Possible change in residency shift / sleep requirement

[Jolie South]

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My thoughts exactly. I can see where a doctor with a wife and kids can have conflicting interests when completing such a grueling residency. But what about the young, single, and no kids crowd? It's still going to be a challenging experience but with less responsibilities to juggle and no guilt for jeapordizing a marriage or a child's upbringing.

so you're just going to wake up magically the day after residency is over and get married and pop out kids?

that stuff doesn't happen in a vacuum. are you going to say no to everyone that asks you out and swear off all relationships until med school and residency are over? are you not going to talk to your friends for 4 years? it's not healthy to eat, breathe, and sleep medicine 100%. you will need time off for yourself and also to maintain friendships and relationships with family at the very least.

 

[MrBurns10]

Keep in mind that while 80 hour weeks are probable for most specialties, unless you're doing surgery, it's not an every week, 50 weeks a year kind of thing.

For example, with internal medicine or peds, a lot of programs have 6-7 months of q4 call where you likely will be pushing 80 hours. But those other months you're on outpatient (45 hours) or electives or some specialty service that doesn't demand quite so much time. Even my residents said that doing 3 months in a row of q4 call was a lot and not usually the norm.

So, 80 hour weeks sound bad and are not a good time, but they won't comprise every week of your residency. Unless you're in surgery, in which case I don't know what to tell ya...here's a banana for your troubles.

 

[Depakote]

Conversation with a post-call M3 last week: "Your life is going to be Hell, this sucks!" (about 30 hours into the sleep deprivation)

Conversation with the same M3 this week: "I love what I'm doing!"

Lack of sleep does horrible things to people.




Wait, I have an idea. We could make a pre-med "practice call" thread...

Every premed who "know's what they're getting into" can stay up for 36 hours straight and post in that thread at regular intervals. It'll be fun. 😉

 

[teddybear]

Conversation with a post-call M3 last week: "Your life is going to be Hell, this sucks!" (about 30 hours into the sleep deprivation)

Conversation with the same M3 this week: "I love what I'm doing!"

Lack of sleep does horrible things to people.




Wait, I have an idea. We could make a pre-med "practice call" thread...

Every premed who "know's what they're getting into" can stay up for 36 hours straight and post in that thread at regular intervals. It'll be fun. 😉

Let's do it.

 

[Excelsius]

...
Wait, I have an idea. We could make a pre-med "practice call" thread...

Every premed who "know's what they're getting into" can stay up for 36 hours straight and post in that thread at regular intervals. It'll be fun. 😉

I actually did that during the summer and still do from time to time: Pre-Medical Simulation of Residency

For those asking for a link to the study about sleep deprivation having no effect on fatalities, just read that thread in Allo/Residency forum that discusses a possible extension of residency durations. I can't find the link right now, but if you can't find it yourself, I'll try to dig it up. By the way, most people in that thread were against longer residencies as well. Given that most students are not married in med school, I don't think it is fair to say that just because the married couples would benefit from longer residencies means that everyone else should be punished by the burden. Probably most of us will be eager to get it over with so that we can get on with out lives. It is not exactly easy to marry (much less have a child) when you're barely making any money and have a debt equivalent to the price of some houses in California. Besides the financial hardships, it would probably not be fair to the child in terms of the very limited attention available to him. Women who are in their 30s during their residency might not have a choice, and that's understandable.

 

[Character]

i embrace the struggle

 

[Just Joshin]

I actually did that during the summer and still do from time to time: Pre-Medical Simulation of Residency

For those asking for a link to the study about sleep deprivation having no effect on fatalities, just read that thread in Allo/Residency forum that discusses a possible extension of residency durations. I can't find the link right now, but if you can't find it yourself, I'll try to dig it up. By the way, most people in that thread were against longer residencies as well. Given that most students are not married in med school, I don't think it is fair to say that just because the married couples would benefit from longer residencies means that everyone else should be punished by the burden. Probably most of us will be eager to get it over with so that we can get on with out lives. It is not exactly easy to marry (much less have a child) when you're barely making any money and have a debt equivalent to the price of some houses in California. Besides the financial hardships, it would probably not be fair to the child in terms of the very limited attention available to him. Women who are in their 30s during their residency might not have a choice, and that's understandable.

