Resident hours - what is considered intolerable?

[ConcernedHusband]

Hi,

My wife started her residency a few months ago in a prestigious program. I knew that the hours will be bad and was ready for it, but now I'm concerned about her health. I understand that most residents work more than the 80 hours per week and that they just lie when logging their hours. I though that that's immoral and advised my wife to be honest (responsible adults don't need to lie in my opinion) but after reading some horror stories here, I'm rethinking it.

My main issue is that recently she's been working under an overly cautious, insecure senior resident who my wife is guiding more often than the other way around. The senior resident gets distracted and wastes a lot of time on things that wouldn't change the course of care and my wife has to constantly remind her to focus on important things. My wife recently started coming home around midnight, works on her notes until 1-2am and wakes up at 5:30 am to go to work. Not always, but a few times per week. We live next to the hospital so that ends up being around 4 hours of sleep. Her senior resident somehow works even longer hours. Other residents are working very long hours as well, longer than 80, but my wife was unlucky and she has more patients than the others. This will last for only a month, but my wife became shaky, pale, exhausted from the lack of sleep, but she denies it. I know for a fact that what she's going through isn't healthy. She's also an agreeable person and doesn't want to rock the boat but I don't know if this is normal. At which point would you complain about the amount of work and hours? I know that the laws are being broken routinely and that you shouldn't complain, but is there a limit? What is too much? What should she do?

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[evilbooyaa]

Most residents don't work over 80 hours. You hear about the ones that do on SDN because people working less than 80 hours aren't complaining on SDN.

She should stop babying the senior resident, get her work done, and get out. Easier said than done, unfortunately. If she's truly at a prestigious program, she could consider discussing her hours with the PD.

Your wife is likely inefficient herself, as getting out at midnight from a day of IM or Peds is the definition of that. That will improve with time as she's less than 2 months into intern year.

 

[twospadz]

There are two sides to every story. However, I'm willing to bet your wife is truly inefficient herself and that is why she staying so long. Most of the residents I knew in my residency who stayed extra hours to write notes were working in a way that was not needed and/or overly excessive. If your wife is writing notes until 1am, this can be mark against her in her program since attendings usually need to sign off on completed notes that day. So they will likely complain in time. Your wife will need to find a solution quick because overall this not sustainable.

 

[ortnakas]

Notes until 1 AM is definitely not normal.

 

[NITRAS]

So much is wrong here. . . . .

 

[rokshana]

Hi,

My wife started her residency a few months ago in a prestigious program. I knew that the hours will be bad and was ready for it, but now I'm concerned about her health. I understand that most residents work more than the 80 hours per week and that they just lie when logging their hours. I though that that's immoral and advised my wife to be honest (responsible adults don't need to lie in my opinion) but after reading some horror stories here, I'm rethinking it.

My main issue is that recently she's been working under an overly cautious, insecure senior resident who my wife is guiding more often than the other way around. The senior resident gets distracted and wastes a lot of time on things that wouldn't change the course of care and my wife has to constantly remind her to focus on important things. My wife recently started coming home around midnight, works on her notes until 1-2am and wakes up at 5:30 am to go to work. Not always, but a few times per week. We live next to the hospital so that ends up being around 4 hours of sleep. Her senior resident somehow works even longer hours. Other residents are working very long hours as well, longer than 80, but my wife was unlucky and she has more patients than the others. This will last for only a month, but my wife became shaky, pale, exhausted from the lack of sleep, but she denies it. I know for a fact that what she's going through isn't healthy. She's also an agreeable person and doesn't want to rock the boat but I don't know if this is normal. At which point would you complain about the amount of work and hours? I know that the laws are being broken routinely and that you shouldn't complain, but is there a limit? What is too much? What should she do?

while she is only a weeks into her residency, staying until midnight, even a few times a week AND still coming home and working on notes is not normal...she is not being efficient enough at work...she needs get help from another senior that is efficient and can show her things to help her with time management. I get it that it can be difficult to get things done while responsible for her pt, but once she signs out around 4 or 5 pm on most days (or 6, 7 pm on a long call day), she should be able to sit down and get her paperwork done.

