Time: "medical residents worked too hard"

[eyang22286]

http://digg.com/health/Are_Medical_Residents_Worked_Too_Hard


thought it might be a interesting addition to what we already know, plus, interesting comments. looks like there are people out there that sympathize =)

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[BlueElmo]

Intersting article. So it seems despite the 80 hour work week limit, many resident still continue to go beyond 100 hours.

 

[NoMoreAMCAS]

I'm hoping that by the time I'm in my residency, the rules are extremely stringent about the 80 hour work week. Or hell, i'd prefer even less. There is nothing on earth I can't learn if I put in 60 hours a week for 5 years.

 

[Law2Doc]

I'm hoping that by the time I'm in my residency, the rules are extremely stringent about the 80 hour work week. Or hell, i'd prefer even less. There is nothing on earth I can't learn if I put in 60 hours a week for 5 years.

Most people would rather do 80 hours/week for 3 years than 60 for 5.

 

[dw2158]

Most people would rather do 80 hours/week for 3 years than 60 for 5.

yeah. also, most of the doctors i know actually speak strangely fondly of their residencies. it was the time when they got to just be a doctor more then they would in the rest of their careers when they had administrative stuff to deal with, etc. being in the hospital for more hours means you can really follow a case from start to finish.

 

[Perrotfish]

yeah. also, most of the doctors i know actually speak strangely fondly of their residencies. it was the time when they got to just be a doctor more then they would in the rest of their careers when they had administrative stuff to deal with, etc. being in the hospital for more hours means you can really follow a case from start to finish.

We know different doctors. The docs I know generally described residency using either the word 'hazing' or 'sweatshop'.

Anyway I don't care so much about them reducing the total number of hours going down, but I really hope they implement the rule that you can only work 16 hours without being allowed to sleep.

 

[Andrew Dufresne]

I don't think the number of hours is a good metric for "how hard" residents work. There's no way those 80 hours are entirely spent on-the-go.

 

[DrJD]

I don't think the number of hours is a good metric for "how hard" residents work. There's no way those 80 hours are entirely spent on-the-go.

Are you serious?

 

[MossPoh]

I don't think the number of hours is a good metric for "how hard" residents work. There's no way those 80 hours are entirely spent on-the-go.

Its the same with anyone that works 40 or 50 hours a week. Major difference is that you can usually get away with chatting it up while getting coffee. Your excel spreadsheets don't die.

 

[turkeyjerky]

Most people would rather do 80 hours/week for 3 years than 60 for 5.

Yes, but every practicing physician I've talked to about the matter has indicated that a decreased number of total work hours wouldn't be a problem if residencies were re-geared as primarily educational experiences for the residents rather than cheap labor for the teaching hospitals.

Ever wonder why the most strident objections to more stringent regulation of work hours are program directors or administrators of teaching hospitals? Because they're the ones who are going to have to worry about filling more shifts or paying for more PAs to cover the work. Remember--Medicare doesn't pay the salaries of PAs.

As for the myself, the 80 hr work weeks don't seem THAT terrible, it's the fact that the hours are averaged over a month and therefore people might work 100 hrs two weeks in a row and then work 60 hrs the next two weeks and still be okay.

 

[NoMoreAMCAS]

Most people would rather do 80 hours/week for 3 years than 60 for 5.

I was referring to a residency that is currently 5 years. If it's a 3 year residency like FM, I can still learn that by doing 60 hours a week for 3 years.

I want the hour cut, and the years to stay the same. It doesn't take that ****in long to learn ANYTHING.

 

[circulus vitios]

Most people would rather do 80 hours/week for 3 years than 60 for 5.

Or cut out all the inefficiencies and wasted time and keep the hours the same. I'm sure surgery residents would love it if their operating time was kept the same, but their residency went from 5 years down to 3-4 years.

 

[amph119]

Most people would rather do 80 hours/week for 3 years than 60 for 5.

I am of course not sure about this since I am not there, but I think this would be the case for me, too.

 

[sirius08]

yeah. also, most of the doctors i know actually speak strangely fondly of their residencies. it was the time when they got to just be a doctor more then they would in the rest of their careers when they had administrative stuff to deal with, etc. being in the hospital for more hours means you can really follow a case from start to finish.