Once again, you're thinking about what's fair to everyone but the patients and this whole "don't punish everyone for the actions of a few" is the hallmark of a child, not a professional. If patient care suffers because of 30 hour shifts, then there shouldn't be 30 hour shifts. It's not about punishment, it's about standard of care. And until someone can link that article, I don't believe it exists. It just sounds bogus to me.

 

[Just Joshin]

I can't find the reference at the moment, but I think this study was only comparing the 80-hour work week to the 100+ hour work week that was in effect earlier. I'm not sure there's a significant difference between my cognitive abilities on 4 hours of sleep or on 2 hours of sleep-- sleep deprivation is sleep deprivation. Maybe they haven't reduced the hours enough to make any significant difference. This wouldn't mean that allowing residents to get a normal/healthy amount of sleep would have no effect on fatalities.

Now THIS sounds likely.

 

[Just Joshin]

I actually did that during the summer and still do from time to time: Pre-Medical Simulation of Residency

So I went and read this thread to see what it's all about. Man, you've got balls dude. I can't believe you compared staying up all night as a pre-med to a residency call schedule. LOL.

 

[DrJD]

thank you for quoting that... very insightful. Everyone seems to be going off on me because they think I'm all for the 100+ hours a week. Yes, I am, if it means they're going to extend our residency. I would rather do those inhumane hours than waste another 2 years out of my dam life. Yes, the original article didn't mention the residency extension, but every other MD I've spoken with has heard the same rumor.

If they're going to make my medical education 10 years (4+6) instead of 8 years (4+4), I will do whatever I have to keep it minimal. I need to get my life back at some point.

To the people who say that I don't know what I'm talking about: I'm a premed, how the hell am I supposed to know what I'm talking about? However, many others have done it before me; why should I be any different? I'll do it just like they did.

I'm sorry why is any of this "wasting" years of your life? If you were working 56 hours per week why would you need to "get your life back." Maybe I'm confused but you complain about the idea of it being two years longer but you have an entire career of 56 to 65 hour weeks coming at you, wouldn't that just make residency "life"?

I'll take 6 years of normal life, compared to 4 years of hell any day...

EDIT: Not trying to be rude, just really curious what your reasoning was...

 

[Bearferret]

I actually did that during the summer and still do from time to time: Pre-Medical Simulation of Residency

For those asking for a link to the study about sleep deprivation having no effect on fatalities, just read that thread in Allo/Residency forum that discusses a possible extension of residency durations. I can't find the link right now, but if you can't find it yourself, I'll try to dig it up. By the way, most people in that thread were against longer residencies as well. Given that most students are not married in med school, I don't think it is fair to say that just because the married couples would benefit from longer residencies means that everyone else should be punished by the burden. Probably most of us will be eager to get it over with so that we can get on with out lives. It is not exactly easy to marry (much less have a child) when you're barely making any money and have a debt equivalent to the price of some houses in California. Besides the financial hardships, it would probably not be fair to the child in terms of the very limited attention available to him. Women who are in their 30s during their residency might not have a choice, and that's understandable.

I don't actually know how I feel about the prospect of extending residencies in order to further shorten the hours, but I think you're missing something critical: in your argument, the implicit assumption is basically that years in residency are "wasted" years of life (one poster even used that term), and that residency is looked at as something just to get through in order for Real Life as a Doctor to set in, and that's why people don't want to extend their residencies. But I guess the major point is that if you did cut the hours down from 80 to 60, that attitude would no longer be true of residency - you would have a life for the duration of your training.

Again, I don't feel like I really know enough about the situation (being a premed) to have a strong opinion on it, but you've got to consider all the factors.

 

[Excelsius]

Once again, you're thinking about what's fair to everyone but the patients and this whole "don't punish everyone for the actions of a few" is the hallmark of a child, not a professional. If patient care suffers because of 30 hour shifts, then there shouldn't be 30 hour shifts. It's not about punishment, it's about standard of care. And until someone can link that article, I don't believe it exists. It just sounds bogus to me.

I am not saying that we should sacrifice patients' lives. Given that some studies show there is no significant difference for patient care, I am saying that all residents should not be punished with longer duration just because some residents are unable or unwilling to work longer hours. Since the hours per week vary drastically among specialties, those who are not willing to put in the work should not choose demanding residencies, like surgery.

