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Is this what a doctor can do with his/hers hours?

Discussion in 'hSDN' started by VeggieForce, Dec 29, 2008.

  1. VeggieForce

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    im a sophomore in high school
    my cousin told me that when ur finished doing residency, u can choose how many hours you want to work. (He is going to be done with undergrad this april and will be doing rotations)
    lets say....i want to be a general internist (internal medicine)
    how many hours would i have to work? and could i choose how many hours i have to work? see.. i dont want to be so stressed and work 80+ hours a week. 60 hours could be good..
     
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  3. CScull

    CScull Is Positive, O Positive
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    A lot. I would highly expect 80+ in the beginning. I've heard of doctors working 30 hours straight. Residency is a pretty long time; you don't want to go into it and burn out... again though you still have a long time before you need to worry about this stuff.

    There've been reports on the news stressing the need to cut doctors hours to reduce unnecessary mistakes due to fatigue. For all we know by then they might have changed things.
     
  4. Law2Doc

    Law2Doc 5K+ Member
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    If your focus is not working long hours, medicine may not be a great choice. Sure there are some part time options out there, and some opportunity to work fewer hours (but often with a commensurate loss of income and advancement opportunities), but these are sometimes harder to find because the way expenses work, it is simply cheaper for practices to hire one person who can work 70 hours/week instead of two who can work 35.
    Bear in mind that med school is 4 years, during later parts of which you may be taking overnight call and working 80 hours/week. Then residency is 3-5 years, during which you will probably be working overnight every 3rd or 4th day and hitting 80 hours/week. After residency the hours are variable, depending on the path you take. Many folks end up working over 80 hours/week post-residency because they are the low person on the totem pole at wherever they end up, have the most to learn, are the least efficent, and because the 80 hour average work week limitation does not protect folks once they finish residency. Over time, most non-surgical physicians end up in more manageable schedules, with the average being closer to 60 hours/week. EM uses shift work and their hours tend to be less than this, but often the hours of younger physicians are heavily weighted toward overnight work, which is less desirable for many.

    In terms of choosing how many hours you work, and when, your best bet may be, after working for an established practice for a while to get down the basics, to hang up your own shingle doing peds, psych or FM and seeing however many patients you wanted per day. But bear in mind that your income is totally based on how much insurance companies will reimburse you per office visit, so you may end up not covering your expenses if you cut your hours low, and running your own business means you will be doing your own paperwork, accounting, marketing -- all of which take a lot of time for which you cannot bill. You may go broke, but you absolutely can see your three patients a day under this set-up if you wanted.

    The more common situation is for physicians these days to have to work crazy hours in primary care fields to earn a decent income, and lately hours have increased each year as reimbursements have gone down, meaning doctors now have to work 70 hours/week just to earn what they previously made working 60 hours/week. Expect this to get worse as the government turns to insurance companies for help making medicine more affordable in coming health care changes.

    Sounds like your cousin is not in the US if he is doing undergrad and then rotations -- in the US you do undergrad, then 4 years of med school (the latter two of which are rotation) and then 3-7 years of residency, maybe a fellowship on top of that, before you go into private practice. So your cousin is not totally wrong, but he may not be being very realistic as to what is financially feasible under the current US system.
     
  5. Law2Doc

    Law2Doc 5K+ Member
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    30 hours straight is pretty much the normal call during residency -- you take call every 3rd or 4th night which means you come in at 6am every 3rd or 4th day and don't go home until you sign out by noon the next day. Not so bad on quiet nights when you get to sleep, but a bit harder on the busy nights when you don't.

    The maximum work hours were reduced to 80 hours/week average a few years back, and while the claim was that it would reduce unnecessary mistakes caused by fatigue, thus far there hasn't been good evidence that the reduction has made a lick of difference. Notwithstanding that, the IOM has issued additional suggested reductions which may go into effect in a few years, which won't reduce the 80 hour limit, but would effect the number of hours in a row a resident could work.
     
  6. tennisball80

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    After residency, family practice will be a less demanding field to work.
     
  7. CScull

    CScull Is Positive, O Positive
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    That's what I've heard too... there was a report a while back on NBC or some news program like that. It would be nice if they split it up more; but then again if the doctors are needed...
     