Not to say that one doesn't learn a lot by working many hours, but I'm sure that cognitive dissonance is a huge part of the "speaking fondly" phenomenon. If you have to suffer a lot for something, you'll come to value it more than if you hadn't (as with fraternity hazing).

 

[flip26]

Yes, but every practicing physician I've talked to about the matter has indicated that a decreased number of total work hours wouldn't be a problem if residencies were re-geared as primarily educational experiences for the residents rather than cheap labor for the teaching hospitals.

This is the real crux of the matter.

 

[dw2158]

Not to say that one doesn't learn a lot by working many hours, but I'm sure that cognitive dissonance is a huge part of the "speaking fondly" phenomenon. If you have to suffer a lot for something, you'll come to value it more than if you hadn't (as with fraternity hazing).

true, true. a good point.

 

[eyang22286]

on completely another note: (i'm not trolling, legitimate question here and i started this thread lol)

often times as a resident you only have time to squeeze in like one meal, but what about bathroom breaks? more specifically, taking a dump. sometimes when i really need to go.... dude... i think it's almost worse than needing to sleep, just can't focus on anything. and taking a dump many times isn't just like going in and taking a wiz (assumption that i'm a guy).

but seriously, what about taking a dump..

 

[werd]

I don't think the number of hours is a good metric for "how hard" residents work. There's no way those 80 hours are entirely spent on-the-go.

if only this were true. it varies a little bit by what rotation you're on, but in general most of the time is spent pretty darn busy... specifically, there's about 5-10 hours/week that's pretty slack, 50 that's busy, and 20-30 that's pretty darn insane (usually during call days after other teams have signed out -> you're admitting and cross-covering up to 60 patients, most of whome you don't know well).
all in all residency is tough but rewarding in how quickly you grow. i think you learn more per hour by doing more hours per week (up to a certain point), simply because you're immersed in it, providing nearly all the care for a patient, rather than providing care for "your" patient's half the time. i've averaged about low 70's per week doing a medicine intern year.

 

[Law2Doc]

Um, yeah it does. You will come out of residency still only having seen a fraction of the cases and done a fraction of the things you would have liked before being promoted to the guy in charge. I've actually spoken to folks from certain countries where the residency and hours are shorter, and they all seem convinced that we do it better here, and that they felt totally f-ed when they got here. There is too much to learn. In fact, many of the 3 year residencies are being increased to 4 years simply as a result of the 80 hour work week -- there is too much to learn to just say -- we'll cram it all into X hours.

 

[Law2Doc]

Yes, but every practicing physician I've talked to about the matter has indicated that a decreased number of total work hours wouldn't be a problem if residencies were re-geared as primarily educational experiences for the residents rather than cheap labor for the teaching hospitals.

Ever wonder why the most strident objections to more stringent regulation of work hours are program directors or administrators of teaching hospitals? Because they're the ones who are going to have to worry about filling more shifts or paying for more PAs to cover the work. Remember--Medicare doesn't pay the salaries of PAs.

As for the myself, the 80 hr work weeks don't seem THAT terrible, it's the fact that the hours are averaged over a month and therefore people might work 100 hrs two weeks in a row and then work 60 hrs the next two weeks and still be okay.

This is the give and take that makes residencies exist. Hospitals are not in the business to train people. They'd really rather have NPs and PAs who are going to stay on after the 4 years, rather than some doctors who are going to be there for a short training stint. But for a nice amount from the government plus a steady supply of cheap labor, they are willing to do so. You can't get the training without the labor -- the pot is not sweet enough and hospitals have better things to do than simply train folks who are going to go off and be in private practice, without getting something in return. The something in return is labor.

As for the hours not seeming terrible, I think you have to experience it to know. I used to work 80 hours a week in law now and then and yet I have to say that in medicine it's just different. As for the averaged 80 hour week, it basically means you can be working 100 hours for more than two weeks in a row if your hours drop off after that. Meaning if you have an easy elective week where you are scheduled to work very few hours, you can have 100+ weeks for 3 weeks straight. You generally get 4 days off a month, but imagine if they are all in the last week of the month, and you are working for 20+ days straight without a break, with overnights every 4th night, and that will give you a better sense of how this could play out in the extreme. (Although normally you will have your 4 days off spread out more regularly).