Try concentrating on the main point. I already said that one of the most important factors here is the quality of the education. Several residents have mentioned that the quality does not depend on hours as much as on efficiency. Long hours by residents mostly appear to be driven by business, so that hospitals end up cutting costs and corners. So, if you want to cut the hours per week, by all means, I am for it. But DON'T increase the duration of residency. Just like some premeds are naive to accept any cut in salary possible, you do the same to accept any duration in residency.

Finally, during my experiments I noticed that personally I am very alert on the 24th hour and the eight hours that follow it.

 

[Excelsius]

So I went and read this thread to see what it's all about. Man, you've got balls dude. I can't believe you compared staying up all night as a pre-med to a residency call schedule. LOL.

Look up the definition of "emulate." I did not claim that it is the same as residency, but it is as good as it gets. If you had read the thread, you'd know that I was trying to shadow a resident on call, but it was not possible. You also missed the part that ofter pulling off 30 hours and working at my first job in the morning, I went to work to my second job and finished later in the evening, around 6pm or later on some days. That amounts to 36 hours, longer than when you're on call, and without any breaks whatsoever. On one occasion I had to present a case in front of a judge on the 31st hour. This may not be an exact carbon copy of a call, but it sure ain't a cakewalk. Try it instead of making fun of the experience.

I don't find your comment above amusing (and most of your other comments, for that matter). Take a maturepill

 

[scarletgirl777]

I am not saying that we should sacrifice patients' lives. Given that some studies show there is no significant difference for patient care, I am saying that all residents should not be punished with longer duration just because some residents are unable or unwilling to work longer hours. Since the hours per week vary drastically among specialties, those who are not willing to put in the work should not choose demanding residencies, like surgery.

Try concentrating on the main point. I already said that one of the most important factors here is the quality of the education. Several residents have mentioned that the quality does not depend on hours as much as on efficiency. Long hours by residents mostly appear to be driven by business, so that hospitals end up cutting costs and corners. So, if you want to cut the hours per week, by all means, I am for it. But DON'T increase the duration of residency. Just like some premeds are naive to accept any cut in salary possible, you do the same to accept any duration in residency.

Finally, during my experiments I noticed that personally I am very alert on the 24th hour and the eight hours that follow it.

Studies show that as the shift wears on, residents get more and more confident in their decisions even as they make more and more errors. So your subjective perception of your experience is irrelevant.

If I find that study in pubmed, I'll let you know.

EDIT: Check out Carskadon M, Dement WC. Cumulative effects of sleep restriction on daytime sleepiness. Psychophysiology. 1981;18:107-113. [FONT=verdana, arial, helvetica, sans-serif]ISI. | [FONT=verdana, arial, helvetica, sans-serif]PUBMED.

Anderson CM, Maislin G, Van Dongen HP, et al. Effect of chronically reduced nocturnal sleep, with and without daytime naps, on neurobehavioral performance. Sleep. 2000;23:A74.

These studies show that people's assessment of their sleepiness does not correlate with quantifiable indicators of their sleepiness.

Also, the paragraph starting on page 8 and ending on page 9 here: http://www.med-ed-online.org/pdf/res00120.pdf

 

[Excelsius]

I don't actually know how I feel about the prospect of extending residencies in order to further shorten the hours, but I think you're missing something critical: in your argument, the implicit assumption is basically that years in residency are "wasted" years of life (one poster even used that term), and that residency is looked at as something just to get through in order for Real Life as a Doctor to set in, and that's why people don't want to extend their residencies. But I guess the major point is that if you did cut the hours down from 80 to 60, that attitude would no longer be true of residency - you would have a life for the duration of your training.

Again, I don't feel like I really know enough about the situation (being a premed) to have a strong opinion on it, but you've got to consider all the factors.

If you are simply talking about resident's quality of life, then no, working 60 hours a week for extra one or two years is not what amounts to quality. Remember that you are paid almost minimum wage during the duration of your residency while your 250K debt keeps accumulating huge compounded interest. Besides not being able to live a normal life since you can't comfortably afford marriage or at least children, the extra years of residency will make it more difficult for you to pay off your debts once you're done. If resident compensation was higher than what you get paid working in McDonald's and if the debt was much less than what it is now, then the extra years of residency might not have had that much of an impact. Given that most residents prefer to finish their residency sooner, those wishes should be respected. Obviously these people are able to manage it, aside from some exceptions.

