I have worked 120+ hour work weeks previously. I have worked more than 80 hours during some weeks in third year but fortunately over the course of the month rotation, it evens out to the 80 hour/week average. This is not about having a work ethic. This is about safety. I would nap prior to driving home if I felt shaky or thought I should not be on the road. However, I shudder at the thought of how many people do not take such precautions or at my younger colleagues who still feel immortal.
Doctors are notoriously horrible at negotiation. If you feel strongly that your school should limit the hours of given rotations, lobby for it. You need to present a strong argument to the administration and patient and student safety is the argument. One patient endangered, one student endangered is too many. It is not because you want or need to study more (although this may well be the case).
I have put in central lines in the SICU under the direction of residents during my surgical rotation. Other students have done LPs, central lines, chest tubes etc. It depends on who you are working with and what part of the year you are in on a given rotation. The amount of responsibility will depend on the hospital, team and how comfortable they are with the student's skills. Without limitations on hours, these procedures could have been performed on hour 85 or 90 or 100 of the week.
Third year is not about just shadowing so students do have responsibility for patients. Is it as much responsibility as interns or residents? No, of course not. However, I would submit that students can be instrumental in patient care and make a difference and even save a life. By taking ownership of the patients, we see things that sometimes others do not.
I agree that students are more likely to use the work-hours limitations (where they exist) in cases where they are not as interested in a given field (i.e., surgery, OB/Gyn, Internal medicine depending on their personality/interest) than during their sub-I. The old guard may think that 80 hours/week makes us wimps. However, house staff used to be just that living in the hospital (not driving, not leaving). I would be less concerned if I and my classmates did not have to drive any real distance to go home (i.e., if we could take a subway home).
Regardless of whether the student will stay to look good to the attending, being up for 36 hours and then getting in a car and driving can be dangerous. Our reflexes can be impaired. I would like to see all of our brethren graduate and have nothing bad befall them on the road.