 

[BlueElmo]

Um, yeah it does. You will come out of residency still only having seen a fraction of the cases and done a fraction of the things you would have liked before being promoted to the guy in charge. I've actually spoken to folks from certain countries where the residency and hours are shorter, and they all seem convinced that we do it better here, and that they felt totally f-ed when they got here. There is too much to learn. In fact, many of the 3 year residencies are being increased to 4 years simply as a result of the 80 hour work week -- there is too much to learn to just say -- we'll cram it all into X hours.

I agree, they proabably have a reason why they make residency years long. There really is that much to learn. Personally, I would rather stick it through 4-6 years of residency training learning as much as possible before I become a full-fledged physician. I don't want to be a physician way down the road and find out I screwed up procedures and whatnot because I wasn't prepared enough.

 

[ar2388]

on completely another note: (i'm not trolling, legitimate question here and i started this thread lol)

often times as a resident you only have time to squeeze in like one meal, but what about bathroom breaks? more specifically, taking a dump. sometimes when i really need to go.... dude... i think it's almost worse than needing to sleep, just can't focus on anything. and taking a dump many times isn't just like going in and taking a wiz (assumption that i'm a guy).

but seriously, what about taking a dump..

no food, no poop

 

[ar2388]

I agree, they proabably have a reason why they make residency years long. There really is that much to learn. Personally, I would rather stick it through 4-6 years of residency training learning as much as possible before I become a full-fledged physician. I don't want to be a physician way down the road and find out I screwed up procedures and whatnot because I wasn't prepared enough.

agreed!! I am originally from Russia and when I hear about how short their training is i get scared!!! right after the 5 years of college + medical school (you go straight to what you want after high school) youhave 1 year of training and thats it... (surgeons too)

 

[oldbearprofessor]

Hospitals are not in the business to train people. They'd really rather have NPs and PAs who are going to stay on after the 4 years, rather than some doctors who are going to be there for a short training stint.

This is off-topic for this thread and also oversimplified. There is no doubt that the financial aspects in terms of direct costs may benefit hospitals in having residencies. However, hospitals have numerous reasons for having physician training programs, including both residencies and fellowships. These include:

1. For primary teaching hospitals (for example, all of the largest Children's Hospitals in the US), it is part of their primary mission. It is also important in their community fund-raising for new space and new programs. Very important.
2. Advanced training programs, e.g. neonatology or critical care fellows, provide trainees who stay 24/7 and provide a level of care not provided by NP and PAs.
3. Training residents and fellows creates a natural pool of attendings who will work at that hospital and admit to that hospital when they are attendings.
4. Along with #1 above, having training programs, especially advanced programs is a key part of recruiting academic faculty and research money which the hospital wants and needs for a range of reasons.

 

[circulus vitios]

This is the give and take that makes residencies exist. Hospitals are not in the business to train people. They'd really rather have NPs and PAs who are going to stay on after the 4 years, rather than some doctors who are going to be there for a short training stint. But for a nice amount from the government plus a steady supply of cheap labor, they are willing to do so. You can't get the training without the labor -- the pot is not sweet enough and hospitals have better things to do than simply train folks who are going to go off and be in private practice, without getting something in return. The something in return is labor.

You make it sound like residents are lucky that the hospital even lets them work there. Does the government not pay hospitals to train residents? Don't the residents make the hospitals money by performing/billing procedures? Don't good residents attract other good residents by giving the program a good name?

 

[tiedyeddog]

How many residencies do the work-hour restrictions even effect? Do residents in Psych, FP, or IM usually work more than 80 hours a week(over the course of a month)?

 

[dw2158]

on completely another note: (i'm not trolling, legitimate question here and i started this thread lol)

often times as a resident you only have time to squeeze in like one meal, but what about bathroom breaks? more specifically, taking a dump. sometimes when i really need to go.... dude... i think it's almost worse than needing to sleep, just can't focus on anything. and taking a dump many times isn't just like going in and taking a wiz (assumption that i'm a guy).

but seriously, what about taking a dump..

BEST QUESTION EVER ASKED ON SDN. i'm very curious about this too

 

[circulus vitios]

How many residencies do the work-hour restrictions even effect? Do residents in Psych, FP, or IM usually work more than 80 hours a week(over the course of a month)?