 

[Depakote]

😆 wow...

why didn't I see that coming?

 

[Just Joshin]

I am not saying that we should sacrifice patients' lives. Given that some studies show there is no significant difference for patient care, I am saying that all residents should not be punished with longer duration just because some residents are unable or unwilling to work longer hours.

Once again, until you produce a link, I don't believe such a study exists. I've never heard of such a thing and it sounds ridiculous frankly.

 

[Just Joshin]

Just like some premeds are naive to accept any cut in salary possible, you do the same to accept any duration in residency.

Look around. There are med students on this thread who want to increase the years in residency in exchange for shorter hours.

Finally, during my experiments I noticed that personally I am very alert on the 24th hour and the eight hours that follow it.

LOL, you really think that staying up on your own and surfing the 'net or whatever it is you do in your time is the same as a call night? You're so foolish.

 

[Just Joshin]

Look up the definition of "emulate." I did not claim that it is the same as residency, but it is as good as it gets. If you had read the thread, you'd know that I was trying to shadow a resident on call, but it was not possible. You also missed the part that ofter pulling off 30 hours and working at my first job in the morning, I went to work to my second job and finished later in the evening, around 6pm or later on some days. That amounts to 36 hours, longer than when you're on call, and without any breaks whatsoever. On one occasion I had to present a case in front of a judge on the 31st hour. This may not be an exact carbon copy of a call, but it sure ain't a cakewalk. Try it instead of making fun of the experience.

I don't find your comment above amusing (and most of your other comments, for that matter). Take a maturepill

I don't care what you did. Until you have life and death issues in front of you, it's not the same.

 

[Just Joshin]

If you are simply talking about resident's quality of life, then no, working 60 hours a week for extra one or two years is not what amounts to quality. Remember that you are paid almost minimum wage during the duration of your residency while your 250K debt keeps accumulating huge compounded interest. Besides not being able to live a normal life since you can't comfortably afford marriage or at least children, the extra years of residency will make it more difficult for you to pay off your debts once you're done. If resident compensation was higher than what you get paid working in McDonald's and if the debt was much less than what it is now, then the extra years of residency might not have had that much of an impact. Given that most residents prefer to finish their residency sooner, those wishes should be respected. Obviously these people are able to manage it, aside from some exceptions.

So you've taken a poll of all residents and given them a choice of shorter hours/longer years vs. longer hours/shorter years and "most" chose the latter?

 

[armybound]

I don't even understand why years/hours per week is being discussed. The article is about combating sleep deprivation.

Or have we already come to the conclusion that people must either be sleep deprived or we need to lengthen residency to get that "quality education" that they're missing from no longer being sleep deprived?

 

[genswim24]

Once again, until you produce a link, I don't believe such a study exists. I've never heard of such a thing and it sounds ridiculous frankly.

http://jama.ama-assn.org/cgi/content/full/298/9/975

I know this was an article often cited. The area of medicine where reducing hours seems to have the least impact is surgery. This is not that surprising since this group often complains the most about the mandatory hour reduction.

 

[circulus vitios]

For all of you pre-meds that are saying 100 hour weeks aren't anything...have you ever actually worked 12, 14, 16 hours days? I've only worked a few 12 hour+ days doing manual labor, and it SUCKS. I can't imagine doing it five or six days a week, WITH CALL, for years on end would be very fun. Restructure residencies to be more efficient, and lower the hours while keeping the lengths the same. I'd rather have a longer residency with less hours than work 80-100 hours a week for 4+ years.

