Shift Duration

[MS05']

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So...don't get me wrong, I love EM and plan on going into the field, but I have to admit that 12 hour shifts are pretty tiring (student wise, so I imagine it's only moreso resident wise) and was wondering if we could get a list of 8 or 10 hour shift residencies going....

 

[roja]

12's are long. and are tiring. The upside to them is you get more days off. The real question you should ask, is how many hours/mo is a place doing... or how many 12's.


Our program is 12's but is transitioning to 8's. Right now the trial is with the 3rd years. Although the expectation is that we will all be going to 8's eventually, except interns.. or that was the last I heard.

as second years, we do 16-17 12's in a 28 day block. Not bad.

 

[Seaglass]

at Wake we do 22-23 8's as interns with fewer each year until you are doing ~16 8's as a third year. Personally, I'd rather have more 8's than 12's.

 

[margaritaboy]

We do 10's here at The Copa, with the exception of a few 12's during a month of Peds ED.

I feel like there is a big difference, where with 10's I still feel able to go the the gym, cook dinner, or rent a movie with my wife, whereas with 12's I'm pretty beat by the end of the shift and my day is over. Then again, I am a career slacker and not very tough.

 

[MS05']

We do 10's here at The Copa, with the exception of a few 12's during a month of Peds ED.

I feel like there is a big difference, where with 10's I still feel able to go the the gym, cook dinner, or rent a movie with my wife, whereas with 12's I'm pretty beat by the end of the shift and my day is over. Then again, I am a career slacker and not very tough.

That's my issue too. After a 12 there's little to no time left during the day to do anything other than get home, eat and go to sleep. With 8's (or even 10's) you can still get out of the hospital and do something.

Here (Buffalo), the PGY-1's do 20 or 21 12's (can't remember) which decreases to 16 12's by PGY-3, but I honestly think I'm going to look for a program with 8 or 10's, not cause I'm lazy, well that's not entirely true, but more so because I'd rather work 22 or so 8's.

Anyone else have any suggestions for 8 or 10 programs?...

 

[roja]

Our interns do 18 12's a 28 day period, so its not to bad. but 8's a better...

 

[docB]

UC Davis does 12s at the main hospital and 10s at the community hospital.

 

[margaritaboy]

MCG does 9's.
Harbor UCLA had a hybrid system for PGY-2,3 of 8's,10's, and 12's (or something like that)
I think Loma Linda had 10's

 

[12R34Y]

Truman at UMKC does 8's.

 

[Medic1895]

12 hour shifts are rough. After 9 hours or so, I'm done.
But it is much better than medicine and 24-30 hour call shifts like I am doing now. (CCU)

Crazy concept - PGY1s should read alot, but we never have time - exactly as others say, we get home, for me I play with my kids for 20 minutes then we both go to sleep. Maybe PGY1s should work less (we need to read) and PGY3s should work more (they need the experience.) Will never happen. (And in 2 years I will be glad it didn't)

At my site our volume has risen dramatically in the last 2-3 yrs - makes 12 hour shifts harder.

We do 17 shifts in 28 dyas, so you would think with 10 days off or so it would be fine, but it was a culture shock for me. And I was a FT medic for 8 years.

Philly

 

[NinerNiner999]

At the Hop, we work 8 hour shifts during the week and 12 hour shifts on the weekends. Pretty consistent 3 on 1 off philosophy, with around 20-21 shifts/28 days PGY I, 16-17 shifts PGY-II, 12-14 shifts PGY-3. The twelves can get tiring, but the eights fly by once you get used to it all. Definitely a front-loaded program here, with a significant drop in hours each year...

 

[DrQuinn]

At USF:
PGY-1s do 18-19 12s in a month period (very nice on the 31 day months)
PGY-2s do a mix of 12s, 10s, 8s (~5 hours less a week than PGY1s)

We don't have PGY-3s yet, so I can't comment on that.

Q

 

[EM guru]

At Akron General we do about twenty 10 hour shifts all three years.

 

[mountebank]

8's are better for the body and soul. Although I like knowing that I can work an 8 hour shift effectively, but I'm beat once I get home.

It's interesting, residents who make the transition from 12 to 8 hour shifts during residency use the "new" free time to read, well that's what they've told me. I'll find out soon enough.