She probably has more patients than others, because she is not discharging her pts in a timely manner. This does not keep her from getting more pts when they are on call or new pts are distributed out...and even then her max as an intern is 10 so if she is not able to handle 10pt without coming home so late, then again, there is something going on with her time management.

and its not your wife's job to focus the senior resident...she need to focus on her job as an intern...if she keeps on staying so long at the hospital, it will be noticed and will draw the attention of her chiefs and her PD...that will not be a good thing.

 

[Oslers_Resident]

There are two sides to every story. However, I'm willing to bet your wife is truly inefficient herself and that is why she staying so long. Most of the residents I knew in my residency who stayed extra hours to write notes were working in a way that was not needed and/or overly excessive. If your wife is writing notes until 1am, this can be mark against her in her program since attendings usually need to sign off on completed notes that day. So they will likely complain in time. Your wife will need to find a solution quick because overall this not sustainable.

I've worked hard in my residency to the point where I thought I would exceed my 80 hours and by the time the end of the week came, it was more like 60.

You have to work REALLY hard to exceed 80 hours. With ACGME caps, there is no way that happens.

 

[mvenus929]

What specialty is your wife in? There are a lot of assumptions being made by the posters here (interns are only capped at 10 in IM... the other specialties, as far as I know, don’t have mandated caps, though individual programs may, getting out at 4-5pm most days, etc).

But, generally, I agree with the others. If she’s not leaving til midnight, it’s not because she’s babying her senior. It’s because she’s not getting her work done. This may be in part because the senior is not efficient and doesn’t model well, but that doesn’t explain everything.

 

[PTPoeny]

Beyond the entirely appropriate concerns noted above that you really cannot do anything about, is your wife eating throughout the day? When things seem (are?) that busy sometimes important, basic self-care activities can get missed and this is actually something you can help with. Small, filling snacks like bars or little packets of nuts can be amazingly helpful to have to take in to work. If she is coming home that late clearly she is not grocery shopping so you keeping the kitchen stocked with easy to grab breakfasts and snacks for throughout the day might help if she is skipping meals...

 

[michaelrack]

That sounds like my schedule as an intern... of course that was back in the old days when most interns/residents were truly interested in learning their craft, rather than maintaining a work life balance

 

[DrMcCoyDO]

That sounds like my schedule as an intern... of course that was back in the old days when most interns/residents were truly interested in learning their craft, rather than maintaining a work life balance

Ahhh, the good old days, when nobody cared about resident health and those who burnt out just “didn’t have what it takes” despite making it through the entirety of the wringer that is med school. I’m definitely sad that I missed that era of overworking residents beyond the point of exhaustion; because, it “builds character” or whatever other excuses they had.

 

[bizdr]

Every once in a while you may get an admit right when you are about to leave, and it's a complicated one - so you can get stuck until midnight. But if you are routinely staying that late and still having to complete notes, something isn't right. It is natural to be inefficient right when you start, but if she doesn't figure something out - it will be miserable!

 

[rokshana]

That sounds like my schedule as an intern... of course that was back in the old days when most interns/residents were truly interested in learning their craft, rather than maintaining a work life balance

you know, my dad used to tell me stories (general surgery intern/urology resident in the late 60s/early 70s so nothing you had to do in residency compares) about how his attending gave him crap about wanting to take his pregnant wife to the store to buy baby clothes, you know, be kinda involved in becoming a father?...
i'm glad that things changed enough that when i was a 3rd year resident, that my program was family centered enough to let me go home to see my dad after he fell out from a saddle embolus (incredibly he survived)...and rest assured while interested in learning my craft, it was just as important be there when my father was in the ICU ...

 

[Stagg737]

@evilbooyaa hit it on the head. My first week was a 95 hour week and second was a 90 hour week, but they were both very busy weeks (second week our chief described as a week from hell) and I was very inefficient. My 4th week was also busy and I still only ended up working a little more than 70 hours once I got my efficiency down. Even with those schedules, I only worked past 10pm twice (first 2 days) and never worked past midnight. If she's regularly working that late she's either going in late, is very inefficient, or is in an extremely malignant program.

I've worked hard in my residency to the point where I thought I would exceed my 80 hours and by the time the end of the week came, it was more like 60.

You have to work REALLY hard to exceed 80 hours. With ACGME caps, there is no way that happens.

