So why do many doctors lack sleep (read details) ?
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Since when are there 32 hours in a day?
I think you misunderstood OP's post. I think he is asking: if a doctor works X number of hours in one shift, does the doctor also get X number of hours off after that shift? For example, if they work from 6 AM to 8 PM on Monday, are they guaranteed to be off at minimum from 8PM Monday night until 10 AM Tuesday morning? He's not implying that there are 32 hours in a day. He wants to know if it's 8-on/8-off, 12-on/12-off, 16-on/16-off, etc.
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No. If you work a 16 hr shift (e.g. from 7 am to 11 pm), you're expected to be back at 7 am the next day. If you work a 30 hr shift (e.g. from 7 am to 1 pm), you're typically off until 7 am the next day.
It's not regulated like that, especially after residency when your hours can essentially be as brutal as you allow them to be in many cases.
To be fair, OP did say "get some good sleep and do many other things," which I would assume includes family and other obligations.
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So its my understanding of how shifts work which was wrong. So in your 7 am till 11 pm example, who works after 11 pm ? It cannot be that nobody does since hospitals must operate 24/7 right? And why does that person get to work only 8 hours / day while the first doctor works for 16 hours ?
Overlap in schedules.
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Sardinia
Can we shoot the person who decided that 12-16 hour shifts were a good idea for a mentally demanding field.
The docs in the NICU unit where I shadowed rotate on a 3 week schedule. Week 1=brutal hours, like 7am-10 pm (at least) M-F and ~4-5 hours on Sun/Sat. Week 2= mornings only but then you're on call almost 24/7 (minus 2-7 pm). You usually don't get called in a ton unless it's baby season. Week 3= Completely off.
Yup, docs schedules overlap but in the NICU often their NPs would be in charge during nights. If something drastic started happening then week 2 docs get called in. They had some really really good NPs so it didn't happen much but I suppose that could change if you were in a different unit.
Yup, docs schedules overlap but in the NICU often their NPs would be in charge during nights. If something drastic started happening then week 2 docs get called in. They had some really really good NPs so it didn't happen much but I suppose that could change if you were in a different unit.
What is that ?
Just because 1 doc is working 16 hours and there are 24 hours in a day doesn't mean another doc is only working 8 to cover the remaining 8 hours. It's more likely that their work hours overlap and that there is more than 1 doc on staff some or all of the time.
That's not the way it works. Without getting into the nitty gritty of scheduling with call schedules, cross cover, jeopardy, etc, suffice it to say it works out fine
16 hr shifts really aren't bad. The tail end of a 30 is difficult if you don't get to sleep at all (though I've only had to do the latter as a student thus far)
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Sardinia
The shifts just don't make sense to me.
Every time you leave, someone new who has not known the patient for the past however long is now responsible for the care of that patient and has to be brought up to speed. This is never done flawlessly or with anywhere near the same amount of information the prior physician had. Quality patient care is a balancing act between patient handoffs and fatigue from long shifts. I guarantee you i provide better care for my patients 16 hours into my shift than night float does at any point during theirs. It's the nature of the beast
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Sardinia
Which would make sense if the patient were only present at the hospital for 16 hours and under your care. When it comes to in-patient issues then you're talking about a series of days. The problem then becomes one of maintaining health standards when "passing off" between physicians occurs so that care does not become markedly diminished. The nature of the beast is imperfect, however requiring physicians to give care when their own mental acuity is on a downhill trajectory s/p 8-12 hours then you're encouraging liabilities to occur, not preventing them. I understand that doctors have remarkable focus, however I've yet to see any literature affirming that a doctor's clinical clarity is unchanged at the eleventh hour.
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No one said "clinical clarity" is at 100% at the end of a long shift. But is whatever marginal decrease in "clinical clarity" likely to outweigh the huge discrepancy in prior knowledge of the patient's baseline, presentation, exam, response to therapy, etc? Not a chance in the world. There's a reason why night float's purpose tends to be "put out fires and make sure people don't die in the middle of the night". In clinical settings where patients' status is more volatile (ICU, postoperatively), we tend to do either long call (30 hr) or 12 hour shifts
How many of those do you do in, say, two weeks time?
