New Guideline Will Allow 1st-Year Doctors to Work 24-Hour Shifts (8 hours longer than current limit)

[sundays24]

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https://www.nytimes.com/2017/03/10/health/us-doctors-residents-24-hour-shifts.html

(I wanted to post this in pre-med allopathic rather than allopathic because I'm still pre-med and I think this info. is relevant for us to see the path we're headed on.)

I might still be limited in my perspective as an undergrad, but 24-hour shifts seem plain crazy to me. I've pulled numerous all-nighters for exams and it never worked out. I couldn't think critically/properly; I only had the brain power to regurgitate memorized facts. And to be expected to make critical healthcare decisions in this state? I knew that the 80-hour weekly limit had been instated some time in the past few years, so I thought maybe things were going to be generally headed in that direction, but I guess not. And the article says that post-first-year residents are already allowed to work 24-hour shifts. Do the pros of 24-hour shifts really outweigh the cons?

 

[Save a life]

(I wanted to post this in pre-med allopathic rather than allopathic because I'm still pre-med and I think this info. is relevant for us to see the path we're headed on.)

I might still be limited in my perspective as an undergrad, but 24-hour shifts seem plain crazy to me. I've pulled numerous all-nighters for exams and it never worked out. I couldn't think critically/properly; I only had the brain power to regurgitate memorized facts. And to be expected to make critical healthcare decisions in this state? I knew that the 80-hour weekly limit had been instated some time in the past few years, so I thought maybe things were going to be generally headed in that direction, but I guess not. And the article says that post-first-year residents are already allowed to work 24-hour shifts. Do the pros of 24-hour shifts really outweigh the cons?

Yeah, from what I've read there have been hundreds of papers and some studies published on the shift hour limits.

Pros to longer hours:
- more continuity of medical care.
- ability to stay longer shifts for surgical residents that want to scrub in on more cases.
- able to follow a patients care longer to monitor the course of their disease.

Cons:
- lack of sleep
- errors due to exhaustion

Obviously, not all shifts in residency will be 24 hours long but this new guideline allows residency programs to have the option of 24 hours in a shift as needed.

 

[ConfusedChemist]

(I wanted to post this in pre-med allopathic rather than allopathic because I'm still pre-med and I think this info. is relevant for us to see the path we're headed on.)

I might still be limited in my perspective as an undergrad, but 24-hour shifts seem plain crazy to me. I've pulled numerous all-nighters for exams and it never worked out. I couldn't think critically/properly; I only had the brain power to regurgitate memorized facts. And to be expected to make critical healthcare decisions in this state? I knew that the 80-hour weekly limit had been instated some time in the past few years, so I thought maybe things were going to be generally headed in that direction, but I guess not. And the article says that post-first-year residents are already allowed to work 24-hour shifts. Do the pros of 24-hour shifts really outweigh the cons?

Ok or not, they already happen. It's not at all uncommon, it's just not reported under the old policy. The other thing is that pulling an all-nighter to study and being up/around and working are 2 very different things. It is possible to be up, alert, and functioning for 24 hours given that you have a post-call day after, and it's not something that only happens in medicine

 

[ConfusedChemist]

When you're a 1st year resident, you don't have enough autonomy to make a significant medical mistake.

No, there is certainly the chance for a significant error to happen. You are an MD with the ability to write orders and prescriptions, and especially overnight there isn't going to be tons of staff around to check

 

[Lucca]

Guess Derm just got more competitive, huh.

80 hour / week "limit" is still in place, so it looks like intern year might be fewer but more intense shifts.

 

[Frogger27]

A lot of physicians have said that working those 24 hour shifts and getting more days off is better than working 6 days of 16 hr shifts. Taking larger chunks at a time out of that "80" hour work week seems to be what many preferred

 

[studentdocftw]

From what attendings have told me they prefer 24 hour shifts for ease of scheduling and continuity of care. Seeing the patient present and discharge allows you to participate in the entire time line(which was a big complaint on the previous system..too many hand offs and not enough learning). Also, you may be able to get full days off, which is preferable to me.