This is completely dependent on the rotation and clinical setting. At my program the IM residents do have some rotations where they regularly have weeks exceeding 80 hours because of the nature of one of the hospitals they rotate at. I also have talked to people at malignant programs who regularly exceed 80 hour work weeks, but manage to keep the average below 80 hours. There are also a few "prestigious" programs that I know people at who are encouraged not to report all hours. It's not REALLY hard at some programs, but it's certainly not as common as some people would suggest.

 

[atomi]

Key question is if wife is in surgery or not. Surgery it’s normal and she’ll get in trouble for being “inefficient” if reports >80 hour work weeks.

Other residencies, you should be capped at 80, and they shouldn’t let you stay more than 16 hours in a row.

Totally normal to do 6x16 days the first month of IM. I did. But by mid year I was averaging 60 hour weeks. It will get better unless surgery.

 

[rokshana]

Key question is if wife is in surgery or not. Surgery it’s normal and she’ll get in trouble for being “inefficient” if reports >80 hour work weeks.

Other residencies, you should be capped at 80, and they shouldn’t let you stay more than 16 hours in a row.

Totally normal to do 6x16 days the first month of IM. I did. But by mid year I was averaging 60 hour weeks. It will get better unless surgery.

the interns can do overnights again...back to 24 hours

 

[mvenus929]

the interns can do overnights again...back to 24 hours

Yes, but if you’re working days for a week, you’re still mandated to have 8 hours off between shifts.

 

[rokshana]

Yes, but if you’re working days for a week, you’re still mandated to have 8 hours off between shifts.

agree, that is true for all interns and residents.

 

[Mass Effect]

You have to work REALLY hard to exceed 80 hours. With ACGME caps, there is no way that happens.

Are you kidding? It happens all the time.

 

[ConcernedHusband]

Hi,

Thank you all for your comments, they are extremely useful. I'd like to address a few points but cannot give details about the department that she's working in for privacy reasons.
- I am sure that she's not as productive as an experienced resident can be, but I also know that she worked in other busy departments and had no issues coming home before 10pm. She is also an overachiever, comes from a family of physicians, has very high scores on all the tests and received extremely good feedback from the attendings so far.
- the problem with the "get her work done, and get out" idea is that she basically needs permission from the senior resident to leave, and when she finishes her things at 7-8 and asks to leave, the resident says "oh can you please do just these 2 things, and also this other thing" which takes and hour and a half, during which other issues come up. The senior resident most likely wants to secure a fellowship in the department and is extremely committed and is dragging my wife with her. The problem is that the resident is not that good nor confident, has some kind of anxiety/OCD and wastes way too much time on irrelevant things. You know those people who easily become obsessed with details and don't know how to prioritize... Whenever my wife and the resident had difference of opinion, they would find our that attending supports my wife's approach.
- the attendings didn't need to sign off on completed notes that day because she had a late admission and she was on call and still had to finish her notes because the night team needed them.
- I understand the scepticism that she's working more than 80 hours, but she is there around 90 hours without counting working on the notes from home, which is on average, in my estimate about 1.5 hours per day off effective work. She counts lecture hours in those 90 even though she has lunch during the lectures. That's about 2-3 hours per week if she has the time to attend. She has maximum allowed number of patients pretty much always and never left the hospital before 7pm. The problem isn't the number of hours, but the lack of sleep and very little time between the shifts. It is a very busy department, to the point that it isn't uncommon for interns to interrupt whatever they're doing and run out from rooms towards the bathroom in the evening because they didn't have the time to pee the entire day... It sounds like a bad parody, I know.
- after talking to her more, my conclusion is that this is a consequence of a combination of circumstances: very busy department, slower than average senior resident, more patients than her peers (the ones who have HALF as many patients are going home at 6-7pm) and her not being as fast as she should be. That being said, the intern who finished that rotation and whose patients my wife took over said that he/she worked till 1am once.

Basically I was very frustrated because I could see her suffer but I couldn't help and didn't know how to advise her as I didn't have a realistic benchmark. I thought 80 hours is reasonable, but than was reading how everyone exceeds that. Her program was advertising themselves how they comply with the ACGME and don't exploit the residents but now that she started working, everyone tells her that it's obvious that they were "embellishing" the truth. I didn't want to advise her to talk to the senior resident or even the program director if that might get her in trouble and if it's completely normal to get some red bull and power through the day after only a few hours of sleep. She told me that her and the senior resident are basically a team and should probably come and go at approximately the same time, but from what I'm reading here, that's not the case. She should have responsibilities that are separate from her resident and when she's done she should go home. Now she has to find out exactly what those are and has to do those things faster because as mentioned above, this isn't sustainable.

