality is that there will be times where your hours suck, you're stressed, and you're tired, even in "benign" fields. In some fields that's the expectation. The only way you have any hope of getting through those times as deriving some kind of satisfaction from the work. A "love for science," looking forward to a high salary, and the other tropes you routinely see in pre-allo won't do it for you. You will be miserable.

 

[circulus vitios]

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.

Limited residency funding from the government. The need to finish residency in a short amount of time because our student loan balances a) are disgustingly high and b) compound during residency. And I'm guessing there are great inefficiencies in medical training, if the ridiculousness of medical school is indicative of what I can expect in the future.

 

[DermViser]

-Above all, make sure you find something that you intrinsically enjoy. Hopefully the residents beat that idea hard enough in this thread. That really is critical to happiness. The reality is that there will be times where your hours suck, you're stressed, and you're tired, even in "benign" fields. In some fields that's the expectation. The only way you have any hope of getting through those times as deriving some kind of satisfaction from the work. A "love for science," looking forward to a high salary, and the other tropes you routinely see in pre-allo won't do it for you. You will be miserable.

Thank god, someone finally said it. ^^THIS. Just "loving science" isn't enough. You'll get thru the first 2 years great probably, but M3 will be a shock to your system. Don't do medical school bc of your love of basic science - medical school isn't the proper career then.

 

[ChiDO]

Hours are self-reported and very tedious to put in accurately. I work until the job is done. Never complain about not going home. Not sure what a post-call day is.

 

[Winged Scapula]

Hmm so clueless. Residents, students the reality if you want to make more than 200k a year in modern medicine you will work >80 hours. I am non surgery and easily top 80 a week. Wife is academics and with all the admin/teaching EASILY works more than 80 hrs. This is life. If you don't like it drop out, or become a mid level.

I would beg to differ and offer a contrasting experience.

I'm in a busy private surgical practice, with 2 academic appointments, teach medical students and residents, enroll patients on clinical trial, work much less than 80 hours per week (including paperwork/admin stuff its generally between 50 and 55 hrs; some weeks closer to 65) and earn significantly more than $200K. All of my partners do as well.And I do it all myself without a midlevel. Heck, our new fresh out of fellowship surgeon had a salary guarantee exceeding that and she probably didn't exceed 20 hrs clinical time each week as she cranked up her practice.

Prior to this position, I worked in academics right out of fellowship and also exceeded $200K with much less than 80 hours per week duties; it is true that I make more now but the inefficiencies and limitations of academics (as well as the recognized tendency for AMC to pay less) were responsible for that.

The residents posting here have really fine tuned the argument about training hours. The fact is that residency, regardless of how soul crushing and physically/psychologically demanding it is, is a finite, short period of time. Sometimes I envy the protection that residency and fellowship afforded me. Now that I'm more than 5 years out in practice, I'm confident and at the top of my game but the responsibility, real and felt by me, is much much greater and the expectations by the patients is more. I had the dubious advantage of not having to focus on work hours for most of my residency; it was miserable going through it but the artificial restrictions on training aren't helpful to patients or my future colleagues.

 

[Apramana]

That only 10% of our happiness appears to be based on our circumstances may be relevant here. As many seem to strongly re-evaluate medicine as a career, both in and after medical school, it seems worthwhile to realize that our attitudes may be far more important to our happiness than the circumstances we try to create for ourselves.

Granted, the rigors of medicine can make some of the happiness-boosting activities outlined below more difficult, but it seems unlikely that those hoping a simple change of circumstances will drastically improve their life satisfaction will find significant payoff. Since many may be sacrificing significant career capital to try to change their circumstances, I think it is important to keep this in mind.

[Edit (10/22): This concept is also probably very valuable to consider for those who may believe that they cannot be happy without a career in medicine, especially as we discuss the very real challenges of the career and the very real costs for many career changers who try to transition to medicine.]

I hope that you find the information below at least as worthwhile as I have.

Thank you very much to all those who contributed to this thread and who may continue to contribute. I sincerely appreciate the valuable insight into medicine. Please have a great day.

http://greatergood.berkeley.edu/topic/happiness/definition
"
How to Cultivate Happiness?
Based on her research, Lyubomirsky has concluded that roughly 50 percent of happiness is determined by our genes and 10 percent by our life circumstance, but 40 percent depends on our daily activities. Here are some of the practices Lyubomirsky and other researchers have identified as ways to boost your happiness.