I'm probably wrong, but I think it applies to every residency except surgical specialties.

 

[BlueElmo]

BEST QUESTION EVER ASKED ON SDN. i'm very curious about this too

maybe take dump in your pants and clean up afterwards?

 

[amph119]

maybe take dump in your pants and clean up afterwards?

Like those crazy super-marathon runners, ha.

 

[BlueElmo]

Like those crazy super-marathon runners, ha.

They really do that?

 

[amph119]

They really do that?

I remember reading something about people who run 100 miles straight without stopping. So... wouldn't that necessarily imply it?

 

[Just Joshin]

How many residencies do the work-hour restrictions even effect? Do residents in Psych, FP, or IM usually work more than 80 hours a week(over the course of a month)?

During residency, IM will almost always push the 80-hour limit. I've researched this on the residency forum and also with the doctor I shadowed. FP can be just as intense, depending on the program. Psych residency is much more chill. Surgery and IM especially are your two specialties that will always reach or go over 80 hours a week.

 

[tiedyeddog]

During residency, IM will almost always push the 80-hour limit. I've researched this on the residency forum and also with the doctor I shadowed. FP can be just as intense, depending on the program. Psych residency is much more chill. Surgery and IM especially are your two specialties that will always reach or go over 80 hours a week.

This is what I meant. I know literally nothing about the lifestyles of residents outside of surgical residents. I know that the 80-hour limit applies to all residencies but I was trying to get at how many residencies actually push 80 hours a week, outside of those.

 

[amph119]

Dude guys, who cares. Half of those 80 hours per week are spent messing around with your best friend who also is a resident, avoiding harassment by a janitor, and hooking up in the on call room.

Duh.

 

[BlueElmo]

So is 100 hour work weeks still the norm despite the 80 hour limit?

 

[sirius08]

I remember reading something about people who run 100 miles straight without stopping. So... wouldn't that necessarily imply it?

No, most long-distance runners take bathroom and water breaks, but carry some kind of food (e.g., energy gel) for the run.

 

[amph119]

No, most long-distance runners take bathroom and water breaks, but carry some kind of food (e.g., energy gel) for the run.

I guess that makes more sense than what I was proposing, haha.

 

[Law2Doc]

This is off-topic for this thread and also oversimplified. There is no doubt that the financial aspects in terms of direct costs may benefit hospitals in having residencies. However, hospitals have numerous reasons for having physician training programs, including both residencies and fellowships. These include:

1. For primary teaching hospitals (for example, all of the largest Children's Hospitals in the US), it is part of their primary mission. It is also important in their community fund-raising for new space and new programs. Very important.
2. Advanced training programs, e.g. neonatology or critical care fellows, provide trainees who stay 24/7 and provide a level of care not provided by NP and PAs.
3. Training residents and fellows creates a natural pool of attendings who will work at that hospital and admit to that hospital when they are attendings.
4. Along with #1 above, having training programs, especially advanced programs is a key part of recruiting academic faculty and research money which the hospital wants and needs for a range of reasons.

While I agree with most of this, most hospitals are not primary teaching hospitals (the community hospitals outnumber academic centers pretty significantly), and even for those that are, much of the above, along with a cheap labor source, is part of the benefit hospitals get in return for training. So I think we probably agree that the hospitals only do residency training if what they get in return is a sweet enough a deal -- meaning they get the cheap labor AND the pool from which to recruit attendings, and the subsidization, etc. If they didn't get this, they would be better off with lower level people who stay on longer rather than spend the time and effort training people -- most of whom won't stay on.

So yeah, I agree it's an oversimplification, but at the core it's not a complex concept -- the non-teaching hospitals (ie most of them) only train residents because it's a good deal for them to do so.

 

[Law2Doc]

I'm probably wrong, but I think it applies to every residency except surgical specialties.

You are wrong -- it applies to ALL residencies, including surgical ones. But the prior poster is correct -- most residencies weren't pushing the 80 hour limit to start with, so the IMPACT is really only on things like surgical fields, IM and OBGYN.

 

[Law2Doc]

You make it sound like residents are lucky that the hospital even lets them work there. Does the government not pay hospitals to train residents? Don't the residents make the hospitals money by performing/billing procedures? Don't good residents attract other good residents by giving the program a good name?