I'm off course trying to make her life easier... I'm doing the shopping, cooking and similar since my career, even though demanding, is nothing compared to the hell that she's going through.

Thank you everyone for the incredibly valuable feedback.

 

[NotAProgDirector]

It is definitely true that if the person "above" you on the hierarchy is inefficient, you get stuck working longer days. Hopefully this is a temporary situation, and either your wife or this resident will rotate onto something new, and the situation will improve.

 

[evilbooyaa]

Hopefully she's switching rotations soon. I'd wait until she switches rotations (or switches senior residents) and how her schedule changes.

 

[GoSpursGo]

- the problem with the "get her work done, and get out" idea is that she basically needs permission from the senior resident to leave, and when she finishes her things at 7-8 and asks to leave, the resident says "oh can you please do just these 2 things, and also this other thing" which takes and hour and a half, during which other issues come up.

I don't think this should be true... when I was done, I would say "see you tomorrow," not "can I go home?"

What are these "2 things and also this other thing" that you bring up? If it's patient care and she has already signed out to the night team, she should be able to reasonably say that the night team can take care of it. If it really is something that needs the day team to wrap up, she still shouldn't be responsible for the other issues that come up during that time. It's literally impossible to take care of every single aspect of patient care by change of shift, and unless you're signing out multiple admissions to the night team, that stuff should get passed on.

 

[Tictactonsil]

A question I've had for awhile is what defines a "four week period" when we talk about averaging one day off per week. Is that any consecutive four weeks, or is it each 4 week rotation?

For example, what if on Rotation 1 you have your first four days off, and on Rotation 2 you have your last four days off. In this scenario you have four days off per rotation, but end up working almost 7 weeks without a day off.

 

[DrMcCoyDO]

A question I've had for awhile is what defines a "four week period" when we talk about averaging one day off per week. Is that any consecutive four weeks, or is it each 4 week rotation?

For example, what if on Rotation 1 you have your first four days off, and on Rotation 2 you have your last four days off. In this scenario you have four days off per rotation, but end up working almost 7 weeks without a day off.

It’s a rolling four week period, from my understanding.

 

[calvnandhobbs68]

A question I've had for awhile is what defines a "four week period" when we talk about averaging one day off per week. Is that any consecutive four weeks, or is it each 4 week rotation?

For example, what if on Rotation 1 you have your first four days off, and on Rotation 2 you have your last four days off. In this scenario you have four days off per rotation, but end up working almost 7 weeks without a day off.

We would typically take it to mean per 4 week rotation (our most residencies block into 4 week segments or some multiple of that). I mean yes, the scenario you’re saying could happen but it’d be kind of weird.

 

[calvnandhobbs68]

I don't think this should be true... when I was done, I would say "see you tomorrow," not "can I go home?"

What are these "2 things and also this other thing" that you bring up? If it's patient care and she has already signed out to the night team, she should be able to reasonably say that the night team can take care of it. If it really is something that needs the day team to wrap up, she still shouldn't be responsible for the other issues that come up during that time. It's literally impossible to take care of every single aspect of patient care by change of shift, and unless you're signing out multiple admissions to the night team, that stuff should get passed on.

Yeah I agree. There should be some signout time to the night team (which should definitely happen by 8pm)...which means she should be signing out everything that she hasn’t already started to do. Yeah, sometimes there’s a crappy admission that shows up a half hour before you need to signout that keeps you there for another hour but shouldn’t be happening every day. Her senior resident shouldn’t be “requesting” her to stay there past signout time.

 

[rokshana]

A question I've had for awhile is what defines a "four week period" when we talk about averaging one day off per week. Is that any consecutive four weeks, or is it each 4 week rotation?

For example, what if on Rotation 1 you have your first four days off, and on Rotation 2 you have your last four days off. In this scenario you have four days off per rotation, but end up working almost 7 weeks without a day off.

technically i don't think that would violate hours, but no one would be scheduled that way.