 

[darkjedi]

My hospital is part of the study that this decision is based off of so I've had to do 30hr calls as an intern.

It's not the greatest, but it also isn't the worst thing. I actually preferred the 24-30 hr call schedule as I felt like I did more learning. On the 'quieter' nights where I can actually catch a nap, the post-call day was glorious and was effectively an extra 'day' off. The alternative is the night float system for night coverage where you have to cover a ton of patients you don't know and with whom you were not involved in the medical decision making process at all, which sucks balls, if not more so than just doing call. I would say most of the residents in my hospital who have done both would probably agree as well.

Plus in most specialties, it's not like you're not going to do call for all of residency, all this rule is changing is whether or not you can do it intern year. As an intern as you generally have a more senior resident with you during call anyway to help watch your back.

There is no perfect system, residency is going to be brutal regardless as there simply just aren't enough residents/physicians to cover the amount of work required in the hospital.

 

[#LifeofaMedStudent]

I never had a problem with 24 hour shifts. In my experience (PGY-4), I actually think 24 hours leads to an easier/more predictable schedule for most people and at the same time does not really increase fatigue. With a 24hour schedule, it’s often 7am-7am. With the 16 hours, it usually becomes some weird hybrid of 7p-11a, or similar.

The "plus 4" hours that they allow for care transition I don't particularly care for. There's no reason it should take 4 hours to hand off a patient. Attendings should be supervising sufficiently enough that an intern of all people can get a patient handed off in 30 min. The plus 4 is what will be abused by systems and damage the little lifestyle you get as an intern.

 

[kamakazi5]

The idea of wanting to work six 16 hour shifts per week indefinitely sounds absolutely terrible.

 

[Psai]

My hospital is part of the study that this decision is based off of so I've had to do 30hr calls as an intern.

It's not the greatest, but it also isn't the worst thing. I actually preferred the 24-30 hr call schedule as I felt like I did more learning. On the 'quieter' nights where I can actually catch a nap, the post-call day was glorious and was effectively an extra 'day' off. The alternative is the night float system for night coverage where you have to cover a ton of patients you don't know and with whom you were not involved in the medical decision making process at all, which sucks balls, if not more so than just doing call. I would say most of the residents in my hospital who have done both would probably agree as well.

Plus in most specialties, it's not like you're not going to do call for all of residency, all this rule is changing is whether or not you can do it intern year. As an intern as you generally have a more senior resident with you during call anyway to help watch your back.

There is no perfect system, residency is going to be brutal regardless as there simply just aren't enough residents/physicians to cover the amount of work required in the hospital.

Worst part of night float is when something goes wrong and you're trying to get a senior to help you but they expect you to know the patient as if you were primary. No I don't know their ef gtfo

 

[mimelim]

Worst part of night float is when something goes wrong and you're trying to get a senior to help you but they expect you to know the patient as if you were primary. No I don't know their ef gtfo

Eh, if their EF is relevant to whatever you need the senior's help with, I can see that being important to know before calling...

 

[DrBowtie]

The idea of wanting to work six 16 hour shifts per week indefinitely sounds absolutely terrible.

Especially when your one off day for the week is a Tuesday

 

[Matthew9Thirtyfive]

I might still be limited in my perspective as an undergrad, but 24-hour shifts seem plain crazy to me.

Not a doc yet, but in the military we do a 24-36 hour day or two every week on top of our regular work schedule, i.e., we don't get to go home after our 24-hr day. It's really not that bad. You get used to functioning with only an hour of sleep (or no sleep depending on what happens--fortunately I usually can get at least a couple hours almost every duty day).

 

[ConfusedChemist]

The idea of wanting to work six 16 hour shifts per week indefinitely sounds absolutely terrible.

Something to consider before committing to this field. Too many people don't, and in my opinion probably accounts for a large proportion of burnt-out residents/physicians

 

[Matthew9Thirtyfive]

Something to consider before committing to this field. Too many people don't, and in my opinion probably accounts for a large proportion of burnt-out residents/physicians

That sort of schedule doesn't apply to most attendings, so it's really just something to consider before ranking certain residency programs or going into a select few fields.