 

[Sessamoid]

The other advantage to having shorter shifts scheduled once you get out of the residency is that it gives you more flexibility during the busy times. It's much easier to ask a guy to stay a couple hours extra if the ED's getting slammed if he's only finishing an 8 hour shift. Asking the same from a guy finishing a 12 hour shift who has to come back for another 12 hour shift in 12 hours just isn't reasonable at all.

 

[DadofDr2B]

At the Hop, we work 8 hour shifts during the week and 12 hour shifts on the weekends. Pretty consistent 3 on 1 off philosophy, with around 20-21 shifts/28 days PGY I, 16-17 shifts PGY-II, 12-14 shifts PGY-3. The twelves can get tiring, but the eights fly by once you get used to it all. Definitely a front-loaded program here, with a significant drop in hours each year...

Have you seen a change in hours worked after complaints of last year? How many hours do you work per week? Are you within the guidlines for residents?
Just wondering if Hopkins has really complied to new work rules.

 

[Apollyon]

Have you seen a change in hours worked after complaints of last year? How many hours do you work per week? Are you within the guidlines for residents?
Just wondering if Hopkins has really complied to new work rules.

The EM RRC limits residents to 12 hours shifts, maximum, 6 days a week, maximum, and 60 hours a week, maximum. That 60 hours would need glaringly obvious excesses that would be difficult to hide, like it is in Internal Medicine or General Surgery, where out of sight IS out of mind.

That problem at JHU was an EM resident who was off-service.

 

[DadofDr2B]

The EM RRC limits residents to 12 hours shifts, maximum, 6 days a week, maximum, and 60 hours a week, maximum. That 60 hours would need glaringly obvious excesses that would be difficult to hide, like it is in Internal Medicine or General Surgery, where out of sight IS out of mind.

That problem at JHU was an EM resident who was off-service.

You might want to read the diary of Dr. Madsen who is the EM resident in question who filed the complaint. He has his entries from the time period in question. It is interesting from his point of view.

http://www.studentdoctor.net/diary/bio.asp?aID=48

 

[NinerNiner999]

In answer to your questions regarding work hours, I would like to clarify a few things. Having finished my month of Surgery and my first month of EM, I have now completed the two most time intensive off and on-service months of my entire three years. During Surgery I averaged 77.5 hours per week - including lectures. The programs at Hopkins are VERY compliant with work hours and have been known to send residents home for being there too long. We log hours on a computer system that warns us when we are close to the limit and notifies our program directors if we are. When I was taking Q3 call and my weeks had three call nights in them, I would only arrive for those days and leave immediately post-call (25 hours on, 75 hours/week). There were no other duties or scut. During my month in the ED, I averaged 56 hours/week including conference. As Apollyon pointed out, shift times are very hard to hide, and I have not stayed any longer than 10 minutes past shift to sign out or finish scut. We use a block scheduling program capped at 56 hours. Conference is taken out of our shift time (i.e. Friday conference days mean 4 hours of lecture, 4 hours of ED time).

To clarify the hour violation in the past - Dr. Madsen was a fresh intern who started on Medicine during his first month of residency and during the first year when work hours were being enforced. There was confusion regarding who to report violations to because the new policy had not been tested yet and as such, a direct contact was made to the ACGME, and not through the proper channels. Two weeks of hours were averaged to constitute his violation, which eventually resulted in a fast reinstatement of Hopkins Medicine. Not to sugar coat the service - Medicine at Hopkins is known for CRAZY hours and long days of rounding and scut - probably still above the 80-hour limit. However, EM residents typically move more efficiently and are able to finish the month well under the 80-hour rule. So far, there have not been any issues with my fellow residents.

 

[ERMudPhud]

Not to sugar coat the service - Medicine at Hopkins is known for CRAZY hours and long days of rounding and scut - probably still above the 80-hour limit.

So despite their loss of accredidation and rapid reinstatement they are still in violation and just hoping not to get caught?

 

[greatdane]

At UMASS, we do 10 hour shifts. 4 on 2 off. It works out great. I think the consistant days off together is just as important as the lenght of shifts...

 

[NinerNiner999]

So despite their loss of accredidation and rapid reinstatement they are still in violation and just hoping not to get caught?