It's all part of the deal -- the hospital gets money cheap labor and the stuff OBP mentioned. If they just got the money it wouldn't be worth their while.

 

[BlueElmo]

It's all part of the deal -- the hospital gets money cheap labor and the stuff OBP mentioned. If they just got the money it wouldn't be worth their while.

Residents get their training and hospitals get cheap labor. Win-win for both!

 

[sirius08]

I guess that makes more sense than what I was proposing, haha.

Yeah, I imagine that running with a full diaper could get uncomfortable.

 

[plsletmein]

http://www.medicalnewstoday.com/articles/150975.php

in today's economy, they really really need the cheap labor

 

[BlueElmo]

Yeah, I imagine that running with a full diaper could get uncomfortable.

Also imagine running with something wet and squishy under there.

 

[vickpick]

a lot of doctors i know work more than 40 hrs a week.. they work like 50-60 hrs a week.. so a resident working 80 hrs a week doesnt seem that bad afterall... as long as u dont have a relationship to waste time, and there are plenty of restaurants arnd so that u dont get tired of eating the same.. I think most people would be fine.

So eat at a restaurant everyday - or the hospital lounge - maybe 20 cent noodles once or twice a week... and waste no mroe time.. just sleeep all the time u get - lol..

and you'll be fine... there won't be a way to get a life then.. so might as welll just stay alive physically..

 

[teachmed27]

"An oft cited 2004 study of intensive-care units found that medical residents made 36% more serious mistakes during 30-hour shifts than during shifts half as long."

In a profession that prides itself on the knowledge of the human body better than any other, it seems archaic and counter-intuitive (and perhaps even contradictory) to allow the body to go without sleep for such a long time. I know the "reason" for sleep remains a mystery, but it is well documented that performance, focus, and mental sharpness decline when deprived of sleep.

It may be okay for other professions to pull crazy hours but residents work directly with people that are sick and even a minor mistake could be deadly With such high stakes, the "rite of passage" argument has to give way. Of course, as already said, the economic aspect is much more complex.

 

[Law2Doc]

"An oft cited 2004 study of intensive-care units found that medical residents made 36% more serious mistakes during 30-hour shifts than during shifts half as long."

In a profession that prides itself on the knowledge of the human body better than any other, it seems archaic and counter-intuitive (and perhaps even contradictory) to allow the body to go without sleep for such a long time. I know the "reason" for sleep remains a mystery, but it is well documented that performance, focus, and mental sharpness decline when deprived of sleep.

It may be okay for other professions to pull crazy hours but residents work directly with people that are sick and even a minor mistake could be deadly With such high stakes, the "rite of passage" argument has to give way. Of course, as already said, the economic aspect is much more complex.

While I basically agree with you to a point, it has also been shown that the most dangerous time for the patient is in the handoff between shifts, not due to mistakes made by tired residents. Longer hours mean fewer handoffs. It should be noted t that patient mortality didn't decrease with the 80 hour work week limitation, so there is a ton of resistance to reducing it further.

 

[sirius08]

While I basically agree with you to a point, it has also been shown that the most dangerous time for the patient is in the handoff between shifts, not due to mistakes made by tired residents. Longer hours mean fewer handoffs. It should be noted t that patient mortality didn't decrease with the 80 hour work week limitation, so there is a ton of resistance to reducing it further.

Interesting - do you have any references for studies that have found this?

 

[NoMoreAMCAS]

Um, yeah it does. You will come out of residency still only having seen a fraction of the cases and done a fraction of the things you would have liked before being promoted to the guy in charge. I've actually spoken to folks from certain countries where the residency and hours are shorter, and they all seem convinced that we do it better here, and that they felt totally f-ed when they got here. There is too much to learn. In fact, many of the 3 year residencies are being increased to 4 years simply as a result of the 80 hour work week -- there is too much to learn to just say -- we'll cram it all into X hours.

I guess i'll have to see when I get there. I feel like it won't be that difficult when I have the opportunity to completely focus my efforts on one specialty, but you never know. From what you say most people have a hell of a time picking up the knowledge and experiencing many of the possibilities, i'll probably end up in the same situation.