Possible change in residency shift / sleep requirement

[Chemist0157]

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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 overpaying them, causing them to work too long, too hard, and lose sleep just to try to feed the system cheap labor.

I guess you meant "underpay"? This residency system is going to be a beast regardless of what they change!

 

[armybound]

I guess you meant "underpay"? This residency system is going to be a beast regardless of what they change!

haha, yes, I meant underpaying.

 

[Jolie South]

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.

that's going to be a lonely existence.

 

[MossPoh]

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. 😉

I kind of suffer from insomnia, so I could probably do that pretty easily if you want. I sleep about 4 hours a day as is. 😉

 

[Bacchus]

Merged naptime thread with this thread.

 

[Instatewaiter]

Keep the 100+ hour weeks and kick out the people who are bitchin', and then we are good to go.

When you actually work multiple weeks in a row that are 80 hours+ in a hospital come back and talk to us. Until then shut up and dont act like you know what you're talking about.

By cutting down on the hours you actually gain some of those years back rather than lose 2 more.

What the hell, as a premed, do you actually know about this? A vague abstract idea that it's going to be hard?

+1

There have been studies that have shown patient care is not affected by long hours. I think it was mentioned in this forum already.

here are a few articles that contradict you and that was just the first page...
http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum


http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

 

[tdittyx2x3]

30 hours is forced sleep deprivation and it shouldn't happen..

And yes, I will surely do it if I have to. I think that the challenge of all this might be half the reason I want it so badly.

"You'll be singing a different tune when...." Yea yea I know already.

 

[phospho]

Until then shut up and dont act like you know what you're talking about.

You do not have to be a jackass to make your point. I clearly stated that I didn't know what it felt like. You do not have to insult anyone to make a point. YOU are an example of what is wrong with people - you're bitter, mean, and you do not know how to communicate with others.

 

[NurWollen]

Would these changes apply to med students on their rotations or just to residents?

Anyway, it seems like a good idea to me, in principle, although I can see it actually hurting residents' lifestyles by actually decreasing the amount of time spent at home... or maybe not.

 

[HumidBeing]

^^^^^^^^^ That is the bucket of cold water that I'm throwing on this bickering.

You guys know how to have a good discussion. Keep it civil. Respect the opinions of other members. Please stick to the actual topic and resist insulting others, directly or indirectly.

If someone's posts irritate you, go to the Troll Sticky and learn how to use the Ignore Function. It is your friend.

Cool it and play nice, everyone.

 

[nevercold]

(1) The current policies are already pretty good. 80-hr work week + 1 day off in 7 and minimum 10 hrs between shifts. 30-hr on shift maximum is good. It should be noted, though, that we don't do "24+6." We care for patients all 30 of those hours, with perhaps a single hour or two being devoted to transition of care or non-patient care educational experiences.

(2) As people get older, they need less sleep, but getting less than 7 hrs a night is not healthy. Maybe you can do it, but it's not healthy. Being overstressed and uni-dimensional as a person is also not healthy. Maybe you can do it, but it's not healthy. Now, correct me if I'm wrong, but medicine is about enhancing health. It is absolutely ******ed and contradictory to be in the field of medicine and openly endorse unhealthy practices, whether it is for your patients or colleagues.

(3) You will never see *everything* in your residency. You have to read to learn about the things you don't get to see. Hour requirements need to strike a balance between sufficient exposure, sufficient time for reading and extra investigation, and maintaining sufficient health to be effective as a doctor and as a learner.

(4) You should be unwilling to throw any moment of your life away. Anything could happen and you could be dead or headed down a very different path at any moment. The current rules are an acknowledgment of the right of individuals pursuing medicine to still be human beings. Sacrifice is one thing, martyrdom is another.

 

[8744]

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 🙄.

You will do very little surgery as a surgery intern relative to the your hours and you will do almost none on call.

 

[armybound]

which rotations are likely to have these 30 hour shifts/long periods of sleep deprivation? all fields, or just surgery?

 

[Just Joshin]

which rotations are likely to have these 30 hour shifts/long periods of sleep deprivation? all fields, or just surgery?

I'm guessing Internal Med is up there too.

 

[armybound]

I'm guessing Internal Med is up there too.

Really? I see internal med residents every week and they never look like they're missing out on any sleep. I even heard one talking on the phone saying he works 6a-6p, though I doubt that's just M-F and the only hours he works.

 

[MrBurns10]

which rotations are likely to have these 30 hour shifts/long periods of sleep deprivation? all fields, or just surgery?

It completely depends on your school's requirements. There are schools that don't require overnight call and those that do, sometimes for certain rotations and sometimes for all. Overnight call can exist in surgery, Ob/gyn, internal medicine, and peds, so any of those have the potential for long, sleepless nights, every 4th night or so. It'll also depend on your team...some residents are nicer than others about letting you sleep if there's not much going on.

As far as residency goes, surgery aside, if you're in IM, peds, or OB you can expect to be overnight call every 3rd-4th night; most times, you'll be lucky to get an hour of sleep.

 

[Just Joshin]

Really? I see internal med residents every week and they never look like they're missing out on any sleep. I even heard one talking on the phone saying he works 6a-6p, though I doubt that's just M-F and the only hours he works.

That hasn't been my experience. I shadowed a 2nd-year IM resident who was on q4 call and miserable.

 

[45408]

I love when ignorance has a voice. Hey dude, there are no 100 hour work weeks. That went out five years ago and the reason was because of all the deaths caused by residents working those hours. If you want to have open-heart surgery with a doctor who's been awake and on-duty for 28 hours, that's your call. I for one, don't.

Of course, you probably won't have a choice. We've got a peds cardiothoracic surgeon here who works pretty much all of the time. I had one of his patients last month who got a 19-hour operation after an aortic dissection. The pt came in during the afternoon/evening, so I'm sure that by the end of the operation, he had been awake for 30-40 hours, depending on his prior call schedule.