  8. CScull

    CScull Is Positive, O Positive
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    When you do that though will you have breaks in time to rest or will you be seeing clients for the entirety of the 30 hours? Just wondering...
     
  9. Law2Doc

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    It depends on the specialty, but generally on call means you are responsible for going down to the emergency department to see new admissions to your service, as well as handle all the crises that come up on the wards for the existing patients on the service. If there are a lot of issues with the existing patients or a lot of new admissions, you can be up all night dealing with them. If nobody new comes in and everybody on your service is resting comfortably during the night with no fevers, irregular heart rhythms, difficulty breathing or other complaints, then you can get some sleep until your pager goes off. Odds of a full night's sleep are pretty low, but a few hours isn't impossible on most call nights. Again it depends on the specialty and how sick the patients are that you have on the floor.
     
  10. CScull

    CScull Is Positive, O Positive
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    Thanks. :)
     
  11. VeggieForce

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    my cuzin does live in US. (i guess i got confused about if he was finished with his undergrad or not. my mistake)

    so after residency will the hours be shorter in internal medicine and family practice?
     
  12. r31ncarnat3d

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    This was covered pretty well by doctors and residents in another thread here.

    From what people said, 50 hours per week is normal as a resident, with 24 hour shifts every fourth day. As a doctor, 60 hours per week maximum during emergency medicine months and 80 hours per week max during off-service months.

    And as for stress, if you're not used to it or can't deal with it, I suggest you consider another field. Being a doctor is constant stress; the way that medical school and residency is designed places much stress on their students so that in the end, only the best are left.
     
  13. Law2Doc

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    Um no. The maximum is 80 hours/week average. Many residencies push close to that average through much of residency, even exceeding it now and then. Surgery will always be at the maximum, fields like IM will hover just below it. You can expect to be working 60-80 hours/week in most residencies, not 50. And overnights in many fields are 30 hours, not 24, and can be as frequent as every 3rd night or every 4th.

    Don't kid yourself that you will be working anything resembling normal business hours in residency -- you won't. The phrase "residency" was derived because at one point residents "resided" in the hospitals and never went home. These days that is less so, but still a much more hectic than a mere 50 hr/week job.

    EM will be lower due to the nature of shift work, so that's not a specialty from which to extrapolate to other fields.
     
  14. Law2Doc

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    The averages in those fields tend to be around 60 hrs/week postresidency. FP has seen the biggest rise over the past decade because as reimbursements get cut FPs find that they have to work longer hours just to earn the same income as prior years.

    In things like surgery, folks often see their hours jump post-residency because they are no longer subject to the 80 hour maximum work week.

    I continue to submit -- if working long hours is not your bag, medicine is going to be a bad choice of careers.
     
  15. CScull

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    Why do hours fall so much after residency? I would think if anything they would increase because by then you're more qualified... is it another money issue? ... because attendings make more?
     
  16. Law2Doc

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    Not a money issue. They fall because the folks in private practice and fellowship take call less frequently -- more like once a week. When you are working overnight every 3rd or 4th night during residency the hours add up fast. When you swap that for 10-12 hour days with less call, the total hours drop. Again I note that surgeons actually often see their hours increase once the 80 hour work week limitation is lifted. Bear in mind that if you are just staring out in private practice there is going to be an expectation of you to see a ton of patients and likely work a higher number of hours than perhaps you will be require to do once you are more senior. Looking at averages sometimes hides this variation.
     
  17. 45408

    45408 aw buddy
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    Because you're not on Q4 call (overnight every 4th night), and depending on your specialty, you can take more days off than you could as a resident. The hospitalists at my school's affiliated hospital work two weeks on, two weeks off. Their two weeks on is pretty busy (plan on 10-14 hours a day for two weeks straight), but then they have two weeks off. Residents here get 3 weeks off per year, and that's it. The rest of the time, they only get four days off per month total.
     
  18. CScull

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    That clears it up a bit, thanks guys.
     
  19. DrReo

    DrReo "Thread Necromancer"
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    It really depends, you have to have a lot of patients to pay off that student debt. Count on at least 60 hours, losing some weekends, later nights, etc.
     

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