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Sardinia
I thought 12 hour shifts were stat quo. I remember ER shifts being 10 and Unit Floors being 12.
It depends on the rotation. In general for me as an intern, every ~4 days is a 16 hr shift with the other shifts being ~11-12 hr working 6 day weeks. I'm in a nonsurgical field though. Surgical residents will tend to be closer to working 16 hours daily in my experience
With the exception of call days. I meant that the higher acuity units tend to have either long call or no call with strict 12 hr shifts, as opposed to various schemes of nightfloat / short call / long call seen on wards. ED is all shift work
All this is why you see so many more people these days wanting to go into "lifestyle" specialties. I know several very competitive people who would love to go into surgery but are instead pursuing derm and other "9-5" specialties instead due to the punishing hours expected of surgeons. Some people love the grind, but I don't know how.
Keep in mind that when the word "shift" is thrown around, that's the bare minimum you are going to be there before you can check out. On wards, we can theoretically check out if we're on short call at 7 pm.... but I've been there many nights until 11:30 because a patient was sick or because I still had H&Ps to write. In the ED, we do 12 hour "shifts" but then usually have a couple hours worth of notes to do after. And even though I love shorter hours, I hate the mentality that comes with the word "shifts." When an intern is checking out while one of their patients is going downhill on the floor because "hey, it's 7 pm and time for me to leave," that is not ok. It's also not ok to be taking short call and be responsible for your team's patients and tell the night team "eh, I don't know anything about them. They're not my patient." Usually, at night, there are way fewer people than during the day taking care of patients (for instance, we have 2 people caring for the number of patients that 15-20 people care for during the day; average about 45-75 patients per person on night float); it's never going to be quite equivalent because you can't possibly know every patient well on nights when you're caring for so many, and it's not a 1:1 person shift change like it is for things like nursing.
Also, doctors are tired because we average 4 days off a month (and may go a couple weeks in between a day off) and, while in the hospital, it can be physically, emotionally, and mentally exhausting a lot of days, which exhausts you way faster than you would expect. It's a different kind of tired than most people are used to. And our schedules change constantly from day to night float without much time to adjust.
Also, doctors are tired because we average 4 days off a month (and may go a couple weeks in between a day off) and, while in the hospital, it can be physically, emotionally, and mentally exhausting a lot of days, which exhausts you way faster than you would expect. It's a different kind of tired than most people are used to. And our schedules change constantly from day to night float without much time to adjust.
I'm hoping my plan of staying single (or no more than DINK) pays off and I'm able to devote most of my time to being a hospitalist.
Keep in mind that there is often a huge difference between residency hours and attending physician hours.
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Il Destriero
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I have 12-hour shifts M-F and work 8 hour shifts Sat/Sun with no call. That is weeks 1 + 3. Weeks 2 + 4 I have 8-hour shifts with weekends off, but I'm on-call 24/7.
It is very brutal. Gladly my now-fiance is also working in the same hospital system and we work the same hours. So we get to see each other when we're off, minus any calls during "call week."
It is very brutal. Gladly my now-fiance is also working in the same hospital system and we work the same hours. So we get to see each other when we're off, minus any calls during "call week."
Also, no matter how you break down the rest of your day, leaving your bed/house before 5 am is always kind of awful.
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Overlaps in shifts are not the correct answer. Many places will have someone cover just the 8 hours in between the 16 hour shift or something like that (sure, there's some overlap, but that doesn't explain why 2 people aren't just trading 16 hour shifts back and forth). Humans have sleep cycles that don't like to be messed with. Working on and off every other 16 hours would be very hard on the body and mind. Working simply nights consistently is already hard enough on many people.
I'm sure there are some other good reasons for setting up shifts this way but I'm too tired to think right now.
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