 

[Ismet]

https://www.nytimes.com/2017/03/10/health/us-doctors-residents-24-hour-shifts.html

(I wanted to post this in pre-med allopathic rather than allopathic because I'm still pre-med and I think this info. is relevant for us to see the path we're headed on.)

I might still be limited in my perspective as an undergrad, but 24-hour shifts seem plain crazy to me. I've pulled numerous all-nighters for exams and it never worked out. I couldn't think critically/properly; I only had the brain power to regurgitate memorized facts. And to be expected to make critical healthcare decisions in this state? I knew that the 80-hour weekly limit had been instated some time in the past few years, so I thought maybe things were going to be generally headed in that direction, but I guess not. And the article says that post-first-year residents are already allowed to work 24-hour shifts. Do the pros of 24-hour shifts really outweigh the cons?

24 hour shifts aren't that crazy. As you said, they're already done by PGY-2's and above. You also end up with more time off and the opportunity to have a Golden Weekend (i.e. both Saturday and Sunday off). Post-call days don't count as days off, so you get your post call and then you also get 1 day off in 7 days worked (averaged over 4 weeks). I don't think I've had 2 days off in a row on an inpatient service month yet.

There's also usually some downtime during the shift where you can get some rest. You'll certainly have your busy shifts where patients are coding and you're getting admissions left and right, but you'll also have your slow shifts where you'll be able to take a nap.

When you're a 1st year resident, you don't have enough autonomy to make a significant medical mistake.

Lol. That is 100% false.

The idea of wanting to work six 16 hour shifts per week indefinitely sounds absolutely terrible.

It's not indefinite. You have heavy months and light months, depending on your specialty. I don't know much about surgical residencies, but for the medical residents you'll have inpatient months, ICU months, outpatient months, elective months. Our outpatient and elective months are chill, usually 8-5 with weekends off, or maybe working a half day Saturday or something.

People do lie about their duty hours, but working 16 hour days 6 days per week grossly violates duty hours. You're never going to be "scheduled" for that, rather you may end up with a 16 hour shift because you're still finishing up work or still in a case. For example, our inpatient shifts start at 7am. If I were to work for 16 hours and leave at 11pm, I would technically not be allowed to return at 7am the next day, as you need at least 10 hours off between shifts. That would put me at coming in at 9am, which hurts me and the whole team. Also doing a 16 hour shift every day for 6 days = 96 hours. You can do that for a week as long as you average out to 80 hours or less per week over 4 weeks. Of course people lie and nothing's stopping them from doing that, but you're not going to actually be scheduled for that kind of shift work back to back.

Especially when your one off day for the week is a Tuesday

I kind of like having a day off during the week. I can get errands done that aren't possible on a weekend.

 

[mimelim]

24 hour shifts aren't that crazy. As you said, they're already done by PGY-2's and above. You also end up with more time off and the opportunity to have a Golden Weekend (i.e. both Saturday and Sunday off). Post-call days don't count as days off, so you get your post call and then you also get 1 day off in 7 days worked (averaged over 4 weeks). I don't think I've had 2 days off in a row on an inpatient service month yet.

There's also usually some downtime during the shift where you can get some rest. You'll certainly have your busy shifts where patients are coding and you're getting admissions left and right, but you'll also have your slow shifts where you'll be able to take a nap.



Lol. That is 100% false.



It's not indefinite. You have heavy months and light months, depending on your specialty. I don't know much about surgical residencies, but for the medical residents you'll have inpatient months, ICU months, outpatient months, elective months. Our outpatient and elective months are chill, usually 8-5 with weekends off, or maybe working a half day Saturday or something.

People do lie about their duty hours, but working 16 hour days 6 days per week grossly violates duty hours. You're never going to be "scheduled" for that, rather you may end up with a 16 hour shift because you're still finishing up work or still in a case. For example, our inpatient shifts start at 7am. If I were to work for 16 hours and leave at 11pm, I would technically not be allowed to return at 7am the next day, as you need at least 10 hours off between shifts. That would put me at coming in at 9am, which hurts me and the whole team. Also doing a 16 hour shift every day for 6 days = 96 hours. You can do that for a week as long as you average out to 80 hours or less per week over 4 weeks. Of course people lie and nothing's stopping them from doing that, but you're not going to actually be scheduled for that kind of shift work back to back.