• Build relationships: Perhaps the dominant finding from happiness research is that social connections are key to happiness. Studies show that close relationships, including romantic relationships, are especially important, suggesting we should make time for those closest to us—people in whom we can confide and who’ll support us when we’re down.
• Give thanks: Research by Michael McCullough, Robert Emmons, Lyubomirsky, and others has revealed the power of simply counting our blessings on a regular basis. People who keep “gratitude journals” feel more optimism and greater satisfaction with their lives. And research shows that writing a “gratitude letter” to someone you’ve never properly thanked brings a major boost of happiness.
• Practice kindness: Research by Elizabeth Dunn and her colleagues finds that people report greater happiness when they spend money on others than when they spend it on themselves, even though they initially think the opposite would be true. Similarly, neuroscience research shows that when we do nice things for others, our brains light up in areas associated with pleasure and reward.
• Give up grudges: Groundbreaking studies by Everett Worthington, Michael McCullough, and their colleagues show that when we forgive those who have wronged us, we feel better about ourselves, experience more positive emotions, and feel closer to others.
• Get physical: Exercise isn’t just good for our bodies, it’s good for our minds. Studies show that regular physical activity increases happiness and self-esteem, reduces anxiety and stress, and can even lift symptoms of depression. “Exercise may very well be the most effective instant happiness booster of all activities,” writes Lyubomirsky in The How of Happiness.
• Get rest: Research has consistently linked lower sleep to lower happiness. What’s more, a study of more than 900 women, led by Nobel Prize-winning psychologist Daniel Kahneman, found that getting just one more hour of sleep each night might have a greater effect on happiness than a $60,000 raise.
• Pay attention: Studies show that people who practice mindfulness—the moment-by-moment awareness of our thoughts, feelings, and external circumstances—not only have stronger immune systems but are more likely to be happy and enjoy greater life satisfaction, and they are less likely to be hostile or anxious. Pioneering research by Richard Davidson, Jon Kabat-Zinn, and others has found that a basic eight-week mindfulness training program can significantly improve our physical and psychological well-being.
• Don’t focus on material wealth: After our basic needs our met, research suggests, more money doesn’t bring us more happiness—in fact, a study by Kahneman found that Americans’ happiness rose with their income only until they’d made roughly $75,000; after that, their happiness plateaued. And research by Richard Easterlin has found that in the long run, countries don’t become happier as they become wealthier. Perhaps that’s why, in general, people who prioritize material things over other values are much less happy, and comparing ourselves with people who have more is a particular source of unhappiness. It also suggests why more egalitarian countriesconsistently rank among the happiest in the world."

 

[DermViser]

That only 10% of our happiness appears to be based on our circumstances may be relevant here. As many seem to strongly re-evaluate medicine as a career, both in and after medical school, it seems worthwhile to realize that our attitudes may be far more important to our happiness than the circumstances we try to create for ourselves.

Granted, the rigors of medicine can make some of the happiness-boosting activities outlined below more difficult, but it seems unlikely that those hoping a simple change of circumstances will drastically improve their life satisfaction will find significant payoff. Since many may be sacrificing significant career capital to try to change their circumstances, I think it is important to keep this in mind.

I hope that you find the information below at least as worthwhile as I have.

Thank you very much to all those who contributed to this thread and who may continue to contribute. I sincerely appreciate the valuable insight into medicine. Please have a great day.

http://greatergood.berkeley.edu/topic/happiness/definition
"
How to Cultivate Happiness?
Based on her research, Lyubomirsky has concluded that roughly 50 percent of happiness is determined by our genes and 10 percent by our life circumstance, but 40 percent depends on our daily activities. Here are some of the practices Lyubomirsky and other researchers have identified as ways to boost your happiness.