 

[chiz2kul]

I wanted to post this comment from that link to your blog:

"I graduated with an MD/PhD in neuroscience and I started my training in neurosurgery in Philadelphia in 1998 prior to the new policy limiting resident hours. At the time, I was 32yrs old with 2 young children (2yrs & 6mos old). I worked the 120hr weeks at a very active trauma center and spent all night up, every other night, caring for patients and often didn’t sign out post-call until 10p (still no sleep) having to then go to medical records to dictate charts for a couple of more hours just to get unsuspended for the next day. I’d get home by midnight and have to be up at 4am to return for the next day. After a couple of months of that physical and pyschological torture, I became more and more depressed, angry all the time from being yelled at by nurses and attendings and myself yelling at nurses, patients, and med students. I increasingly found myself crying in the call room alone and feeling helpless and hopeless. By 6 months into my internship, I had hardly ever seen my children awake and my wife felt I was becoming more and more distant. One night during a particularly brutal call, I found myself facing a list of ~65 patients for whom I only had a name, room number and diagnosis and a beeper that wouldn’t stop going off. That night I felt like there were 2 ways out — one was off the roof of the hospital and the other was out the front door. Thank God I had the strength to choose the front door. That day I quit and never returned and I have never regretted that decision which saved both my life and my family. I re-matched in Pediatrics and completed my medical training thankful for only having to work 80hr weeks (imagine that?!). I still get emotional recounting those difficult times. Was it necessary to make me work 80-120hrs in order for me to become a ‘good’ physician — absolutely NOT. It dehumanized me and I can assure you that patients don’t benefit from the care of dehumanized physicians. How can you care for someone else if you can’t even care for yourself? Forget 24hrs, NOBODY should be expected to work longer than 12 continuous hours with full days off during each 7 day period. Anything else is INHUMANE and unecessary and benefits nobody. As dramatic as my story may sound, it is hardly unique. I’m glad there has been some progress with this very important issue, but there is much, much more to accomplish and I salute those making a stand."

quote]

Wait...you can just walk out like that? Or does this story have extra dramatic flavor?

 

[ayushman80]

I used to be in a job that required me to regularly work over 90 hours a week. In that job we also had people's lives to worry about. I don't understand why working 80 hrs is such a huge deal. It is absolutely ridiculous that these people think working 80 hrs/wk in those shifts is too tiring. Working a 100 hour week for several years in a row is not realistic either. However, working 80 hours is no different than what a single mother with a job does. Nor is it any different than most engineers and many military members (lives are at stake here also). If these people can suck it up for a few years so can we. Especially since we know beforehand what we are getting ourselves into.

 

[Just Joshin]

http://jama.ama-assn.org/cgi/content/full/298/9/975

I know this was an article often cited. The area of medicine where reducing hours seems to have the least impact is surgery. This is not that surprising since this group often complains the most about the mandatory hour reduction.

That article was already addressed in this post:

I can't find the reference at the moment, but I think this study was only comparing the 80-hour work week to the 100+ hour work week that was in effect earlier. I'm not sure there's a significant difference between my cognitive abilities on 4 hours of sleep or on 2 hours of sleep-- sleep deprivation is sleep deprivation. Maybe they haven't reduced the hours enough to make any significant difference. This wouldn't mean that allowing residents to get a normal/healthy amount of sleep would have no effect on fatalities.

If you guys are thinking that by saying that 100 hours vs. 80 hours results in the same amount of resident errors means that there's no correlation between hours on-duty and errors, you have a HUGE leap in your logic. In fact, I dare say that article backs up the rest of us who say that 80 hours is still too much and that hours need to be reduced.

 

[phospho]

For all of you pre-meds that are saying 100 hour weeks aren't anything...have you ever actually worked 12, 14, 16 hours days? I've only worked a few 12 hour+ days doing manual labor, and it SUCKS. I can't imagine doing it five or six days a week, WITH CALL, for years on end would be very fun. Restructure residencies to be more efficient, and lower the hours while keeping the lengths the same. I'd rather have a longer residency with less hours than work 80-100 hours a week for 4+ years.

no one said 100 hour weeks aren't "anything"...

As residents we'll be getting screwed either way, whether it's 80 hours or 100 hours... i'd rather get screwed doing the 100 hours and get this s.hit over with quicker.

I'm a financial analyst at a large corp. About 5 months ago they laid off 3 people in my department. Since then I've regularly been doing 70-110 hours a week. Yes, I am make a crap load of money in overtime (much more than any resident would ever make), but I do know what it feels like to work that long. At least once a month (during billing), I go to work at 9 a.m. and leave at 5 p.m. the next day. It's not a walk in the park, but I can get used to it.

