Residency Work Hours

[ferral]

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Is there a policy on work hours for veterinary residents? This has been a huge issue in human medicine over the last few years.....

I pasted part of the human medicine residency work hours policy (below). I'm wondering if there's something comparable in vet med.

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(2) That resident physician total duty hours must not exceed 80 hours per week, averaged over a two-week period and that our AMA work with GME accrediting bodies to determine if an increase of 5% may be appropriate for some training programs. (New HOD Policy)

(3) That workdays that exceed 12 hours are defined as on-call. (New HOD Policy)

(4) That scheduled on-call assignments should not exceed 24 hours. Residents may remain on-duty for up to 30 hours to complete the transfer of care, patient follow-up, and education; however, residents may not be assigned new patients, cross-coverage of other providers’ patients, or continuity clinic during that time. (New HOD Policy)

(5) That on-call be no more frequent than every third night and there be at least one consecutive 24-hour duty-free period every seven days both averaged over a two-week period. (New HOD Policy)

(6) That on-call from home be counted in the calculation of total duty hours and on-call frequency if the resident physician can routinely expect to get less than eight hours of sleep. (New HOD Policy)

(7) That there should be a duty-free interval of at least 10 hours prior to returning to duty. (New HOD Policy)

 

[Bill59]

No there's nothing comparable to the Accreditation Council for Graduate Medical Education's rules on human medicine resident hours.

Veterinary residencies are regulated by the particular specialty board, for example surgery residencies by the ACVS (or similar board in other countries). The specialty usually has requirements and guidelines for residency training but limiting hours has so far not been a focus for most of them. And of course the individual institutions may have some sort of policy on work hours.

 

[ferral]

Thanks for answering Bill!
With that said, in general, do you think that there are similar problems in veterinary medicine as in human medicine with residents being overworked and concerns about quality of patient care etc?

 

[Bill59]

I think most places would be in compliance with the guidelines you posted most of the time. But there's certainly times when a house office works more than 80 hours in a week or are in the hospital for more than 24 hours.

There's no question that sleep deprivation affects performance in some areas (equal to something like 3 drinks of ethanol in some studies ) but it's hard to point to a specific mistake that's due to lack of sleep. That's because you're not going to see things like a resident falling asleep doing a surgery. It's more subtle and insidious.

More importantly though, when you're dead tired you start to resent more work -- you can begin to see the clients/patients as the "enemy" standing between you and sleep. It affects your attitude and compassion.

And that's not what you want to be teaching interns and residents.

I think a much bigger risk to patient safety is lack of supervision after hours. Inexperience is much more dangerous than any problems with being tired. Most internships and residencies do a really good job of this by providing a good back up system. But there's a few places where junior house officers are at time over their heads without adequate backup .... in my opinion.

 

[xaelia]

I have some firsthand and some secondhand knowledge of equine veterinary interns being abused far and beyond what an MD intern would ever experience. My significant other gets three days off a month, will typically cover nighttime treatments four or five nights out of the week, and is on-call for surgical emergencies two weeks out of the month. It's not uncommon for her to have several consecutive days with 4 hours of sleep or less while working full 7:30am - 6pm days. And she's at a relatively benign internship at a private equine hospital.

Sure, I might work for up to 30 hours straight every fourth or fifth night for half the months out of next year, but at least I'll get ~18 hours off before coming back in after that.

 

[Bill59]

And she's at a relatively benign internship at a private equine hospital.

In general, I think some of the private internships abuse their interns more than teaching hospitals. Unfortunately, there is absolutely no oversight of veterinary internships as there is for veterinary schools or residencies. Some of the private hospital internships are nothing more than cheap labor instead of what they're supposed to be -- a training program.

 

[eep29]

I actually work in graduate medical education managing a large medicine program. The duty hours policy (no more than 80 hours averaged every 2 weeks) is relatively new. It's only been in practice for 4 years now, and a lot of attendings say it has disadvantages. The major one being that residents coming out of residency or fellowship are not going to be ready for the "real world" in the sense that attendings do not have to abide by the duty hour policy and thus, be thrown into an on call situation over the weekend where they essentially get no sleep and are on call for 48 hours straight. The duty hour policy doesn't prepare newly graduated residents for that, and it can be overwhelming. My boss comes in very cranky after being on call over the weekend, and he still has to come in and do his normal hours on top of that M-F. There's no time off in between the on call weekend, and the regular work week.

So it may be to a veterinary intern/residents benefit not to fall into a required duty hour policy in the long run. Just an opinon from the other side of the fence to chew on.

 

[bass4booty]

Why do you care? You will work 80 hrs as a student, let alone as an intern or a resident. By the time you've done it for 5 years just to get in to a residency, you just grin and bear it to do what you want and get the best training possible.

 

[Habibti]

Why do you care? You will work 80 hrs as a student, let alone as an intern or a resident. By the time you've done it for 5 years just to get in to a residency, you just grin and bear it to do what you want and get the best training possible.

You seem to be forgetting a minor detail: There is life outside of your job. Some of us have relationships/marriages, friends, and children. Working 80 hours a week makes those relationships hard enough. Working far more than 80 makes them almost impossible. I can't speak for everyone else on here, but I'm not willing give up everything just for my job. In my opinion, although my job will be very important to me, there are more important things.

 

[AuburnPreVet]

Agreed - 80 hrs/wk is nearly 12 hours a day 7 days a week, year round...
The thought of doing more than 80 hours in one week, on a regular basis, sounds rough. I think most programs realize this w/o the need for a "rule" ... the few residents that I've interacted with worked VERY long days, but I highly doubt it was >80 a week even including rounds, reading time. But, I'm sure it happens... just not on a regular basis.

 

[birdvet2006]

the few residents that I've interacted with worked VERY long days, but I highly doubt it was >80 a week even including rounds, reading time. But, I'm sure it happens... just not on a regular basis.

I agree...not many do >80 hrs/week.

I am not a resident, but an intern. I work 5 12-hour shifts per week (or 4 15-hour shifts). This adds up to 60 hrs/week. Then there is journal club (roughly 1 hr every other week), the intern lecture series (2 hours weekly), and not to mention time you put in doing paperwork (it's not overly uncommon to be there for 16-18 hours in a day). If you're on call over the weekend...it adds in more hours. But mostly, I work less than 80 hours a week. I even get off 1-1.5 hours early sometimes, due to "slow days". Now - this isn't one of the notorious internships like AMC or Angell...thankfully. 🙂

For residents, depending on the residency, you may have a busier or lighter schedule. Residents that actively see a lot of emergency cases will be worked harder, I think. Specialties such as dermatology and exotics don't often get called in after-hours and therefore I don't think their schedule would be as burdensome.

 

[jerky1280]

I just wanted to put in my $0.02, even though I have no experience in the veterinary or even medical field.

I am currently in Navy flight school, and find the hours those in the medical field work rediculous. I have worked 18-24 hours days in my career, so I know what it's like, but also know how much it affects judgement and motor skills/coordination. The navy's rest policy is that pilots have a maximum 12-hour "crew day", which starts at your flight brief and ends when you drive off the base. You are required to have 12 hours of "crew rest" between flights. In the aviation field (as it is with the medical field) you have to be 100% on your game, because any small error can kill someone. Too many fatigue-related mishaps have killed too many people in aviation, so they've developed strict rules to mitigate the dangers of fatigue. I wonder how many medical mistakes due to fatigue to undocumented? I certaintly wouldn't want the surgeon who's been up 24 hours operating on me.