• Build relationships: Perhaps the dominant finding from happiness research is that social connections are key to happiness. Studies show that close relationships, including romantic relationships, are especially important, suggesting we should make time for those closest to us—people in whom we can confide and who’ll support us when we’re down.
• Give thanks: Research by Michael McCullough, Robert Emmons, Lyubomirsky, and others has revealed the power of simply counting our blessings on a regular basis. People who keep “gratitude journals” feel more optimism and greater satisfaction with their lives. And research shows that writing a “gratitude letter” to someone you’ve never properly thanked brings a major boost of happiness.
• Practice kindness: Research by Elizabeth Dunn and her colleagues finds that people report greater happiness when they spend money on others than when they spend it on themselves, even though they initially think the opposite would be true. Similarly, neuroscience research shows that when we do nice things for others, our brains light up in areas associated with pleasure and reward.
• Give up grudges: Groundbreaking studies by Everett Worthington, Michael McCullough, and their colleagues show that when we forgive those who have wronged us, we feel better about ourselves, experience more positive emotions, and feel closer to others.
• Get physical: Exercise isn’t just good for our bodies, it’s good for our minds. Studies show that regular physical activity increases happiness and self-esteem, reduces anxiety and stress, and can even lift symptoms of depression. “Exercise may very well be the most effective instant happiness booster of all activities,” writes Lyubomirsky in The How of Happiness.
• Get rest: Research has consistently linked lower sleep to lower happiness. What’s more, a study of more than 900 women, led by Nobel Prize-winning psychologist Daniel Kahneman, found that getting just one more hour of sleep each night might have a greater effect on happiness than a $60,000 raise.
• Pay attention: Studies show that people who practice mindfulness—the moment-by-moment awareness of our thoughts, feelings, and external circumstances—not only have stronger immune systems but are more likely to be happy and enjoy greater life satisfaction, and they are less likely to be hostile or anxious. Pioneering research by Richard Davidson, Jon Kabat-Zinn, and others has found that a basic eight-week mindfulness training program can significantly improve our physical and psychological well-being.
• Don’t focus on material wealth: After our basic needs our met, research suggests, more money doesn’t bring us more happiness—in fact, a study by Kahneman found that Americans’ happiness rose with their income only until they’d made roughly $75,000; after that, their happiness plateaued. And research by Richard Easterlin has found that in the long run, countries don’t become happier as they become wealthier. Perhaps that’s why, in general, people who prioritize material things over other values are much less happy, and comparing ourselves with people who have more is a particular source of unhappiness. It also suggests why more egalitarian countriesconsistently rank among the happiest in the world."

Do you have a yoga mat at home and do you practice Kabbalah?

 

[Law2Doc]

That was published in 2003, using data from 2001-2002. The salaries are thus over a decade old.

And will be over two decades old by the time many of the premeds on this board actually are practicing. I think there have been many studies in multiple specialties that have shown that thanks to reimbursement "adjustments", doctors are working much longer hours, and in many cases somewhat lower salaries than what is reflected on that table. I wouldn't take that table as gospel anymore. It was much closer to the truth when I and others referenced it in a thread when I first joined SDN.

 

[DermViser]

Except you're wrong. Academics may work long hours, but they did that to themselves by going into academics. You can find positions paying over 200k working less than 80 hours a week. I could post pages of IM hospitalist gigs that are 7 on/7 off with 12 hour shifts that pay 200k+ a year. FP you'd be hard pressed to even find a way to work 80 hours a week, given the schedules of most offices and patient preferences. EM, it just doesn't happen. Psych, PM&R, derm, and the like, 80 hours a week is certainly not normal lol. Just because you and your wife's lives suck doesn't mean you couldn't go online right now and find a gig working elsewhere that gave you less hours per week if you were willing to leave academia.

I like that chart (mainly bc I like charts). But why is Urology an "uncontrollable" specialty?

 

[Law2Doc]

Pretty sure you do that one to yourself. I don't know a single physician outside of the surgical subspecialties that clocks over 80 hours a week regularly as an attending because they have to. There's a few hospitalists that pick up extra hours and end up working 18-30 days straight sometimes, but that's really them doing it to themselves for the money, not because they're being forced to be their group.

While I think there's a range, this statement isn't really true. I know a LOT of people who saw their hours jump up dramatically when they finished residency, for the following reasons: (1) A lot of practices expect their junior partners to "pay their dues" bd do the lions share of the call. (2) there is no such thing as a post call day after residency. If you are up all night with patienrs, you still put in that full day the next day. (3) home call for attendings can be a Blessing or a curse. If things or quiet for the week, you get a light week. If you get called every night that can be a lot worse than doing one or two overnight in house calls. (4) when you are the attending your butt is on the line. No more safety net. So for a while you are going to be reviewing everything a resident "said" they took care of, and writing long notes in the charts in case it ever becomes "exhibit A" in a court case -- you won't be going home at the normal time, out of caution. (5) early in any Job you need to prove yourself. You never wow the bosses by being the guy who comes in late and leaves early. You have to play the face time and politics game in this and any job. (6) to get ahead you ususlly need to expand your role. Someone is looking for an officer or committee chair of something you are all over it. Even if it takes a lot of time, it ingratiates you to the higher ups and translates to job security.