Granted, they're not "life and death" decisions or anything remotely close to the stuff residents have to do, but let's get real, it's not like residents are sitting there for 30 hours making life altering decisions. I'm not trying to belittle their work, but I've spoken to a lot of residents, and there are a lot of things that can be done in "cruise control" after a good amount of experience. It's not like TV where they spend the whole day running from one room to the next deciding if Mrs. Smith should have an abortion or die.

 

[Just Joshin]

I used to be in a job that required me to regularly work over 90 hours a week. In that job we also had people's lives to worry about. I don't understand why working 80 hrs is such a huge deal. It is absolutely ridiculous that these people think working 80 hrs/wk in those shifts is too tiring. Working a 100 hour week for several years in a row is not realistic either. However, working 80 hours is no different than what a single mother with a job does. Nor is it any different than most engineers and many military members (lives are at stake here also). If these people can suck it up for a few years so can we. Especially since we know beforehand what we are getting ourselves into.

Spoken like a true pre-med.

 

[circulus vitios]

no one said 100 hour weeks aren't "anything"...

As residents we'll be getting screwed either way, whether it's 80 hours or 100 hours... i'd rather get screwed doing the 100 hours and get this s.hit over with quicker.

I'm a financial analyst at a large corp. About 5 months ago they laid off 3 people in my department. Since then I've regularly been doing 70-110 hours a week. Yes, I am make a crap load of money in overtime (much more than any resident would ever make), but I do know what it feels like to work that long. At least once a month (during billing), I go to work at 9 a.m. and leave at 5 p.m. the next day. It's not a walk in the park, but I can get used to it.

Granted, they're not "life and death" decisions or anything remotely close to the stuff residents have to do, but let's get real, it's not like residents are sitting there for 30 hours making life altering decisions. I'm not trying to belittle their work, but I've spoken to a lot of residents, and there are a lot of things that can be done in "cruise control" after a good amount of experience. It's not like TV where they spend the whole day running from one room to the next deciding if Mrs. Smith should have an abortion or die.

That's office work. I'm talking about being up and on your feet, walking around, talking, performing procedures, performing surgery, etc for 14+ hours. There's a big difference. I can do 14 hours of office work no problem. Doing physical work for 14 hours is a bit different.

 

[phospho]

That's office work. I'm talking about being up and on your feet, walking around, talking, performing procedures, performing surgery, etc for 14+ hours. There's a big difference. I can do 14 hours of office work no problem. Doing physical work for 14 hours is a bit different.

I can see your point, and I agree with you.

Yes, I'm a premed, and I don't know what it's like, but I will get used to it. other residents have done it before me - they were fine, so I will be fine.

I will work whatever hours it will take to keep my residency length at what it is right now.

 

[MrBurns10]

That's office work. I'm talking about being up and on your feet, walking around, talking, performing procedures, performing surgery, etc for 14+ hours. There's a big difference. I can do 14 hours of office work no problem. Doing physical work for 14 hours is a bit different.

I'm going to respectfully disagree with this. It's easier to stay up all night when there are things you have to concentrate on (like procedures), and walking around and talking also helps. It's when you sit down and have to write orders or discharge paperwork that it becomes horribly painful to be awake.

 

[teddybear]

I'm going to respectfully disagree with this. It's easier to stay up all night when there are things you have to concentrate on (like procedures), and walking around and talking also helps. It's when you sit down and have to write orders or discharge paperwork that it becomes horribly painful to be awake.

Agreed.

 

[Excelsius]

I'm going to respectfully disagree with this. It's easier to stay up all night when there are things you have to concentrate on (like procedures), and walking around and talking also helps. It's when you sit down and have to write orders or discharge paperwork that it becomes horribly painful to be awake.

Not only that, but if you are doing something you love, like surgery, it's much easier to keep the concentration and not feel that you are going to pass out. That's why my most difficult times were during the times when I was surfing the internet in the middle of the night. But if I headed to the gym or went to work, I felt very alert. Of course, then while driving home, especially during traffic, I could barely keep my eyes open. A lot of people here are just saying things without having tried anything. I guess thinking about being on call is much better than practicing the next best thing available. A vicarious simulation 🙄.

 

[Just Joshin]

Not only that, but if you are doing something you love, like surgery, it's much easier to keep the concentration and not feel that you are going to pass out. That's why my most difficult times were during the times when I was surfing the internet in the middle of the night. But if I headed to the gym or went to work, I felt very alert. Of course, then while driving home, especially during traffic, I could barely keep my eyes open. A lot of people here are just saying things without having tried anything. I guess thinking about being on call is much better than practicing the next best thing available. A vicarious simulation 🙄.