I would not suggest that the residents are all working (or even assigned to work) above the work hour limit. As mentioned above, we report our own hours via a computerized system that tabulates our hours for us. Is it possible that a few residents work beyond the 80 hour limit? - sure, and it probably happens on most medicine/surgery services and in most programs in the country. The question is whether it is documented as such. I can, however, safely say that EM residents are below the 80 hour limit. Also, having not rotated through the medicine service yet, I can only go on what those who have rotated through tell me. I hope it is helpful 😉

 

[Scrubbs]

Drexel works a mixxed bag through the years. Interns work 10hr shifts... 6 on, 2 off. Second years work 12hr shifts 6 on 4 off (yup... 4 full days off in a row - which is worth the 12's!). Third years combine the schedules working some 12's with the 6/4 week and some 8's with the 6/2 week.

 

[DadofDr2B]

I would not suggest that the residents are all working (or even assigned to work) above the work hour limit. As mentioned above, we report our own hours via a computerized system that tabulates our hours for us. Is it possible that a few residents work beyond the 80 hour limit? - sure, and it probably happens on most medicine/surgery services and in most programs in the country. The question is whether it is documented as such. I can, however, safely say that EM residents are below the 80 hour limit. Also, having not rotated through the medicine service yet, I can only go on what those who have rotated through tell me. I hope it is helpful 😉

Your wording sounds like an attorney talking. "Documented hours" do not equal actual hours worked necessarily. Are "documented hours" different than actual hours? Do you punch a clock? Just curious.

 

[Seaglass]

Yes, like anything in life that is on the "honor" system you can choose what you write down for your hours. In my experience from friends in surgery and medicine they tend to fudge a little in favor of the 80 hour rule. No one wants their program pulled.

 

[osuer]

To clarify the hour violation in the past - Dr. Madsen was a fresh intern who started on Medicine during his first month of residency and during the first year when work hours were being enforced. There was confusion regarding who to report violations to because the new policy had not been tested yet and as such, a direct contact was made to the ACGME, and not through the proper channels.

Just to clarify a few things here--I do find it interesting that people at Hopkins still talk of the inappropriate efforts on my part to follow the "channels of communication." I know I was criticized extensively for this last year, and much of the retaliation was justified in residents' mind because of this argument. I know it's been over a year since this happened, but it's ironic that this statement still seems to circulate, despite various publications and reports that indicate the contrary.

It was my effort to follow the "appropriate channels" that led to Dr. Wiener's (the Hopkins IM program director) identification of me as the letter writer and the directed retaliation from the administration and residents. As I've mentioned numerous times, I spoke with my supervising residents, my attending physician, and my program director prior to submitting my signed letter to the ACGME, in which I reported the violations. In my efforts to follow the "appropriate channels," I was told that nothing could be done about the violations. All agreed, of course, that the program was in blatant violation of the regs. The story is outlined in the residentdiary.com link included in this thread, as well as in articles by the Associated Press, in The New Physician, in business journals, and in a piece I wrote for The New Physician.

Unfortunately, it is exactly this argument that individuals must follow the "appropriate channels" that will continue to lead to the violations NinetyNiner999 suggest currently exist in the Hopkins Department of Internal Medicine; anonymous reporting procedures do not exist for the ACGME work hours regs, and, due to the nature of the ACGME enforcement policies, residents and administration seem to feel justified in retaliating against those who report because of the damage that report may do to the program.

Troy Madsen
Ohio State EM, PGY-2

 

[NinerNiner999]

Perhaps the inappropriate channels alluded to have become a party line of sorts for the institution. I have no doubt that every effort was made on your part to properly follow the channels, and can see how the "appropriate channels" can become confused and mottled by the political hierachy that exists within the walls of any large medical institution, including Hopkins. Again, having no first-hand experience with the Medicine service, I cannot intelligently say whether work hours exist, but I can say with confidence that a work hour limit is only as good as those who report their hours with honesty. When we first discussed the work hours debaucle during residency orientation, there was an admitted two-sided confusion regarding what the proper channels to follow were.

I can say, however, that I feel no sense of retaliation from any off-service specialty, including Medicine, towards the EM residents. If anything, the result of the ACGME crackdown has opened the eyes and ears of program directors throughout our institution to avoid such a situation from continuing. In my choice to rank Hopkins, I considered the impact of the work hours and feel comfortable with my choice.