Also, ignorance apparently STILL has a voice. At the last surgery conference I went to, one of the residents had logged over 100 hours in a week, and they called him out on it. It happens, and you've got a big mouth.

 

[45408]

this is ******ed... i can't believe the AMA or whoever ******* running this organization is supporting longer residencies. We ALL knew what we were getting ourselves into beforehand. We all knew about the long ass hours.

I need a doctor who knows his stuff even in his sleep, i.e. that 31st hour of being awake. I want to be a resident who will graduate knowing that I know my stuff backwards and forwards.

Keep the 100+ hour weeks and kick out the people who are bitchin', and then we are good to go.

Spoken like a true pre-med.

 

[midwesterner]

(1) The current policies are already pretty good. 80-hr work week + 1 day off in 7 and minimum 10 hrs between shifts. 30-hr on shift maximum is good. It should be noted, though, that we don't do "24+6." We care for patients all 30 of those hours, with perhaps a single hour or two being devoted to transition of care or non-patient care educational experiences.

(2) As people get older, they need less sleep, but getting less than 7 hrs a night is not healthy. Maybe you can do it, but it's not healthy. Being overstressed and uni-dimensional as a person is also not healthy. Maybe you can do it, but it's not healthy. Now, correct me if I'm wrong, but medicine is about enhancing health. It is absolutely ******ed and contradictory to be in the field of medicine and openly endorse unhealthy practices, whether it is for your patients or colleagues.

(3) You will never see *everything* in your residency. You have to read to learn about the things you don't get to see. Hour requirements need to strike a balance between sufficient exposure, sufficient time for reading and extra investigation, and maintaining sufficient health to be effective as a doctor and as a learner.

(4) You should be unwilling to throw any moment of your life away. Anything could happen and you could be dead or headed down a very different path at any moment. The current rules are an acknowledgment of the right of individuals pursuing medicine to still be human beings. Sacrifice is one thing, martyrdom is another.

For numbers 2-4: Well said! We all (or almost all) want to learn as much as we can about medicine, want to help people, are smart, and so forth...but we're people too, and I still want to live a healthy and balanced life. Not just tell my patients to be healthy and try to cure them while messing up my own health. Sleep does a lot of great things for the body. It's crazy that we'll study those things in medical school yet deprive ourselves of them as if we're superhumans.

 

[Perrotfish]

Alright, here's my solution for this. Let me know what y'all think:

1) 60 hour work weeks, extend the residencies. Shift work to cover the nights.

2) Demand adequate pay (starting at at least 80K with significant annual raises) during residency.

Now I know what you're thinking: Sleep and pay? Before I'm 35? Is that possible? The truth is that other professions have been doing this for years. For example: Engineers. Egnineers need to go through a (may vary slightly by state) 5 year 'engineering in training' period before recieving their professional engineering licence. During this period they need to work for a licenced engineer on any work requiring an engineering licence (i.e. any project big enough to kill someone if it falls down). Yet, somehow, despite the fact that they are not fully licenced, they have managed to negotiate for both good salaries and good hours. Also, no abuse.

See the only reason that everyone here is terrified of extending residencies is that they are convinced that residency must necessarily involve low pay and abuse, because that was how the system has always been. Which wasn't necessarily a bad system (the low pay part, I mean) when our training was a one year Internship, but now that we have some residencies lasting 7 years and maybe 10 if we're limited to 60 hour weeks and we need to demand to be paid for our work. If you can change residency from a period of 'pledging' medicine to just a normal, well compensated part of our careers then they're free to extend residencies all they want to and we're free to go home and sleep and see our families.

Unfortunately, the hospitals are basically a trust, which means the only way to negotiate with them is collectively (via a union) or legally (by making it clear working too many hours is malpractice). Also, like any form of hazing you try to get rid of, there will be residistance from the old people that learned medicine via the current system. After all, they went through this terrible system and now you not only want to sleep, you want a portion of their salary (money's coming from somewhere) so you can make a living wage?. Sooo... union, anyone?

 

[Bacchus]

Alright, here's my solution for this. Let me know what y'all think:

1) 60 hour work weeks, extend the residencies. Shift work to cover the nights.

2) Demand adequate pay (starting at 80K with significant annual raises) during residency.

Now I know what you're thinking: Sleep and pay? Before I'm 35? Is that possible? The truth is that other professions have been doing this for years. For example: Engineers. Egnineers need to go through a (may vary slightly by state) 5 year 'engineering in training' period before recieving their professional engineering licence. During this period they need to work for a licenced engineer on any work requiring an engineering licence (i.e. any project big enough to kill someone if it falls down). Yet, somehow, despite the fact that they are not fully licenced, they have managed to negotiate for both good salaries and good hours. Also, no abuse. See the only reason that everyone here is terrified of extending residencies is that they are convinced that residency must necessarily involve low pay and abuse. If you can change residency from a period of 'pledging' medicine to just a normal, well compensated part of our careers then they're free to extend residencies all they want to and we're free to go home and sleep and see our families.

Unfortunately, the hospitals are basically a trust, which means the only way to negotiate with them is collectively. Union, anyone?

Will you be the spokesperson?

 

[Perrotfish]

Will you be the spokesperson?

Unfortunately, I'm on a Navy scholarship. 'Sorry I can't help you Admiral, I'm on strike'. Doesn't quite work. On the other hand, this is one of the few areas where the military is way ahead of the civilian world: military residency pays nearly twice as much as civilian residencies, since the military will never pay you less than a line officer of equivalent rank (plus no debt). So if they extend residencies and cut hours I guess I'm all for it. But, yeah, you civies should really start negotiating.