 

[Apollyon]

technically i don't think that would violate hours, but no one would be scheduled that way.

When I was a resident, there were Duke Surgery residents that would work 24 days straight, to get those 4 days together. Some would be scheduled that way. I'm just saying it's more than just plausible.

 

[togaedere]

The point tho is that these residents were scheduling themselves to get the four days off in a row, intentionally. Not as plausible to be initially scheduled for that.

When I was a resident, there were Duke Surgery residents that would work 24 days straight, to get those 4 days together. Some would be scheduled that way. I'm just saying it's more than just plausible.

 

[mvenus929]

It’s a rolling four week period, from my understanding.

It's for the rotation, and the rotation can be 4 weeks, or a month.

We used to have rotations that were 1 month long, and it was really annoying to get 'flagged' for duty hour violations when someone would have a weekend on like day 2-3 of the rotation, and then only 2-3 other days off in the month, because the way our system was set up, it would look at rolling 4 week averages. As chief, I would explain it on the back end that it was not actually a duty hour violation.

 

[DrMcCoyDO]

It's for the rotation, and the rotation can be 4 weeks, or a month.

We used to have rotations that were 1 month long, and it was really annoying to get 'flagged' for duty hour violations when someone would have a weekend on like day 2-3 of the rotation, and then only 2-3 other days off in the month, because the way our system was set up, it would look at rolling 4 week averages. As chief, I would explain it on the back end that it was not actually a duty hour violation.

Alright, good to know. 👍

 

[operaman]

I’ve heard of other interns at well know IM programs staying until those hours but I can’t for the life of me figure out what they did with all those hours in the day. As a surgical intern and almost never stayed til midnight unless I was on call that night. We never had caps on number of patients and typically carried lists of 20-40 patients, rounded on everyone and had all notes done soon after breakfast. Signout was usually around five or six pm and I was rarely there much after that. Rarely there will be a last minute consult or admission or emergency but those are the exceptions. Even now with a busy service, a full OR day or a clinic day of 40-60 patients AND a last minute 5:59 emergency, I’m still home by 8 or 9 with all my notes done.

It’s far enough into the year that she should be more efficient. I cannot imagine what anyone is doing there until midnight on a Med or peds service. They aren’t rounding. There aren’t OR cases going late. Daily notes should have been done 12 hours earlier.

She can ask her senior for clearly delineated tasks earlier in the day and then get those done and sign out. There shouldn’t be new work coming in after sign out; that’s why there is a night team on call. I’m all about not punting work to the night team but sometimes care continues overnight and they need to pick up the torch. Your wife is no longer a student and does not need permission to leave after getting her work done and signing out. She can also say “I’ll sign that out to the night team” for things that they can follow up on or new issues that arise.

The flip side is she needs to bust arse during the day and proactively seek out additional work from the senior BEFORE night shift comes on. Get that crap squared away early and it will also show she’s a team player despite putting her foot down after six and going home when her work is done.

 

[URHere]

Hours like that shouldn't happen every day, but they do happen occasionally. I'm towards the end of residency and I've only stayed past midnight maybe 4-5 times (this excludes 28 hour calls where you are by default staying past midnight). Similarly, I can count on one hand the times when I have completely obliterated duty hours.

All of my longest days were times when long call went exceedingly wrong. Some days, you just get 10 admissions in a 1-2 hour period. If you're unlucky, most of those patients will have multiple medical issues to manage simultaneously, and a few will be critically ill, but not *quite* sick enough for the ICU. For a senior resident, seeing each of those patients may take only 10-15 minutes, but interns get berated for not knowing details ("when did the patient quit smoking? Do they have a living will?), so they spend significantly more time on interviews and looking through old records (even longer early in the year when they haven't yet learned to pick out relevant things). Even verifying and ordering home meds can take an eternity when most patients have no idea what they take and you need to resort to calling nursing homes, family members, or outside hospitals to make sure some critical medicine isn't missed. On top of that, most programs require long call residents to cover 3-5 other teams full of equally complex patients, and you get paged a lot about people you've never met. You are also responsible for attending rapids/codes at many hospitals (like mine) and that can easily take you away from your work for an hour or so.