Actually, what I'm saying is based on what residents and doctors have been saying, on what studies show, and on the errors that were the result of the 80-100 hour work weeks. But go ahead and ignore all that since it doesn't jibe with your opinion as a pre med who stayed up all night one night.

 

[Jss1545]

Saw this on NYTimes today...

http://www.nytimes.com/2008/12/03/health/03doctors.html?_r=1

Any thoughts?

 

[alwaysaangel]

They're already bickering about it in this thread:

http://forums.studentdoctor.net/showthread.php?t=583140

 

[phospho]

Not only that, but if you are doing something you love, like surgery, it's much easier to keep the concentration and not feel that you are going to pass out. That's why my most difficult times were during the times when I was surfing the internet in the middle of the night. But if I headed to the gym or went to work, I felt very alert. Of course, then while driving home, especially during traffic, I could barely keep my eyes open. A lot of people here are just saying things without having tried anything. I guess thinking about being on call is much better than practicing the next best thing available. A vicarious simulation 🙄.

👍

 

[Just Joshin]

I think it's a fabulous idea!

 

[Kaustikos]

So, to sum up, people are being presumptious when they're not even doing this? Awesome.

So you see, “Medical Errors,” like “Patient Care,” is nothing more than another blunt weapon with which to bludgeon rebelious residents into submission. It is another despicable appeal to shame and an abuse of the resident’s sense of duty. The fact that most residents buy this argument is because they lack the conceptual tools to refute it.

grabbed this from panda bear and i'm just wondering what the correct way to fight back would be? It's an interesting point, but I didn't see where he clarified where a resident should start.

I've had my share of 12 hour work days but I won't EVER make the argument that it's in the same capacity of 12 hour work days as a physician. Also, making the arguement that you stayed up as long as a resident would on average has no weight in this argument. I've stayed up 40 hours in my undergrad, but I wasn't doing the work of a physician. I was doing undergraduate work...

I would love to hear more opinion from people who are actually in residency/dealing with this, but the logical solution would be to actually go TO THOSE FORUMS on sdn and read what they're saying.

From what I gather - talking to people in medical school/residency, the answer is a mixed bag so far. Some just don't have a solution but simply say that it sometimes sucks and sometimes is boring. Sometimes it's hectic, sometimes it's mundane.

 

[Livingapparatus]

I think people need to realize the difference between working 80 to 100 hour weeks for a couple months and 4+ years.

After just a year of working 2 jobs I am mentally and emotionally exhausted, being sleep deprived has made me apathetic towards patients that I have direct contact with and its a struggle to care for them to my best abilities. These patients need all your attention and its hard to do that when your thinking about sleeping in your car instead of going home so you can get a couple more z's. I would never want this from a doctor that was taking care of a family member.

Sleep keeps me human and its the only thing I look forward to now. I understand making sacrifices for this profession but sanity should not be what I have to give up.

If anything needs to be changed its the efficiency of teaching hospitals and lowering the amount of bull****.

Just a couple of pennies

 

[Kaustikos]

Not only that, but if you are doing something you love, like surgery, it's much easier to keep the concentration and not feel that you are going to pass out. That's why my most difficult times were during the times when I was surfing the internet in the middle of the night. But if I headed to the gym or went to work, I felt very alert. Of course, then while driving home, especially during traffic, I could barely keep my eyes open. A lot of people here are just saying things without having tried anything. I guess thinking about being on call is much better than practicing the next best thing available. A vicarious simulation 🙄.

I wonder how many times people have used that argument and been wrong...

 

[Kaustikos]

I think I have a solution;

all pre-meds who think they know should volunteer at a hospital and shadow physicians for the exact duration that a resident would work.

Have fun

 

[kansaskid]

yeah, just like in kindergarten!
(not sarcasm, genuine excitement)

 

[MrBurns10]

If anything needs to be changed its the efficiency of teaching hospitals and lowering the amount of bull****.

That's definitely the biggest key, and hindrance, to resident happiness and effectiveness.