I kind of like having a day off during the week. I can get errands done that aren't possible on a weekend.

I don't think I've ever referred to our days as a "shift". There is just work to do that you keep doing until it is done and the patients are taken care of.

 

[Ismet]

I don't think I've ever referred to our days as a "shift". There is just work to do that you keep doing until it is done and the patients are taken care of.

We hand-off to night team after 12 hours. I usually have to stay later to finish up notes especially if there's late admissions. But after checkout to the night team, we're "off" aka they're the ones managing the pages and calls about patients. May vary between programs and probably varies a lot between medical vs surgical residencies.

 

[Endoxifen]

.

 

[RogueUnicorn]

a Golden Weekend (i.e. both Saturday and Sunday off)

AKA - "weekend"

I don't think I've ever referred to our days as a "shift"

the only people I've heard refer to "shifts" are ED and anesthesia peeps

 

[TXMED_1695]

With a 2 hour break time, I would signup up for 24 hour rotations.

 

[mwsapphire]

That sort of schedule doesn't apply to most attendings, so it's really just something to consider before ranking certain residency programs or going into a select few fields.

I second this. My uncle is a doc, and he described that the 30- hour shifts he did while doing IM residency were hell, but after he got almost 20 hours off, and could catch up on sleep. Also, if you're somebody who can nap strategically ( as in, you have two hours off in the afternoon, can you manage to grab a quick snooze? Or are you too awake because it's technically daytime?) it's not as bad as you're thinking.
Most people need at least 7 hours of sleep a night, and they do manage to survive residency. You don't need to be one of those people who only sleeps like 4 hours a night.

 

[JB50]

Well this thread was an eye-opener. Lol.

 

[Lucca]

this topic has me curious, for the physicians on the forum: What is the longest amount of time spent consecutively at a hospital while in training you have experienced or observed?

 

[mimelim]

this topic has me curious, for the physicians on the forum: What is the longest amount of time spent consecutively at a hospital while in training you have experienced or observed?

52 hours

Edit: Continuously physically in the hospital. I forget how many of those hours I wasn't technically 'on duty'. Nobody would have faulted me for going home in the middle, but when there is other stuff to do at the hospital, sometime I find that it makes sense to just live there for a while.

 

[Winged Scapula]

this topic has me curious, for the physicians on the forum: What is the longest amount of time spent consecutively at a hospital while in training you have experienced or observed?

42 (as Chief on Vascular) straight without sleep; 72 in house (same).

 

[Goro femme]

this topic has me curious, for the physicians on the forum: What is the longest amount of time spent consecutively at a hospital while in training you have experienced or observed?

I trained after 2003. About 48 hours. It was partially due to a blizzard. Ironically, at the start, I dropped my first signed attending contract in the mailbox in front of the hospital and wondered if it would get there. Much like increased healthcare regulations haven't improved care, mailmen aren't held to the same standards they were once known for.

 

[ConfusedChemist]

That sort of schedule doesn't apply to most attendings, so it's really just something to consider before ranking certain residency programs or going into a select few fields.

It can, though. There is a reduction in hours, but especially in community settings (i.e. where most doctors work) it's not uncommon. And in some surgical disciplines, you're still working extremely long days

5+ years of residency is not something to discredit, either. Image yourself being nearly 30, after 8+ years of university. Do you want to have kids? What if your SO is also in medicine? There's a lot of things to consider that many pre-meds don't know about when entering

 

[Matthew9Thirtyfive]

It can, though. There is a reduction in hours, but especially in community settings (i.e. where most doctors work) it's not uncommon. And in some surgical disciplines, you're still working extremely long days

5+ years of residency is not something to discredit, either. Image yourself being nearly 30, after 8+ years of university. Do you want to have kids? What if your SO is also in medicine? There's a lot of things to consider that many pre-meds don't know about when entering

I had a long ass post written out, but it looked pretentious so I deleted it. Suffice to say that I currently work 70-80 hours a week and am gone 1-2 nights per week. I'm on my 7th work day in a row and will not be home until tomorrow, then have to start again on Monday. I'm used to long hours and a ****ty schedule. This is light for me, and most of the time I'm at 80+. On deployment it was more like 100.