As a result I've known many people who went from working 70-80 hours a week in residency to 100+ shortly after joining a practice or staff. I think in most cases this was more of making a series of wise career moves than "doing it to yourself". Sure they could skimp and risk lawsuits and job termination and the reputation of being lazy. But I don't really see doing what it takes to shine at your job and stay out of court as "optional".

 

[Law2Doc]

...But why is Urology an "uncontrollable" specialty?

When you gotta go, you gotta go...

 

[DermViser]

When you gotta go, you gotta go...

 

[Cyberdyne 101]

A few of the surgical residents here have remarked on the challenges of preparing for life as an attending during the residency years. Are some programs really that much better than others in terms of operative training?

 

[tiedyeddog]

A few of the surgical residents here have remarked on the challenges of preparing for life as an attending during the residency years. Are some programs really that much better than others in terms of operative training?

Yes. Even I as a lowly 4th year, after doing aways rotations at varying places, can see there is an obvious operative experience between places.

Something I noticed was that even if you go to a place with a heavy operative load it is still up to the individual to put in the effort and time to become a good surgeon. A great program can still turn out a ****ty surgeon if that person doesn't try.

 

[SouthernSurgeon]

A few of the surgical residents here have remarked on the challenges of preparing for life as an attending during the residency years. Are some programs really that much better than others in terms of operative training?

There are vast differences in operative training. The problem is it is really hard as an outsider to know what you are getting. The things that matter, to me, for operative training are:

1) Volume. You just have to have enough experience, and volume is something non-negotiable to me. If residents are struggling to get the minimum case requirements, it's a big red flag. I will probably finish with 1200-1300 cases at the current rate (even with my...let's just say...less than perfect...logging habits).
2) Complexity. Some may argue back and forth on this one, but if you are graduating with like 200 lap choles, 250 breast cases...maybe that's a little too much. This is skewed by my career goals (surgical oncology) - but I want to be doing some big whacks and getting as much exposure to difficult dissections, anatomical variance, etc.
3) Autonomy. This is harder and harder in the modern era of regulatory requirements. And it varies a ton from attending to attending how much they will let you do. But you have to get experience leading the case/dissection, taking juniors through cases, operating alone. It's a totally different experience - even something as simple as setting up retractors can be a lot harder than you think!
4) You. I have more cases than any of my classmates. Nearly double one of them. I don't mean this as a humblebrag. But your training is what YOU make of it. Some people seem to get this more than others. I was always the one stalking the ORs, taking opportunities to double scrub with chiefs, volunteering to cover cases post-call. That pays dividends when you get a reputation as someone who can be counted on. You have to take ownership of your education.

 

[Cyberdyne 101]

There are vast differences in operative training. The problem is it is really hard as an outsider to know what you are getting. The things that matter, to me, for operative training are:

1) Volume. You just have to have enough experience, and volume is something non-negotiable to me. If residents are struggling to get the minimum case requirements, it's a big red flag. I will probably finish with 1200-1300 cases at the current rate (even with my...let's just say...less than perfect...logging habits).
2) Complexity. Some may argue back and forth on this one, but if you are graduating with like 200 lap choles, 250 breast cases...maybe that's a little too much. This is skewed by my career goals (surgical oncology) - but I want to be doing some big whacks and getting as much exposure to difficult dissections, anatomical variance, etc.
3) Autonomy. This is harder and harder in the modern era of regulatory requirements. And it varies a ton from attending to attending how much they will let you do. But you have to get experience leading the case/dissection, taking juniors through cases, operating alone. It's a totally different experience - even something as simple as setting up retractors can be a lot harder than you think!
4) You. I have more cases than any of my classmates. Nearly double one of them. I don't mean this as a humblebrag. But your training is what YOU make of it. Some people seem to get this more than others. I was always the one stalking the ORs, taking opportunities to double scrub with chiefs, volunteering to cover cases post-call. That pays dividends when you get a reputation as someone who can be counted on. You have to take ownership of your education.

While browsing through Uncle Harvey and Orthogate, I've noticed that ppl on those sites tend to criticize the levels of autonomy at big-name academic programs (with some exceptions of course). Is there any validity to this criticism or are ppl just knocking the big-shot programs because they didn't match there? Obviously, this isn't relevant to me at the moment, but it has generated curiosity.
Thanks again for your feedback!