It's not uncommon to get to sign out time as an intern and realize that you haven't even started notes for your new admissions. Or double checked orders. Or verified meds. Or staffed with your attending. And sign out for 50 patients takes an awfully long time in itself. Right or wrong, most of this work (writing notes, verifying meds, etc) falls to the interns. Good seniors will know how to divide and conquer but not all seniors have learned that skill yet.

That being said, not every day should go like that. If it does, then the team is not being efficient and some serious damage control needs to happen.

 

[GoSpursGo]

It's for the rotation, and the rotation can be 4 weeks, or a month.

We used to have rotations that were 1 month long, and it was really annoying to get 'flagged' for duty hour violations when someone would have a weekend on like day 2-3 of the rotation, and then only 2-3 other days off in the month, because the way our system was set up, it would look at rolling 4 week averages. As chief, I would explain it on the back end that it was not actually a duty hour violation.

I'm pretty sure that it's intended to be a four week rolling period, which is why it would get flagged. You may have successfully been able to explain it on the back end, but I know my fellowship program had to make changes to our first year fellows' schedules because a four week period overlapping the end of one rotation (where they worked extra overnight call while one fellow is on vacation) and the beginning of the next would result in a duty hours violation.

 

[Raryn]

There were two periods in my residency where I'm pretty sure I broke duty hours (I never logged accurate duty hours after the first month - just the hours I was scheduled to work, wasn't worth the mental effort to keep track of my actual time in and out when >95% of the time it was well within the rules):

A) My very first ward month, August of intern year, with a senior that sucked donkey !@#$ and was the least helpful person I've ever had the displeasure of working with. I would often be writing notes till 11 pm or later, particularly on a call shift. Why? It was just an alignment of negative factors, including the fact I was extremely inefficient. This sounds like basically where the OP's spouse is, a routine problem that will fix itself over time. Give it another few months, inefficiency gets better, working with a different senior, and life gets a lot easier. By the following May (~9 months later), with a different senior, I was regularly finishing all work by 3pm and leaving early on non-call days (interns signed out to each other, so I scratched their back and they scratched mine).

B) ICU days during winter my PGY3 year - we were regularly well above the patient cap because it was a closed ICU and there was no one else to take care of the patients. There were days I was home at midnight and back 5 hours later. Processes were changed with changes to the role of the ICU fellows and midlevels to try to lessen impact of a similar situation later on because this was more of a system issue that required fixing (that affected more than just me).

 

[jw3600]

Honestly you have to admire the gall of some of these PDs and leadership members. Can you imagine looking at a 30 something year old in the eyes with a wife/husband and 2 kids and telling them they’ll be working 85-90 hours this week. And they’ll probably make about $8/hour for that week. I know it happens in other fields like law and finance too but they do seem to get paid a little better. Regardless of who it is no one should be working those hours.....
It’s crazy how numb people can get to having no problem ****ting all over someone’s life because “that’s the way it is.” These people would have done great in the SS.

 

[michaelrack]

Honestly you have to admire the gall of some of these PDs and leadership members. Can you imagine looking at a 30 something year old in the eyes with a wife/husband and 2 kids and telling them they’ll be working 85-90 hours this week. And they’ll probably make about $8/hour for that week. ” These people would have done great in the SS.

If I was still in academics, I would have no problem doing this... there were many weeks I worked over 100 hours. Today's residents have it easy

 

[jw3600]

If I was still in academics, I would have no problem doing this... there were many weeks I worked over 100 hours. Today's residents have it easy

And you’re proud of this?

 

[GoSpursGo]

Honestly you have to admire the gall of some of these PDs and leadership members. Can you imagine looking at a 30 something year old in the eyes with a wife/husband and 2 kids and telling them they’ll be working 85-90 hours this week. And they’ll probably make about $8/hour for that week. I know it happens in other fields like law and finance too but they do seem to get paid a little better. Regardless of who it is no one should be working those hours.....
It’s crazy how numb people can get to having no problem ****ting all over someone’s life because “that’s the way it is.” These people would have done great in the SS.