I'm also 32 and have two kids. Working this kind of schedule does not preclude kids if you are present when you're at home. It's hard but you just have to put it the effort. This might skew my perspective of "long hours," as I consider it a good week if I'm under 70.

 

[ConfusedChemist]

I had a long ass post written out, but it looked pretentious so I deleted it. Suffice to say that I currently work 70-80 hours a week and am gone 1-2 nights per week. I'm on my 7th work day in a row and will not be home until tomorrow, then have to start again on Monday. I'm used to long hours and a ****ty schedule. This is light for me, and most of the time I'm at 80+. On deployment it was more like 100.

I'm also 32 and have two kids. Working this kind of schedule does not preclude kids if you are present when you're at home. It's hard but you just have to put it the effort. This might skew my perspective of "long hours," as I consider it a good week if I'm under 70.

Of course, it's definitely possible to have both those things with a busy career. All I;m saying is that I think many premeds (again, not directing this at you because I know nothing about you) aren't aware of the realities of this, especially for women

 

[Matthew9Thirtyfive]

Of course, it's definitely possible to have both those things with a busy career. All I;m saying is that I think many premeds (again, not directing this at you because I know nothing about you) aren't aware of the realities of this, especially for women

That's part of the reason adcoms want you to shadow.

 

[sundays24]

especially for women

I'm a woman, and this knowledge hasn't deterred me in the slightest from wanting to become a physician. Maybe I'm just still too young, but I can only envision myself being a physician in the future; I really can't imagine and am not thinking about starting a family at this point in my life.

 

[ConfusedChemist]

I'm a woman, and this knowledge hasn't deterred me in the slightest from wanting to become a physician. Maybe I'm just still too young, but I can only envision myself being a physician in the future; I really can't imagine and am not thinking about starting a family at this point in my life.

As am I. Never did I say that you should be deterred from medicine, not even close. I said that people should in general, be more aware of the hours/sacrifices that training in some disciplines can require.

 

[SouthernSurgeon]

AKA - "weekend"

Actually, in its truest form, a golden weekend is post-call Friday, off sat/sun. So nearly three straight days off.

And either way, don't underestimate the value or scarcity of a full weekend off. With the 2011 hours and switch to night float schedules, I had friends who went >6 months of their intern year without one. The difference between having one day off vs two is huge.

 

[smq123]

this topic has me curious, for the physicians on the forum: What is the longest amount of time spent consecutively at a hospital while in training you have experienced or observed?

36, straight without sleep.

Full day of inpatient peds. One of my OB continuity patients came in at 5pm in labor. Labor lasted all night. Labor course and the delivery was fairly harrowing so I didn't sleep. Kid ended up in NICU. Back to inpatient peds at 7am, once we finished her postpartum paperwork. I was supposed to go home at noon, but it was the Friday before a major holiday and we were slammed. Went home at 7pm or something.

I DID fall asleep while waiting to present to the peds attending, but woke up because one of the surgeons happened to be passing by and started chucking spitballs at me.

 

[NeuResurgens]

I work 12s right now and I absolutely love working long hours a few days a week and then having the other days off

 

[mimelim]

Actually, in its truest form, a golden weekend is post-call Friday, off sat/sun. So nearly three straight days off.

And either way, don't underestimate the value or scarcity of a full weekend off. With the 2011 hours and switch to night float schedules, I had friends who went >6 months of their intern year without one. The difference between having one day off vs two is huge.

Since taking over our schedules, I have made virtually all of our days off Saturday/Sunday combos. Virtually everyone prefers it. You have to work two weeks straight, but getting consecutive days off is worth it.