Program schedule and burnout

[premedk]

---

Members don't see this ad.

What programs have schedules to prevent burnout? For example my home program has rotations in blocks of 4 weeks of inpatient and 2 weeks outpatient(4+2). This guarantees 2 weekends every 6 weeks, and two "break" weeks of outpatient after every inpatient rotation. Even on in-patient, residents generally work 9-10hr days, with a long day of admitting every 4th day, and 1 day off a week. This generally works out to 60-65hrs a week for most inpatient rotations, and outpatient is generally 40 hr weeks. Personally, I need sleep and some free weekends go see friends/family, this type of schedules allows for that, while still providing great training.

Are there other places that have similar schedules or have other mechanisms in place to prevent burnout and allow for actual weekends every few weeks? I know a lot of applicants and programs don't really care, but this is definitely something I'm looking for as I apply.

 

[dyeguy21]

A lot of programs are going to the x+y system. It has been received with almost universal approval. At the interviews you go to they will all make a big deal out of it.

 

[dozitgetchahi]

What programs have schedules to prevent burnout? For example my home program has rotations in blocks of 4 weeks of inpatient and 2 weeks outpatient(4+2). This guarantees 2 weekends every 6 weeks, and two "break" weeks of outpatient after every inpatient rotation. Even on in-patient, residents generally work 9-10hr days, with a long day of admitting every 4th day, and 1 day off a week. This generally works out to 60-65hrs a week for most inpatient rotations, and outpatient is generally 40 hr weeks. Personally, I need sleep and some free weekends go see friends/family, this type of schedules allows for that, while still providing great training.

Are there other places that have similar schedules or have other mechanisms in place to prevent burnout and allow for actual weekends every few weeks? I know a lot of applicants and programs don't really care, but this is definitely something I'm looking for as I apply.

Wish I was going to a program like that now.

My program has a 'classic' schedule for upper levels - blocks are back-to-back, 1/2 day of clinic a week, q4 overnight (28 hour) call.

I'm on a four-month stretch of back to back wards months currently, and it's brutal.

 

[Stedari]

Both Minnesota and Mayo have 4 + 4 programs which alternate inpatient and consult months. So, half of the year you have your weekends off which is a pretty sweet gig.

 

[HelpPleaseMD]

Both Minnesota and Mayo have 4 + 4 programs which alternate inpatient and consult months. So, half of the year you have your weekends off which is a pretty sweet gig.

damn that is cush

 

[bananas85]

AM i the only one, I feel like I would be more burned out by 2 weeks of clinic back to back than the floors. maybe my clinic was particularly bad but between those MSK pains, Refilly prescriptions, disability forms, handicap stickers, .. NO thanks Give me the floor month instead.

 

[premedk]

Both Minnesota and Mayo have 4 + 4 programs which alternate inpatient and consult months. So, half of the year you have your weekends off which is a pretty sweet gig.

That sounds pretty amazing! Anyone know of any other programs that have similar schedules.

 

[IMreshopeful]

AM i the only one, I feel like I would be more burned out by 2 weeks of clinic back to back than the floors. maybe my clinic was particularly bad but between those MSK pains, Refilly prescriptions, disability forms, handicap stickers, .. NO thanks Give me the floor month instead.

I'm glad someone has the same unpopular opinion as me. I don't enjoy doing weeks on end of primary care clinic, so I am glad my institution did not switch to the x+y model. The result would also have been significantly less elective time.

Usually we make sure people don't have more than six weeks of inpatient at a time, and certainly never back to back ICU months. I'm happy with my weekly continuity clinic. We don't have them on certain rotations (ICU, for example), so the compromise for that is having to double up on some elective months as well, but so far this has been okay.

 

[premedk]

I'm glad someone has the same unpopular opinion as me. I don't enjoy doing weeks on end of primary care clinic, so I am glad my institution did not switch to the x+y model. The result would also have been significantly less elective time.

Usually we make sure people don't have more than six weeks of inpatient at a time, and certainly never back to back ICU months. I'm happy with my weekly continuity clinic. We don't have them on certain rotations (ICU, for example), so the compromise for that is having to double up on some elective months as well, but so far this has been okay.

To be fair, I don't like gen medicine clinic either, but if it allows for more weekends off and no back to back, ward months, I'm all for it. Also at our program, it's only 2 days of gen medicine clinic and 3 days of specialty clinic or inpatient consults for 2 weeks. I wouldn't be opposed to programs without such a system, as long are there are enough elective/ambulatory/consult months to breakup working 10+hrs for 6/7 days a week for months at a time. Most programs I'm looking at only have 3-4 months of "break" rotations PGY1 and PGY2, which means your life is on hold for 8-9 months out of the year.