I'm not sure if you saw my comment earlier, but I mentioned that in almost every residency (minus surgery, I'm guessing), you're NOT going to be working 80 hours a week for 4 years...you're going to be working 80 hours a week for 6-7 months, 2-3 consecutive months at a time. Well, usually...some programs will have more call than others. And on those off months in between you're working significantly less (45-60). It's still not a walk in the park, but it's not 80 hours either.

 

[Nemuri]

so you're just going to wake up magically the day after residency is over and get married and pop out kids?

that stuff doesn't happen in a vacuum. are you going to say no to everyone that asks you out and swear off all relationships until med school and residency are over? are you not going to talk to your friends for 4 years? it's not healthy to eat, breathe, and sleep medicine 100%. you will need time off for yourself and also to maintain friendships and relationships with family at the very least.

For someone who doesn't want an intimate relationship until they're in their 30's, has no close friends within a 4 hour drive of them, and could care less about family ties, I doubt making work life is a bad thing.

 

[Chemist0157]

I don't even understand why years/hours per week is being discussed. The article is about combating sleep deprivation.

Or have we already come to the conclusion that people must either be sleep deprived or we need to lengthen residency to get that "quality education" that they're missing from no longer being sleep deprived?

I wrote something like this earlier. I think alot of people enter a thread knowing what they're going to say before they even read what the real topic is. 🙄

I've worked many 12-hour shifts, and they sucked. BUT, it does seem to go by quicker and easier while I was really busy and constantly on my feet. I didn't feel tired until near the end of it. However, I don't see how I could last a day's worth of hours without only getting tired near the end or while doing paperwork or whatever. I'm prepared to do whatever is required of me, and unfortunately, I have zero control over whatever kind of policies there will be once I go into residency. The only thing that bothers me about a longer residency is those loans accumulating. Of course, in the end, I may consider a more normal life during residency worth more than the extra money it cost me in loans.

 

[cheshir3]

I think that article had a lot of excellent tips for cutting down on sleep deprivation.

And, since everyone else is ignoring the actual content of the article and instead arguing about hours, here's my 2cents. As a pre-med, I will freely admit I have absolutly no relevant experience in regards to working 30+hours and being on call constantly. But I sure as hell aren't going to act all macho and say I can handle that. I'd much rather be able to sleep, think rationally, and be able to provide good and consistent patient care during the entirety of my shift than suffer through hell. If someone could come up with a solution to the mountains of debt accumulating during residency, I would be all for a slightly longer residency.

 

[Just Joshin]

I think that article had a lot of excellent tips for cutting down on sleep deprivation.

And, since everyone else is ignoring the actual content of the article and instead arguing about hours, here's my 2cents. As a pre-med, I will freely admit I have absolutly no relevant experience in regards to working 30+hours and being on call constantly. But I sure as hell aren't going to act all macho and say I can handle that. I'd much rather be able to sleep, think rationally, and be able to provide good and consistent patient care during the entirety of my shift than suffer through hell. If someone could come up with a solution to the mountains of debt accumulating during residency, I would be all for a slightly longer residency.

I think that in the case of a longer residency, the government should mandate certain restrictions on loan interest rates while in training. It's obviously not something that's going to happen tomorrow, but if they begin trying to restructure, then they can do it for the long run. Look at the Libby Zion case. It took nearly 20 years until the changes born out of that case were implemented, but they eventually were.

 

[armybound]

I think that article had a lot of excellent tips for cutting down on sleep deprivation.

And, since everyone else is ignoring the actual content of the article and instead arguing about hours, here's my 2cents. As a pre-med, I will freely admit I have absolutly no relevant experience in regards to working 30+hours and being on call constantly. But I sure as hell aren't going to act all macho and say I can handle that. I'd much rather be able to sleep, think rationally, and be able to provide good and consistent patient care during the entirety of my shift than suffer through hell. If someone could come up with a solution to the mountains of debt accumulating during residency, I would be all for a slightly longer residency.

On top of what you're saying, residents often put themselves into a sleep-deprived situation because they need that extra money, so they moonlight (I know you read that in the article).

It's pretty obvious that the institute of medicine is doing this to itself.. overworking its residents and underpaying them, causing them to work too long, too hard, and lose sleep just to try to feed the system cheap labor.

 

[cheshir3]

I think it sounds pretty awesome.