Here's my monthly unpopular opinion... keep in mind I'm a current fellow, so I'm very recently familiar with residency hours (and first year fellowship hours are worse):

If you want to be a competent physician capable of acting independently after residency, then you need to work a lot of hours. The only way your learn is through seeing a LOT of patients, and yeah, seeing a patient for 10 hours and then taking off without seeing how they progress overnight or over a golden weekend means that you don't learn as much from your patient as doctors who trained 10 years ago. So unless you're the superstar who goes home at the end of a 10-12 hour day and proceeds to read for a few hours at night... how are you making up for that time that you're no longer at the hospital learning? I for one had to study HARD to pass my boards, when ostensibly you should be well-trained just by doing residency. Residents work fewer hours in other countries, but their residencies are also several years longer--do you really want to add a year or two onto the end of your training to keep your hours down? I don't.

It's not as if the fact that your early 30s are going to be hard because of residency was concealed when you went to med school, and certainly nobody made you do it. So I don't see why it would take any gall on the part of a PD to ask you to do what you already knew was coming, and is in fact necessary for your training.

 

[LucidSplash]

Honestly you have to admire the gall of some of these PDs and leadership members. Can you imagine looking at a 30 something year old in the eyes with a wife/husband and 2 kids and telling them they’ll be working 85-90 hours this week. And they’ll probably make about $8/hour for that week. I know it happens in other fields like law and finance too but they do seem to get paid a little better. Regardless of who it is no one should be working those hours.....
It’s crazy how numb people can get to having no problem ****ting all over someone’s life because “that’s the way it is.” These people would have done great in the SS.

This is overly dramatic.

 

[doc05]

Really important, what specialty is she in? This is very important

 

[GUH]

Here's my monthly unpopular opinion... keep in mind I'm a current fellow, so I'm very recently familiar with residency hours (and first year fellowship hours are worse):

If you want to be a competent physician capable of acting independently after residency, then you need to work a lot of hours. The only way your learn is through seeing a LOT of patients, and yeah, seeing a patient for 10 hours and then taking off without seeing how they progress overnight or over a golden weekend means that you don't learn as much from your patient as doctors who trained 10 years ago. So unless you're the superstar who goes home at the end of a 10-12 hour day and proceeds to read for a few hours at night... how are you making up for that time that you're no longer at the hospital learning? I for one had to study HARD to pass my boards, when ostensibly you should be well-trained just by doing residency. Residents work fewer hours in other countries, but their residencies are also several years longer--do you really want to add a year or two onto the end of your training to keep your hours down? I don't.

It's not as if the fact that your early 30s are going to be hard because of residency was concealed when you went to med school, and certainly nobody made you do it. So I don't see why it would take any gall on the part of a PD to ask you to do what you already knew was coming, and is in fact necessary for your training.

For exceptional cases, it can definitely be educational to follow a patient for a while without relief.
But you'd have a tough time convincing me that it's really a good learning experience to stay in person in a hospital for 30+ hours to follow bread-and-butter chest pain r/o acs, rhabdo, or s/p lap chole patients and to continue taking new admissions for the same things into the next day. And while I'm not at a program that pressures residents to ignore work hours rules, that's the kind of *stuff* that I've seen at programs which do. "Oh, Dr. Smith (who has been here since 6 AM the previous day), great job yesterday and on call overnight. You can just see these two new admissions this morning and then after rounds (which may or may not even be over by noon), you can sign your notes and head home!" Most residents are not learning much from that.
If it's a once or twice-in-a-lifetime opportunity to follow a patient with a rare presentation, I think most residents would be willing to go the extra mile and not pay such close attention to the work hours limits. But those do not happen every day.

 

[GoSpursGo]

For exceptional cases, it can definitely be educational to follow a patient for a while without relief.
But you'd have a tough time convincing me that it's really a good learning experience to stay in person in a hospital for 30+ hours to follow bread-and-butter chest pain r/o acs, rhabdo, or s/p lap chole patients and to continue taking new admissions for the same things into the next day. And while I'm not at a program that pressures residents to ignore work hours rules, that's the kind of *stuff* that I've seen at programs which do. "Oh, Dr. Smith (who has been here since 6 AM the previous day), great job yesterday and on call overnight. You can just see these two new admissions this morning and then after rounds (which may or may not even be over by noon), you can sign your notes and head home!" Most residents are not learning much from that.
If it's a once or twice-in-a-lifetime opportunity to follow a patient with a rare presentation, I think most residents would be willing to go the extra mile and not pay such close attention to the work hours limits. But those do not happen every day.