 

[gutonc]

To be fair, I don't like gen medicine clinic either, but if it allows for more weekends off and no back to back, ward months, I'm all for it. Also at our program, it's only 2 days of gen medicine clinic and 3 days of specialty clinic or inpatient consults for 2 weeks. I wouldn't be opposed to programs without such a system, as long are there are enough elective/ambulatory/consult months to breakup working 10+hrs for 6/7 days a week for months at a time. Most programs I'm looking at only have 3-4 months of "break" rotations PGY1 and PGY2, which means your life is on hold for 8-9 months out of the year.

My program (which has since moved to an X+Y schedule) had 1 "break" rotation intern year. It's not that atypical honestly. At least we're not Gen Surg residents, where, unless they do a research year, they usually get 1 or 2 "break" rotations total during the 5 years of residency.

 

[IMreshopeful]

To be fair, I don't like gen medicine clinic either, but if it allows for more weekends off and no back to back, ward months, I'm all for it. Also at our program, it's only 2 days of gen medicine clinic and 3 days of specialty clinic or inpatient consults for 2 weeks. I wouldn't be opposed to programs without such a system, as long are there are enough elective/ambulatory/consult months to breakup working 10+hrs for 6/7 days a week for months at a time. Most programs I'm looking at only have 3-4 months of "break" rotations PGY1 and PGY2, which means your life is on hold for 8-9 months out of the year.

As an intern I got total of 2 months of "break" rotations along with 4 weeks of vacation built in. As a PGY-2 I had three months of "break" rotations, with 1 month of an outpatient rotation and 4 weeks of vacation. Yes, I had back to back inpatient months (longest stretch was 3), but it wasn't that bad. They also never back-to-backed ICU rotations for us, which I

As for life being "on hold"... bit subjective. During the beginning part of intern year sure I was at work till 7-8 pm frequently when not on call. By the midpoint-end of the year I would be routinely out by 5 pm, sometimes earlier if my cointern was nice and offered to hold cross cover for an hour or two earlier/light patient load. Even on inpatient rotations there is room for a life. I would be able to go home, eat dinner with my wife or go out, etc. even if it wasn't hard core college style partying.

 

[235009]

AM i the only one, I feel like I would be more burned out by 2 weeks of clinic back to back than the floors. maybe my clinic was particularly bad but between those MSK pains, Refilly prescriptions, disability forms, handicap stickers, .. NO thanks Give me the floor month instead.

Most x+y models are +1 not +2 so you usually don't do back to back clinic weeks. I wholeheartedly agree with you about how annoying clinic is now as a senior but that week was such a nice break as an intern, especially toward the beginning of the year when we would be scheduled for 2 or 3 patients per half day (with a significant no show rate) and a golden weekend at the end of the week. The x+y model gives your schedule more regularity and makes clinic less of a chore as it's your only responsibility that whole week. It's also more in line with how people practice medicine nowadays.

 

[gutonc]

The x+y model gives your schedule more regularity and makes clinic less of a chore as it's your only responsibility that whole week. It's also more in line with how people practice medicine nowadays.

Just wanted to comment on this part in particular. Especially in procedure-heavy and inpatient consult-heavy sub-specialties, larger groups are moving to this model where they have an inpatient doc for the week (usually just a week) without any clinic duties. The GI, Pulm, Cards and Renal groups that I work with at a community teaching hospital use this model and I think it's a pretty good approach. Keeps your clinic day from getting destroyed by consults and procedures that keep you there until 9pm. I think this is less common in the academic world...at least it is in my limited experience.
Bottom line...unless you're going to be a PCP or a hospitalist (or a sub-specialist with minimal inpatient/consult/procedure responsibilities), get used to an X+Y schedule.

 

[IMreshopeful]

Most x+y models are +1 not +2 so you usually don't do back to back clinic weeks. I wholeheartedly agree with you about how annoying clinic is now as a senior but that week was such a nice break as an intern, especially toward the beginning of the year when we would be scheduled for 2 or 3 patients per half day (with a significant no show rate) and a golden weekend at the end of the week. The x+y model gives your schedule more regularity and makes clinic less of a chore as it's your only responsibility that whole week. It's also more in line with how people practice medicine nowadays.

2 or 3 patients? I consistently got 4-5 patients in my PM clinic as an intern. Wish I had your no-show rate - although they often schedule acute visits for when we have cancellations (which is fine - those are easy enough).

Of course, given that in PP primary care people see anywhere from 20-30 patients a day the fact that we complain about 4-5 patients for one afternoon is sort of sad :/