But the fact is that you often don't know who is going to be an "exceptional case" when you admit them, and whether we like to admit it or not there is educational value in repetition.

I'm not suggesting we completely go back to the "bad old days" where people literally worked 120hr/wk. And board pass rates seem to be doing fine for now, so we're probably in an OK place. But I do not support further work hour restrictions, and while I support a little bit of cathartic complaining as much as the next person, there is educational value in the time we spend in the hospital.

 

[IlDestriero]

I don't think this should be true... when I was done, I would say "see you tomorrow," not "can I go home?"

What are these "2 things and also this other thing" that you bring up? If it's patient care and she has already signed out to the night team, she should be able to reasonably say that the night team can take care of it. If it really is something that needs the day team to wrap up, she still shouldn't be responsible for the other issues that come up during that time. It's literally impossible to take care of every single aspect of patient care by change of shift, and unless you're signing out multiple admissions to the night team, that stuff should get passed on.

Telling the senior resident that you’re peacing out and declining the offer to help is a more senior resident move, certainly late internship, not what you want to do a. s a new intern. You’re reputation from the start will follow you and be very difficult to change. Become a slacker later. When you get the reputation as a solid citizen that kills it every day, and maybe sometimes walks on water, you can tell them all to choke on it and you’ll be fine. Get that reputation first.

 

[GoSpursGo]

Telling the senior resident that you’re peacing out and declining the offer to help is a more senior resident move, certainly late internship, not what you want to do a. s a new intern. You’re reputation from the start will follow you and be very difficult to change. Become a slacker later. When you get the reputation as a solid citizen that kills it every day, and maybe sometimes walks on water, you can tell them all to choke on it and you’ll be fine. Get that reputation first.

Not if they're staying until midnight... of course we don't have all the details, and I'm sure some of the problem was inefficiency on the part of the intern, but I really struggle to imagine what tasks the senior resident was asking for at 9pm that were not more appropriate for the night team.

 

[Mad Jack]

If you're signing out at 7, what in the world could keep you until past midnight regularly aside from inefficiency?

 

[gutonc]

If you're signing out at 7, what in the world could keep you until past midnight regularly aside from inefficiency?

It definitely shouldn't be a regular thing.

But when I was an intern, we could accept admits up to 6:30 (or the cap), with NF coming in at 7. There was more than one occasion where we'd get a 3-5 patient bolus from the ED between 6 and 6:30. Then you have to go see them all, write the admit orders and notes and make sure they're all tucked in before sign out. Staying to 9 wasn't uncommon in those situations, depending on the patient and your senior. Staying to midnight happened once or twice that I can recall.

 

[mvenus929]

Telling the senior resident that you’re peacing out and declining the offer to help is a more senior resident move, certainly late internship, not what you want to do a. s a new intern. You’re reputation from the start will follow you and be very difficult to change. Become a slacker later. When you get the reputation as a solid citizen that kills it every day, and maybe sometimes walks on water, you can tell them all to choke on it and you’ll be fine. Get that reputation first.

There’s a difference between the intern that tries to peace out at 3pm because they’re “done” with their work, and one who signs out to the night team at the appropriate time and finishes up their work to head home. Similarly, there’s a difference between an intern that’s managing a large service on a busy floor and one that is barely managing 3 patients and hides out all day to avoid doing more work.

By the sounds of it, the OP’s wife falls into the second camp, trying to manage a busy service with an inefficient senior.

I’ve known lazy seniors that insist on making the interns do everything, or ones who are horribly inefficient themselves so that they are staying until 9pm every night. The interns still leave relatively on time (maybe an hour after sign-out starts).

 

[Postictal Raiden]

It definitely shouldn't be a regular thing.

But when I was an intern, we could accept admits up to 6:30 (or the cap), with NF coming in at 7. There was more than one occasion where we'd get a 3-5 patient bolus from the ED between 6 and 6:30. Then you have to go see them all, write the admit orders and notes and make sure they're all tucked in before sign out. Staying to 9 wasn't uncommon in those situations, depending on the patient and your senior. Staying to midnight happened once or twice that I can recall.

This is my life when I’m doing wards at the VA